BOARD MEETING - West Coast DHB · draft minutes of the west coast district health board meeting...

West Coast District Health Board Te Poari Hauora a Rohe o Tai Poutini

BOARD MEETING 1 APRIL 2005

AGENDA

AND MEETING PAPERS

TABLE OF CONTENTS

TABLE OF CONTENTS 1 AGENDA 3 BOARD MEMBERS’ DISCLOSURES OF INTERESTS 5 ABBREVIATIONS 7 DRAFT MINUTES OF THE WEST COAST DISTRICT HEALTH BOARD MEETING HELD FRIDAY 4 MARCH 2005 10 BOARD CORRESPONDENCE FOR MARCH 2005 25 CHAIRMAN’S REPORT 26 CHAIRMAN’S CORRESPONDENCE FOR MARCH 2005 27 CHIEF EXECUTIVE’S REPORT 28 FINANCE REPORT 33 WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEETINGS 48 DRAFT MINUTES OF THE HOSPITAL ADVISORY COMMITTEE MEETING 49 DRAFT MINUTES OF THE DISABILITY SERVICES ADVISORY COMMITTEE MEETING 56 DRAFT MINUTES OF THE COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEETING 60 PRIMARY MENTAL HEALTH STRATEGIC PLAN 65 WCDHB HEALTHY EATING HEALTHY ACTION IMPLEMENTATION PLAN 87 RECRUITMENT AND RETENTION STRATEGIES 96 KARAKIA 104 INFORMATION PAPERS WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEMBERS TERMS OF APPOINTMENT

WCDHB Meeting Papers 1 April 2005 Page 1

AGENDA

FOR THE WEST COAST DISTRICT HEALTH BOARD MEETING TO BE HELD IN THE BOARD ROOM, CORPORATE OFFICE,

GREYMOUTH ON FRIDAY 1 APRIL 2005 COMMENCING 9:15 AM

Karakia

1. Welcome

2. Apologies

3. Standing Orders

4. Disclosures of Interests

5. Minutes of the Meeting held Friday 4 March 2005

6 Matters Arising

7 Board Correspondence

8. Chairman’s Report

9. Chairman’s Correspondence

10. Chief Executive’s Report

11. Finance Report

12. Reports from Board Advisory Committees

13. Primary Mental Health Strategic Plan

14. Healthy Eating Healthy Action Implementation Plan

15. Recruitment and Retention Strategies

16. Date of Next Meeting

17. Information Papers IN COMMITTEE • Minutes of the Meeting held Friday 4 March 2005

• Matters Arising • Board Member Items • Oral Health Strategy • Contracts • 2004/05 District Annual Plan • 2005/06 District Annual Plan • CEO Recruitment • Risk Register

OIA 1982 5.9(2)(i) Commercial NZPHDA Sch 3 cl 32(a)

• RACS Report Update OIA 1982 5.9(2)(g)ii Personal Information NZPHDA Sch 3 cl 32(a)


BOARD MEMBERS’ DISCLOSURES OF INTERESTS

Member Disclosure of Interest Professor Gregor Coster Chairman

• Director - PHARMAC • Director - Cornwall Management Limited • Director - Cornwall Nominees Limited • Chairman - New Zealand Institute of Rural Health

Dr Christine Robertson Deputy Chairman

As self employed person, does work on contract for: • HealthPAC - regularly • Comcare Charitable Trust - regularly • WCDHB - occasionally • HDANZ (Health and Disability Auditing New Zealand Ltd) –

occasionally Husband is Deputy Chair of the Board of Coast Care Trust and is a Justice of the Peace who undertakes judicial duties in Court. Also Alternate Controller for Civil Defence for the Grey District Council

Ms Robyne Bryant • Trustee - Board of Coast Care Trust • Employed by WestREAP as Early Childhood Education Team

Leader

Mrs Julie Kilkelly • Member - Pharmaceutical Society • Member - New Zealand College of Pharmacists • Member - Pharmacy Defence Association • Director - Kilkelly Kartage Ltd • Trustee - West Coast PHO Board – Co-opted Pharmacist • Director - Olsen’s Pharmacy (since 2002)

Mr Mohammed Shahadat • Member - New Zealand Law Society • President - Hokitika Lions Club 2001-2002 • Principal Partner - Murdoch James and Roper

Dr Malcolm Stuart • Employed by WCDHB as Head of Department, Anaesthesia and Consultant Anaesthetist

• National Committee - Australian New Zealand College of Anaesthetists

• Member - Association of Salaried Medical Staff As a self employed person: • Medical Advisor - St John Ambulance Service

Mr John Vaile • Director - Vaile Hardware Ltd • Wife has an unresolved employment matter with WCDHB

Dr Carol Atmore • Contracted by WCDHB and South Link Health as GP Liaison Officer

• Member - South Link Health • General Practitioner - employed by Dr Mark McLaughlin • Decision Support Software Editor - Enigma Publishing


(Auckland based)

Mr Brian Wilkinson • Registered Pharmaceutical Chemist • Justice of the Peace

Mrs Glenys Baldick Leave of absence effective 28 February 2005

• Chairman - Health Sector Welfare Society • Chairman - Junior Doctors’ Round Table • Trustee - Nelson Hospital Equipment Trust


ABBREVIATIONS

# NOF Fractured Neck of Femur (broken hip) 1° Primary 2° Secondary 3° Tertiary A&E Accident & Emergency A+ Auckland Healthcare ADHB Auckland DHB ALOS Average Length of Stay ANDRG Australian National Diagnosis Related Group ASMS Association of Salaried Medical Specialists AT&R Assessment, Treatment & Rehabilitation Unit BDC Buller District Council BOPDHB Bay of Plenty DHB C&CDHB Capital and Coast DHB CAA Child Acute Assessment CAMHS Child & Adolescent Mental Health Service CAP Canterbury Association of Physicians CC Complications & Co-morbidity CCMAU Crown Companies Monitoring Unit CCN Clinical Charge Nurse CCU Critical Care Unit CD Clinical Director CDHB Canterbury DHB CEA Collective Employment Agreement CFA Crown Financing Agency CHA Crown Health Association CHL Canterbury Health Limited CICU Cardiac Intensive Care Unit CMDHB Counties Manukau DHB COMRAD Radiology Reporting System CPAC Clinical Priority Assessment Criteria CPHAC Community & Public Health Advisory Committee CSSD Central Sterile Supplies Department CTA Clinical Training Agency CWD Case Weighted Discharge DAO Duly Authorised Officer DAP District Annual Plan DDG Deputy Director General DHB District Health Board DHBNZ District Health Boards New Zealand DNA Did Not Attend DON Director of Nursing DOSA Day Of Surgery Admission


DRG Diagnostic Related Grouping DSAC Disability Services Advisory Committee DSD Disability Support Directorate DSP District Strategic Plan DSS Disability Support Services EAP Employee Assistance Programme ED Emergency Department EMT Executive Management Team ENT Ear, Nose and Throat ER Employment Relations FSA First Specialist Assessment GP General Practitioner HAC Hospital Advisory Committee HAHS Hospital and Health Services HBDHB Hawke’s Bay DHB HFA Health Funding Authority HHS Hospital & Health Service HMD Hospital Monitoring Directorate (former CCMAU) HNA Health Needs Analysis HOP Health of Older Persons HR Human Resources HTG Hospital Technical Group HVDHB Hutt Valley DHB ICD 9 International Code of Diseases ICU Intensive Care Unit IDF Inter District Flow IEA Individual Employment Agreement IEC Individual Employment Contract IPA Independent Practice Association (GP Group) IRF Inter Regional Flow ISDN Integrated Services Digital Network IT Information Technology Kai Arahi Term generally refers to “guide” and /or advisor KPI’s Key Performance Indicators LDHB Lakes DHB LMC Lead Maternity Carer MDHB MidCentral DHB MECA Multi Employer Collective Agreement MHAC Mental Health Advisory Committee MOH Ministry of Health MOSS Medical Officer Special Scale. A doctor with 4+ years post-graduate experience but not a

specialist MRT Medical Radiation Technologist NDHB Northland DHB NGO Non Government Organisation NICU Neonatal Intensive Care Unit NMDHB Nelson Marlborough DHB NZNO New Zealand Nurses Organisation


O&G Obstetrician and Gynaecologist ODHB Otago DHB OIA Official Information Act OP Outpatients Ora Services Term used to describe all activities that promote health and prevent diseases that are

undertaken in the primary care setting for children and their families and whanau PBFF Population Based Funding Formula PCG Project Control Group Pegasus One of the IPA’s PHO Primary Health Organisation PMS Patient Management System PNA Professional Nursing Advisor Primary Services Services that receive self referred patients PRIME Primary Response in Medical Emergencies PSA Public Services Association QA Quality Assurance QHNZ Quality Health New Zealand RDA Resident Doctors Association RFP Request for Proposal RHA Regional Health Authority RHMU Residual Health Management Unit RMO Registered Medical Officer. A junior doctor with 0-4 years post-graduate experience Runaka Assembly SCDHB South Canterbury DHB SDHB Southland DHB Secondary Services Services where a primary carer must refer patients. Provided in a hospital supported by

specialists, and meeting standard clinical criteria SHO Senior House Officer SMT Senior Management Team SOI Statement of Intent SSC State Services Commission Stargarden Payroll System STD Sexually Transmitted Diseases TAIRDHB Tairawhiti DHB Tamariki Children – usually refers to children up to and including 14 years of age Tangata Whenua People of the land”, most commonly referring to traditional Maori Iwi occupants of a region

or district TARADHB Taranaki DHB Tino Rangatiratanga Absolute Sovereignty WAIKDHB Waikato DHB WAIRDHB Wairarapa DHB WAITDHB Waitemata DHB WCDHB West Coast DHB Whanau Family Whanau Ora Health and wellbeing WHANDHB Whanganui DHB WTF Waiting Times Fund YTD Year to Date


DRAFT MINUTES OF THE WEST COAST DISTRICT HEALTH BOARD MEETING HELD FRIDAY 4 MARCH 2005 AT 9:36AM IN THE BOARDROOM, CORPORATE

OFFICE, GREYMOUTH

PRESENT Gregor Coster, Chairman

Christine Robertson, Deputy Chair Brian Wilkinson John Vaile Julie Kilkelly Carol Atmore Robyne Bryant Malcolm Stuart Mohammed Shahadat

IN ATTENDANCE John Luhrs, Chief Executive Glenys Baldick, Acting Chief Executive Designate Vikki Carter, Community Liaison Officer Wayne Champion, Chief Financial Manager Ebel Kremer, General Manager Operations Kevin Hague, General Manager Planning and Funding Gary Coghlan, General Manager Maori Health Alison McDougall, Minute Secretary

APOLOGIES Nil Karakia – Robyne Bryant

1. APOLOGIES, WELCOME

The Chairman welcomed everyone to the meeting and introduced Glenys Baldick as Acting Chief Executive Designate. No apologies were received.

2. STANDING ORDERS

The Chairman waived the Standing Orders unless there is reason to reinstate them later in the meeting.

3. DISCLOSURES OF INTERESTS

The following amendments were made to Board Members’ disclosures of interest:

John Vaile


• Amend, “Wife no longer employed by WCDHB but retains an interest…”, to now read, “Wife has an unresolved employment matter with WCDHB”.

Robyne Bryant • Remove, “Employed by Coast Health Care as a Maori Mental Health Worker”. • Remove, “Member – New Zealand Nurses Organisation” • Remove, “Member – New Zealand College of Midwives” • Remove, “Member – Mawhera Maori Women’s Welfare League” • Remove, “Member – PSA” • Add, “Employed by WestREAP as Early Childhood Education Team Leader”

4. MINUTES OF THE PREVIOUS BOARD MEETING HELD 17 DECEMBER 2004

• Page 17, Item 11, second paragraph, add “travel to” before “health assessments…”. • Page 17, Item 11, second paragraph, add “be used to” before “provide information...”. • Page 20, Item 14, amend time moved out of In Committee to 4:20pm.

Moved: Christine Robertson, Seconded: Mohammed Shahadat

It was RESOLVED that the Minutes of the West Coast District Health Board meeting held 28 January 2005 were a true and accurate record subject to the amendments above.

5. MATTERS ARISING

Discuss the written advice received from the MoH with Poutama Ora on the Memorandum of Partnership with Papatipu Runanga. On hold. Consider staggering the date of expiry for Advisory Committee members terms. Included in papers. Completed. Obtain data around primary care referrals from the West Coast to other DHBs, a breakdown by service and data on time spent on CDHB waiting lists for services WCDHB does not provide. Primary care data to be reported to CPHAC and secondary data reported to HAC. The General Manager Planning and Funding advised there is an In Committee paper which partially addresses the item. The Research and Planning Officer is working on more information for a future meeting. Prepare a scoping paper on the Rural GP Postgraduate Training Programme noting arrangements need to be in place by April 2005 for a November 2005 commencement. Included in papers. Completed. Work with the Sexual Health Co-ordinator and her team to produce a scoping paper on the sexual health service in Buller with consideration to future expansion to South Westland. The Chief Executive advised this paper is in progress with budgetary implications being considered. The paper will be included for the next meeting.


Develop a process for consulting with Committees and the Board on the DAP planning process and present to the Board for sign off. The General Manager Planning and Funding advised this is complete for the 05/06 year and the paper for subsequent years will be prepared in time for the next planning process. Reporting status amended to July 2005. Arrange for Community and Public Health’s West Coast Public Health Plan to be circulated to all Board members once it has been finalised. The Chair, CPHAC advised the Plan is still in draft form. A Board member queried whether the Management is adequately resourced to complete the work required for the Board and whether timeframes for action items should be more realistic. The Chief Executive advised that in the event a timeframe is not imposed by the Board, Management prioritises the items within it’s workload. Meet to discuss the membership and length of terms for members of Board Advisory Committee community members. Included in papers. Completed. Provide a summary of the report on BMS by Ruth and Jim Vause in a format suitable for public release. The Chief Executive advised he has not yet received a report. Investigate the cost of conducting the IOD Financial Reporting and Analysis course on the West Coast for the entire Board in comparison to the cost of sending individual members to attend the course in Christchurch. The Chairman advised the Board of costs for the course.

Moved: Malcolm Stuart, Seconded: Christine Robertson

Motion: THAT costs of up to $4,475 are approved by the West Coast District Health Board for five Board members to attend the Institute of Directors Financial Reporting and Analysis course in Christchurch. Motion carried.

Write a letter to Greville Wood acknowledging his outstanding work on the GP training programmes and write to the three GPs thanking them for providing a placement for the students. Completed. Revise the transport paper to include recommendations for the Board and information on timeframes for travel to attend appointments, who qualifies for Ministry funding, use of the Whanau Facility in conjunction with transport services, consultation with Councils and any other intersectoral work. The General Manager Planning and Funding requested the reporting status of this item be amended to June 2005. Circulate contact details for all Board and Advisory Committee members to Board members. Completed. Crown Financing Agency


A Board member requested an update on progress with the CFA project. The Chief Executive advised good progress is being made. The CFA will not be reporting to WCDHB in the first instance but the report will be supplied in due course.

6. CHAIRMAN’S REPORT

6.1 Meeting With West Coast Private GPs

The Chairman, Chief Executive, Acting Chief Executive and General Manager Planning and Funding met with the West Coast private GPs and representatives of the PHO. Maureen Pugh and Tony Kokshoorn attended the meeting which was cordial. The meeting discussed a wide range of issues regarding general practice on the Coast. The Chair will report further on this later in the meeting.

6.2 Meeting With Graham Ewing

The Chairman met with Graham Ewing, Employment Consultant, EQI Global on 22 February 2005 in regard to the CEO recruitment process.

6.3 Meeting With Martin Sawyers

The Chairman advised he met with Martin Sawyers, Mayor, Buller District Council on 21 February 2005. They had a wide ranging discussion which was cordial regarding health services in the Buller region. The Chairman advised he will report further later in the meeting.

6.4 PHARMAC Board Meeting

The Chairman attended the Board meeting held on 23 February 2005 in Wellington and a consultation hui held at the Marae in Hamilton on 22 February 2005.

6.5 Meeting With Canterbury DHB

The Chief Executive, Acting Chief Executive, the Chairman and the Deputy Chair had a teleconference on 1 March 2005 with the CEO and Chair of CDHB to progress discussions on how the Boards wish to work together regarding services for WCDHB.

Moved: Gregor Coster, Seconded: Christine Robertson It was RESOLVED to accept the Chairman’s report.

7. CHAIRMAN’S CORRESPONDENCE

Moved: Gregor Coster, Seconded: John Vaile It was RESOLVED that the Chairman’s correspondence Inwards was accepted and Outwards endorsed.

8. CHIEF EXECUTIVE’S REPORT

The Chief Executive advised Management is currently focussing on the annual planning process. There have been delays as the funding envelope has only been received from the


Ministry in the last week, however the 12 March 2005 deadline remains which will be a challenge to meet.

8.1 Recruitment

A Board member noted there does not seem to be much progress in recruitment and this is of concern. The Chairman requested an update from the Chief Executive. The Chief Executive advised that recruitment of medical practitioners is a major issue nationally and internationally particularly in smaller areas. WCDHB is the smallest DHB and this presents a significant challenge in attracting medical staff. As reported at the last meeting, an advertisement in line with the new ASMS Agreement has been placed for GPs and significant progress is being made in that area with announcements of several GP appointments to be made shortly. In terms of secondary care collaboration is continuing with CDHB and it is a case of thinking differently about some services are delivered. Two O&G appointments have also recently been made. The Board member suggested the Chief Executive organise a report for the Board on recruitment strategies and efforts to recruit and retain staff. The Board agreed and the Chairman requested the Chief Executive organise a paper for the next meeting.

Action: Chief Executive

Moved: Julie Kilkelly, Seconded: Malcolm Stuart It was RESOLVED to accept the Chief Executive’s Report

9. FINANCE REPORT

The Chief Financial Manager advised the ytd deficit is currently $613k. This is mainly due to an inability to recruit and retain medical staff which has led to a reduction in costs. There is a surplus of $83k for January which is $390k better than budget. Outputs are down partly due to recruitment and retention issues and also because the budget is based on an equal 12 month split despite the usual slow down in production over December and January. The Chief Financial Manager advised the PRISM pilot site in Hari Hari is progressing well and the decision has been made to move the project on to the next stage which will be a roll out to all of South Westland, excluding Haast as there is no broadband coverage. This will mean that patient data will be available at all sites throughout South Westland and data such as lab results will be received faster. At a future stage this data will be able to be accessed from A&E and the system could be made available to other providers in the future. The Deputy Chair noted that at the last meeting there was discussion around the Chief Financial Manager providing a definitions list for the “Other” expense category. The Chief Financial Manager will provide this for the next meeting.

Action: Chief Financial Manager The Deputy Chair noted the Capex budget is over for this year and queried how this is managed. The Chief Financial Manager advised the budget has not been updated for $600k of additional funding for PACS. WCDHB entered the year with more cash than expected due to extra revenue received late last year and the Capex budget has been under spent in previous years and this money has accumulated.


A Board member noted that A&E attendances are over target ytd and queried if this is due to after hours arrangements and GP cover. The Chairman requested HAC investigate the issue and report back to the Board. A Board member queried if it is possible to see the accounts split between the primary and secondary provider arms. The Chief Executive advised that high level figures for primary including rural nursing could be provided, however he is reluctant to see a practice specific set of accounts bearing in mind there are private providers and related matters of commercial sensitivity. The figures could be reported to the Board In Committee if required. The Chairman advised this could be reported to the Board in the context of a future project, not in the public section. A Board member queried if commencement of works for the Dementia Unit is still scheduled for April. The Chief Executive advised there is approximately a three month timing differential and Management is engaged with CDHB to provide project management assistance. The Chairman advised that the delay is partly due to the Ministry of Health revisiting funding issues for the project. A Board member noted Other Directors Fees are over budget ytd. The Chief Financial Manager advised this variance relates to catering and Board training. This may be a timing issue as there have been two Board workshops this year and this figure should match budget by year end.

Moved: Malcolm Stuart, Seconded: Brian Wilkinson It was RESOLVED to accept the Finance Report.

10. REPORTS FROM ADVISORY COMMITTEES

10.1 Hospital Advisory Committee

The Chair, HAC advised there has not been a meeting since her last report however HAC has been involved in the DSP process.

10.2 Community and Public Health Advisory Committee

10.2.1 Recommendations to the Board

Discussion about where Mental Health issues are referred to and followed up now that MHAC has been disestablished resulted in the following recommendation.

Recommendation: THAT the Community and Public Health Advisory Committee recommends that the West Coast District Health Board direct Management to consider programmes of work from the former Mental Health Advisory Committee with a view to re-allocate to other Advisory Committees as appropriate.

The Deputy Chair advised this matter was discussed by the Board when MHAC was disestablished and the Board had agreed that primary mental health issues were to be considered by CPHAC, disability support issues by DSAC and provider arm mental health matters be considered by HAC. The Board also agreed that the Chair, HAC was to be given responsibility by the Chairman, WCDHB to be the link between Management and the Advisory Committee Chairs for consideration of these matters.


The Board noted that it has already been resolved how the work will be undertaken.

10.2.2 Reporting Back on Board Referred Items

Cervical Screening Janet Hogan, Manager Cervical Screening/Sexual Health gave an overview of cervical screening services on the West Coast. Statistics were provided which showed that the West Coast region has the lowest percentage of eligible women enrolled on the National Cervical Screening Register. It was pointed out that there were some inaccuracies in the methods used to calculate the figures, however allowing for this would not be likely to significantly change the overall result. Various initiatives over the past 12 months have been aimed at increasing enrolment and cervical screening rates. The Ministry of Health are funding two breast and cervical screening focus group meetings on the West Coast (Westport & Hokitika) and CPHAC have asked Janet to report back to the next CPHAC meeting with regional data from these meetings, likely reasons why women are not enrolling in the programme, the estimated number of smears that need to be done to reach benchmark rates and suggested initiatives to improve enrolment and cervical screening rates.

10.2.3 Other Items of Interest

WCDHB Maori Health Plan Gary Coghlan, General Manger Maori Health gave a presentation summarising the objectives of the WCDHB Maori Health Plan and implementation status of each of these. Tasks identified as lacking progress included: • Surveying Maori accessing health services to determine barriers to access • Establishing a pilot project to identify and review pathways of care into and out of

mainstream services Gary was asked to identify, prior to the next CPHAC meeting, any specific areas where CPHAC may be able to assist and report back on these.

10.3 Disability Services Advisory Committee

The Chair, DSAC noted that one of the Committee members raised the possibility of a barrier free audit of the organisation, particularly considering the Board is about to embark on a new building programme. DSAC recommends the Board undertake a barrier free audit of existing and proposed facilities. The Chief Executive advised he does not see any significant issues arising out of an audit and it is entirely appropriate to incorporate the principles of barrier free into new programmes. The Chair, DSAC advised there are providers available for the audit and it could be tendered out. The Chief Executive advised the audit will be co-ordinated through the facilities area. The Chairman requested the audit report be provided to DSAC and to HAC who will advise Management of any issues which need to be addressed bearing in mind the need to prioritise expenditure.

Moved: John Vaile, Seconded: Mohammed Shahadat WCDHB Meeting Papers 1 April 2005 Page 16

Motion: THAT the West Coast District Health Board accepts the recommendation of the Disability Services Advisory Committee that the Board undertakes a barrier free audit of all its facilities, including incorporating barrier free principles into the planning of any new building facilities and alterations. Motion carried.

10.4 Audit, Risk and Finance Committee

The Chair, ARFC advised that the Committee met this morning and there are a number of recommendations to the Board. A report has been prepared by the internal auditor and one of the matters raised was that of approval of the Chairman’s expenses. There were no issues in regard to the actual expenses, rather the process for approval.

Moved: Mohammed Shahadat, Seconded: Robyne Bryant Motion: THAT the Chairpersons expenses be reviewed and signed off by the Deputy Chairperson THAT the Board Policy and Procedure Manual be amended to reflect his policy. THAT the Board Policy Manual, Fees and Expenses, be amended to allow the Board Chairperson to delegate responsibility for validating claims. Motion carried.

