BOPDHB 2015-16 Annual Plan - Final with signatures 26 Aug · BOPDHB Annual Plan and Statement of...

BOPDHB Annual Plan and Statement of Intent 2015/16 Page ii

Annual Plan 2015/16

Bay of Plenty District Health Board

Published in September 2015 by the

Bay of Plenty District Health Board P O Box 12024, Tauranga, 3143

ISSN: 2230-4371 (Print)

ISSN: 2230-438X (Online)

This document is available on the Bay of Plenty District Health Board website: www.bopdhb.govt.nz

http://www.bopdhb.govt.nz/

BOPDHB Annual Plan and Statement of Intent 2015/16 Page iii

Annual Plan 2015/16

Bay of Plenty District Health Board

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Our Vision – Tā Mātou Moemoea Healthy, thriving communities – “Kia Momoho Te Hāpori Oranga”

Our Mission – Tā Mātou Matakite Enabling communities to achieve good health, independence and access to quality services

Our Values – Ā Mātou Uara

CARE Our CARE values underpin the way we work together to provide you with a better-connected health system that is patient and whanau centred. CARE means:

Compassion

Attitude

Responsiveness

Excellence

The CARE values are aligned to our He Pou Oranga Tangata Whenua Māori determinants of health principles.

He Pou Oranga Tangata Whenua Māori determinants of health principles

Wairuatanga Understanding and engaging in a spiritual existence.

Rangatiratanga Positive leadership.

Manaakitanga Show of respect or kindness and support.

Kotahitanga Maintaining unity of purpose and direction.

Ukaipotanga Place of belonging, purpose and importance.

Kaitiakitanga Guardianship and stewardship over people, land and resource.

Whanaungatanga Being part of and contributing collectively.

Pukengatanga Teaching, preserving and creating knowledge.

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Table of Contents _____________________________________________________________________

Tumu Whakarae - Executive Leadership ................................................................. 3 Message – from the Chair of the Bay of Plenty District Health Board (BOPDHB) ..................... 3 Message – from the Chair of Te Rūnanga Hauora Māori ō Te Moana ā Toi .............................. 5 Message – from the Chief Executive Officer ............................................................................... 7 Signatories - Primary Care Board Chairs ........................................................................................ 10 Signatories - Primary Care Chief Executive Officers .................................................................... 11 Executive Summary ........................................................................................................................... 13

Kōwae Tahi - Module One: Introduction and Strategic Intentions ..................... 20

1.1 Context – What is the Bay Of Plenty District Health Board? ..................... 20 1.1.1 Structure of this Plan............................................................................................................... 21 1.1.2 Performance Story .................................................................................................................. 21

1.2 Strategic Intentions ........................................................................................ 24 1.2.1 Our vision – Tā Mātou Moemoea ........................................................................................... 24 1.2.2 Our mission – Tā Mātou Matakite .......................................................................................... 24 1.2.3 Our values – Ā Mātou Uara ..................................................................................................... 24 1.2.4 Local Strategic Priorities .......................................................................................................... 24 1.2.5 Integrated Healthcare in the Bay of Plenty – Bringing together Primary, Secondary and

Community care ...................................................................................................................... 25 1.2.6 Position Statements ................................................................................................................. 26 1.2.7 Treaty of Waitangi .................................................................................................................... 26 1.2.8 The Health Sector Challenges and Pressures ..................................................................... 26

1.3 Regional Operating Environment ................................................................. 27

1.4 Local Operating Environment ....................................................................... 28 1.4.1 Nature and Scope of Functions – Our Role and Purpose ................................................. 28 1.4.2 Our Geography and Population ............................................................................................ 29 1.4.3 Health Profile ............................................................................................................................ 31