The Chair, ARFC recorded his thanks to the Finance team in producing the Annual Report, which has been given the equal second highest rating of all DHBs. The Chair, ARFC advised a letter has been received from the Minister of Health noting that DHBs can now enter into finance leases without Ministerial consent. The ARFC discussed the internal audit report from Deloitte regarding rural nursing finance and risk issues. The Chairman noted it was a positive report. The Chair, ARFC noted that new financial reporting standards are being introduced and the ARFC will be kept up to date by Management.

11. ADVISORY COMMITTEE MEMBERSHIP

The Chair, HAC advised that the Advisory Committee Chairs have discussed the issue of Committee membership and have a number of recommendations for the Board included in papers. The recommendations address the vacancies from 01 May 2005, the need to stagger terms of appointment and the requirement to have one Maori member on each Committee. The recommendations included that of inviting former MHAC community appointees to apply for the vacancies.


A Board member requested clarification on the status of member Greville Wood. The Chair, HAC advised he is appointed to CPHAC as a GP representative and he will hold this appointment for the term of his employment as a GP. The Board member queried if there will be a review of the GP representative to CPHAC. The Chair, HAC advised that as it is an “ex officio” appointment, there would be no review unless Greville ceases to practice as a GP. The Board discussed the recommendations and community members terms and conditions of appointment.

Moved: Christine Robertson, Seconded: Julie Kilkelly Motion: THAT the West Coast District Health Board: i. Extends to three years the current term of appointment of :

- B. Beckford, HAC, from 1/5/05 to 25/6/06 (appointed 25/6/03) - B. Greer, CPHAC, from 1/5/05 to 12/11/06 (appointed 12/11/03)

ii. Confirms that G. Wood, CPHAC is extended from 4 March 2005 with

the duration of his term being as a GP representative and for a period of 3 years and Confirms that B. Beckford, CPHAC, is an appointed member with the expiry date of September 07

iii. Proceeds to advertise for the following vacancies:

- HAC 3 members - DSAC 3 members - CPHAC 1 member

iv. Writes a letter to the current members whose term is not being

extended: - Thanking them for their service to the Committees on which they

have served - Outlining the reason why they are not automatically being re-

appointed - Inviting them to re-apply on the understanding that, in the event

that there are more applicants than vacancies, they will go through the appointment process with any other applicants as per the Board’s policy and procedures.

v. Invites the two community members who were serving on MHAC at the

time of its demise, to apply on the same basis as any current HAC, DSAC and CPHAC member whose membership has expired.

vi. Invites any member of the community/previous suitable candidates for

vacancies whom it is believed could contribute to the work of the committees, to apply making clear that their appointment will be subject to them successfully going through the appointment process.

vii. Makes the terms of appointment as follows:

- HAC 1 for 2 years and 2 for three years - DSAC 1 for 2 years and 2 for three years - CPHAC 1 for 3 years


viii. Ensures that each committee has at least one Maori member:

- HAC currently met By R. Wallace whose term expires 1/5/05 - DSAC may be met by appointing to DSAC the yet to be

appointed Maori Board member - CPHAC met by membership of Board member R. Bryant and if

term of B. Greer is extended Motion carried.

12. PRIMARY MENTAL HEALTH STRATEGIC PLAN

The Chief Executive noted the Primary Mental Health Strategic Plan is an excellent initiative and the primary sector has been consulted in development of the Plan. Work is being done on the Primary Liaison Worker and Intervention Service. A number of Board members noted a number of typing errors and inconsistent references in the Plan. The Chairman suggested the Board may wish to defer approval of the Plan to the next meeting so that these errors can be corrected, as long as there is no urgency for approval. The General Manager Mental Health Services apologised for the errors and advised the only urgency would be in the establishment of the Access West Coast Committee and in having an agreement in intervention and liaison service. The Ministry of Health is looking to fund the PHO for these components but before the project can proceed Board approval is necessary. A Board member queried the figures relating to employment of the Primary Practice Liaison Worker. The General Manager Mental Health Services advised that figure should be 0 - 17% with mild to moderate mental illness as severe mental illness is covered by secondary care. A Board member queried whether the PHO has approved funding and the General Manager Mental Health Services advised this has not yet been confirmed. The Plan went through a consultation process and it was identified in the Plan at the time that funding would come from the PHO. The PHO has not responded otherwise. The Chairman advised the Board will require more information to approve the Plan and requested the General Manager Mental Health Services review the Plan, making the appropriate corrections and submit again at the next meeting.

Action: General Manager Mental Health Services

13. IN COMMITTEE

Pursuant to Clause 32a, Schedule 3 of the New Zealand Public Health & Disability Act 2000 members of the public are to be excluded from the portion of Friday 4 March 2005 meeting of the West Coast District Health Board that relates to the following items on the grounds that the public conduct and discussion of the following items would enable the WCDHB to carry out, without prejudice or disadvantage, commercial activities granted by Section 9(2)i of the Official Information Act 1982. • Minutes of the Meeting held Friday 28 January 2005 • Matters Arising • Board Member Items • Crown Financing Agency Loan Renewal • Capital Charge • DSS Funding


• Primary Practice • WCDHB/CDHB Partnership Agreement • Capex

− Grey Base Hospital Elevator Services • Contracts

− Coast Care Trust − Clinical Training Agency

• Implementation of 2004/05 District Annual Plan • 2005/06 District Annual Plan • District Strategic Plan • Risk Register Pursuant to Clause 32a, Schedule 3 of the New Zealand Public Health & Disability Act 2000 members of the public are to be excluded from the portion of the 4 March 2005 meeting of the West Coast District Health Board that relates to the following items on the grounds that the exclusion of the public is to allow the maintenance of effective conduct of public affairs through the protection of such Ministers, officers, and employees of the West Coast DHB from improper pressure or harassment and that this disclosure would prejudice the protection granted by Section 9(2)(g)ii of the Official Information Act 1982. • RACS Report Update

Moved: Gregor Coster, Seconded: Christine Robertson It was RESOLVED to move into In Committee at 11:06pm

14. MOVING OUT OF IN COMMITTEE

Moved: Christine Robertson, Seconded: Carol Atmore

It was RESOLVED to move out of In Committee at 4:16pm

15. ITEMS TO BE REPORTED FROM THE IN COMMITTEE SECTION

15.1 Primary Practice Ownership

The Board noted Carol Atmore’s conflict of interest as a GP employed by a West Coast private practitioner as declared at previous meetings and Carol voluntarily abstained from voting for all motions relating to primary practice ownership.

Moved: Robyne Bryant, Seconded: Christine Robertson Motion: THAT West Coast District Health Board recognises that its ownership of general practice services on the West Coast is likely to provide the most stable and sustainable platform for primary care services in, at least, the short to medium term and seeks to retain the practices it currently owns. 1 abstained – Carol Atmore Motion carried.


Moved: Robyne Bryant, Seconded: Julie Kilkelly Motion: THAT West Coast District Health Board does not seek to purchase other general practices. 1 abstained - Carol Atmore Motion carried.

Moved: Gregor Coster, Seconded: Christine Robertson Motion: THAT West Coast District Health Board instructs management to continue to provide for the option of continued private ownership of some general practices for the foreseeable future, including the potential for new privately owned practices to become established. 1 abstained - Carol Atmore Motion carried.

Julie Kilkelly noted a conflict of interest as a Trustee of the PHO as declared at previous meetings and voluntarily abstained from voting for motions regarding the PHO.

Moved: Christine Robertson, Seconded: Mohammed Shahadat Motion: THAT West Coast District Health Board continues to work alongside the West Coast PHO to encourage it to develop a strategic plan that is consistent with the New Zealand Primary Care Strategy and clarifies the role it intends to fill in respect of practice ownership and the employment of primary care professionals. 2 abstained - Carol Atmore, Julie Kilkelly Motion carried. Moved: Christine Robertson, Seconded: Robyne Bryant Motion: THAT West Coast District Health Board indicates a willingness to consider approaches by community-based charitable trusts wishing to negotiate transfer to their ownership of general practices. 1 abstained - Carol Atmore Motion carried.

Moved: Julie Kilkelly, Seconded: Robyne Bryant


Motion: THAT West Coast District Health Board instructs management to consult with primary care professionals it employs, and with other key stakeholders in primary care, to identify improvements it can make to structure, policy and procedures to enhance its performance as an owner of general practice services and employer of primary care professionals. 1 abstained - Carol Atmore Motion carried.

15.2 Elevator Services

Moved: Malcolm Stuart, Seconded: John Vaile Motion: THAT The West Coast District Health Board approves the capital expenditure request for up to $252,000 for the refurbishment of the elevator services at Grey Base Hospital. Motion carried.

15.3 Consultation on Buller Health Services Review

The Board discussed community consultation on the Buller Health Services Review and approved a consultation document, to be released for consultation in conjunction with the WCDHB’s District Strategic Plan in March/April 2005.

16. NEXT MEETING

Friday 1 April 2005, 9:15am, Boardroom, Corporate Office, Greymouth.

There being no further business the meeting concluded at 4:18pm


MATTERS ARISING FROM THE WEST COAST DHB BOARD MEETINGS

Item No.

Board Meeting

Date

Action Item

Action Responsibility

Reporting Status

Agenda Item Ref

5 5 March 2004 Discuss the written advice received from the MoH with Poutama Ora on the Memorandum of Partnership with Papatipu Runanga.

Chief Executive On hold. On hold.

14.1 5 November 2004 Obtain data around primary care referrals from the West Coast to other DHBs, a breakdown by service and data on time spent on CDHB waiting lists for services WCDHB does not provide. Primary care data to be reported to CPHAC and secondary data reported to HAC.

General Manager Planning and Funding

April 2005 Completed. In Committee

13.1.1 17 December 2004 Work with the Sexual Health Co-ordinator and her team to produce a scoping paper on the sexual health service in Buller with consideration to future expansion to South Westland.

Management May 2005

13.1.1 17 December 2004 Develop a process for consulting with Committees and the Board on the DAP planning process and present to the Board for sign off.

General Manager Planning and Funding

July 2005

Completed for 05/06

13.1.3 17 December 2004 Arrange for Community and Public Health’s West Coast Public Health Plan to be circulated to all Board members once it has been finalised.

Chair, CPHAC As soon asinformation is available.

Report not yet received.

5 28 January 2005 Provide a summary of the report on BMS by Ruth and Jim Vause in a format suitable for public release.

Management As soon asinformation is available.

Report not yet received.

11 28 January 2005 Revise the transport paper to include recommendations for the Board and information on timeframes for travel to attend appointments, who qualifies for Ministry funding, use of the Whanau Facility in conjunction with transport services, consultation with Councils and any other intersectoral work.

Management June 2005

8.1 4 March 2005 Provide a report on recruitment strategies and efforts to recruit and retain staff to WCDHB.

Chief Executive April 2005 Completed.


Item No.

Board Meeting

Date

Action Item

Action Responsibility

Reporting Status

Agenda Item Ref

9 4 March 2005 Provide a list of definitions for the “Other” expenses category. Chief Financial Manager April 2005 Completed.

12 4 March 2005 Make appropriate changes to the Primary Mental Health Strategic Plan as requested by the Board and re-submit the Plan for Board approval.

General Manager Mental Health Services

April 2005 Completed.


BOARD CORRESPONDENCE FOR MARCH 2005

Date Sender Addressee Details Response Date Response Details

10 March 2005 Christine Robertson Community Advisory Committee Members Various - Appointments to Committees - -

.


CHAIRMAN’S REPORT

The Chairman will give a written update at the West Coast DHB meeting on Friday 1 April 2005.


ng Papers 1 April 2005 Page 27

CHAIRMAN’S CORRESPONDENCE FOR MARCH 2005

WCDHB Meeti

Date Sender Addressee Details Response Date Response Details

14 March 2005 Mark Prebble, SSC Gregor Coster Election Guidance Not required

State Servants, Political Parties and Elections: Guidance for the 2005 Election Period

Issued by the State Services Commissioner

2005

State Services Commission, March 2005. Much of this guidance relates to the relationships, expectations and interactions among State servants, Ministers, Members of Parliament and political parties that can take on particular significance prior to a general election. The latter part of the guidance covers matters following an election, including government formation and briefing new Ministers. This guidance identifies common principles and obligations for those who work in the State Services. Note: This publication supersedes ‘Public Servants, Political Parties and Elections’

published in 2002. ISBN 0-478-24486-X

CONTENTS Introduction ................................................................................................................................ 2

Prior to a General Election........................................................................................................ 3 Official Comment........................................................................................................................... 3

Communication Campaigns ........................................................................................................... 3

Programme Launches..................................................................................................................... 3

Use of Agency Resources .............................................................................................................. 3

Contact with Members of Parliament and Political Parties............................................................ 3

Official Information Requests........................................................................................................ 4

Attendance at Caucus and Caucus Committees ............................................................................. 4

Pre-election Economic and Fiscal Update ..................................................................................... 5

State Servants Standing for Election.............................................................................................. 5

Costing Parties’ Policies ................................................................................................................ 5

Costing Parties’ Policies - During Government Formation ........................................................... 6

Significant Decision Making by the Government.......................................................................... 6

Following a General Election .................................................................................................... 7 Caretaker Convention..................................................................................................................... 7

Forming a Government .................................................................................................................. 7

Briefing a New Minister................................................................................................................. 7

Announcement of Portfolios .......................................................................................................... 8

Where to get more information................................................................................................. 9 New Zealand Public Service Code of Conduct.............................................................................. 9

Political Neutrality Fact Sheets ...................................................................................................... 9

Public Servants and Select Committees ......................................................................................... 9

Cabinet Manual .............................................................................................................................. 9

Step by Step Guide....................................................................................................................... 10

Cabinet Office Circulars .............................................................................................................. 10

Parliamentary Practice in New Zealand....................................................................................... 10

The Standing Orders of the House of Representatives ................................................................ 10

Voting Under MMP: Everything You Need to Know about New Zealand’s Electoral System .. 10

Electoral Act 1993........................................................................................................................ 10

Appendix 1: Guidelines for Costing Party Political Policies .......................................... 11

Appendix 2: Ombudsmen Report on Official Information Act Releases during………..

an Election Period ........................................................................................ 13 Issues arising from investigations under the Official Information Legislation............................ 13

Introduction This guide covers the main things employees in the “State Services”1 need to know prior to and following a general election. Much of the guide relates to the relationships, expectations and interactions amongst State servants, Ministers, Members of Parliament (MPs), and political parties that can take on particular significance prior to a general election. The latter part of this guide covers matters following an election, including government formation and briefing new Ministers. The main message is that, if State servants are to be able to effectively serve successive Governments that may be drawn from different political parties, they must be, and be seen to be, politically neutral. For this reason, in an election year the ordinary business of government should continue, although special care should be taken over media releases, advertising campaigns, handling of Official Information Act (OIA) requests, public speaking engagements, programme launches and release of discussion documents. State servants who are unsure about how to deal with a particular matter should ensure they obtain advice from a senior manager in their agency. For further guidance please email: [email protected].

1 “State Services” can be summarised to mean:

(a) All instruments of the Crown in respect of the Government of New Zealand, whether Departments, corporations, agencies, or other instruments.

(b) Includes the Education service, except for Tertiary Education Institutes.

2

mailto:[email protected]

Prior to a General Election With the exception of the guidance on State Servants Standing for Election and Costing Parties’ Policies (see below), most of this section applies to State servants irrespective of the timing of an election. However, an election year creates an environment in which particular care is required from State servants in dealing with these matters.

Official Comment An election year increases media interest in the activities of government. Where media statements or other public comment are concerned, there should be a clear understanding of which matters are primarily political and which are operational, and which are to be handled by the Minister and which by the agency. It is important that those employees authorised to speak on behalf of an agency appreciate this and understand the environment in which they are operating.

Communication Campaigns In the run-up to an election, agencies should consider whether communication campaigns generally, and advertising specifically, could be seen as ‘party political’, even if they might be unexceptionable at other times. This does not mean that communication campaigns that inform people of their rights and obligations should stop. If there are any doubts about how an advertising or public information campaign might be perceived, consideration should be given to waiting until the new Government is formed, for advice contact the State Services Commission or the Office of the Auditor-General. The ‘Guidelines for Government Advertising’ in Appendix 2 of the Cabinet Manual 2001 contains some general guidance (www.dpmc.govt.nz/cabinet/manual/appendix2.html).

Programme Launches Similarly, the launch of a new programme or initiative may take on a ‘party political’ character in an election period. State servants should work with Ministers as usual, but take care to avoid association with the political aspects of any such event, or with the preparation of supporting material which has a political character.

Use of Agency Resources It is inappropriate for agency premises or other resources to be used for ‘electioneering’ (there is specific provision made, however, under the Electoral Act 19932 for political parties to use public schoolrooms for election meetings). State servants should also be careful about providing their work place contact details to outside organisations. For instance, receiving party political material (for personal information) via agency fax or email may undermine the perception of political neutrality.

Contact with Members of Parliament and Political Parties Contact between State servants and MPs is always sensitive, but may become more so in an election year. That may particularly be the case in regional offices of agencies that may have routine contact with MPs in their capacity as electorate representatives acting on behalf of constituents. State servants should be sensitive to the fact that, in an election year, a MP will

2 Refer to section 154.

3

http://www.dpmc.govt.nz/cabinet/manual/appendix2.html

have the dual role of advocate for a constituent and a campaigner for re-election. Local managers should contact their head office if they are uncertain of how to handle a specific case. Apart from responding to constituency concerns raised by a local MP, any contact between State servants and representatives of political parties within or outside the Government should take place only with prior Ministerial approval.

Official Information Requests It is particularly important that the Official Information Act works during the election period, as the Act exists to inform the public of the workings of government. To preserve the political neutrality of the State Sector, agencies must give effect to the statute in a timely fashion. Requests for information from political parties should generally be treated in the same way as any other official information request. Where an official information request comes from a party or MP (including party research units) State servants should consult with their chief executive and Minister. Where there is any disagreement between the responsible Minister and the chief executive over whether information should be released, the request should be transferred to the Minister’s office, because this

“...is the only way in which the department can meet its constitutional duty to follow Ministerial direction and the obligation to comply with the Official Information Act....Each case of this kind needs to be carefully handled at a senior level within the department, including reference back to the Minister for further consideration if necessary”.3

However, if the request relates to a statutory role in an agency then no consultation is required with the Minister. In a previous election period, the Ombudsmen reported that State servants exceeded their mandate and became involved in assessing the political consequences of release, rather than making the decision in a politically neutral manner. The Ombudsmen said “it is improper for State servants, expected by the public to be neutral, to use official authority or influence to attempt to interfere with, or affect, the result of a General Election”4. State servants must appreciate the need for speedy decisions on releasing, or not releasing, information. State servants must not attempt to extend the timeframes specified in the OIA for the release of information on the basis of fallacious reasons, including the need to consult with Ministers. State servants should assess Official Information requests in the usual way, looking carefully at the grounds. The potential for released material to adversely affect the Government’s electoral prospects is not a lawful reason for withholding it. Official Information requests need to be handled with care, at a senior level. For more information on the Official Information Act 1982 see the Cabinet Manual 20015.

Attendance at Caucus and Caucus Committees State servants are not usually expected to attend caucus meetings of the political parties represented in the House. However, if a State servant’s attendance is requested, permission

3 From Cabinet Manual 2001, 6.34 4 Report of the Ombudsmen for year ended 30 June 1991, pp 16-21 5 6.10-6.43

4

from their chief executive and/or direction from the Minister is required. State servants should not undertake work at the direction of caucuses, nor should they service caucuses or their committees. Any instructions, which might emerge from caucus discussions, should come from the Minister. If a State servant is invited to attend a caucus committee meeting in a personal capacity, their chief executive’s agreement should be obtained before attending.

Pre-election Economic and Fiscal Update While usual processes apply, as the election draws closer, timing becomes important. Briefings to Ministers should be timed to ensure that significant decisions can be included in the Pre-election Economic and Fiscal Update (which the Treasury prepares under the Public Finance Amendment Act 2004). The Update is normally published four to six weeks before the election and must include ‘to the fullest extent possible’ information on all government decisions and other circumstances that may affect the fiscal and economic outlook.

State Servants Standing for Election State servants are entitled to stand for election to Parliament but are subject to the provisions of the Electoral Act. They must notify their chief executive of their intention to stand. Candidates from the State Services must take leave from their job for a period before the election (at least between Nomination Day and the first working day after Polling Day, but sometimes for a longer period as determined by their chief executive after consultation with the State servant). Someone included on a party list becomes a candidate on Nomination Day when the list is lodged with the Chief Electoral Office. If declared elected, a State servant will immediately be deemed to have “vacated” their position. If unsuccessful they may resume work on the first working day after Polling Day.

State servants who are involved in political parties or who comment publicly on political matters need to be particularly careful that they do not abuse their position by:

• revealing advice given to Ministers

• disclosing information they are not authorised to disclose

• criticising Ministerial policy with which they have been professionally involved, or

• purporting to express a departmental view where they are giving their own view.

Costing Parties’ Policies It is the routine business of most agencies to cost policy options. However, agencies may be asked by their Minister to cost the policies of parties in government, or to cost other parties’ policies where Ministers wish to use this information for partisan purposes (e.g. during election campaigns). Special rules have been designed to cover such situations to protect State Sector political neutrality while providing Ministers with the information they require. The rules require Ministers to specify the proposals to be costed where they are unclear. They prohibit State servants from making broad assumptions about policies or commenting on the merits of policies. These rules are attached as Appendix 1. If State servants are uncertain over the application of these rules, they should seek advice from the Treasury and State Services Commission.

5

Costing Parties’ Policies - During Government Formation Agencies may be asked to cost policies as part of the information and advice they offer during the negotiations between political parties to form a government following an election. These costings should be dealt with in terms of the State Services Commission’s circular (www.ssc.govt.nz/negotiations) on the process for supporting negotiations between political parties to form a government.

Significant Decision Making by the Government Unless a general election has resulted from the Government losing the support of the House, there is no caretaker convention which applies in the period immediately before an election. However, governments have chosen to restrict their actions to some extent at this time recognising the potential for an imminent change of government. These actions include deferring significant appointments and government advertising that may be inappropriate during an election campaign – see Cabinet Circular (CO(05)2) www.dpmc.govt.nz/cabinet/circulars/co05/2.html. In practice, the period of restraint extends from approximately three months before the general election is due.6

The Secretary of the Cabinet is able to give advice on decision making during the pre-election period.

6 For detailed information regarding the invoking of the caretaker convention see Cabinet Manual 2001, 4.14.

6

http://www.ssc.govt.nz/negotiations

http://www.dpmc.govt.nz/cabinet/circulars/co05/2.html

Following a General Election

Caretaker Convention After an election, it may be necessary for the incumbent government to remain in office for a period until a new administration is sworn in or it becomes clear that the incumbent government continues to have the support of the House necessary to govern. During such periods, the incumbent government is still the lawful executive authority, with all the powers and responsibilities that go with executive office. Ministers are therefore entitled to receive the same level of support they normally receive from agencies, including being advised and getting information. Governments, however, have traditionally constrained their actions during this period, in accordance with what is known as the caretaker convention.

There are two arms to the caretaker convention:

• where it is clear who will form the next government, but they have not taken office, and

• where it is not clear who will form the next government.7

Detailed guidance on the application of the caretaker convention is set out in the Cabinet Manual, paragraphs 4.16-4.31 (www.dpmc.govt.nz/cabinet/manual/4.html). The Secretary of the Cabinet is available to provide advice to Ministers and agencies about the application of the caretaker convention. Ultimately the Prime Minister will determine how a matter should be dealt with during this period.

Forming a Government The formation of a Government is a political process, and the State Services Commission manages any involvement by State servants. If approached to provide information or advice, State servants should refer the request to the State Services Commissioner, through their chief executive. Agency officials may provide information or technical support on specific questions to political parties for the purposes of government formation negotiations only when authorised by the Prime Minister to do so and must follow the relevant guidance.8

Briefing a New Minister One of the duties of State servants following an election is to brief the incoming Government and new Ministers. These matters are discussed in more detail in the Cabinet Manual 2001 – paragraphs 4.46 and 4.48.9 The Department of the Prime Minister and Cabinet will advise agencies separately of any additional specifications or requirements over and above those in the Cabinet Manual 2001. The briefing material should focus on the incoming Minister’s needs. It should be modest in size reflecting the pressures on the incoming Ministers. The amount of detail included in the briefing will vary depending on whether the Minister concerned has had any prior involvement with the portfolio, and whether there has been a change of government. Agencies must be able to provide this sort of briefing at short notice. 7 For detailed information regarding the caretaker convention see the Cabinet Manual 2001, 4.16-4.24. 8 See SSC CE Circular Negotiations Between Political Parties to Form a Government.9 2.155-2.157, 4.46 and 4.48.

7

http://www.dpmc.govt.nz/cabinet/manual/4.html

Any requests under the Official Information Act for the briefing material must be dealt with in terms of the criteria of the Act10. Because the public release of briefings is for individual Ministers to determine, a briefing for an incoming Minister is confidential until the Minister or the new Government decides to release it.

Announcement of Portfolios Agencies should not assume that an Opposition spokesperson will necessarily become the Minister where there is a change of Government. Spokespersons should not be given any briefing material until the Prime Minister-designate formally announces portfolios. This announcement usually takes place shortly before Ministerial warrants are issued.

10 See the Official Information Act 1982, Sections of 9 (2) (f) (iii) and (iv) and 9 (2) (g) which recognise the maintenance of

constitutional conventions to protect the confidentiality of information provided to Ministers by officials, the political neutrality of the State Sector, and the importance of officials being able to give free and frank advice to Ministers, and also Section 15 (A) (i) (b) which provides that the normal time limit to reply to an Official Information request may be extended if consultations (for instance, with an incoming Minister) are necessary for a proper response to a request.

8

Where to get more information State servants who are unclear about how to deal with a particular matter should contact their senior management. The three central agencies may also be asked for advice:

• State Services Commission – State services conduct and the process for providing information to political parties engaged in negotiations to form a government. Email: [email protected].

• Secretary of the Cabinet – the operation of Government and constitutional matters.

• Department of Prime Minister and Cabinet – briefings for incoming Ministers.

• The Treasury – fiscal and budgetary matters.

Further sources of information are provided below, many of which can be accessed via the State Services Commission website: www.ssc.govt.nz and the Ombudsmen’s Office www.ombudsmen.govt.nz.

New Zealand Public Service Code of Conduct Issued by the State Services Commissioner (2001). The Code prescribes minimum standards of integrity and conduct for public servants and emphasises political neutrality. This is available on the SSC website – www.ssc.govt.nz/coc

Political Neutrality Fact Sheets In September 2003, four question and answer fact sheets were produced by the State Services Commission on political neutrality:

• What is ‘political neutrality’ and what does it mean in practice?

• Political views and participation in political activities.

• The relationship between the Public Service and Ministers.

• The relationship between the Public Service and MPs.

As a follow-up, in June 2004, a fifth fact sheet was produced: Political neutrality for staff who interact with the public (front line staff). This fact sheet was a combination of the first four facts sheets put into an easy to read format and directly aimed at front line staff. See SSC website – www.ssc.govt.nz/political-neutrality

Public Servants and Select Committees State Services Commission (2002). These guidelines cover the principles of the relationship between public servants and select committees; public servants as witnesses or advisers; attendance by Ministers at select committees; and attendance by a public servant in a private capacity. See SSC website – www.ssc.govt.nz/select-committees-guidelines

Cabinet Manual Cabinet Office (2001). This is the key guide to central government decision making, for those working within government. It is also a primary source of information on constitutional and procedural matters, for those outside government (www.dpmc.govt.nz/cabinet/index.htm).

9

mailto:[email protected]

http://www.ssc.govt.nz/

http://www.ombudsmen.govt.nz/

http://www.ssc.govt.nz/coc

http://www.ssc.govt.nz/political-neutrality

http://www.ssc.govt.nz/select-committees-guidelines

http://www.dpmc.govt.nz/cabinet/index.htm

Step by Step Guide Cabinet Office (2001). This guide sets out the processes approved by Cabinet for Cabinet and its committees. It helps departments and Ministers' offices meet Cabinet's requirements for developing and presenting proposals to Cabinet (www.dpmc.govt.nz/cabinet/index.htm).

Cabinet Office Circulars The Cabinet Office will also issue circulars from time to time throughout the election period, providing guidance on various procedural and constitutional issues. See www.dpmc.govt.nz/cabinet/circulars/index.html

Parliamentary Practice in New Zealand D McGee, (2nd edition, 1995). This text provides a comprehensive description of the procedures of Parliament. It must be read in the context of the 1996 changes to the Standing Orders.

The Standing Orders of the House of Representatives (1996). These are the rules used by the House of Representatives to govern its own procedures. New Standing Orders were adopted in late 1995 following the Report of the Standing Orders Committee.

Voting Under MMP: Everything You Need to Know about New Zealand’s Electoral System Electoral Commission (1996). This provides a general account of the MMP electoral system and the constitutional context within which it operates. It includes appendices on how boundaries are drawn, electoral history, and the St Lague formula, as well as a useful glossary of terms.

Electoral Act 1993 See www.legislation.govt.nz

10

http://www.dpmc.govt.nz/cabinet/index.htm

http://www.dpmc.govt.nz/cabinet/circulars/index.html

http://www.legislation.govt.nz/

Appendix 1: Guidelines for Costing Party Political Policies Requests for costings of policies of any political party should be provided only at the written request of the Minister of Finance or a Responsible Minister. A request from a member of a Minister's staff is not sufficient authority in itself. The Chief Executive is responsible for receiving any request, assigning any tasks, and seeing that the costs and any accompanying material conform to the rules, and that any response is released in writing (under the signature of the chief executive, or appropriate, authorised senior officer) to the Minister who made the request. If a request for costings is made to a government department other than the Treasury, the request is to be referred to the Office of the Minister of Finance in the first instance. In any event the departments concerned need to be absolutely clear about the allocation of tasks to co-ordinate effort and resources, and work in close co-operation with each other. The procedures to be followed should be conveyed in writing. All requests for costings of policies or proposals of political parties are to be documented in full, and all workings, correspondence, sources, procedures, and decisions recorded. Agencies should keep a record of the resources used in preparing a political costing. Only those persons directly involved in the actual costings should be privy to the exercise. Costings should be limited to factual data readily available in the Treasury or other agencies and should contain:

• no additional commentary, such as the merits or otherwise of the policy proposal

• no value judgements, or subjective assumptions

• no unsubstantiated or unreasonable technical assumptions - it should be clearly stated if the assumptions could lead to more than one possible costing

• a clear explanation of all sources, and of any assumptions used.

If there is any doubt as to the nature or basis of the request, clarification must be sought from the Minister of Finance or Responsible Minister concerned. All responses should be drafted on the understanding that they may be requested and released under the Official Information Act 1982. In some instances it may be appropriate to meet the Minister’s request by having the costings done by a qualified expert outside the Public Service. If so, this should be made clear in reporting to the Minister concerned. The convention between Ministers and agencies in these circumstances is that Ministers will not require or use information on costings in a way which might damage the neutrality of the Public Service, and hence its ability to serve successive Governments. Note: These rules should not be applied where agencies are required to provide costings:

• in order to assist Ministers to make a decision about whether or not to exercise the Financial Veto under Standing Orders 312-317, since these will be required as part of the normal business of government (CO (98) 15).

11

• during a period of negotiations between political parties to form a government following an election. Requests for costings that occur as a result of this process should be dealt with in terms of Negotiations Between Political Parties to Form a Government: Guidelines on Support from the State Sector provided by the State Services Commission.

12

Appendix 2: Ombudsmen Report on Official Information Act Releases during an Election Period The following is an extract from the Report of The Ombudsmen/Te Kaitiaki Mana Tangata, for the year ended 30 June 1991, pp 16-19.

Issues arising from investigations under the Official Information Legislation

Release of information prior to a General Election

The Chief Ombudsman's investigation into the release of "Prime Ministerial Briefing Papers - Bank of New Zealand Data", (case W2733) which is the subject of a separate report to the House of Representatives, highlighted the need for access to reliable economic information prior to a general election. A General Election is the central event in a constitutional democracy, and it is undeniably in the public interest that all political parties seeking electoral support be able to explain adequately how they intend to deal with issues arising from perceived advantages or disadvantages in the state of the economy, and design the policies which they hope will be supported when the electorate votes. The economy always will be of central importance in any election campaign. The Chief Ombudsman therefore suggested that Parliament consider a means by which an authenticated non-political survey of the state of the economy could be published for all to see and understand before a General Election. He highlighted four criteria which he considered to be critical to such a review: (i) There should be statutory authority for the review prescribing its independence and its

funding.

(ii) The publishing body should be part of the official machinery of government, having authority to access all relevant information in all departments of State.

(iii) The publishing body should operate preferably out of the Department of Statistics which has a history of protected independence in publishing.

(iv) The subject-matter to be covered in the assessment should be specified in the legislation.

The General Election also raised some other issues. For example, we [the two Ombudsmen] both experienced difficulties in getting officials to whom requests were made for information to co-operate in meeting time frames related to the date of the General Election. The maximum time frames of the Official Information Act were used extensively to avoid releasing politically sensitive information required by various individuals, Members of Parliament and special interest groups for the election campaign. This very undesirable practice failed to appreciate the constitutional importance of ensuring that the electorate was well informed before it committed itself to selecting the parliamentarians from whom a government would be formed. What concerned us was that officials with a duty under the Act to release all information unless there was good reason to withhold in terms of the legislative criteria, exceeded their mandate and became involved in assessing political consequences of release, rather than making the decision in a politically neutral manner. While it is argued by some that the State Sector Act may have affected the constitutional notion of a politically neutral Public Service, we believe that it is improper for officials, expected by

13

the public to be neutral, to use official authority or influence to attempt to interfere with, or affect, the result of a General Election. Regard was often had by officials to the likely political consequences of releasing the information held by the organisation when assessing the time frames imposed by the Act. Evidence was available to show that, notwithstanding that the information could not be withheld in terms of the provisions of the Act, its release could be delayed beyond the General Election date by invoking the full legal 20 working day time limit, and by attempting to use fallacious reasons for extending those time frames. Two examples show the nature of the problem we faced. The Chief Ombudsman received a request from an Opposition Member of Parliament for a review of a decision taken by a departmental official to extend the time frame for responding for a further 20 working days, to enable the official to consult with Ministers on the release of the information sought. The information was readily available. The Member's request to the department was made on 10 September and appeared to be passed around between officers for some days, eventually arriving with the officer authorised to release around 1 October. The request was then held by that officer until 10 October, when he notified to the Member of Parliament an extension of 20 working days to 7 November (the General Election took place on 27 October), ostensibly on the grounds of the need to consult with Ministers. When the Chief Ombudsman reviewed the extension he considered it was unreasonable as there had clearly been sufficient time after initial receipt for the department to consult with Ministers. (It could not transfer the request to the Minister in terms of section 14(b) of the Act because it did not meet the test of being more closely connected with the functions of the Minister.) Apart from the need for consultation being questionable, the department was well aware from the nature of the information that the Member of Parliament required a response before the General Election. In attempting to justify the extension of time to the Chief Ombudsman, the Chief Executive said the matter was potentially quite sensitive and that it would be unfair not to consult. The Chief Ombudsman did not disagree with this (providing the Chief Executive made the final decision and not the Minister), but already plenty of time had elapsed during which consultation could have taken place. The Chief Executive then went on to say in justification of the need to consult, The release of such information at this time could adversely affect the Government's electoral prospects. Nowhere in the Act is this a withholding provision and, apart from the question of whether the Chief Executive as a non political official was entitled to make this assessment, it was not appropriate to use the pretence of needed consultation to extend the time for a reply well beyond the Election date when there had already been plenty of time for consultation to take place. Believing that deliberate procrastination was taking place, the Chief Ombudsman held that the extension was unreasonable and that the decision on release should be given by 24 October. It is gratifying to report that the department met that date and released the information requested to the Member of Parliament with few deletions. However, it probably arrived too late to meet the objectives of the Member who requested it. The Ombudsman had a similar example. An urgent request was made to the department on 17 September for statistical data required by a special interest group to test before the General Election whether an announced policy and expectations of the then government were achievable in practice. The department refused the request on 28 September and the Ombudsman received a letter asking for review on 2 October. On 19 October the Ombudsman

14

by fax, on grounds fully set out, expressed the opinion, subject to the Chief Executive's final comments, that the request for information should not have been refused. The department was urged to release the information straight away if the opinion was agreed to, and otherwise to advise the reasons for disagreement by 3pm on Wednesday, 24 October. By facsimile message dated 23 October, but not sent till 2.47pm on 24 October, the department stated it did not wish to disagree with the Ombudsman's opinion, but would prefer to release the information in response to a formal recommendation. The Ombudsman was told that on receipt of the formal recommendation the statistics would be released to the requestor. A formal recommendation to release was faxed early on the morning of 25 October. The following day, the last working day before the General Election, the Ombudsman was made aware by the requestor that the Department was unlikely to release the information that day. Immediate inquiries established that, contrary to the undertaking given, the information had been sent to the Minister because it was regarded as protocol to get the Minister's approval for release of possibly sensitive information. There had been ample time when the department first received the request to consult the Minister. The Ombudsman pointed out that any consultation should have been carried out in accordance with section 15(5) of the Official Information Act in the course of making a decision on the release of the information. Furthermore, she pointed out that the Act did not provide for veto or approval by a Minister after a recommendation had been made, and that the way this matter had been handled by the Department could be seen to be unduly obstructive and to have frustrated the principles, purposes and procedures of the Official Information Act. These examples were not unique in that difficult period. What surprised us was that officials appeared to not appreciate the significance of the need for speedy decisions, and the extreme importance of a well-informed electorate at the time of a General Election. While an inward looking perspective is understandable at such a time, we did think that professional public officials would recognise the importance of one of the purposes of the Official Information Act to the effectiveness of a General Election. That purpose bears repeating here because it is so relevant to a General Election:-

4(a) To increase progressively the availability of official information to the people of New Zealand in order-

(i) To enable their more effective participation in the making and administration of laws and policies; and

(ii) To promote the accountability of Ministers of the Crown and officials,-

and thereby to enhance respect for the law and to promote the good government of New Zealand.

15

State Services Commission

General Election 2005: Guideline for State Servants1 1

Election Fact Sheet / March 2005Election Fact Sheet / March 2005 / 0-478-24482-7

General Election 2005:


Guidance for State Servants1

Questions

What is “political neutrality”? ..............................................................2

Why is political neutrality so crucial during a general election? ..........2

Can I express my own political views in my job? ................................2

Can I be politically active in my community? .......................................3

Can I use work premises or resources for party political purposes? .... 3

What if a MP requests information during the election period? ............3

What if the media contact me at work about an election issue? ..........4

What if I want to stand as a candidate in the election? ........................4

How involved can I be on election day? ..............................................4

Remember these key points: ..............................................................5

As the country prepares for this year’s general election, it is timely to consider some of the implications of this event for employees in the State Services (“State servants”). This fact sheet provides you with some guidance during the election period, both at work and outside working hours.



Election Fact Sheet / March 2005

Q

Q

Q

What is “political neutrality”?

The “State Services”2 serve the government of the day. But they must also be able to serve successive governments. This means that State servants must ensure not only that they, and their agency, maintain the confidence of their current Minister, but also that the same relationship can be established with future Ministers. In order to do this, State servants must be politically neutral, i.e. they must perform their jobs professionally and without bias towards one political party or another.

Why is political neutrality so crucial during a general election?

State servants need to take particular care how they conduct themselves during the election period. A series of fact sheets has been circulated to departments on the importance of political neutrality within the Public Service.3 You may have read some of these. Political neutrality means that you need to be, and be seen to be, politically neutral at all times. This takes on particular significance in the run up to, during and in the immediate period after, a general election.

Political neutrality maintains the public’s trust and confidence in the institutions of government. It ensures there is continuity in the business of government regardless of who is in power. Political neutrality protects you against any inappropriate political pressure that could be brought to bear on you at work. There is an increased need for this protection over an election period, when normally acceptable situations and working relationships can take on particular significance and sensitivity.

The political neutrality principle is relevant for State servants in all jobs. Regardless of the work you do, you must not behave, or be seen to behave, either at work or outside working hours, in any way that could compromise your agency. The more senior your position, the more important it is for you to be vigilant in this respect.

At election time you can expect more interest than usual in your work. There will be greater public awareness of the way State servants conduct themselves over this

period, so this is a time to take extra care.

Can I express my own political views in my job?

You have the same democratic rights, including the right of free speech, as all other New Zealanders. However, because you are a State servant you have to consider carefully whether you express your political views, and if so, when and how you do so.

It is understandable and natural that your political affiliations might come up in the course of conversations with your colleagues at work. However, you must avoid pushing a party line or expressing your political views in a way that could be taken as a comment about your job. You must not campaign for a party or a candidate at work.

If you are speaking publicly, avoid showing any political bias. During the election period you must be particularly careful about this. It is important not to be seen to

bring politics into your job or your job into politics.

1 State servants and public servants are defined as in section 52 and section 3 of the Electoral Act 1993.

2 “State Services” is defined in section 2 of the State Sector Act 1988

3 Refer to www.ssc.govt.nz/political-neutrality

www.ssc.govt.nz/political-neutrality




Q

Q

Q

Can I be politically active in my community?

The principle of political neutrality remains the same during an election as it does at

all other times. It covers both your time at work and outside working hours.

It is acceptable for most State servants, who are not working closely with Ministers, to belong to a political party. However, you need to use your judgement so you don’t compromise your political neutrality. The more senior your position, the more care you will need to exercise if taking on a public role within a political party. If in doubt seek guidance from your manager or head office HR staff.

New Zealand is a small country and if you are an active member of a political party you cannot avoid it being known. Staff with leadership roles should not involve themselves in activities such as delivering flyers, displaying party political bumper stickers or publicising a party with a hoarding outside their house. It is not acceptable for any State servants to agree to have their photo included in political party advertising.

If you are actively involved with a political party you should advise your manager or chief executive as soon as possible. Together, you can work out whether this could cause conflict for you, your workplace and agency and if so, what steps could be taken to manage this conflict. Remember, political neutrality requires that you must not cause embarrassment to your Minister, your agency or your work colleagues.

Can I use work premises or resources for party political purposes?

No. Public resources must not be used for party political purposes. This means you cannot allow your local MP or another election candidate to use your work premises for meetings. You must not give your work or agency contact details – including phone, fax and email – to organisations that are involved with the election campaign. Your work premises cannot be used for electioneering. There is one exception to this – a provision of the Electoral Act 19934 allows political parties to use public schoolrooms.

You must not use your work email to communicate about political issues or use the work photocopier or printer to run off party political material. If you are sent a party political email either delete it or refer it to your manager or chief executive, but do not respond or forward the email to any other person. You must not put up political party

posters at work or in a departmental vehicle, or wear political badges at work.

What if a MP requests information during the election period?

As always, the Official Information Act applies to such requests. Your agency will have in-house guidance on MP requests. In an election year a MP has the dual role of advocate for his or her constituents and is also a campaigner for re-election. This can make a difficult situation out of what might otherwise be routine contact between a MP and a local office. If you receive a request from a MP or another candidate in the election and you are unsure how the Official Informa- tion Act applies, you should refer the request to your manager. Managers should contact their chief executive if they are unsure how to handle a specific situation.

4 Refer to section 154




Q

Q

Q

What if the media contact me at work about an election issue?

You must follow your agency’s media policy. If you are contacted by the media you must not reply unless you are the authorised spokesperson. If you are not authorised to speak, refer the call to your spokesperson or to your manager. If you are the spokesperson, as always, stick to explaining policy – do not defend or

criticise it.

What if I want to stand as a candidate in the election?

If you want to stand for election to Parliament either on a party list or for a constitu-ency, you will have to take annual or unpaid leave and stand down from your position at least from Nomination day until the first working day after Polling Day.5 This period may begin before nomination day if your manager believes that your candidacy could affect your ability to carry out your work. If you are elected you are considered to have vacated your agency position. If you stand and are unsuccessful you may go back to work on the first working day after Polling Day.

State servants who stand for election need to take particular care not to abuse their position by disclosing information they are not authorised to disclose, revealing information that is not available to the public, or putting forward their own views as those of their agency.

You need to consider carefully the consequences of standing for Parliament and being unsuccessful. Gaining a high political profile in the community could affect the

relationship you might have with Ministers in the future.

You should let your manager or chief executive know as soon as you decide

to stand as a candidate.

How involved can I be on election day?

State servants should be encouraged to vote and to participate in the administration of the election, for example as an election official. However, involvement in political activity is more complex.

As a guideline for what is appropriate on election day, avoid situations that could be a source of embarrassment to your agency, or confusion for people who know you work for a government agency.

If you hold a leadership position, or have a high profile in your community as a State servant, you should avoid being visibly associated with a political party on elec-tion day. This means you should not drive electors to polling booths on behalf of a political party or preside over events at a party’s headquarters. Similarly, if you are at a candidate’s post-election party you run the risk of compromising your impartiality. You could also attract the attention of the media.

The skills of many State servants may be valuable in assisting the election process by carrying out the tasks of a scrutineer. Although candidates nominate scrutineers, it would not be regarded as an unacceptably partisan activity, provided you do not visibly identify with a political party. This means that when scrutinising election activities in a polling booth or at the returning office you must not wear a party rosette.

5 The conditions are set out in the Electoral Act 1993, section 52.




Q

Being a State servant is not always straightforward. However, talented people who wish to make a contribution to New Zealand have a great opportunity to do so in the State Services. It can be a testing time around elections, avoiding conflict and balancing the many aspects of your life – work, family,

friends, and outside interests and activities.

Remember these key points:

Political neutrality maintains the public’s trust and confidence in the institutions of government. It ensures there is continuity in the business of government regardless of who is in power.

Political neutrality protects you against any inappropriate political pressure that could be brought to bear on you at work.

If you are concerned about a situation that you think might threaten your political neutrality, remember to talk to your manager or chief executive.

For more detailed election guidance see: www.ssc.govt.nz/election_guidance

www.ssc.govt.nz/election_guidance


CHIEF EXECUTIVE’S REPORT

RECRUITMENT / VACANCIES FOR FEBRUARY/MARCH 2005

POSITION STATUS Senior Medical Staff General Surgeon An active recruitment campaign is set to take place

week beginning 21 March comprising advertising in specialist journals, supported by internet/website advertising. One potential candidate has been sent a letter of offer and has verbally accepted. Another potential candidate is scheduled for interview.

Anaesthetist Actively recruiting. Two potential candidates have

expressed an interest in working on the West Coast. This expression of interest is being pursued.

Orthopaedic surgeon As above, an active recruitment launch is scheduled

with all activity supported by medical specialist agencies. Locum cover in place until end of April.

O&G Full complement. GPs - Buller An active recruitment launch is underway with targeted

advertising in key publications and collaborative efforts from recruitment agencies. Cover is currently provided with both permanent and locum doctors in place.

GP Dobson As above with regard to the strategy for securing GPs

to Westport, an active search is underway whilst locum cover is in place in the medium term. A letter of offer has been sent to a potential candidate and we are awaiting acceptance.

GP South Westland A permanent appointment has been made and will be

effective 3rd September 2005. Locum cover in place until this time.

GP Grey Medical Centre Two potential candidates have expressed interest and

the recruitment process is in progress. A letter of offer has been sent to a potential candidate and we are awaiting acceptance.

A&E Specialist Letter of offer has been sent and we are waiting

acceptance.

8

POSITION STATUS Nursing Staff RN Reefton No applicants – re-advertising Rural Nurse Specialist Whataroa Position advertised Staff Nurses – OR Position advertised Mental Health OT Community Mental Health Position advertised Team Leader Acute IPU Interviews in progress Community Mental Health Worker Buller

Position advertised

Temporary CAMHS Worker Position advertised RN IPU Position advertised Allied Health Staff Pharmacist Position advertised Charge Pharmacist Position advertised Social Workers Position advertised Other HR Manager External consulting firm actively recruiting for potential

candidates. DON/GM Primary Care Structure and job description(s) being reviewed. Surgical Registrar Position advertised PA to DON On hold Meningococcal School Base Co-ordinator

Position advertised

Business Analyst Position advertised Laundry Washman Position advertised Laundry Assistant Position advertised

FLUORIDATION On Monday 14 March 2005 the Grey District Council received a presentation on fluoride from Dr Martin Lee with WCDHB’s Research and Planning Analyst, General Manager Planning and Funding, and Community Liaison Officer. As a result the Council have now opened the discussion on fluoride to the public. Submissions must be made to the Grey District Council by 20 April 2005. WCDHB expects there to be significant public debate on this issue and will be providing proven scientific evidence to the public in support of the submission.