1.5 Nature and Scope of Functions .................................................................... 32

1.6 National, Regional and Local Strategic Outcomes ..................................... 33 1.6.1 National Strategic Outcomes ................................................................................................. 33 1.6.2 Minister’s Letter of Expectations ........................................................................................... 33 1.6.3 Non-financial Monitoring Framework .................................................................................... 34 1.6.4 Regional Strategic Outcomes ................................................................................................ 34 1.6.5 Local Strategic Outcomes ...................................................................................................... 36

1.7 Key Risks and Opportunities ............................................................................ 36 1.7.1 Achieving health equity ........................................................................................................... 36 1.7.2 Living within our means .......................................................................................................... 37 1.7.3 Health System Workforce Shortages ................................................................................... 37 1.7.4 Regional Collaboration ........................................................................................................... 38

1.8 Key Measures of Performance ......................................................................... 38 Outcome One – People are supported to take greater responsibility for their health .............. 39 1.8.1 Fewer People Smoke ............................................................................................................... 40 1.8.2 Reduction in vaccine preventable diseases ......................................................................... 41 1.8.3 Improving health behaviours ................................................................................................... 42 Outcome Two - People stay well in their homes and communities ............................................. 43 1.8.4 Children and adolescents have better oral health ............................................................... 44

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1.8.5 Early detection of treatable conditions ................................................................................. 45 1.8.6 Fewer people are admitted to hospital for avoidable conditions ....................................... 46 1.8.7 People maintain functional independence ............................................................................ 47 Outcome Three - People receive timely and appropriate specialist care ................................... 48 1.8.8 People are seen promptly for acute care ............................................................................. 49 1.8.9 People have appropriate access to elective services ........................................................ 50 1.8.10 Improved access to mental health services ........................................................................ 51 1.8.11 More people with end stage conditions are supported ...................................................... 52

Kōwae Rua - Module Two: Delivering on Priorities and Targets ........................ 55

2.1 Health Targets..................................................................................................... 57 2.1.1 Shorter Stays in Emergency Departments .......................................................................... 57 2.1.2 Improved Access to Elective Surgery ................................................................................... 58 2.1.3 Shorter waits for Cancer treatment - Faster Cancer Treatment ....................................... 61 2.1.4 Increased Immunisations ......................................................................................................... 65 2.1.5 Better help for Smokers to Quit ............................................................................................. 69 2.1.6 More Heart and Diabetes Checks .......................................................................................... 74

2.2 Better Public Services: Better Results for New Zealanders ......................... 77 2.2.1 Reduce the incidence of Rheumatic Fever ........................................................................... 77 2.2.2 Children’s Action Plan (CAP) .................................................................................................. 79 2.2.3 Prime Ministers Youth Mental Health Project...................................................................... 82 2.2.4 Reduce the Prevalence of Obesity ........................................................................................ 84 2.2.5 Healthy Families New Zealand ............................................................................................... 85 2.2.6 Social Sector Trials................................................................................................................... 86

2.3 System Integration ............................................................................................ 87 2.3.1 Integrated Healthcare in the Bay of Plenty ........................................................................... 87 2.3.2 Primary Care ............................................................................................................................. 94 2.3.3 Improving Access to Diagnostics ........................................................................................102 2.3.4 Rising to the Challenge ........................................................................................................104 2.3.5 Long Term Conditions ..........................................................................................................107 2.3.6 Diabetes Care Improvement Packages .............................................................................108 2.3.7 Stroke ......................................................................................................................................111 2.3.8 Cardiac – Secondary Services .............................................................................................112 2.3.9 Health of Older People ...........................................................................................................114 2.3.10 Whānau Ora ..........................................................................................................................116 2.3.11 Maternal and Child Health ...................................................................................................118

2.4 Māori Health – Achieving Equity – Key actions from Māori Health Plan123

2.5 National Entity Priority Initiatives ............................................................... 126

2.6 Living Within Our Means .............................................................................. 129

2.7 Improving Quality.......................................................................................... 130

2.8 Actions to Support Regional Delivery of Regional Priorities .................. 133

2.9 Spinal Cord Impairment Action Plan .......................................................... 134

Kōwae Toru - Module Three: Statement of Performance Expectations .......... 137

3.1 Statement of Performance Expectations ................................................... 137

3.2 Output Classes .............................................................................................. 137

3.3 Measures of DHB performance by output class........................................... 139 3.3.1 Prevention services ...............................................................................................................139 3.3.2 Early detection and management .......................................................................................139 3.3.3 Intensive assessment and treatment ..................................................................................139