MENINGOCOCCAL B VACCINATION CAMPAIGN With vaccination due to start on the West Coast on 7 June, the Ministry of Health has agreed to increase the funding of this public health initiative by $21,000, bringing the total budget to approximately $570,00. The campaign will see 8,500 children and youths under the age of 20 vaccinated over a six month period. As well as publicising the Meningococcal B campaign the DHB will also promote the need to be vigilant for the signs of the disease, as those receiving the Meningococcal B vaccine will not be immune from other strains of the disease.


DEFIBRILLATORS In the past month Malcolm Stuart and Irene Lineham have travelled through the South Westland region providing instruction on the use of Automatic Defibrillators to Rural Nurses. The nurses will all now have a defibrillator based permanently with them, reducing the time it takes to get this piece of potentially life saving equipment to patients. A defibrillator has also been placed at Jacksons Bay.

DEMENTIA UNIT We are currently awaiting formal confirmation from Canterbury DHB that they will project manage the dementia unit construction project. The project is still scheduled to be completed in March 2006. A steering group and clinical integration group have been scoped and will commence work shortly. The MOH have been informed that costs have significantly increased since funding was first approved for the project. The business case will be updated for the MOH by the end of this month, emphasising that the relocation of the dementia unit will mean the complete closure of Seaview Hospital.

INTERSECTORAL COLLABORATION As a first step towards intersectoral collaboration the Chairman and myself are planned to meet with the three West Coast Mayors the day prior to the Board meeting.

DISTRICT ANNUAL PLAN 2005/06 The first draft of the 2005/06 District Annual Plan has been completed and forwarded to the Ministry of Health.

WCDHB CLINICAL BOARD The establishment of WCDHB’s Clinical Board is near completion. A small number of elected members still need to be nominated for the Board and once this has occurred the Board can be established and meet to formulate terms of reference. It is anticipated that the establishment of the Clinical Board will be completed by the middle to end of April.

COMMUNITY CONSULTATION A consultation process has commenced for the District Strategic Plan. Public meetings are being held Coast wide and this has been, and will continue to be, advertised in all West Coast newspapers, a number of which have also printed articles in relation to the consultation process. Meetings and hui are scheduled as follows: • Karamea – Monday 21 March • Westport – Tuesday 22 March and 5 April • Reefton – Wednesday 23 March and 13 April • Greymouth – Tuesday 29 March and 12 March • Hokitika – Wednesday 30 March and Monday 22 April WCDHB Meeting Papers 1 April 2005 Page 30

• Whataroa – Thursday 31 March • Haast – Sunday 3 April • Fox Glacier – Monday 4 April Information on the District Strategic Plan consultation process is also available on the WCDHB website and the organisation has written to 178 community groups calling for submissions, enclosing consultation booklets. A number of people have already contacted WCDHB to obtain copies of the booklets, which is extremely positive. The Primary Care Strategy consultation process will commence in mid May.

CEO EXTERNAL MEETINGS

• Southlink Health – Greymouth • St John Ambulance – Greymouth • Canterbury District Health Board – Teleconference • NZ College of Midwives – Greymouth • Southern Region DHB Chairs and CEOs meeting – Christchurch • South Island Shared Services Agency Ltd Board meeting – Christchurch • Maureen Pugh, Westland District Council – Teleconference • Hon Damien O’Connor – Teleconference • Martin Sawyers, Buller District Council – Teleconference

Author: Chief Executive – 22 March 2005

WCDHB WHANAU HOUSE This graph shows that a total of 180 people stayed at the Whanau House from March 2004 to February 2005. 104 (58%) of those people were from the Buller region.

WCDHB Whanau Room: Total consumers for 2004 Total consumers: March 2004 – Feb 2005 180Buller consumers: March 2004 – Feb 2005 104

15

5

2119 16

6

129 11

8

19

12

6 6

1412 8

3

15

5

24

9

19

10

0

5

10

15

20

25

Mar-04

Apr-04

May-04

Jun-04

Jul-04Aug-04

Sep-04

Oct-04

Nov-04

Dec-04

Jan-05

Feb-05

Whanau Room 2004

Totalconsumers

Bullerconsumers

Whanau House Occupancy Rate


December 2004 shows the highest rate of occupancy for the year at 83.9 percent. The average occupancy rate overall was 64.5 percent and the lowest rate recorded was at 46.67 percent in June 2004.

Month Total House consumers

Nights occupied per

month House

occupancy rateMax.

consumers per stay

Total heads on pillows per month

Mar-04 15 16/27 59.26% 4 45 Apr-04 21 24/30 80.00% 5 75 May-04 16 17/31 54.84% 4 24 Jun-04 12 14/30 46.67% 2 23 Jul-04 11 22/31 70.97% 3 31 Aug-04 19 21/31 67.74% 2 26 Sep-04 6 15/30 50% 3 36 Oct-04 14 20/31 64.5% 6 62 Nov-04 8 23/30 76.7% 3 45 Dec-04 15 26/31 83.9% 4 30 Jan-05 24 17/31 54.8% 2 26 Feb-05 19 18/28 64.3% 3 30

TIKANGA RECOMMENDED BEST PRACTICE On the 16th March 2005 the GM Maori Health met with representatives of Te Runanga O Makaawhio to discuss Tikanga Recommended Best Practice (TRBP). The GM Maori Health also talked with the Chairman of Te Runanga O Ngati Wae Wae who has invited him to speak with Ngati Wae Wae at their monthly meeting after Easter. With the support of both Runanga, this document will then go back to staff for further feedback. Auckland DHB GM Maori Health, Kris McDonald has confirmed that he is happy for Naida Glavich, Chief Tikanga Advisor and Angela Barnes to come to the West Coast to assist with the introduction and launch of this project. Auckland DHB has generously offered to pay for this.

PRIMARY CARE The GM Planning and Funding asked the GM Maori Health to provide input into the Primary Care Plan. A draft of this work has been submitted to the GM Planning and Funding. Currently the West Coast Primary Health Organisation has no Maori Health Plan so the South Link Health Maori Manager has asked the GM Maori Health to assist him to develop a PHO Maori Health Plan.

Author: General Manager Māori Health – 22 March 2005


FINANCE REPORT

Financial Overview February 2005

Actual Budget Variance Variance Last Yr Actual Budget Variance Variance Last Yr Full Yr Full Yr Full Yr ActMonth Month Month YTD YTD YTD Forecast Budget Last Yr

REVENUEProvider 4,308 4,363 (55) (1.3%) 4,277 33,859 34,905 (1,046) (3.0%) 34,056 52,816 52,316 52,013Governance & Administration 86 84 3 3.0% 85 721 670 51 7.6% 663 1,008 1,008 997Funds & Internal Eliminations 2,311 2,242 69 3.1% 2,062 19,821 17,933 1,888 10.5% 15,516 27,600 26,900 25,209

6,705 6,688 17 0.3% 6,424 54,401 53,509 892 1.7% 50,235 81,424 80,224 78,219

EXPENSESProvider Personnel 2,516 2,688 172 6.4% 2,605 20,708 21,909 1,201 5.5% 20,456 32,083 32,983 31,158 Outsourced Services 379 352 (27) (7.7%) 286 3,394 2,803 (591) (21.1%) 2,538 5,115 4,215 3,858 Clinical Supplies 519 493 (26) (5.3%) 399 3,780 3,841 61 1.6% 3,700 5,752 5,752 5,447 Infrastructure 1,017 1,033 16 1.5% 942 8,037 8,237 200 2.4% 7,849 12,517 12,357 11,965

4,431 4,566 135 3.0% 4,232 35,919 36,790 871 2.4% 34,543 55,467 55,307 52,428

Governance & Administration 176 164 (12) (7.4%) 173 1,225 1,367 142 10.4% 1,109 2,070 2,070 1,731Funds & Internal Eliminations 2,249 2,127 (122) (5.7%) 1,906 18,021 17,018 (1,003) (5.9%) 15,333 26,127 25,527 24,498

6,856 6,857 1 0.0% 6,311 55,165 55,176 11 0.0% 50,985 83,664 82,904 78,657

Net Result (151) (169) 18 (10.7%) 113 (764) (1,667) 903 (54.2%) (750) (2,240) (2,680) (438)

OPERATING RESULTS The monthly result for February 2005 is a deficit of $151k, which is $18k better than budget ($169k deficit). The provider deficit of $201k is $80k worse than budget ($281k deficit). The governance and administration deficit of $12k is $10k worse than budget ($2k deficit). The funder arm surplus of $62k is $53k worse than budget ($115k surplus). The year to date (February) result is a deficit of $764k, which is $903k better than budget ($1,667k). The year to date provider deficit of $2,684k is slightly worse than budget ($2,509k). Other areas are significantly better than budget (governance and administration $193k and funder arm $881k).

REVENUE Revenue for the month of $6,705k is in line with budget ($6,688k). Provider revenue $4,308k is down $55k on budget ($4,363k). Reduced ACC orthopaedic revenue ($40k) and reduced home based support volumes ($35k) have been partially offset by increased surgical throughput. The provider arm caught up some of its year to date under production during the month, with the wash-up liability to the funder arm for underproduction against contracted volumes reducing by $30k1. Funder revenue $6,117k is up $77k on budget ($6,040k) due to adjustments to the funding envelope since the budget assumptions were set (March 2004), including the devolution of funding responsibility for Med Lab South.


1 We have not assumed that overproduction will be offset against underproduction except for where a specific trade-off has been agreed between the funder and provider.

Year to date (February) revenue $54,401k is up $892k on budget ($53,509k). Year to date provider revenue $33,859k is down $1,046k on budget ($34,905k), mainly due to

es of $1,241k1.

al pecialists) and intellectual disability services (relating to patient numbers at Seaview). One area

manage our roughput throughout the remainder of the year, so as to still achieve our planned volume and mix

t assumptions were was set (March 2004), including the evolution of funding responsibility for Med Lab South

th of February 2005 ($6,856k) were on budget ($6,857k).

rovider expenses for the month are under budget by $135k. budget, due to

improvements in the recruitment of key medical staff. Nursing costs and Allied Health costs nd Mental Health).

educed volumes

osts are up on budget due to the cost of transferring acute patients

cont ched by increased revenue.

ear to date provider expenses are under budget by $871k.

Personnel costs are under budget ($1,201k) due to the difficulty in attracting and retaining key 91k) as we have used locum staff to

e time, Other Clinical and Client Costs are up on budget

esult.

wash-up liability to the funder arm for underproduction against contracted volum Areas with significant underproduction include orthopaedic, gynaecological and paediatric surgery and paediatric and general medicine (all relating to difficulties attracting and retaining medicsof notable overproduction is general surgery, where we have made use of available theatre capacity brought about by the shortage of specialist staff in other surgical disciplines. Accident and emergency attendances and maternity are also significantly over target year to date. This overproduction ($535k total), has not been recognised in our accounts as we have not changed the mix of services purchased by the funder arm. Instead, we plan tothof outputs for the year. Year to date funder revenue $49,265k is up $947k on budget ($48,318k) due to adjustments to the funding envelope since the budged

EXPENSES Expenses for the mon

P Personnel costs are under budget ($172k). Medical costs are on

are below budget due to unfilled vacancies (Social Work a Outsourced services are above budget ($27k) as we have engaged locum RMOs due to an

inability to recruit directly. Treatment Disposables and Patient Appliances are under budget due to our r(Seaview) and the mix of services provided (Audiology). Other Clinical and Client Cto other centres for treatment.

Funder arm expenditure is over budget for the month, due to the devolution of new funder racts. These increases are mat

Year to date (February 2005) expenses ($55,165k) were on budget ($55,176k). YThe reasons for this match the reasons outlined in previous months;

clinical staff. Outsourced services are above budget ($5cover some of our clinical vacancies.

Treatment Disposables are under budget due to declining patient numbers at Seaview. Instruments and Equipment and Patient Appliances are significantly under budget due to our reduced surgical volumes. At the samdue to the cost of transferring acute patients to other centres for treatment.

Facilities costs are under budget ($118k). Interest costs are over budget due to capital charge payments on our equity balance, which is significantly higher than budget due to our favourable year to date financial r


Year to date funder arm expenditure is $66k up against budget. The reasons for this match the

afte owed back

ng that our 2004-05 result will be better than budget based on our favourable ance and due to confirmation of MoH funding for the Holidays Act and the

NZNO nurses “pay jolt”.

staffing costs (new staff and overtime in order to catch up on volumes) ill offset year to date savings as we work to catch up on our year to date under delivery against

UAL PLAN (DAP) of Health for approval.

for $11.2m being of a short- about our ability to obtain

ongoing deficit funding.

ncies that resulted from the closure of Huia Villa at Seaview.

le 2003-04 nancial result and our favourable year to date result.

waiting receipt of the first portion of equity funding for our agreed 2004-05 e tight if payment is not received from the Ministry of Health as expected.

ital expenditure for the 2004-05 financial year to date (February 2005) of $1,853k is ($2,383k). Note that this budget includes additional funding for the combined

PACS/SAN/IT Infrastructure Project that was approved in committee in the November Board

reasons outlined for the monthly result, ie: increased expenditure relating to contracts devolved r the budget was set have largely been offset by the credit for the wash-up liability

to the funder arm by the provider.

FORECAST We are now forecastiyear to date perform

This forecast needs to be treated with caution, as it is difficult to judge the extent to which increased recruitment andwthe provider arms contracted volumes.

2005-06 DISTRICT ANNWe have now submitted the first draft of our 2005-06 DAP to the Ministry

STATEMENT OF FINANCIAL POSITION Current liabilities remain unconventionally high due to RHMU financingterm nature. The short-term rollovers of this loan create uncertainty

Current employee liabilities have reduced from prior months but are still slightly higher than budget due to the mix of redunda Overall our Balance Sheet has improved significantly, with our debt to debt plus equity ratio now at 44.1%, compared with 47.5% this time last year. This improvement reflects our favourabfi

CASHFLOW We are currently still adeficit. Cashflow will b

CAPEX Approved capwithin budget

meeting (without this adjustment the budget would be $1,733k). These figures do not include the iSOFT Patient Administration / Clinical Information System Project approved in committee in the December Board meeting, as this project is still subject to the national capital approval process.


DEBTORS Debtors remain in control. Increase in the value of our debtors year to date is directly attributable

g.

In the last board meeting I was asked to provide a list of items that make up the category “Other

Other Equipment-Depreciation

ad Debts

ol Charges

reight tering

ls

lling

ns

iture

rating Costs” line in the Governance and Admin and the Consolidated Statement of l Performance also includes Financing Costs (i.e.; Interest and Capital Charge), which are

Provider Arm Statement of Financial Performance (see comments on nterest Coast” earlier in this report).

PRIMARY INTEGRATION SYSTEMS MANAGEMENT

plementation. Unfortunately Haast doesn’t yet have the telecommunications d for PrISM, so implementation at Haast will be delayed.

to increased fundin

OTHER OPERATING EXPENCES

Operating Expenses” Items include;

Other Equipment-Minor BBad Debts Recovered Doubtful Debts Credit ContrStock Adjustments Printing & FormsStationery & Supplies Postage, Courier, FReception and CaOther Office ExpensesBooks, Journals, PeriodicaAdvertising Staff Support & CounseCorporate Training Staff RelatioSundry Trust Funds Expend The “Other OpeFinanciashown separately in the “I Year to date, Other Operating Costs (excluding Financing Costs) total $1,127k, which is only $11k over budget ($1,116k). Of this, $10k relates to advertising costs for the CEO recruitment process.

IT PROJECTS – PRISM (PROJECT) As reported last month, the PrISM project has now moved from the Hari Hari pilot site stage to full South Westland iminfrastructure require WCDHB Meeting Papers 1 April 2005 Page 36

All other (West Coast DHB owned) South Westland sites are currently in the process of having telecommunications connections established, ready for PrISM equipment installation. We are currently in discussion with Rata Te Awhina Trust (the West Coast regions only targeted

PICTURE ARCHIVING AND COMMUNICATIONS

etwork (SAN).

n the Network Infrastructure Upgrade front, plans for the relocation of our server room have been

ernal maintenance staff.

suppliers of the PACS software in the xt month or so.

PATIENT ADMINISTRATION SYSTEM / CLINICAL

Southland, however we are still in the process of ee approval for our PAS / CIS implementation.

Maori provider) on a proposal aimed at including them in the PrISM project. The West Coast DHB has been granted one-off MoH Whatataka (Maori health innovation) funding for this purpose.

IT PROJECTS – PACS (SYSTEM) The first parts of the PACS project are the Network Infrastructure Upgrade and tender process for the Storage Area N Ofinalised. Construction will commence in the next month or so, with most of the work being conducted by West Coast DHBs int Tender documents have been finalised for the SAN and the tender process is now under way. We plan to enter into detailed contract negotiations with the ne

IT PROJECTS – PAS / CIS (INFORMATION SYSTEM) Southland are now in the detailed implementation planning process for their PAS / CIS project. We have been actively involved in this withseeking regional and national capital committ

Author: Chief Financial Manager – 17 March 2005 Approved by CEO


DHB CONSOLIDATED - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full YrRevenueCore MoH Funding 6,068 6,024 44 0.7% 5,846 48,842 48,189 653 1.4% 44,742 73,441 72,241 69,867 Other MoH Funding 352 423 (71) (16.8%) 328 3,228 3,379 (151) (4.5%) 3,507 5,071 5,071 5,278 Patient / Consumer Sourced 220 205 15 7.3% 210 1,751 1,640 111 6.8% 1,623 2,460 2,460 2,504 Non Health Related 65 36 29 78.5% 40 580 301 279 92.9% 363 452 452 570

6,705 6,688 17 0.3% 6,424 54,401 53,509 892 1.7% 50,235 81,424 80,224 78,219

Payments to Providers 2,249 2,127 (122) (5.7%) 1,906 18,021 17,018 (1,003) (5.9%) 15,332 26,127 25,527 24,497

Personnel CostsMedical Personnel 539 545 6 1.1% 637 3,663 4,424 761 17.2% 3,992 6,064 6,664 6,041 Nursing Personnel 1,002 1,062 60 5.6% 982 8,647 8,633 (14) (0.2%) 8,423 12,998 12,998 12,979 Allied Health Personnel 594 666 72 10.8% 599 5,073 5,471 398 7.3% 4,902 7,918 8,218 7,379 Support Personnel 86 102 16 15.7% 108 799 816 17 2.1% 788 1,226 1,226 1,184 Management / Admin 373 395 22 5.6% 370 3,181 3,281 100 3.0% 2,920 4,966 4,966 4,491

2,594 2,770 176 6.4% 2,696 21,363 22,625 1,262 5.6% 21,025 33,172 34,072 32,074

Outsourced Services 394 365 (29) (7.9%) 299 3,506 2,902 (604) (20.8%) 2,646 5,264 4,364 4,019

Clinical SuppliesTreatment Disposables 83 95 12 12.6% 80 687 748 61 8.2% 681 1,117 1,117 1,015 Diagnostic Supplies 7 10 3 30.0% 12 84 81 (3) (3.7%) 85 125 125 153 Instruments & Equipment 99 97 (2) (2.1%) 67 692 738 46 6.2% 688 1,113 1,113 1,017 Pt Appliances, Implants, Prostheses 89 104 15 14.4% 70 609 793 184 23.2% 819 1,031 1,181 1,170 Other Clinical & Client Costs 241 187 (54) (28.9%) 170 1,708 1,481 (227) (15.3%) 1,427 2,366 2,216 2,092

519 493 (26) (5.3%) 399 3,780 3,841 61 1.6% 3,700 5,752 5,752 5,447 Infrastructure CostsHotel Services, Laundry & Cleaning 203 226 23 10.3% 214 1,724 1,807 83 4.6% 1,770 2,703 2,703 2,630 Facilities 243 274 31 11.2% 231 2,065 2,186 121 5.5% 2,136 3,276 3,276 3,274 Transport 102 99 (3) (2.8%) 95 754 779 25 3.2% 707 1,176 1,176 1,109 IT Systems & Communication 86 101 15 15.2% 97 717 811 94 11.6% 766 1,218 1,218 1,148 Democracy 32 33 1 3.6% 23 206 264 58 21.9% 159 396 396 239 Professional Fees & Expenses 96 50 (46) (90.9%) 32 367 402 35 8.8% 300 606 606 464 Other Operating Costs 338 318 (20) (6.3%) 319 2,662 2,540 (122) (4.8%) 2,444 3,975 3,815 3,756

1,100 1,102 2 0.2% 1,011 8,495 8,790 295 3.4% 8,282 13,349 13,189 12,620

Expenses Total 6,856 6,857 1 0.0% 6,311 55,165 55,176 11 0.0% 50,985 83,664 82,904 78,657

Surplus (Deficit) (151) (169) (18) 10.7% 113 (764) (1,667) (903) 54.2% (750) (2,240) (2,680) (438)


DHB PROVIDER ARM - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full Yr

RevenueCore MoH Funding 3,804 3,817 (13) (0.3%) 3,819 29,426 30,534 (1,108) (3.6%) 29,499 46,259 45,759 45,077 Other MoH Funding 234 305 (71) (23.4%) 217 2,287 2,439 (152) (6.2%) 2,617 3,661 3,661 3,943 Patient / Consumer Sourced 220 205 15 7.3% 210 1,751 1,640 111 6.8% 1,623 2,460 2,460 2,504 Non Health Related 50 36 14 40.5% 31 395 292 103 35.4% 317 436 436 489

4,308 4,363 (55) (1.3%) 4,277 33,859 34,905 (1,046) (3.0%) 34,056 52,816 52,316 52,013

Personnel CostsMedical Personnel 539 545 6 1.1% 637 3,663 4,424 761 17.2% 3,992 6,064 6,664 6,041 Nursing Personnel 1,002 1,062 60 5.6% 982 8,647 8,633 (14) (0.2%) 8,423 12,998 12,998 12,979 Allied Health Personnel 594 666 72 10.8% 599 5,073 5,471 398 7.3% 4,902 7,918 8,218 7,379 Support Personnel 86 102 16 15.7% 108 799 816 17 2.1% 788 1,226 1,226 1,184 Management / Admin 295 313 18 5.8% 279 2,526 2,565 39 1.5% 2,351 3,877 3,877 3,575

2,516 2,688 172 6.4% 2,605 20,708 21,909 1,201 5.5% 20,456 32,083 32,983 31,158

Outsourced Services 379 352 (27) (7.7%) 286 3,394 2,803 (591) (21.1%) 2,538 5,115 4,215 3,858

Clinical SuppliesTreatment Disposables 83 95 12 12.6% 80 687 748 61 8.2% 681 1,117 1,117 1,015 Diagnostic Supplies 7 10 3 30.0% 12 84 81 (3) (3.7%) 85 125 125 153 Instruments & Equipment 99 97 (2) (2.1%) 67 692 738 46 6.2% 688 1,113 1,113 1,017 Pt Appliances, Implants, Prostheses 89 104 15 14.4% 70 609 793 184 23.2% 819 1,031 1,181 1,170 Other Clinical & Client Costs 241 187 (54) (28.9%) 170 1,708 1,481 (227) (15.3%) 1,427 2,366 2,216 2,092

519 493 (26) (5.3%) 399 3,780 3,841 61 1.6% 3,700 5,752 5,752 5,447 Infrastructure CostsHotel Services, Laundry & Cleaning 203 225 22 9.8% 214 1,717 1,797 80 4.5% 1,758 2,687 2,687 2,615 Facilities 243 273 30 11.0% 230 2,064 2,182 118 5.4% 2,131 3,270 3,270 3,271 Transport 98 93 (5) (5.4%) 77 709 729 20 2.7% 653 1,101 1,101 1,021 IT Systems & Communication 86 101 15 14.9% 97 717 808 91 11.3% 764 1,213 1,213 1,144 Interest 187 177 (10) (5.6%) 177 1,526 1,416 (110) (7.8%) 1,323 2,288 2,128 2,002 Professional Fees & Expenses 57 30 (27) (90.0%) 23 233 239 6 2.5% 176 358 358 244 Other Operating Costs 143 134 (9) (6.7%) 124 1,071 1,066 (5) (0.5%) 1,044 1,600 1,600 1,668

1,017 1,033 16 1.5% 942 8,037 8,237 200 2.4% 7,849 12,517 12,357 11,965

Expenses Total 4,431 4,566 135 3.0% 4,232 35,919 36,790 871 2.4% 34,543 55,467 55,307 52,428

Allocated from Governance & Admin 78 78 0 0.0% 79 624 624 0 0.0% 620 936 936 936 Surplus (Deficit) (201) (281) 80 (28.5%) (34) (2,684) (2,509) (175) 7.0% (1,107) (3,587) (3,927) (1,351)


DHB GOVERNANCE AND ADMIN - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full Yr

Revenue 86 84 3 3.0% 85 721 670 51 7.6% 663 1,008 1,008 997

Personnel CostsManagement / Admin 78 82 4 4.9% 91 655 716 61 8.5% 569 1,089 1,089 916

Outsourced Services 15 13 (2) (15.4%) 13 112 99 (13) (13.1%) 108 149 149 161

Infrastructure Costs 0 Transport 4 6 2 35.5% 18 45 50 5 9.3% 54 75 75 88 IT Systems & Communication 0 0 0 100.0% 0 0 3 3 100.0% 2 5 5 4 Professional Fees & Expenses 39 20 (19) (92.1%) 9 134 163 29 18.0% 124 248 248 220 Other Operating Costs 8 13 5 37.0% 18 88 103 15 14.2% 108 154 154 126 Democracy 32 29 (3) (9.6%) 24 191 234 43 18.2% 144 350 350 216

83 69 (14) (20.6%) 69 458 552 94 17.1% 432 832 832 654

Expenses Total 176 164 (12) (7.4%) 173 1,225 1,367 142 10.4% 1,109 2,070 2,070 1,731

Allocated to Provider (78) (78) 0 0.0% (79) (624) (624) 0 0.0% (620) (936) (936) (936)Surplus (Deficit) (12) (2) (10) 421.7% (9) 120 (73) 193 (264.2%) 174 (126) (126) 202

DHB FUNDER ARM - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget YTD ActualPersonal HealthFunding Received 4,419 4,329 90 2.1% 4,250 35,577 34,632 945 2.7% 33,857 53,548 51,948 52,590 Provider Payments (4,378) (4,258) (120) 2.8% (4,202) (34,092) (34,065) (27) 0.1% (33,949) (52,597) (51,097) (52,043)

41 71 (30) (42.2%) 48 1,485 567 918 161.9% (92) 951 851 547 Mental HealthFunding Received 795 794 1 0.1% 771 6,360 6,355 5 0.1% 6,174 9,532 9,532 9,268 Provider Payments (835) (794) (41) 5.1% (764) (6,387) (6,355) (32) 0.5% (6,140) (9,533) (9,533) (9,259)

(40) (0) (40) 86263.5% 7 (27) (0) (27) 7186.9% 34 (2) (1) 9 Disability SupportFunding Received 802 834 (32) (3.8%) 809 6,471 6,670 (199) (3.0%) 4,042 10,005 10,005 7,277 Provider Payments (756) (790) 34 (4.3%) (716) (6,298) (6,318) 20 (0.3%) (3,844) (9,477) (9,477) (7,202)

46 44 2 4.5% 93 173 352 (179) (50.9%) 198 529 528 75

Funds ManagementFunding Received 86 83 3 4.0% 84 688 661 27 4.0% 661 992 992 997 Interest on Funds Account 15 0 15 0.0% 8 169 0 169 0.0% 44 0 0 81

Allocation to DHB Governance (86) (83) (3) 4.0% (84) (688) (661) (27) 4.0% (661) (992) (992) (997)15 0 15 0.0% 8 169 0 169 0.0% 44 0 0 81

TotalsTotal Funds Revenue 6,117 6,040 77 1.3% 5,922 49,265 48,318 947 2.0% 44,778 74,077 72,477 70,213 Total Funds Expenditure (6,055) (5,925) (130) 2.2% (5,766) (47,465) (47,399) (66) 0.1% (44,594) (72,599) (71,099) (69,501)Surplus (Deficit) 62 115 (53) (46.0%) 156 1,800 919 881 95.9% 184 1,477 1,378 712


DHB CONSOLIDATED - STATEMENT OF FINANCIAL POSITION AS AT FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act

Current AssetsCash 3,444 2,926 518 17.7% 3,152 Short term Investments 2,256 1,256 1,000 79.6% 906 Debtors & Prepayments 6,998 6,937 61 0.9% 7,269 Inventory 589 578 11 1.9% 602 Assets for Sale 210 210 0 0.0% 364

13,497 11,907 1,590 13.4% 12,293 Non Current AssetsLand & Buildings 19,506 20,395 (889) (4.4%) 20,655 Equipment (incl IT) 5,400 5,179 221 4.3% 5,097 Vehicles 80 116 (36) (31.0%) 136 Investments 2 0 2 0.0% 2

24,988 25,690 (702) (2.7%) 25,890 Current LiabilitiesAccounts Payable 7,932 6,127 1,805 29.5% 7,607 Employee Entittlements 3,953 3,901 52 1.3% 3,645 Current Portion of Term Loans 11,247 32 11,215 35046.9% 11,516

23,132 10,060 13,072 129.9% 22,768

Net Funds Employed 15,353 27,537 (12,184) (44.2%) 15,415

Term LiabilitiesEmployee Entittlements 2,231 2,120 111 5.2% 2,210 Other Term Liabilities 6 11,201 (11,195) (99.9%) 215

2,237 13,321 (11,084) (83.2%) 2,425 Crown EquityCrown Equity 43,147 45,147 (2,000) (4.4%) 42,630 Retained Earnings (30,074) (30,979) 905 (2.9%) (29,685)Trust Funds 43 45 (2) (4.4%) 45

13,116 14,213 (1,097) (7.7%) 12,990

Net Funds Employed 15,353 27,534 (12,181) (44.2%) 15,415


DHB CONSOLIDATED - STATEMENT OF CASHFLOWS FOR THE MONTH OF FEBRUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD

Operating ActivitiesOperating Receipts 6,704 6,683 21 0.3% 5,565 52,727 53,088 (361) (0.7%) 48,135

Payments to Personnel 2,553 2,766 213 7.7% 2,670 21,168 22,593 1,425 6.3% 20,449 Payments to Providers 1,586 1,225 (361) (29.4%) 1,857 8,423 10,162 1,739 17.1% 7,713 Interest & Capital Charge 249 179 (70) (39.1%) 32 2,275 2,893 618 21.4% 2,023 Payments to Suppliers, GST, etc 1,564 2,453 889 36.2% 1,622 20,202 19,590 (612) (3.1%) 16,771 Operating Payments 5,952 6,623 671 10.1% 6,181 52,068 55,238 3,170 5.7% 46,956 Net Cashflow from Operating 752 60 692 1161.3% (616) 659 (2,150) 2,809 (130.7%) 1,179

Investing ActivitiesSale of Fixed Assets 0 0 0 0.0% 0 0 0 0 0.0% 1 Increase (Decrease) in Investments 0 0 0 0.0% 0 1,000 (2) (1,002) 50100.0% 0 Purchase of Fixed Assets 26 220 194 88.2% 123 1,127 1,761 634 36.0% 1,176 Net Cashflow from Investing (26) (220) 194 (88.2%) (123) (2,127) (1,759) (368) 20.9% (1,175)

Financing ActivitiesFinancing ReceiptsEquity Injections 0 0 0 0.0% 1,500 0 2,000 (2,000) (100.0%) 1,500 Loans Raised 0 0 0 0.0% 0 0 0 0 0.0% 11,195

0 0 0 0.0% 1,500 0 2,000 (2,000) (100.0%) 12,695 Financing PaymentsRepaid Debt 28 9 (19) (211.1%) 31 100 177 77 43.5% 11,367

28 9 (19) (211.1%) 31 100 177 77 43.5% 11,367 Net Cashflow from Financing (28) (9) (19) 211.1% 1,469 (100) 1,823 (1,923) (105.5%) 1,328

Opening Cash 2,746 3,096 (350) (11.3%) 2,422 5,012 5,012 0 0.0% 1,820 Net Cashflow 698 (170) 868 (511.3%) 730 (1,568) (2,086) 518 (24.8%) 1,332 Closing Cash 3,444 2,926 518 17.7% 3,152 3,444 2,926 518 17.7% 3,152


WEST COAST DISTRICT HEALTH BOARD DEBT REGISTER

Lender's name RHMU BNZ Toyota BNZLoan Identified As Renewal CT Scanner Lease OverdraftDebt Amount - face value $11,195,000 $104,562 $100,724 $3,600,000Instrument type Term Loan Amortised Loan Lease OverdraftFixed / Floating interest rate Fixed Fixed Fixed FloatingFixed rate 6.71% 8.64% VariousFloating rate base and margin BKBM+0.225%Interest payment frequency Quarterly Quarterly Monthly DailyCovenants (Debt to Debt + Equity ratio) 55% 55% 55%Covenants (Interest Cover EBID) 1.3x 2.5x 3.0x

Next Payment Due When 31/3/05 28/2/05 17th of month any time How much $11,195,000 $26,140 $3,834 any amount

Next Rollover / Refinance Due When 31/3/05 N/A How much $11,195,000 N/A Plan Refinance RHMU Pay off over 5 years

3 month roll over

March 2005 Term Loan Fixed 11,195,000$ May 2004 BNZ CT Scanner 26,140$

Interest Rate HedgingThe West Coast DHB has engaged in a 5 year interest rate swap, effectively fixing the refinancing rate of $4.3M of its RHMUloan at 6.78% per annum for 5 years commencing 1 July 2004.This swap is effectively "in the money" as it has locked in a fixed 5 year rate which is cheaper than the 5 year rate that wouldhave been offered by RHMU.

Upcoming Loan Repayments

(Excludes Overdraft and Lease Payments)

AS AT FEBRUARY 2005


Fortnight Ended 22/03/2005 05/04/2005 19/04/2005 03/05/2005 17/05/2005 31/05/2005 14/06/2005 28/06/2005

Opening Balance 2,462,165 (642,019) 1,773,922 1,041,136 (1,911,864) 98,280 (2,930,860) (75,716)

Cash InRevenue 426,001 3,820,941 897,214 250,000 3,940,144 950,000 4,790,144 850,000 Loan Funds - - - - - - - 850,000 Equity - 1,000,000 - 1,680,000 - 1,000,000 - - Asset Sales - - - - - - - -

Cash OutPayroll Costs 886,361 1,030,000 980,000 870,000 880,000 880,000 860,000 580,000 Creditors Payments 1,633,824 750,000 650,000 1,678,000 750,000 1,878,000 750,000 1,628,000 GST - 325,000 - 300,000 - 1,335,000 - 300,000 PAYE / ACC 325,000 300,000 - 300,000 300,000 300,000 325,000 325,000 Loan & Interest Pmts - - - - - 26,140 - - Capex 685,000 - - 1,735,000 - 560,000 - 235,000

Closing Balance (642,019) 1,773,922 1,041,136 (1,911,864) 98,280 (2,930,860) (75,716) (1,443,716)

AssumptionsThat dementia unit construction will commence in April or MayThat $1M of deficit support will be received in MarchThat $1.68M of deficit support will be received in late April (and that our deficit for the year will be $2.68M)That $1M of equity for development (the dementia unit) will be received in late May

Note:Our Overdraft limit is $3.6M

WEST COAST DISTRICT HEALTH BOARDCASH FLOW FORECAST AS AT 16 MARCH 2005


WEST COAST DISTRICT HEALTH BOARDDIRECTORS SCHEDULE

SUMMARY OF EXPENDITURE YEAR TO DATE TO 28 FEBRUARY 2005Note: Figures GST Exclusive

Actual Budget VarianceAnnual Budget

Directors Fees 112,542 124,000 (11,458) 186,000

Directors ExpensesTravel Expenses 17,629 26,664 (9,035) 39,996Other 10,700 3,328 7,372 4,992Total 28,329 29,992 (1,663) 44,988

Advisory Committee Costs 21,103 41,336 (20,233) 62,004Election Costs 36,064 26,664 9,400 39,996

TOTAL EXPENSES 85,496 97,992 (12,496) 146,988

WCDHB BOARD OF DIRECTORS FEES & EXPENSES $198,038 $221,992 ($23,954) $332,988


Financial Performance Indicators for February 2005

Net result after tax $000 -151 -169 113

Net Result/Net Funds Employed % (Annualised) % -11.8 -7.4 8.8

Earnings* /Net Funds Employed % (Annualised) % 19.7 10.2 27.6

Revenue/Net Funds Employed (Annualised) times 5.2 2.9 5.0

Debt** /Debt + Equity (BNZ definition) % 65.9 62.2 66.0

Debt*** /Debt + Equity (CFA definition) % 46.2 44.1 47.5

Revenue/Fixed Assets (Annualised) times 3.2 3.1 3.0

Interest cover times 4.3 3.3 9.3

** Debt exclusive of Overdraft - Bank of New Zealand definition of Debt / Debt + Equity*** Arranged Debt inclusive of Overdraft - Crown Funding Agency definition of Debt / Debt + Equity

Month Actual

Month Budget

* Earnings = operating surplus/(deficit) before interest, capital charge, tax and depreciation.

Month Last Yr

NOTES 1 Net result as a percentage of Net Funds Employed-

Provides a projected annual return on Long Term Funding based on current months performance.

2 Earning / Net Funds Employed-

Provides a projected annual return, from normal operations, as a percentage of Long Term Funding, based on current months performance.

3 Debt to Debt + Equity Ratio

A measure that indicates the extent to which assets are financed by debt (excluding any overdraft balance). (This is consistent with the Bank of New Zealand definition of debt).

4 Interest Cover-

Shows ability to meet interest expense from Operating Surplus. Calculated as: operating surplus before interest, capital charge and depreciation divided by interest expense.


GLOSSARY OF FINANCIAL TERMS Assets - Economic resources owned or controlled by the WCDHB, as a result of past transactions, for the entity’s future benefit.

Current Assets are those assets that are expected to be converted into cash in the next accounting period, i.e. within the next 12 months.

Non Current Assets are long-term assets that are held for use in the productive process and are not expected to be converted into cash in the next accounting period. CAPEX (Capital Expenditure) - The Purchase of non-current assets. Capital Charge – All DHBs are required to pay capital charge in order to recognize the cost of financial resources vested in them by the Crown. Capital Charge is levied at 11% per annum on the DHBs Crown equity balance. Capital charge is equivalent to the value of dividends and capital gains that shareholders would normally require from a private organization. Debt - An obligation of WCDHB to pay a sum of money within a specified time.

Debt to Debt + Equity Ratio - A measure that indicates the extent to which assets are financed by debt. (Excluding any overdraft balance). (This is consistent with the Bank of New Zealand definition of debt).

Equity (Owners Equity, Shareholders Funds) - A claim against the assets of the WCDHB. Represents a residual claim to all assets not claimed by holders of external liabilities. FTE - Full Time Equivalent employees

Interest Cover - Shows ability to meet interest expense from Operating Surplus. Calculated as: Operating surplus before interest, tax & depreciation divided by interest expense. Liabilities - An amount owed by WCDHB to non-owners. Current Liabilities are obligations to pay an amount or perform a service in the next accounting period, i.e. within the next 12 months. Non-Current Liabilities are those obligations requiring settlement beyond the next accounting period. Net Funds Employed - The total of Non current Liabilities plus Total Shareholders’ Funds.

NHPIDE (Nursing Hours Per Inpatient Day Equivalent) - Nursing Hours is the sum of total hours spent in direct patient care over each shift. Calculated as: Actual Nurse hours divided by total inpatient bed days.

Operating Surplus- Surplus attributable to ordinary and continuing operations. Leave Liability – The total amount of accrued leave benefits owing to employees. Covers Annual, Long Service and Parental leave as well as Retirement Gratuities and Lieu days owing.

Author: Chief Financial Manager – 17 March 2005


WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEETINGS


DR

AFT

DRAFT MINUTES OF THE HOSPITAL ADVISORY COMMITTEE MEETING

HELD FRIDAY 28 JANUARY 2005 AT 8:02AM IN THE BOARDROOM, CORPORATE OFFICE, GREYMOUTH

PRESENT:

Christine Robertson, Chair Glenys Baldick, Deputy Chair Brian Wilkinson, WCDHB Member Gregor Coster, WCDHB Chairman Barbara Beckford Kathryn Cannan Margaret Moir Richard Wallace (for part)

IN ATTENDANCE:

John Luhrs, Chief Executive (for part) Ebel Kremer, General Manager Operations Wayne Champion, Chief Financial Manager Malcolm Stuart Julie Kilkelly Alison McDougall, Minute Secretary

APOLOGIES: Gregor Coster (lateness) John Luhrs (lateness)

1. WELCOME, APOLOGIES & AGENDA

The Chair welcomed everyone to the meeting and introduced the two new members of the Committee, Brian Wilkinson and Glenys Baldick, who is also the Deputy Chair.

Gregor Coster joined the meeting at 8:04am

2. DISCLOSURES OF ADVISORY COMMITTEE MEMBERS’ INTERESTS

Gregor Coster • Remove, “Trustee – The University of Auckland Primary Health Care Trust • Amend, “Chairman - New Zealand Institute of Rural Health”


• Remove, “Trustee – Goodfellow Foundation” Barbara Beckford • Add, “Member - National Ethics Committee” Christine Robertson • Amend, “Husband is Deputy Chair of Coast Care Trust…”

DA

F

T• Page 10, Item 4, seventh paragraph, second sentence should now read, “…urgent cases, 6 months waiting time for semi urgent…”

3. MINUTES OF THE LAST MEETING

Moved: Barbara Beckford, Seconded: Kathryn Cannan

It was RESOLVED that the Minutes of the Hospital Advisory Committee Meeting held Friday 3 December 2004, were a true and accurate record of the meeting subject to the above amendments.

RDiscuss a morning tea or lunch with clinicians, Board, HAC and EMT members with EMT.

4. MATTERS ARISING / ACTION & RESPONSIBILITY LIST

Completed. The Chair queried if there is a plan for regular meetings. The Chief Executive advised that meetings could be held on a six monthly or quarterly basis. Gregor Coster suggested a six monthly meeting with clinicians would be appropriate. Seek further clarification from the South Island Advocacy Service on the figures provided to HAC at the Service’s presentation at the August meeting. The Chief Executive advised this item is in progress.

Richard Wallace joined the meeting at 8:17am

Provide an update on progress with Nurse Practitioners locally and on a national level. Due April 2005. Provide an update on the role of the GP Liaison Officer prior to the position’s March review. Due March 2005. Provide a report on implementation of the evaluation tool for Trendcare along with the measures to be used in the evaluation. March 2005. Provide the first quarterly report (high level) on variances between services and possible reasons for the variances. The General Manager Operations tabled the report.


Prepare a report with information on the impact of Credentialling and HPCA on the provider arm. Due March 2005. Provide exception reports on above as issues emerge through the credentialling process in relation to the HPCA. Ongoing and as needed.

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Provide a breakdown of maternity figures in Greymouth on the proportion of primary and secondary deliveries and the number of caesareans and inductions. Agenda item. Ensure any new abbreviations used in papers are added to the list provided. In progress. Clarify the potential conflict of interest for a training provider in terms of their ability to be both the identifier of unmet needs and a possible provider. Included in papers. Provide reasons why patients, some urgent, are waiting 18 months to be seen in some service areas. Included in papers. Agenda Items from the previous meeting. The Chair advised that the effect of IDFs on the provider arm was included on the Agenda for the previous meeting. This is an issue that is to go to the Board first, which will take place sometime in first half of this year. The Board may or may not identify issues for the provider arm. The Chair advised she discussed the HNA with the General Manager Planning and Funding. The HNA is underway and only available electronically at the moment. The General Manager Planning and Funding provided information for timing of planning processes at yesterday’s workshop. The General Manager Planning and Funding would like the draft DSP/associated processes to be prepared and reviewed by the Advisory Committees. There will then be opportunities to feed into other documents. In order to meet the February deadline the Chair suggested that the General Manager Planning and Funding should send out the draft consultation process document to HAC members, who are then to provide feedback to the Chair, who will collate responses and forward to Planning and Funding. The Chair will ask for Board approval to alter the HAC timetable to allow input to occur at later stages.

5. CORRESPONDENCE

Moved: Margaret Moir, Seconded: Barbara Beckford It was RESOLVED that the correspondence Inwards was accepted and Outwards endorsed.

6. STRATEGIC GOVERNANCE MATTERS

6.1 Draft Health Needs Assessment Regional Project 2004

Resolved as per discussion in Matters Arising.


6.2 Trendcare

The Chair noted at the last meeting that it was decided that HAC now requires quarterly reports on high level variations between services and any possible reasons for these variances.

FT

The General Manager Operations advised the tabled paper is very high level and identifies some of the inefficiencies identified, particularly in CCU and Parfitt, mainly as they are such a high acuity areas. The two new Nurse Managers are focussing more on nursing hours per patient, particularly utilisation throughout the hospital and moving away from the silo approach. The General Manager Operations noted that a Committee member has suggested it may be useful to have an occupancy line and this will be included for the next report. A Committee member suggested a line should also be included for resourced beds. The Chief Executive advised that resourced beds are the number of beds being staffed whether they are occupied or not. The Committee member suggested this issue needs to be monitored by HAC, with points identified being referred to the Board The committee decided it would be good for HAC to consider configuration issues in general in its advisory role to the Board. The Chair will raise these items with the Board at today’s meeting seeking approval for committee involvement

DThe Chief Executive advised Management has started on a positive and “aggressive” marketing campaign for GPs based on the new SMO MECA. The new MECA means vocationally registered GPs are included on the specialist scale. The first advertisement in line with the MECA appeared in the 26 January issue of NZ Doctor magazine as an A4 sized advertisement. The Chief Executive acknowledged the input of the Board Chairman and EMT in production of the advertisement, as well as the Rural GP Network. The website advertising through the Rural GP Network has also been revisited and Management has agreed to blind advertisements in US and Canadian publications.

RAA Committee member suggested that all these issues could be included in a Secondary Care

Plan. The Chair advised she will seek approval from the Board to pursue development of the Secondary Care Plan, with the possibility of a scoping paper presented to HAC for the April meeting and consideration given to a longer meeting to allow discussion.

7. CHIEF EXECUTIVE’S REPORT

7.1 Recruitment

A Committee member queried if the GPs currently employed by WCDHB are being offered the same package as advertised. The Chief Executive advised that vocationally registered WCDHB GPs who are members of ASMS are aware they will be entitled to the new rates. WCDHB has also advised non-ASMS members they are willing to negotiate. WCDHB’s non vocationally registered GPs are already paid at a rate higher than the scale in the agreement. The Committee member advised it would not be appropriate to be offering greater salaries to locums than the permanent staff. The Chief Executive advised that locums are employed for a short time and they are paid the locum rate which is constantly changing depending on the individual.

7.2 WCPHO Funding

A Committee member queried progress on moving the PHO from interim to access funding. The Chief Executive advised a submission has been made to the Ministry of Health by WCDHB on behalf of the WCPHO. A presentation was given to Ministry of Health officials by the General Manager Planning and Funding and GP Liaison Officer and was positively received, although at this stage no formal response has been received.


7.3 Neighbourhood Nursing Innovation

A Committee member requested a formal update on the Neighbourhood Nursing Project. The Chief Executive advised Management should be able to provide a detailed update for the next meeting after the management of change process is complete.

7.4 Cervical Screening Services

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T The percentage of smears taken on the West Coast was queried and a Committee member

noted the figure for the West Coast is 64% ,the lowest in the country. The Committee member advised she has investigated this figure and notes that most of the smears are taken by GP practices. She has requested the issue as an agenda item for the next CPHAC meeting. It was suggested that the matter be noted to the Board and the Board may then decide to refer the matter to CPHAC and the WCPHO.