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3.3.4 Rehabilitation and support ...................................................................................................139

3.4 People are supported to take greater responsibility for their health ..... 141 3.4.1 Fewer people smoke.............................................................................................................141 3.4.2 Reduction in vaccine preventable diseases ......................................................................141 3.4.3 Improving Health Behaviours ..............................................................................................142

3.5 People stay well in their homes and communities ................................... 143 3.5.1 An improvement in childhood oral health ............................................................................143 3.5.2 Long-term conditions are detected early and managed well ..........................................144 3.5.3 Fewer people are admitted to hospital for avoidable conditions ....................................145 3.5.4 People maintain functional independence .........................................................................146

3.6 People Receive Timely and Appropriate Care ........................................... 147 3.6.1 People receive prompt and appropriate acute and arranged care ..................................147 3.6.2 People have appropriate access to elective services ......................................................148 3.6.3 Improved health status for people with a severe mental illness .....................................149 3.6.4 People with end stage conditions are supported ..............................................................150 3.6.5 Support Services ...................................................................................................................150

Kōwae Whā - Module Four: Financial Performance ........................................... 154

4.1 Introduction ....................................................................................................... 154

4.2 Financial Performance Summary ................................................................... 155

4.3 Prospective Statement of Financial Position ................................................ 163

4.4 Asset Management ........................................................................................... 164

4.5 Prospective Detailed Financial Statements .................................................. 175

Kōwae Rima - Module Five: Stewardship ............................................................ 182

5.1 Managing Our Business .................................................................................. 182 5.1.1 Our People ...............................................................................................................................182 5.1.2 Organisational Performance Management .........................................................................187 5.1.3 Funding and Financial Management ...................................................................................189 5.1.4 National Health Sector Entities .............................................................................................189 5.1.5 Risk Management ...................................................................................................................189 5.1.6 Performance and Management of Assets...........................................................................190 5.1.7 Shared decision making participation ..................................................................................191

5.2 Building Capability ........................................................................................... 193 5.2.1 Collaboration .........................................................................................................................193 5.2.2 Information Communications Technology ....................................................................197 5.2.3 Streamlined Contracting .....................................................................................................200 5.2.4 Capital and Infrastructure Development ........................................................................200 5.2.5 Service Improvement...........................................................................................................200

5.3 Workforce ....................................................................................................... 202 5.3.1 Managing our workforce within fiscal restraints.........................................................202 5.3.2 Safe and competent workforce ........................................................................................205 5.3.3 Child Protection Policies ...................................................................................................206 5.3.4 Children’s Worker Safety Checking ...............................................................................207

5.4 Organisational Health ...................................................................................... 207 5.4.1 Governance ............................................................................................................................207 5.4.2 Planning and Funding Health and Disability Services .....................................................209 5.4.3 Providing Health and Disability Services ...........................................................................209

5.5 Reporting and Consultation ........................................................................... 212 5.5.1 Consultation with the Minister and Ministry of Health ......................................................212

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5.5.2 External Reporting.................................................................................................................212 5.5.3 Ownership Interests ..............................................................................................................212

Kōwae Ono - Module Six: Service Configuration ............................................... 216

6.1 Service Coverage and Service Change ........................................................ 216 6.1.1 Service Coverage ..................................................................................................................216 6.1.2 Service Change .....................................................................................................................216 6.1.3 Service Issues ........................................................................................................................217

Kōwae Whitu - Module Seven: Performance Measures ..................................... 220 7.1 Performance Measures 2015/16 .............................................................................................220