AFA Committee member queried if there is an implication for the provider arm with a private GP

in Greymouth leaving the Coast. The Chief Executive advised it is a funder issue in terms of the GP being the owner of a practice that is a member of the PHO. The Chief Executive advised he recently met with the GP, Grey District Council Mayor and Chair of the WCPHO and this will see a positive initiative with a health centre being proposed for Greymouth. Gregor Coster noted he has discussed the matter with Damien O’Connor and Damien has indicated support for WCDHB plans to develop GP provision in Greymouth and would publicly support an application for capital funding. The matter will be discussed by the Board.

7.5 PHO Progress

7.6 Further Information Requested at the Previous Meeting

7.6.1 Maternity Figures

A Committee member queried the period of time measured in the data. The General Manager Operations will clarify this for the next meeting. The high rate for caesareans was noted. The Chief Executive advised that in the most recent MoH Hospital Benchmark Report, the WCHDB is consistent on rates. HAC discussed whether it would be appropriate to seek further information on caesarean rates. The Chair requested Management provide 12 month retrospective data for the April meeting.

Action: General Manager Operations

7.6.2 Waiting List Times

A Committee member noted the waiting time for colonoscopies appears to be high and requested clarification of figures. Malcolm Stuart noted that the figures may relate to surveillance colonoscopies which are entered into the system for each year even though the patient may only need the procedure every five years. The patient remains in the system so they do not fall off the list. A Committee member advised these patients should not be on the waiting list as they are elective and would like this process benchmarked with other DHBs to ensure the information is being represented correctly.

Action: General Manager Operations

Moved: Barbara Beckford, Seconded: Margaret Moir It was RESOLVED to accept the Chief Executive’s report.


8. FINANCE REPORT

The Chief Financial Manager advised that the report produced for this month’s papers includes the accounts for November. The December accounts will be reported in the next meeting papers. The Chief Financial Manager advised that the 2004/05 DAP was accepted in December last year and the budget has been updated to reflect that.

DFT

Provider arm revenue is down due to under production as a result of a lack of key clinical staff. The November result is worse than budget primarily due to the impact of the Holidays Act and the cost of locums and transfers. Underproduction for December is at zero despite theatre shutdown over Christmas and the provider arm should achieve throughputs for the year. The overall deficit forecast for the year is now $300k worse than budget which is an improvement on the initial forecast of $500k worse than budget.

A Committee member noted that A&E attendances are up and queried if this can be predicted. The General Manager Operations advised it is dependent on the number of GPs in the area and subsequent overflow on A&E.

RA Committee member noted the Capex budget is exceeded for the ytd. The Chief Financial Manager advised that overspend relates to unbudgeted expenditure on PACS of around $600k. This was originally planned for the following year but brought forward due to the situation with orthopaedics.

A

The Chair queried if signing of the DAP has done anything to ensure the DHB has a longer term for the loan roll over. The Chief Financial Manager advised the loan was rolled over in December for three months. The next roll over may be for 6 months as the DAP only covers the 04/05 year and there is no funding certainty for the 05/06 year. The CFA is currently undertaking a review of the WCDHB’s financial position as part of its loan review.

Moved: Christine Robertson, Seconded: Brian Wilkinson It was RESOLVED to accept the Finance report.

9. OPERATIONAL INDICATORS

A Committee member noted ophthalmology figures are included with outpatients and there is a waiting list over 18 months. The General Manager Operations advised there were difficulties with CDHB providing service and NMDHB were approached to provide service. An arrangement was made with a private provider from Nelson to provide the service in Greymouth and Buller. CDHB have requested WCDHB revisit the ophthalmology agreement and the General Manager Operations and Chief Executive are visiting CDHB to discuss. Services are also being provided on the surgical bus. The Chair requested ophthalmology figures be provided in a graph for it’s own speciality and include a comment to explain the graph.

10. KEY ISSUES / ITEMS OF INTEREST TO REPORT TO THE BOARD

10.1 Recommendations to the Board

HAC recommends that six monthly meetings be organised for Board and HAC members with management and senior clinicians.

10.2 Seeking Approval for Further Consideration


• HAC seeks approval to advance the development of a Secondary Care Plan starting with a scoping paper in April.

• HAC seeks permission to change dates and duration of meetings, if necessary, to accommodate deliberation on/input into the DSP and Secondary Care Plan while maintaining the ability to monitor operational/financial figures in a timely fashion.

10.3 Reporting Back on Board Referred Items

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T • HAC has received the first quarterly report on Trendcare (high level variances between

services) and will continue to monitor the key issue identified. There appears to be a silo approach to staff utilisation. Action is in place to reduce this and is likely to be reflected in the data in the next quarter’s report which will also have some refinements to add value to the report.

10.4 Other Items of Interest

F• HAC noted the low cervical screening rate for the West Coast and recommends the Board consider further action be taken as both funder and provider of services.

• The Chief Financial Manager is forecasting overall volumes to be on target for year end with costs slightly up on budget.

• HAC is delighted by the proactive approach taken by Management in recruitment of GPs.

Kathryn Cannan left the meeting at 9:56am

DThe next meeting will be held on Friday 1 April 2005 at 8:00am in the Boardroom, Corporate Office, Greymouth.

11. NEXT MEETING DATE

The Chief Executive noted this will be his last HAC meeting before his departure from WCDHB and recorded his thanks for the support of the Committee. The Chair recorded her thanks to the Chief Executive for the support he has provided in progressing the work of the Committee.

12. ATTENDANCE AND ADMINISTRATION FORMS

Actioned.

There being no further business to discuss the meeting concluded at 9:59am


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DRAFT MINUTES OF THE DISABILITY SERVICES ADVISORY COMMITTEE MEETING

HELD ON WEDNESDAY 16 FEBRUARY 2005 IN THE BOARD ROOM, CORPORATE OFFICE COMMENCING AT

8.33 AM PRESENT: John Vaile, Chairman, WCDHB member

Mohammed Shahadat, Deputy Chair, WCDHB member Elinor Stratford Dianne Lewis Maureen Frankpitt Gloria Hammond

IN ATTENDANCE: Hecta Williams, General Manager Mental Health Melanie Penny, Planning & Funding Analysis

Bianca Kramer, Minute Recorder APOLOGIES: Gregor Coster, Chair WCDHB

Christine Robertson, WCDHB Kevin Hague, General Manager Planning & Funding 1. WELCOME / APOLOGIES The Chairman welcomed everyone to the meeting. 2. DISCLOSURE OF INTEREST No change 3. AGENDA CHECK No change 4. MINUTES OF LAST MEETING

Page 5 Under the heading “Disclosure of Interest” – Wife no longer works for DHB as unresolved employment issues, should read as – has unresolved

Page 6 Under the heading Item 13, 3rd paragraph, change the wording to read “It might be possible for Active West Coast to administer a fund if available, also correct the spelling of Halberg Trust


Under the heading Item 15 in the first paragraph, change effecting to affecting.

Under the heading “Action and Responsibility List”, should read as – copies of to have an ordinary life

Moved: Elinor Stratford , Seconded: Maureen Frankpitt

It was RESOLVED that the Minutes of the Disability Services Advisory Committee meeting held 15 December 2004 were a true and correct record following the amendments listed as above.

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5. MATTERS ARISING FROM LAST MEETING There were no matters arising from the minutes. 6. ACTION AND RESPONSIBILITY LIST

Copies of “To have an ordinary life” were handed out to the committee members. The Chairman will follow up the letter inviting the West Coast PHO to attend the next

DSAC meeting 7. QUALITY & SAFETY PROJECT

The report will be placed on the agenda for discussion at the next meeting. 8. DEMENTIA UNIT UDATE

The General Manager Mental Health updated the committee on the progress made. A Canterbury District Health Board team are to the lead project, (the same team used for CHCH women’s hospital), subject to final signoff. Subject to any unforeseen factors, the Dementia Unit should be in place by March 2006. One possible hold up would be the availability of contractors, as there is so much work at the moment contractors do not appear to be tendering for the bigger projects. Concept plan – will be reviewed after an Architect has been appointed. Costs have increased quite significantly. Does the concept plan now meet the needs? a user group process. Will be based on what’s best for the patients. When formal project management is in place next step is to tender out to find an Architect. Next comes agreeing on design and adjusted cost. Then funding will be worked on. Steering groups have been set up to work through their processes, need to align the mental health and older persons, they will develop service provision frame work. Workgroup is being set up this week. General Manager Mental Health attended a meeting with the Ministry of Health last week and discussed the project, including the increasing cost, and what is needed to do to ensure funding. The staff at Seaview have been updated on the progress and management of change issues are currently being worked through with them. The transporting of staff from Hokitika to the new unit in Greymouth will follow the same format as when the in-patient unit was relocated to Grey Base Hospital. This will also depend on the number of staff travelling.

9. INCLUSION OF MENTAL HEALTH ISSUES INTO DISABILITY SERVICES ADVISORY

COMMITTEE


Mental Health Advisory Committee (MHAC) has been disestablished. The three remaining advisory committees will be pick-up sections relevant to their own areas. Community Pubic Health Advisory Committee (CPHAC) will takeover Primary Mental Health DSAC will take over Secondary, Community, disability and Hospital Advisory Committee (HAC) will monitor the provider arm services. MHAC members, report to board before term of present members, sitting members will be asked to reapply, so that we have continuity on the committee.

10. DISTRICT STRATEGIC PLAN

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Melanie Penny, Planning & Funding Analyst, gave explanation of the draft document and recommend it be used as a loose guide. Any suggestions are to be forwarded to Bianca Kramer as soon as possible.

11. REGIONAL LAND TRANSPORT COMMITTEE

To be carried over until the next meeting 12. WATER FLUORIDATION

Melanie Penny, Planning & Funding Analyst, spoke to the committee about the Water Fluoridation project currently being worked on. It has been established that those with a disability do have worse oral health, a number of reasons where given for this, not always a fault of the individual. The high cost of dental treatment is prohibitive to a large number of people, and then there is the need for further visits. With Water fluoridation, you don’t have to remember to buy it and there is no need to change behaviour patterns to benefit. Fluoridation works well for those with higher decay rates, for those groups it can reduce decay by half. Water Fluoridation is cheap, Ministry of Health provide 100% cover for the cost of setting up and then it is approximately 50c per year per person to carry on. Originally, it was felt Councils were against but times have changed and information is more readily available. Planning & Funding Analyst said they have meetings arranged to give their presentation to council meetings, they will be visiting Westland District Council tomorrow. This presentation was given to the Board and approved. 80% of the population have their own natural teeth, fluoridation is not only beneficial to children. Those not on reticulated water, will still benefit from the ‘halo effect’, children going to school, adults going to work and drinking fluoridated water (tea, coffee etc) while there. Some water filters do filter the fluoride out, at this stage the information as to which ones was not available.

13. GENERAL BUSINESS

This item was not on the agenda, Committee member just wanted to make a comment regarding quality and safety and barrier free audits. The committee member would like the Board to consider having a barrier free audit run so any changes made can be barrier free. A barrier free audit looks at heights of light switches, safety measures for those who are visually and hearing impaired (fire alarms etc), physical barriers toilets etc. 1:5 have some form of disability and they are not always visible. Standards need to be taken into account in the planning stage, building standards for disabled and barrier free standards are two different things, barrier free standards are tighter than the building standards.


That DSAC recommends that the Board undertakes a barrier free audit of all its facilities, including incorporating barrier free principles into the planning of any new building facilities and alterations.

Another point brought up was “What is the DHB doing in terms of disability training for staff?” Go back and review the plan and see what it indicates. This is to be placed on the agenda for the next meeting.

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14. NEXT MEETING

Wednesday 4 May 2005 15. ATTENDANCE AND ADMINISTRATION FORM

The Chairman asked the committee to fill in the attendance and administration forms and return them today.


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DRAFT MINUTES OF THE COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEETING

HELD 16 FEBRUARY 2005, IN THE BOARDROOM, CORPORATE OFFICE, GREYMOUTH AT 10:41 AM

PRESENT: Julie Kilkelly, Chair

Carol Atmore, Deputy Chair Barbara Beckford Shar Ransom Robyne Bryant (arrived 10.45)

IN ATTENDANCE: Kevin Hague, General Manager Planning & Funding

Melanie Penny, Research and Planning Analyst Gary Coghlan, General Manager Maori Health Darcy Varka, Community and Public Health Janet Hogan, Manager Cervical Screening / Sexual Health Tina Fox, Regional Cervical Screening Health Promoter

Bianca Kramer, Minute Secretary

APOLOGIES: Gregor Coster, Chairman, WCDHB

Christine Robertson, Deputy Chair, WCDHB Lindy Mason Greville Wood Cheryl Brunton Barbara Greer Gerri Vanderzanden, Community and Public Health Robyne Bryant (lateness)

1. WELCOME, APOLOGIES

The Chair welcomed everyone to the meeting and introduced the visitors. The Chair explained to committee members that the new West Coast District Health Board is in office and members have been appointed to various advisory committees. Current CPHAC Board appointees are Julie Kilkelly (Chair), Carol Atmore (Deputy Chair and New Member) and Robyne Bryant. The WCDHB is now reviewing the composition of all advisory committees as part of its 3 yearly process.

2. DISCLOSURES OF INTEREST

The following changes were made to the disclosures of interest. WCDHB Meeting Papers 1 April 2005 Page 60

Robyne Bryant • Remove Mental Health Worker as of 18 February 2005 • Add employed by Westland R.E.A.P as Team Leader of Early Childhood Education Barbara Beckford • Add member National Ethics Advisory Committee

3. AGENDA CHECK

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Primary Care Plan to be place on agenda at 5.6 4. MINUTES OF LAST MEETING HELD 13 OCTOBER 2004

• Page 7 - Shar Ransom put in an apology for December meeting and it was not noted

• Page 13 - Under the heading “In Committee”, end of the third sentence replace the

word pubic with public

Moved: Robyne Bryant Seconded: Barbara Beckford

It was RESOLVED that the Minutes of the Community and Public Health Advisory Committee meeting held 15 December 2004 were a true and correct record following the amendments listed above.

5. ACTION/ RESPONSIBILTY LIST, MATTERS ARISING & UPDATES

Updates on resolutions progressed to the WCDHB from the last CPHAC meeting: That the WCDHB receives an annual report on diabetes in the district to be referred to the DHB and CPHAC starting September 2005

Status: Actioning General Manger Planning & Funding That the WCDHB supports in principle a sexual health service in Buller with consideration to future expansion to South Westland and directs management to work with the Sexual Health Co-ordinator to produce a scoping paper for the March 2005 Board meeting

Status: Progressing That the WCDHB supports in principle the West Coast Rural GP Postgraduate Training Programme noting arrangements need to be in place by April 2005 for a November 2005 commencement and requests management prepare a scoping paper for consideration by the Board at the March 2005 meeting

Status: Progressing


That CPHAC recommends that the WCDHB hold a planning workshop annually for Advisory Committee work streams to consider the District Annual Plan, District Strategic Plan and Health Needs Analysis

Status: Implemented – First One Planning – Next One – General Manger Planning & Funding

West Coast Public Health Plan

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This was passed out by Gerri and Cheryl at the last meeting and they have requested that the committee has a look over it with a view to identifying West Coast priorities and what type of information we would like to see in a quarterly report to CPHAC. The Chair requested that committee members read the plan and get comments to her by 28 February 2005.

Action: Committee Members Action: Minute Secretary– copy of plan to Shar

5.1 Undergraduate Training Programme First intake of students coming next week. 5.2 Rural GP Training Programme Greville not present to update progress. Defer to next meeting. 5.3 Child & Youth Health Strategy No further meetings have occurred yet this year. Shona McLeod to update at next meeting. 5.4 Provider KPIs/Monitoring No further reports available at this stage. Kevin will provide reports for the next meeting as applicable. The Chair reiterated that CPHAC is trying to establish a reporting template that monitors Primary Care service provision in a way similar to how HAC monitor the Hospital Service provision. CPHAC also interested in looking at Social Determinants of Health reports for the region further down the track. It is envisaged that will all feed into the annual planning process.

Action: General Manager Planning & Funding

5.5 Maori Health Plan 2003-06 – Implementation Report 2003 The Chair reminded committee members that the Maori Health Plan had been endorsed by the WCDHB in June 2003 and noted that CPHAC was pleased to be receiving a report on progress towards objectives. Gary Coghlan, GM Maori Health gave a presentation summarising the objectives of the Maori Health Plan, tasks needing to be completed and the status of each of these. Tasks identified as lacking progress included:

- Surveying Maori accessing health services to determine barriers to access - Establishing a pilot project to identify and review pathways of care into and out

of mainstream services


General discussion ensued and Gary was asked to identify areas where CPHAC may be able to assist for the next agenda.

Action: Gary Coghlan

5.6 Primary Care Plan Chapters currently being collated. General Manager Planning and Funding hopes to have a draft available for the next meeting.

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AFThat CPHAC recommends that the WCDHB direct management to consider programmes of

work from the former MHAC with a view to reallocate to other advisory committees as appropriate

TA committee member queried where Mental Health issues are referred to and followed up now that MHAC has been disestablished. Discussion followed which resulted in the following resolution:

Action: General Manager Planning & Funding

Moved: Robyne Bryant Seconded: Carol Atmore

Motion Carried

6. CORRESPONDENCE

Nil received Nil sent

7. GENERAL BUSINESS

7.1 Health Needs Analysis/District Strategic Plan/ DAP05/06 Draft DSP consultation document distributed by GM Planning and Funding. The questions in the document are aimed at being thought provokers and the goal is to get the community thinking about their vision for health services into the future rather than in the short term. Kevin asked for comments and suggestions to be fed back to him within the next 2-3 weeks.

Action: Committee Members

Action: Minute Secretary – copies to absent committee members

7.2 Cervical Screening Janet Hogan, Manager Cervical Screening/Sexual Health gave an overview of cervical screening services on the West Coast. Statistics were provided which showed that the West Coast has the lowest percentage of eligible women enrolled on the Cervical Screening Register. It was pointed out that there were some inaccuracies in the methods used as the figures were based on the 1986 estimates for projected regional growth to 2001. Rather than growth, the West Coast had experienced a population decline of 6.8% which could significantly change the result. Despite this, we could still end up being the lowest ranking region once figures are updated. It was also noted that 1.7% of eligible


women on the West Coast live at the Gloriavale Christian Community and they do not participate in screening. Various initiatives over the past 12 months have been aimed at increasing enrolment and cervical screening rates and these have included: establishment of a full time regional cervical screening promoter, who is also a fully trained smear taker who is available (on request) to visit disabled people in their homes and run clinics at various West Coast sites. Increased funding for up to 700 free cervical smears per annum which have been uptaken and this provides a basis to lobby for funding for an even greater number of free smears annually.

DJohn Luhrs (on behalf of the WCDHB) wrote to Robyn Steed, Chief Executive of the Institute of Rural Health seeking information about scholarships and to date the Chair CPHAC is not aware of a reply to this. Bianca to follow up. Greville has further information he may be able to provide so this item will remain on the agenda for the next meeting.

RAThe committee asked, if possible, for our regional feedback from these meetings to be

presented at the next CPHAC meeting along with a report from Janet which includes perceived and real reasons why women are not having smears taken, the estimated number of smears that need to be taken to reach benchmark rates, the number of West Coast general practices without smear takers, and suggested new initiatives to increase rates (which may include improving recall processes). It was acknowledged that work is also occurring with regard to changes in the national cervical screening programme.

FJanet mentioned that there is soon to be breast and cervical screening focus group meetings in Westport and Hokitika, which have been funded by the Ministry of Health.

T Clinical supervisory support for nurses training as smear takers in order to increase the

number of nurses trained to take smears and thus improve access

Buller Women’s Health Day (next to be in Reefton in November 2005)

Work place smear clinics (on request) DHB staff smear clinics Promotion at various group meetings

Action: Janet Hogan/Tina Fox

7.3 Scholarships

Action: Minute Secretary

Attendance & Administration Forms These were inadvertently left out of the papers so Bianca will send them out to members. Please include attendance and travel for the recent Board Planning Workshop on the same form.

Action: Minute Secretary Next Meeting The next meeting is to be held in the Board Room, Grey Hospital on Wednesday 4 May, 2005 at 10.30am. There being no further business the Chair thanked everyone for attending and the meeting concluded at 1.23 pm.


PRIMARY MENTAL HEALTH STRATEGIC PLAN RECOMMENDATION: THAT the West Coast District Health Board approves the Primary Mental Health Strategic Plan, and the budget and activities associated with implementation.


WCDHB PRIMARY MENTAL HEALTH STRATEGIC PLAN During 2002 the Ministry of Health estimated that 20% of the adult population will experience some form of mental illness at some stage during their life. Of this 20%, it is estimated that 12% will experience mild – moderate mental illness, 5% will experience moderate mental illness and 3% will experience severe mental illness. The strategic plan has been developed based on national and international research, and considerable consultation with community organisations, individuals and service providers, to meet the needs of the West Coast population, in line with Ministry of Health guidelines. This plan focuses on the 17 % of the population with mild to moderate mental illness. This is the population for whom mental health services are provided for in Primary Care Settings. In fact the vast majority of mental health services are provided in a primary care setting by primary care physicians. Consultation identified a number of issues both in providing and accessing Primary Mental Health Services on the West Coast, which have been addressed by developing strategies to Enhance and strengthen Primary Mental Heath including Alcohol and Other Drug Services, Improve the Integration between Primary and Secondary Care providers, Create a Mentally Healthy and Supportive Community, Improve Access to Primary Mental Health Care Pivotal to the implementation of the plan is the development of an ‘Access West Coast’ committee, to form the communication link required to develop an integrated Mental Health Service and to facilitate and monitor the implementation of the Primary Mental Health Strategic Plan. Further, the draft plan has formed the basis of a successful PHO application for additional funding for primary mental health innovations, which will ensure that key strategies can be piloted within a short period of time. Implementation of the plan is budgeted to cost $280,450 with $ 200,000 of new funding approved by they Ministry of Health for PHO mental health innovations (for a 2 year pilot), RECOMMENDATION: THAT the West Coast District Health Board approves the Primary Mental Health Strategic

Plan, and the budget and activities associated with implementation.

Author: GM Mental Health and Research and Planning Analyst – 22 March 2005 Approved by CEO


Primary Mental Health Strategic Plan

February 2005


Background The Ministry of Health (2002) estimates that 20% of the adult population will experience some form of mental illness at some stage during their life. Of this 20%, it is estimated that 12% will experience mild – moderate mental illness, 5% experience moderate mental illness and 3% experience severe mental illness. The trend of providing services in hospital settings has changed with the realization that most mental health care needs are more appropriately met in the community, either by specialist community mental health teams (3% with severe illness) or by primary care providers (17% with mild-moderate illness). In fact the vast majority of mental health services are provided in a primary care setting by primary care physicians. The pattern of mental illness is however, different for Maori; including higher acuity levels of mental illness, with a significant reason for this being late presentation for treatment (Ministry of Health, 2002b). Further, there is a difference in the trends of referral to services and hence service provision for Maori, with 38% of Maori referrals, coming from law enforcement or welfare services (te Puni Kokiri, 1996). Indicating that Primary Health Care Services need to be more accessible to Maori to reduce the trend of Maori having higher acuity levels of mental illness and reverse the trend of late referral to mental health services. In February 2001, the New Zealand Government released its Primary Health Care Strategy (Ministry of Health, 2001). The strategy set a new direction for the provision of primary health care in New Zealand, putting greater emphasis on “…population health and the role of the community, health promotion and preventative care…”. The goal of the Primary Health Care Strategy, in line with the New Zealand Health Strategy (2000) is to increase the health status of the population and reduce health inequalities by reorienting services. The reorientation of services requires moving to a system where services are organised around the needs of a defined group of people (an “enrolled population”). The local structure through which this happens is through the development of Primary Health Organisations (PHO’s) which are funded by, and responsible to the District Health Board for the provision of primary health care services for their enrolled population. While the New Zealand Health and Primary Health Care Strategies set the future direction for the provision of primary health care services in New Zealand, a review of Primary Mental Health Care (Ministry of Health, 2002) set about making a commitment to

“ensuring that plans were developed in the primary health care sector that were consistent with the National Mental Health Strategy and addressed the primary mental health needs of the population” (Ministry of Health, 2002).

The requirement of reorienting Primary Health Services and the implementation of the Primary Mental Health Strategy provides an opportunity for the development of a comprehensive and responsive mental health service, in a systematic and informed way.


Ultimately providing the opportunity to (amongst other things)

• increase collaboration between primary and secondary mental health care providers, • develop and provide primary mental health services based on the needs of the population, • strengthen the primary sector in the provision of mental health care, • address the barriers of access to primary health care services for mental health patients, and

in turn improve the health status of the population, A recent New Zealand study , The MAGPIE study (2003), indicated that 35% of the population attending GPs in New Zealand meet the DSM-IV criteria for a diagnosable mental illness. Additionally, and of extreme importance, 50% of these people are undiagnosed, (Magpie, 2003) and hence untreated. In addition to this the physical health needs of mental health clients also remain unmet, and individuals with a diagnosed mental illness have considerably poorer physical health status, with increased rates of morbidity and mortality than the general population, (Mental Health Commission, 2004). There are many reasons for the high percentage of patients attending Primary practices with undiagnosed mental illnesses, as well as additional barriers to accessing Primary Health Services, which prevents the delivery of both physical and mental health care, at many stages (including screening, assessment, and treatment). Hence the need for an integrated and responsive mental health system to ensure that we meet the mental health needs of the 20% of the population with mental illness. Which also provides an opportunity to address unmet physical health needs of all mental health patients, which in turn will ultimately have an impact on the high rates of physical morbidity and mortality associated with major mental disorders. Purpose & Scope Developing a responsive mental health service which flows through promotion – prevention – primary care – early intervention – secondary care - rehabilitation, and across all diagnoses and severities, requires a comprehensive assessment of the current services and the ongoing needs of the population. The purpose of the primary mental health project was to ascertain the mental health needs of the West Coast population, and to develop a strategic plan, with the view to implement over 5 years, which addresses the needs of the population and meets the aims of the Primary Mental Health Strategy. In addition the plan looks specifically at meeting the previously identified objectives required/outlined in the WCDHB District Annual Plan, namely to;

Meet The Needs Of The 17% Of The Population With Diagnosable (mild to moderate) Mental Disorder Improve Access For People With Mild To Moderate Mental Health Issues To Primary Mental Health Care On The West Coast Improving Access to Primary Health Care for People with Severe and Enduring Mental Illness (3%) treated by Coast Health Care Mental Health Service.

The Scope of the Primary Mental Health Strategic Plan is to make recommendations to the West Coast District Health Board in regard to addressing the physical and mental health needs of the West Coast population who experience mental illness. It is part of the development of both the overall Primary Health and Mental Health Plan for the West Coast.


Key Results Responses to the surveys have provided a vast amount of information about the provision and perception of Primary Mental Health Service on the West Coast. The information includes the gaps in service, barriers to access as well a comprehensive repertoire of suggestions on how to enhance primary mental health service provision, for the West Coast population. There were a significant number of barriers to accessing primary mental health services identified, as important issues for the Provision of Primary Mental Health Care on the West Coast, the main barriers were cost, stigma, transport, isolation and service issues. In addition to this primary health providers identified several barriers in the provision of mental health services. The foremost issues identified by providers as requiring attention are:

• The cost barrier to accessing primary care & the cost of the provision of primary mental health services (e.g. Longer consultation times required etc)

• The need for increased collaboration with secondary Mental Health Services • The need for additional mental health training for Primary Providers • Staff retention/recruitment Issues

Consultation with consumers, family/whanau members, community organisations, the wider community and workers in key intake positions with the Secondary Mental Health Services, have substantiated the issues raised by primary providers. International and National literature also identifies some of these issues as barriers to accessing primary mental health services. The key issues associated with the provision of primary mental health care, were prioritised. With the top five issues the West Coast District Health Board should be addressing being:

Individual family/whanau

Survey Community Services

Survey PMH Providers Survey

Improving Secondary

Services Improving Secondary

Services Cost barrier to access &

Provision Support Services Support Services Increased collaboration

with secondary services Education and Prevention Education and Prevention Training for Primary

Providers Money/Cost barrier

To access Money/Cost barrier

To access Staff retention/

recruitment Addressing Stigma

In addition to these, it was clear that there were recommendations that were beyond the scope of the Primary Mental Health Plan. This feedback has been passed onto those developing a Youth Health Plan, and the Alcohol and Other Drug Services Steering Group for consideration.

Conclusion For primary mental health care to flourish it must be part of a continuum of care integrated with other primary health services, and secondary mental health services to ensure patients receive the services they need with minimal obstruction. Achieving this on the West Coast will require the development of a model through which integrated care can be delivered, and a strengthening in the relationship between primary providers and mental health services. Strengthening this relationship is a key step towards a better-integrated and more efficient heath care system overall.


The following strategic plan has been developed based on National and International research, and considerable consultation with community organisations, individuals and service providers, to meet the needs of the West Coast population, in line with Ministry of Health guidelines. References: Mental Health Commission (2004). “Our Physical Health…Who Cares” Occasional Paper, Number 5, April 2004. Mental Health

Commission. Ministry of Health (2000). The New Zealand Health Strategy Wellington, New Zealand. Ministry of Health (2001). The Primary Health Care Strategy Wellington, New Zealand. Ministry of Health (2002). Primary Mental Health: A review of the opportunities. Wellington, New Zealand


Primary Mental Health Strategic Plan

To develop a comprehensive Mental Healthpromotion – prevention – p

rehabilitation – long

O

Enhance Primary Mental Hea Strengthen Primary Mental He Improve Integration between Create a Mentally Healthy and Improve Access to Primary M

Strategy Priority

Access West Coast Establish First Primary Care Liaison Worker

High

Brief Intervention Service

High

Facilitate Improved Access to Primary Care through GP Link

High

Mäori Health Liaison Worker

High

Training and Education

Medium – High

Family Counselling Service

Medium - High

Health Promotion Medium – High Shared Care Medium Discharge Planning Medium

Peer Support Medium Support Groups Medium

Mentally Healthy West Coast coeffective and integrated health p

menta

WCDHB Meeting Papers

Vision:

mmunities with fair and equitable access to romotion/prevention, primary and secondary l health services.

Aim:

System with an integrated Continuum of Care through rimary care – early intervention – secondary care –

term care across all diagnoses and severities.

bjectives:

th including Alcohol and Other Drug Services ath including Alcohol and Other Drug Services

Primary and Secondary Care Supportive Community

ental Health Care

Responsibility Time frame

DHB and PHO April 2005 Access West Coast Employed by June

2005 Access West Coast

Secondary Service & Access West Coast

Already commenced

Access West Coast Scoping completed by December 2005

Access West Coast / Primary Care Liaison Worker

Begin July 2005

DHB to lead Begin by August 2005

DHB & CPH Finish by Dec 2006 Access West Coast Finish by Dec 2006 Secondary Service & Access West Coast

Finish by Dec 2006

Access West Coast Finish by Dec 2006 Access West Coast Finish by Dec 2006

Developed by June 2005

1 April 2005 Page 72

Objective: Ensure Implementation and Monitoring of the Primary Mental Health

Strategic Plan

Strategies: Access West Coast Activities: Establish an ‘Access West Coast’ Committee to

• Facilitate and monitor the implementation of the Primary Mental

Health Strategic Plan. • Form the communication link required to develop an integrated

Mental Health Service

Performance Indicators

• Joint Committee established between the PHO and DHB representation from primary and secondary mental health providers and community stakeholder representation, including Maori

• Report to the West Coast District Health Board – through CPHAC

• Strategies in the Strategic Plan allocated to Access West Coast are

implemented successfully, including for Maori.

Priority • Establish First Responsibility • WCDHB and WCPHO Time Frame • Established April 2005


Objective: Strengthen Primary Mental Heath including Alcohol and Other Drug

Services on the West Coast

Strategies: Mental Health and Alcohol and Other Drug Liaison Worker

Activities: • Establish a Mental Health and Alcohol and Other Drug Liaison Service, which is responsive to the needs of the community (including to Maori), to provide assistance to Primary Practitioners with patient management, screening, assessment, care planning, and referral for patients presenting with Mental Illness in General Practice.

• The Primary Practice Liaison worker should be targeted to assist

with the 17% of the population with a mild to moderate mental illness, and will carry no caseload.

• The liaison worker would also provide training and education

opportunities for General Practitioners and Practices Nurses in both a formal and informal way, (and to Rural Nurse Specialists and other Primary Health Providers through formal training).

• The service should also create a much-needed vital link between

primary and secondary providers, providing a constant and dedicated presence in relation to the training of primary care providers in the provision and management of mental health patients.

• Alternative funding to pay General Practices a set fee for services

provided to each patient, including face to face consultations, phone contact with the liaison worker and any administration required should be investigated. This will ensure that the increased cost to practices of providing primary mental health services, which are nationally and internationally acknowledged to cost more (through more frequent visits, increased length of time required for consultations and increased practice nurse and GP time) are fairly compensated for.

• Referral Pathways will be clearly defined so that all groups of

providers know exactly where to refer to, which should ensure timely follow up.



• Working Links with primary and secondary providers, established and maintained

• Links with Mäori providers and within Maori communities established

and maintained

• Acceptability to patients and provider buy in to scheme

• Satisfaction with service by patients and providers

• Improved access to secondary support, for primary providers

• Decrease in inappropriate referrals to secondary service/increase in appropriate referrals to secondary service.

• Increased outcomes for clients-HoNOS reports show increase or no

decline in patient outcomes.

• Reporting indicates equitable access by age, gender, ethnicity, and rural location.

Priority • High

Responsibility • Access West Coast Time Frame • June 2005


Objective: Enhance Primary Mental Heath including Alcohol and Other Drug Services

on the West Coast Strategies: Develop a Brief Intervention Service Activities: • Engage with PHO and about the specific needs of Brief Intervention

Service. • Establish Funding for Brief Intervention Service, employing

Suitability Qualified Health Professionals to provide up to 6 free individual counselling sessions, for patients diagnosed with a mild-moderate mental illness (17% of the population) including Alcohol or Other Drug Addiction, who do not require secondary referral and not eligible for ACC funded counselling.

• This service should be flexible to allow group sessions/courses to

be developed if this is clinically indicated. For individuals who require more than 6 sessions a referral should be made by either the Primary Provider or the Brief Intervention Workers to Coast Health Care Mental Health Service.

• The Brief Intervention Service should be mobile covering Westport

Greymouth and Hokitika on a regular basis and more rural areas by appointment.

• Referral to the service should occur through General Practitioners,

Practice Nurses, and Rural Nurse Specialists, and upon screening through Te Waka Hauora.

• Referral may also be made by Community Mental Health Teams,

on completion of a comprehensive assessment, where the patients does not meet the criteria of the specialist service, but does require intervention. This referral should occur in with consultation with the patient’s Primary Care Provider, as that is where responsibility of care will be transferred to upon completion of intervention.


• Patients satisfaction with the intervention • Primary/Secondary Provider Satisfaction with the service • Maori tangata whaiora and provider satisfaction with service • Self reported outcome improvement • Clinical indicators of improved patient outcomes • Reduction in number of mild –moderate referrals to secondary

services/Increase in number of appropriate referrals made • Reporting indicates equitable access by age, gender, ethnicity, and

rural location. Priority • High Responsibility • Access West Coast Time Frame • Developed by June 2005


Objective: Enhance Primary Mental Heath including Alcohol and Other Drug Services

on the West Coast

Strategies: Facilitate a collaborative approach to the provision of Family Mental Health Counselling and Support Services.

Activities: • Ascertain the current extent and accessibility of Family Counselling Services on the West Coast.

• Establish relationships with current agencies that provide

counselling such as Family Focus, Relationship Service, and Rata Te Awhina and determine their current capacity to provide family mental health counselling.

• Establish current eligibility criteria and referral processes and any

gaps in current family health counselling available on the West.

• Establish accessibility and acceptability of family counselling services for Maori, including by different cultural aspects, such as what is acceptable for Tangata whenua and what is acceptable for maata waka.

• Investigate existing group programs for children, adolescents, Mäori,

parenting, men’s or women’s groups; facilitate the development of programs if required.

• Work with existing agencies to promote the further development of

support for families and family members experiencing mental illness.

• Work with existing agencies to support children of families experiencing mental illness.

• Support providers to access currently available funding streams to

meet needs. Performance Indicators

• Gaps in current Family Health Counselling Services identified. • Services established, that are acceptable to and meet the needs of

the community.

• Service available/implemented monitored by funder.

Priority • High Responsibility • Access West Coast Time Frame • Begun by August 2005


Objective: Strengthen Primary Mental Heath including Alcohol and Other Drug

Services on the West Coast

Strategies: Training & Education

Activities: PHO and Access West Coast to work together to identify training and education needs for

• General Practitioners • Practice Nurses • Rural Nurse Specialists

And to develop comprehensive, ongoing and culturally appropriate training plan for primary providers. Including

• Formal Training Courses • Utilising placements in Secondary Services as a

training tool • Informal 1:1 training with Mental Health Liaison Worker • Formal sessions identified as needed by Liaison Worker • Access to training provided by Secondary Services

Consideration should be given to opening this training up to other health providers and community agencies, to ensure maximum utilisation of available resources and that a consistent message is given to service users.


• Completion of Mental Heath Training Plan for Primary Providers

• Ongoing monitoring of education and training requirements - shows a decrease in staff identifying Mental Health as an area of training need

• Increase in provider reported competence and confidence in

provision of primary mental health services.

• Increase in number of providers with formal qualifications in Mental Health

• Increase in number of appropriate referrals to secondary service

• HoNOS or other MHSMART outcome measures shows no

decrease in patient scores

Priority • Medium -High Responsibility • Access West Coast and Primary Care Liaison Worker Time Frame • Begun by July 2005


Objective: Improve access to primary Mental Health Care Strategies: Facilitate improved access to primary care GP Link Activities: • Appoint co-ordinator facilitate process.

• Develop a relationship with Work and Income New Zealand to

ascertain ways to facilitate an improvement in the access individuals with mental illness, including alcohol and other drug, have to primary care, through the redistribution of disability allowance payments direct to General Practitioners.

• Ascertain number of patients in primary and secondary care that

would benefit from-improved access to primary care through this redistribution of their Disability Allowance to their General Practitioners.

• Consider implementing the project in stages, in Hokitika, Reefton,

Buller and Greymouth.

• This service should be evaluated 6 months from implementation.


• Relationship with Work and Income New Zealand established and maintained.

• Project acceptable to clients and primary providers.

• Ongoing Client, GP and Work and Income satisfaction with project.

• Increased access to primary health care services, including physical

health checks and screening (numbers reported compared to those received in year prior to Implementation).

• Ongoing improved access to mental and physical health services

• Improved physical and mental health status of clients, proven

through use of HoNOS and regular screening/early detection/.

• 95% of Secondary Mental Health Service clients linked to a GP or Rural Nurse Specialist.

• 95% of Maori clients of Secondary Mental Health Services are

linked to a GP or Rural Nurse Specialist or other primary health provider

Priority • High Responsibility • Access West Coast and Secondary Mental Health Service Time Frame • Implemented by December 2005 (Already Commenced)


Objective: Improve access to Primary Mental Health Care

Strategies: Investigate the possibility of a Mäori Health Liaison Worker, as a way of

improving Maori access to primary mental health services. Activities: • Scope out the details surrounding a Mäori Health Liaison Worker in

Primary Care services to work across all primary health diagnoses but including improving Maori patients access to Primary Mental Health Services.

• Includes an education and training role to enable Primary Health

Care Workers to gain education regarding health issues impacting the Maori population. This would include working with the Mental Health Liaison Worker on the Primary Mental Heath Training Plan

• Provide a vital link between primary care providers and Mäori

communities and service providers as well as iwi, hapu and whanau

• Investigate the use of funding for Services to Improve Access


• Scoping completed successfully • Funding secured for position

• Provider, community and patient satisfaction with service

• Improved access to Primary Mental Health Care

Priority • High Responsibility • Access West Coast Time Frame • Scoping completed by Dec 2005


Objective: Create a mentally healthy and supportive community

Strategies: Health Promotion

Activities: • Evaluate Current Mental Health and Alcohol and Other Drug

Promotion Services in conjunction with Community and Public Health, and other health promotion providers.

• Asses Mental Heath promotion Services in terms of services

to Maori and Maori health promotion Services in terms of the Mental Health Component.

• Develop a Mental Health and Alcohol and Other Drug Health

Promotion Planning conjunction with Community & Public Health. Ensure the plan addresses stigma and discrimination, and the promotion of services (early access is a form of prevention).

Performance indicators

• Review of Mental Health and Alcohol and Other Drug Promotion Service completed.

• Recommendations from review implemented.

• Mental Health and Alcohol and Other Drug Promotion Plan

completed which is acceptable to community, provider and funder.

• Target indicators set in developed plan are meet over time.

Priority • Medium -High Responsibility • WCDHB and Community and Public Health Time Frame • Begin ASAP – completed by December 2006.


Objective: Improve the integration of primary and secondary care.

Strategies: Shared Care Activities: • Engage with primary providers through Access West Coast and the

Mental Health Liaison Worker to strengthen relationship and implement the transfer of lead care of stable secondary care patients to General Practitioner, with support from secondary service or Mental Health Liaison Worker. General Practitioner as lead carer is part of the multidisciplinary team and collaborative care plans are developed, for suitable patients. Transfer of care or access back to secondary service is available if required.

• The multidisciplinary team involves the Maori Mental Health team

when appropriate.

• Establish number of patients suitable for shared care, insuring access to care plus funding when eligible.


• Shared care patient management plans developed for identified clients.

• Patient’s outcomes, using HoNOS continue to show

improvement/no deterioration for client.

• Increased integration and liaison between primary and secondary care providers – reported by primary and secondary care providers and evidenced through increase number of patients receiving shared care.

• Number of agreed transfers of care completed.

Priority • Medium Responsibility • Access West Coast Time Frame • Completed by December 2006


Objective: Improve the integration of primary and secondary care.

Strategies: Discharge Planning/transfers of care from IPU and CMH to Primary Care

Activities: • Engage with primary providers through Access West Coast and the

Mental Health Liaison Worker to strengthen relationship and identify mechanisms to facilitate General Practitioners or Practice Nurses attending discharge meetings, and being involved in discharge planning.

• Source funding for paying for GP or Practice Nurses to attend

meetings – capped if required.

• Introduce G.P/Practice Nurse participation at discharge planning meeting for their patients who have been in the top 3% who are stabilised and ready for discharge, as well as for unplanned discharges from both Community Mental Health Service and Manaakitanga Inpatient Service.

• Consideration should be given to the role of pharmacists in the

discharge planning process.


• Links between Primary and Secondary Services established and maintained.

• Number/percentage of planned discharges from secondary mental

health service to primary care involving GP or Practice Nurse.

• Number/percentage of unplanned discharges from secondary mental health service involving G.P or Practice nurse.

• GP, Practice Nurse, client, family/whanau, secondary service

satisfaction with care planning.

• Client shows improvement/no deterioration in HoNOS or other MHSMART outcome measures after 6 months.

• Improved access to physical health screening/checks assured.

Priority • Medium Responsibility • Access West Coast and Secondary Mental Health Service Time Frame • Completed by December 2006



Strategies: Peer Support

Activities: • Access West Coast to Monitor the Wellington Warmline Peer

Support Phone Services pilot.

• Investigate Warmline Implementation if Wellington Pilot is successful.

• Ascertain extent of need for Peer Support network/groups,

including the need for peer support for adolescents.

• Establish successful peer support networks/groups based on identified need.


• Successful Implementation of Warmline if indicated - including uptake and satisfaction of clients and providers with service.

• Peer support groups and networks established in areas

ascertained as requiring them.

• Satisfaction with peer support networks and groups implemented.

Priority • Medium Responsibility • Access West Coast and Primary Care Liaison Worker Time Frame • Completed by December 2006



Strategies: Support Groups

Activities: • Access West Coast to instigate a review of support groups

available in the community.

• Create resource/way to promote current support groups and services in the community.

• Investigate ways to facilitate the development of support

groups including support for Maori, as required.


• Resource of support services completed and distributed widely throughout the community.

• Successful support groups established as required – with

satisfaction from clients and providers.

Priority • Medium Responsibility • Access West Coast Time Frame • Completed by December 2006


West Coast District Health Board Primary Mental Health Strategic Plan Budget

Strategy Associated costs Estimated cost Comments/ Notes Access West Coast Democracy costs associated with establishment of Access West

Coast Committee (attendance fees for participants, catering etc) $4,200.00 Calculated as follows: Attendance fees 10 members @12 meetings p.a @$30

fee = $3,600; Catering $50 per meeting @ 12 meetings p.a Primary Care Liaison Worker Costs of establishing and running Mental Health Alcohol and

Other Drug Liaison Service including salary, travel and office expenses, training & education, administration and payments to GPs

$108,000.00 Funded by MOH for 2 years

Brief Intervention Service Salaries and on costs of Qualified Health Professional to provide service (estimated 1 FTE)

$92,000 Funded by MOH for 2 years

Facilitate Improved Access to Primary Care through GP link

No specific costs identified - change in service $

Facilitate collaborative approach toprovision of Family Mental Health Counselling & Support Services

No specific costs identified - change in service $

Training & Education Possible increased training costs Training needs to be evaluated. May result in increased training costs or reallocation of training costs already budgeted for

Kai Awhina/ Maori Health Liaison worker for Primary Health

Costs of Kai Awhina for Primary Health position including salary, training and education costs

$60,000.00 Possible funding sources identified, not confirmed. Funding required prior to implementation.

Health Promotion No specific costs identified - evaluation of current promotion service

$ Already budgeted for in Community & Public Health Promotion

Shared Care Payment to GPs/ pharmacists to attend multi-disciplinary team meetings and compensate for compliance costs associated with additional reporting requirements

$12,500.00 Estimated at $250 per payment, 50 patients per annum. Cost to be shared between PHO/DHB

Discharge Planning Attendance fees to GPs or Practice Nurses for participation in discharge planning meetings for patients

$3,750.00 Calculated at $75 per meeting @ 50 visits per annum. Cost to be shared between PHO/DHB

Peer Support No specific costs identified - evaluation of service $ Warmline would not implemented unless funding received for costs of implemention

Support Groups No specific costs identified - evaluation of service $ Total estimated cost per annum $280,450.00 less funding from MOH $200,000.00 Balance to be funded: $80,450.00 DHB sourced funding for MDT meetings and attendance fees $8,125.00 DHB sourced funding for Access West Coast $4,200.00 Available DHB funding $12,325.00 Funding yet to be sourced before full implementation possible Kaiawhina $60,000.00 PHO funding for MDT meetings and attendance fees $8,125.00 External funding required $68,125.00 Funding Summary MOH $200,000.00 DHB $12,325.00 Other sources -to be negotiated $68,125.00 Total $280,450.00


WCDHB HEALTHY EATING HEALTHY ACTION IMPLEMENTATION PLAN

The Ministry of Health released Healthy Eating Healthy Action (HEHA) in 2003 and subsequently the HEHA Implementation Plan in 2004. In order to achieve its goal of improving nutrition, increasing physical activity and reducing obesity, the HEHA Plan necessitates the active involvement of multiple players, including DHBs. Not every action in the Plan is relevant to DHBs, so the WCDHB HEHA Implementation plan details how we will work on the West Coast to implement HEHA. Community and Public Health have been involved in the development of our local plan. More information is available in the HEHA documents on the Ministry of Health’s website. RECOMMENDATION: THAT the West Coast District Health Board adopts the WCDHB Implementation Plan for

the New Zealand Healthy Eating, Healthy Action Strategy.


Healthy Eating – Healthy Action Oranga Kai – Oranga Pumau

WCDHB Implementation Plan

Maintaining good nutrition, regular physical activity and a healthy weight presents more opportunity for West Coasters to improve their life expectancy and quality of life than any other health intervention.

Accordingly, ‘Improving nutrition and reducing obesity and increasing levels of physical activity’ is a key priority in the West Coast District Health Board’s District Strategic Plan (2002 – 2012). It is also strongly related to key priority areas including reducing the incidence and impact of diabetes, cardiovascular disease and cancer and improving oral health. Increased levels of physical activity and improved nutrition also potentially affect other DHB priorities, including mental health, child health and older persons health.

In recognising the importance of these areas of action, the Ministry of Health released its Health Eating – Healthy Action: Oranga Kai – Oranga Pumau Strategy (HEHA; 2003) and subsequently the Health Eating – Health Action: Oranga Kai – Oranga Pumau Implementation Plan (2004). The HEHA Implementation Plan acknowledges the importance of working with a range of stakeholders from across society. It includes education, sport and recreation, non-government organisations and even the food industry as key players in the implementation of HEHA.

This document outlines expected role of the West Coast DHB in implementing HEHA, this includes hospitals, clinical and specialist services, the West Coast PHO, primary healthcare providers (general practitioners, practice nurses, rural nurses, pharmacists etc) and our public health unit.

In the interests of keeping this document focused on implementation, please refer to those listed below for more information: • • •

Healthy Eating – Healthy Action: Oranga Kai – Oranga Pumau: A Strategic Framework (Ministry of Health, 2003) Healthy Eating – Healthy Action: Oranga Kai – Oranga Pumau: A Background (Ministry of Health, 2003) Healthy Eating – Healthy Action: Oranga Kai – Oranga Pumau: Implementation Plan: 2004 - 2010 (Ministry of Health, 2004)

All are available on the Ministry of Health’s website: www.moh.govt.nz


http://www.moh.govt.nz/

Objective 1: Build Healthy Public Policy Objective 1 centres on coordination, collaboration, policy development and intersectoral activity. In particular there is evidence to support the use of setting-based nutrition policies and guidelines, making the best use of legislation and standards and promoting exclusive breastfeeding for 6-months. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Document and engage with stakeholder groups that could have an influence on nutrition and physical activity for Maori on the West Coast

Database of stakeholders completed

Phase 1 1

Active West Coast (AWC) continues to operate as an interagency steering group to promote physical activity on the West Coast. It involves representatives from the health and disability sectors, local government and Maori (as identified above). AWC can develop its role further to support activities that also promote healthy eating and smokefree messages.

AWC continues to meet with broad representation

Phase 1 1

Develop and implement nutrition and physical activity policies in settings, especially those settings which provide access high priority population groups, including schools, preschools, hospitals and health services and marae, in conjunction with the Heart Foundation where appropriate.

Nutrition and Physical Activity Policy implemented in a wide range of settings

Phase 1-3 4

Continue to develop and implement of policies that support breastfeeding, including the support of the DHB’s Baby Friendly Hospital Initiative (BFHI).

Promotion and support of breastfeeding

Phase 1 5

" Fifty years ago people finished a days work and needed rest. Today they need exercise." Anon


Objective 2: Create Supportive Environments Current environments are obesogenic, in that they support the consumption of high fat and/or high energy foods, often low in nutritional value. Objective 2 covers a number of settings, with evidence to support changes to the local environment to support healthy choices. Components of a supportive environment include provision of education, physical activity programmes, modified retail options and reduced barriers to physical activity. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Support the implementation of nutrition and physical activity policies in settings, especially hospitals and health services.

Number and coverage of programmes

Phase 1-3 7, 10

Promote the consumption of vegetables and fruits in a variety of settings, especially those which provide access to high need populations, through the ongoing work of public health nurses, C&PH, the Cancer Society, the Heart Foundation and 5+ a Day.

National Nutrition Survey Phase 1-3 9

AWC continues to develop district level alliances and networks between health agencies and TAs to inform and influence district planning, including making submissions on LTCCP’s.

Networks developed. Phase 1 10

Utilise opportunities to run forums to foster identification of nutrition and physical activity and obesity as priorities for TAs, e.g. Te Wai Pounamu Health Promotion Coalition Forum.

# forums held Phase 2-3

Support health promotion initiatives in schools and encourage schools to become Health Promoting Schools and to include nutrition, physical activity and obesity issues as a priority.

# HPSs that identify nutrition, physical activity and obesity as priorities.

Phase 1

" A person’s health can be judged by which he takes two at a time - pills or stairs." Joan Welsh


Objective 3: Strengthen Community Action Objective 3 covers community action programmes and local initiatives, particularly the evaluation and dissemination of information on successful programmes. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # The West Coast Community Nutrition and Physical Activity Project is a community action programme for high needs groups that resources key community people

As defined by the Project Phase 1 12

Through participation in South Island Nutrition and Physical Activity Network, Active West Coast and other Fora disseminate information about evaluated, successful community action initiatives especially those effective in achieving health gain in high-need groups.

Mechanism to share information established within and between agencies.

Phase 2 12

Promotion a community gardening project in conjunction with other agencies including Work and Income, Housing NZ, and district councils.

Phase 3⊗ 12

"Living a healthy lifestyle will only deprive you of poor health, lethargy, and fat." Jill Johnson

⊗ Dependent on new resources becoming available


Objective 4: Develop Personal Skills Objective 4 includes the wider workforce becoming involved in promoting nutrition and physical activity such as teachers, employers, community leaders and community workers. Evidence supports the need for enthusiastic support and involvement from management, involvement of employees from all levels of the workforce in planning and implementation and training for staff involved in implementation. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # West Coast Community Nutrition and Physical Activity Project (especially Appetite for Life) & Active West Coast work to increase knowledge and skills of community members, about nutrition and physical activity, especially those in more socio-economically deprived communities.

Number and coverage of education programmes.

Phase 2-3 13,19

Disseminate information about training programmes to early childhood centres and school teachers°.

Number and coverage of professional training opportunities.

Phase 2 15

"It's bizarre that the produce manager is more important to my children's health than the paediatrician." Meryl Streep

Objective 5: Reorient Health Services °°Other work commitments may limit uptake


http://www.brainyquote.com/quotes/authors/m/meryl_streep.html

The health sector must lead the way towards a healthier community. Objective 5 centres on process and structure. In particular the role of health services are identified as important, especially primary health services, in counselling and supporting patients to adopt healthy lifestyles. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Through participation in South Island Nutrition and Physical Activity Network and other Fora create a list of evidence based weight loss programmes/services

List developed Phase 1-2 17

Appetite for Life could be expanded or redeveloped to be appropriate and accessible for men⊗

Number and coverage of effective programmes

Phase 2-3 17

Build nutritional and physical activity indicators into District Annual Planning processes and other health sector planning, including PHO reports on BMI and physical activity frequency of all patients, to enable identification of needs and assist with the development of activities to improve nutrition and physical activity health promotion plans.

Changes in practice signalled in Annual Reports

Phase 1-2 18,19

Conduct planning meetings with nutrition and physical activity stakeholders to prioritise actions to promote healthy eating and healthy action.

Changes in practice signalled in Annual Reports.

Phase 1-2 1,18

Establish effective formalised mechanisms to facilitate meaningful Maori participation at all levels.

Mechanisms established and implemented

Phase 2 20

"The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease."

Thomas Edison

⊗ Dependent on new resources becoming available


Objective 6: Monitor, research and evaluate There is currently a lack of evidence regarding the effectiveness of physical activity and nutrition programmes. Objective 6 includes monitoring of indicators and supporting evaluation or programmes. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Evaluation of all initiatives and programmes built into project plans Stocktake of existing monitoring

of physical activity and nutrition related outputs completed. Monitoring process developed. Number of independent evaluations published.

Phase 1 22,23

Objective 7: Communication This objective focuses on the development of a comprehensive communication plan including social marketing, brand creation and guidelines for the media. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Using the resources developed nationally to promote increased physical activity and healthy eating.

Social marketing plan developed and implemented.

Phase 1-2 24

"Tama tu, Tama ora; Tama noho, Tama mate." Whakatauki


Objective 8: Workforce Objective 8 focuses on the health and physical activity workforce and includes working with tertiary training institutions, identifying gaps in training, and coordinating and collaborating with the health and physical activity sectors. WCDHB Specific Actions Measure Timeframe Link to HEHA

Outcome # Ti Pikorua, Inequalities, Te Reo Maori and other training programmes available to health sector staff provide opportunities to build mainstream workforce capability to respond more effectively to the needs of Maori and to contribute to health gain.

Strategy developed and implemented.

Phase 1 25

"You can't lose weight without exercise. But I've got a philosophy about exercise. I don't think you should punish your legs for something your mouth did. Drag your lips around the block once or twice."

Gwen Owen


RECRUITMENT AND RETENTION STRATEGIES


West Coast DHB Human Resources Department Recruitment and Retention Strategies – 2005 going forward Introduction The West Coast DHB Human Resource Department’s strategic plan is developed from the 2002 - 2012 organisational strategic plan that identifies where the West Coast DHB is at, where it is going, and how it is going to get there. Much of the focus of the Human Resources department and accordingly the strategic plan, is on workforce development given the challenges the organisation has faced, both historically and to date, recruiting and retaining staff, in particular, in the professional and specialised job categories. The workforce development plan that is incorporated into the organisations DAP, lays out the actions to be taken in order to achieve the West Coast DHB human resource goals and objectives. The West Coast DHB DAP has been developed taking into account, priority areas identified by the Ministry of Health (MoH), DHBNZ and the Health Workforce Advisory Committee (HWAC). Recruitment and retention strategies developed incorporate findings from the MoH analysis of the future workforce needs of DHBs where it is indicated that there is a requirement for a different mix of workforce skills to those of the present.

Issues include:

• more skilled personnel are required in community-based and primary health care settings; • Maori development and action on reducing health inequalities will mean continuing

initiatives to develop the Maori workforce; • changing health needs of an ageing population; • advances in technology causing different specialist skills to be required.

Three workforce issues identified by HWAC also guide strategic direction and focus for West Coast DHB. They are as follows: Staff Shortages

The main areas of concern continue to be General Practitioners in rural practices, adequate locums for rural General Practice, Medical Specialists, Registered Nurses, Allied Health staff and qualified Maori providers. Recruitment

As mentioned above, recruitment of qualified staff has historically been a challenge, with specific issues, linked to professional isolation and changing professional body requirements relating to scope of practice, facing those recruiting in rural areas. Numerous strategies have and continue to be undertaken, including collaborating with other large organisations on the West Coast, working with other DHBs, etc., but as this continues to be a national problem, a national effort is required to address this issue. Retention

There is a shortage of skilled medical staff throughout NZ. This places pressure on our attempts to retain professional staff. The West Coast DHB and its workforce WCDHB Meeting Papers 1 April 2005 Page 97

The West Coast DHB has a turnover of approximately $80 million and is split into the following main areas:

• Mental Health Services • Surgical Services • Medical and Rehabilitation Services • Assessment, Treatment and Rehabilitation Services • Nursing Services • Community and Primary Care Services

There is a wide range of career opportunities for people with different skills, qualifications and abilities. Example occupations include:

• Registered nurse • Occupational therapist • Physiotherapist • Dietitian • Physicians • General, Orthopaedic, O&G Surgeons • General Practitioners • Administrative and management positions

Each area within the DHB also relies on the support of a variety of other occupational groups, e.g. technicians, administration, finance, management and IT personnel.

The West Coast DHB, employs approximately 579.20 FTE.

Medical Personnel 26.60 FTE

Nursing Personnel 220.10 FTE

Allied Health Personnel 204. 30 FTE

Support Personnel 33.60 FTE

Management / Administration Personnel

94.60 FTE

Total FTEs 579.20 FTE

Strategies to address identified Recruitment & Retention challenges

Recruitment and Selection

HR Resource

The West Coast DHB has a dedicated 1.0 FTE resource solely focused on recruitment. Recently, due to a staff departure, the organisation capitalized on the opportunity to hire a tertiary qualified, experienced practitioner to the role of Human Resources Co-ordinator, responsible for driving all recruitment activity within the organisation. Already, several proactive initiatives have been developed to meet the service delivery needs of the organisation. For example, a multifaceted advertising campaign, commencing week beginning March 21 2005, will roll out targeting Medical Specialists for Grey Base hospital and General Practitioners for the Buller region - see attached adverts developed in conjunction with senior medical staff.

HR Policy & Procedure Review


Shortly, a review of the Human Resource Policy and Procedures manual will commence, beginning with the recruitment and selection policy, to ensure those involved in recruitment activity apply the policy and procedures fairly and consistently. Following reissuing the R&S policy and procedure, a training programme will accompany it in order to refresh the management team on key principles imperative to hiring the ‘right person’ to a role and the far reaching consequences of hiring the ‘wrong person’. This process will be driven by the Human Resources Manager and supported by the Human Resources Co – ordinator both of whom will act in proactive advisory capacities. Targeted Message to the Market The West Coast DHB will continue to develop recruitment materials that clearly communicate to the target audience it is seeking to recruit. Recruitment processes will be focussed on identifying the target market, designing customised recruitment messages and delivering these messages to the target audience. As mentioned above, this strategy is currently being undertaken specifically with regard to Medical Specialists and General Practitioners and is further supported by activity undertaken in collaboration with recruitment agencies specialising in health recruitment e.g. the Rural General Practitioners Network (RGPN) assist our initiatives to hire GPs. All recruitment activity places a significant emphasis in profiling the lifestyle and outdoor pursuit opportunities that exist across the region. The environment and outdoor activity options that exist here are the ‘points of difference’ that set our organisation and its employment options apart from other health care employers. Our environment not only attracts people to the region but it will also assist keep them here longer. Attracting Maori candidates

A key goal of the Human Resources recruitment and selection strategy and the West Coast DHB Maori Health Plan is to increase and strengthen the Maori health and disability workforce. The objective is to increase Maori in the workforce at all levels to reflect the percentage of Maori living on the West Coast.

In order to develop the health and disability workforce, the following actions will need to take place: • the WCDHB will set Maori workforce targets for the next three years • the WCDHB will actively seek to recruit Maori employees to the health and disability workforce • the WCDHB will work in particular with Tai Poutini Polytechnic and other educational

organisations in a collaborative manner to provide opportunities for Maori to train in health careers

This will ensure that the Human Resources policy that allows for recruitment and retention development of Maori staff will be implemented. This strategy will actively target Maori employees for Maori specific employment and for mainstream services. Through advertising and recruitment practices, we will use a less traditional approach to target Maori via the distribution of adverts and information to community centre’s, Marae, tertiary institutions and schools as well as networking with organisations who provide scholarships to Maori students

Flexibility in Hours/Days of Work When replacing outgoing employees, the organisation considers the workability of offering part-time working arrangements and or job sharing opportunities. By offering this flexibility, the organisation is more likely to attract back employees who have previously worked here but left to either start or care for their family. Previous employees bring with them institutional knowledge that reduces the amount of down time getting up to speed in a new WCDHB Meeting Papers 1 April 2005 Page 99

job. Also, individuals who haven’t worked for us but are considering returning to the work force on a part time basis are an untapped market that requires a tailored approach with regard to the advertising message. Employee Benefits Reimbursement of relocation costs has long been considered a remuneration package prerequisite for key appointments. Although certain guidelines need to be met, the organisation will continue to offer this benefit to aid recruitment of senior and specialised appointments. A further benefit offered to candidates upon appointment is an accommodation allowance, or free accommodation, for the first 4 weeks of employment. Given the scarcity of quality accommodation on the West Coast, when appointing to senior and or specialised roles, including accommodation into a package is vital to offset the difficulties experienced moving to a geographically remote region and getting up to speed in a new role. The recruitment strategy to attract RMOs includes monetary incentives (e.g. free or subsidised accommodation). The organisation is committed to ensuring that a consistent approach is adopted across the organisation to prevent disparity, a factor that is widely known to contribute to turnover. Assistance with transport and usage of a vehicle is also included in remuneration packages especially when there is an on call component to a role or the position is working in a remote location. A factor that has featured in contributing to the departure of several senior medical staff pertains to secondary education options in the Coast region. The Human Resources department is exploring the option of making a contribution towards secondary school fees and including this feature into advertising and promotional material.

Work to attract more 16-25 year-olds to the health industry The health workforce is ageing and this trend is confirmed by data from workforce statistics. To maintain the future skills base of the sector, action must be taken now to recruit more young entrants. At the same time there needs to be industry education co-operation to develop career and learning pathways for the industry and then to raise awareness of these among young people. Initiatives in this area will play an important part in improving the quality of entrants and enabling the organisation to compete more effectively with other recruiting organisations. The development of local employer-school and employer-polytechnic/university relationships will also contribute to addressing some of these skill loss issues along with collaboration in national Workforce champion projects that focus specifically on this topic. Collaboration with Canterbury DHB The organisation is in discussions with Canterbury DHB to explore possible options to address short, medium and long term staff shortages within our service, in particular in the specialist medical areas. These options include exploring making joint appointments e.g. a doctor working 3 days in Christchurch and 2 days West Coast or roster collaboration where our short tem service gaps are factored into Canterbury’s rosters. Significant progress is being made in this area with the General Manager Operations leading this initiative with his Canterbury counterpart. Retention In conjunction with proactive recruitment activity is an equal focus on employee retention, imperative for maintaining a quality workforce. The West Coast DHB has the following commitment, and measures in place, to maximise retention rates: • organisational commitment to the promotion of workforce diversity WCDHB Meeting Papers 1 April 2005 Page 100

• a commitment to career development and advancement of employees Learning and Development The evaluation and selection process represents the final stage of recruiting. Once the candidate is selected, further training needs should be identified. Career development opportunities, or a lack thereof, are often a primary contributor to staff turnover. A comprehensive, relevant company Orientation day for new employees will support the selection process following commencement in a new role. The West Coast DHBs company orientation has recently been reviewed, revised and reformatted with additional components, specifically tailored for senior medical staff, available to these key staff members within the first fortnight of employment. Job-specific training support together with generous education leave is a further initiative to support recruitment processes and maximise retention. For example, increased training opportunities result in increased exposure of doctors and other health workers to practice in provincial, and especially, rural settings. This strategy is recognised internationally as an important part of a long term strategy aimed at maintaining a skilled and responsive health and medical workforce in provincial and rural areas. The Rural Medical Training Reference Group set up by DHBNZ to advise the MoH on postgraduate Rural Medical training and the development of training paths for Rural General Practitioners, recently released their initial findings and plan going forward. The report outlines the need for DHBs to assist address the immediate and forecasted continued shortage of rural GPs by providing structured learning opportunities at a post graduate level. This initiative is at the planning stages at present but is a valid and proactive measure that will assist avert an ongoing shortage of this professional group, imperative to the provision of primary health care services in our rural community. • recognising contributions made by employees to the organisation • ensuring a fair and equitable system for evaluating employee performance.

Performance Management

A formal performance management system update is planned to ensure regular feedback to staff occurs on a formal basis and importantly, to make certain that performance and training is linked and planned for promoting continual skill development. Tabled as part of a longer term strategy for the department is incorporating succession planning into the performance management process to support retention initiatives.

Co-operative Initiatives

Working with other DHB's to share information will assist achieve organisational objectives by working smarter. Collaborating on national initiatives and projects such as the activities undertaken by the Workforce Champion group (National HRMs) will facilitate these processes also.

Engaging the support of key stakeholders also plays an important part in assisting achievement of recruitment and retention objectives. For example, to engage commitment on the part of the learner, basic skills needs should be initiated from the bottom up. Trade Unions could play a key role in this particular aspect, providing non-threatening encouragement to come forward and helping to make the whole area more focused on the learner. Maori providers and stakeholders should be approached to participate in developing training programmes and to access in-house training opportunities.


In partnership with other stakeholders, WCDHB could review and share successful changes to working practices, pay and conditions, within and outside the health sector, which have improved the retention of skilled labour. Each strategy tabled will be monitored to assess • effectiveness: - performance measures and benchmarks will be set to monitor progress, e.g.

links to the in-house performance management system, employee satisfaction assessments, etc, and;

• evaluated and adjusted against the plan as needed. This includes a review of the planning

strategies outlined in the action plan, e.g.: recruiting, selection, career development, retention, etc, and

• revised to address new workforce and organisational issues i.e. new workforce and

organisational issues, as well as the dynamic nature of the organisation, the West Coast DHB will need to make revisions to the workforce plan for future action.

Summary The West Coast DHB Human Resource department has identified and instigated the aforementioned proactive initiatives to address Recruitment & Retention challenges faced by the organisation: To recap, they are as follows:

• Clear recruitment and selection policy, applied fairly and consistently; • The appointment of a dedicated recruitment co-ordinator; • Targeted internet and relevant media advertising; • Profiling the lifestyle and outdoor pursuit opportunities that exist across the region; • Part-time working arrangements and job sharing opportunities; • Reimbursement of relocation costs for key appointments; • Accommodation allowance for the first 4 weeks of employment; • Assistance with transport and usage of vehicle for key appointments were on call is a

requirement of the role; • Exploring school fee contribution; • RMO's: monetary incentives (e.g. free or subsidised accommodation, etc; • Collaboration with Canterbury DHB Learning and Development • A revised company Orientation day for new employees with additional components; specifically

tailored for senior medical staff; • Job-specific training support; • Generous education leave;

Performance Management

• A formal performance management system update is planned to ensure regular feedback to staff occurs;

• Performance and training linked to ensure continual skill development;

Co-operative Initiatives

• Working with other DHB's to share information. Collaborating on national initiatives. • Building close relationships with key organisations, e.g. medical council, immigration services,

ministry of health, etc.


The Human Resources Department is confident that exploring and implementing each proactive initiative detailed above will address both the short and long term recruitment and retention concerns that provide a significant challenge to the organisation. A consistent multi faceted approach to recruitment and selection that promotes the multitude of benefits of working in this region, while off setting the more challenging aspects (geographically isolated province with inclement weather patterns), we consider will make inroads towards changing the perception of the population (national and global) who have an inaccurate understanding of the rewards that exist here both professionally and personally.

Author: Human Resource Manager – 22 March 2005 Approved by CEO


KARAKIA

E Te Atua i runga rawa kia tau te rangimarie, te aroha, ki a matou i tenei wa Manaaki mai, awhina mai, ki te mahitahi matou, i roto, i te wairua o

kotahitanga, mo nga tangata e noho ana, i roto i tenei rohe o Te Tai Poutini mai i Karamea tae noa atu ki Awarua.

That which is above all else let your peace and love descend on us at this time so that we may work together in the spirit of oneness on behalf of the

people of the West Coast.


INFORMATION PAPERS

WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEMBERS TERMS OF APPOINTMENT

HOSPITAL ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date Dr Christine Robertson 7 February 2002

(Re-appointed 17 December 2004) For the period served as an appointed Board member. December 2007

Glenys Baldick 17 December 2004 For the period served as an appointed Board member. December 2007

Brian Wilkinson 17 December 2004 For the period served as an elected Board member. December 2007

Richard Wallace 1 May 2002 3 years 1 May 2005

Margaret Moir 1 May 2002 3 years 1 May 2005

Kathryn Cannan 1 May 2002 3 years 1 May 2005

Barbara Beckford 25 June 2003 (Re-appointed 4 March 2005)

1 year 25 June 2006

DISABILITY SERVICES ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date John Vaile 7 February 2002

(Re-appointed 17 December 2004) For the period served as an elected Board member. December 2007

Mohammed Shahadat 17 December 2004 For the period served as an elected Board member. December 2007

Gloria Hammond 1 May 2002 3 years 1 May 2005

Maureen Frankpitt 1 May 2002 3 years 1 May 2005

Elinor Stratford 1 May 2002 3 years 1 May 2005

Dianne Lewis September 2004 3 years September 2007

Vacancy COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date Julie Kilkelly 7 February 2002

(Re-appointed 17 December 2004) For the period served as an elected Board member. December 2007

Dr Carol Atmore 17 December 2004 For the period served as an elected Board member. December 2007

Robyne Bryant 7 February 2002 (Re-appointed 17 December 2004)

For the period served as an elected Board member. December 2007

Lindy Mason 1 May 2002 3 years 1 May 2005

Barbara Greer 12 November 2003 (Re-appointed 4 March 2005)

1 ½ years 12 November 2006

Greville Wood Re-appointed 4 March 2005 3 years 3 March 2008

Cheryl Brunton Ex officio

Sharon Ransom September 2004 3 years September 2007

Barbara Beckford Co-opted September 2004 Appointed 4 March 2005

2 years (from date of co-opt) 30 September 2007

BOARD MEETING - West Coast DHB · draft minutes of the west coast district health board meeting...

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