Kōwae Waru - Module Eight: Appendices ........................................................... 227 8.1 Glossary of Terms ....................................................................................................................228 8.2 Structure of the Health Sector ................................................................................................232 8.3 Output Classes and Output Categories .................................................................................233 8.4 Production Plan .........................................................................................................................238 8.5 BOPDHB Organisational Structure ........................................................................................239 8.6 BOPDHB CARE Values Table ................................................................................................241 8.7 Te Ekenga Hou Māori Health Strategic Plan Summary ......................................................242 8.8 Minister of Health’s Letter of Approval ...................................................................................243

Note: This plan should be read in conjunction with the Bay of Plenty District Health Board (BOPDHB) Māori Health Plan (MHP), Te Ekenga Hou Māori Health Strategic Plan (see Appendix 8.7 for the summary) and the Midland Regional Services Plan (RSP) at www.bopdhb.govt.nz.

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Tumu Whakarae - Executive Leadership Message – from the Chair of the Bay of Plenty District Health Board (BOPDHB) Achieving the Board’s vision of healthy thriving communities remains a top priority for the Board in 2015/16. This can only be achieved through working in partnership with all of our healthcare providers across the health system from the orderlies in the hospital, to the Nurses working in General Practice, our NGO providers to our Aged Residential Care facilities across the Bay of Plenty. Everyone has a role to play in ensuring that we provide the best care to our population. Also critical to our success is working with the Māori Health Rūnanga representing the 18 Iwi to ensure that we reflect the aspirations and priorities of our Māori community. From our joint workshop in late 2014, we confirmed our commitment in driving integration and to continuing improvement in the areas of Child and Youth; Health of Older People; Māori Health - Reducing inequalities; and those living with Chronic Conditions. Working together, we will make a difference. More and more we are also working with other Government agencies such as the Ministry of Social Development, Ministry of Education, Child Youth and Family Services to develop multi-agency responses to the needs of our communities. We are committed to the continued support of the Social Sector Trails and the development of the Children’s Team in the Eastern Bay of Plenty to improve the health and wellbeing of our children and youth. Working as part of an Integrated Health System is paramount to our success. For us, that means that we are continuing to look at how we can make sure that health services are more coordinated between hospital and community services, that we are enabling our health professionals to share important information across different health settings, that we are working with our communities to improve their understanding of health information and most importantly in whatever we do we take a whanau, patient centred approach. We have been making steady progress against the Minister of Health’s Targets especially in the area of reducing wait times in our Emergency Departments, Better Help for Smokers to Quit, and Better Diabetes and Cardio Vascular Services. We are committed to achieving the new Health Targets and continuing to build on our performance with Childhood Immunisations. Our Values are paramount to our success and we are continuing to incorporate our CARE values both within the organisation and with our wider provider network.


2015/16 will be a challenging year, however we will continue to strive to achieve our goals, improve our patients experience, improve the health of our population and build on the excellent network of health services we have across the Bay of Plenty.

Sally Webb Ron Scott

Chair Deputy Chair

Bay of Plenty DHB Bay of Plenty DHB

Date: August 2015 Date: August 2015


Message – from the Chair of Te Rūnanga Hauora Māori ō Te Moana ā Toi Tēnā koutou katoa. Anei te mihi ā te Rūnanga Hauora Māori ō Te Moana ā Toi. Ko te tumanako kei te noho ora mai koutou ngā whānau katoa. “Toi Ora – Optimum Wellbeing” remains our overall goal in improving health for our population, in particular Māori. It is great to acknowledge the united stance that the Rūnanga and the Board have taken in regards to endorsing Whanau Ora where “Every service offered or funded by the BOPDHB should contribute to the transfer of knowledge and skills to whanau/family that enables them to self-manage their own health conditions.” Whanau Ora at its core is about empowering whanau/families to take control of their future to be self-determining, living healthy lifestyles, participating fully in society, and being economically secure. We will continue to work with the Whanau Ora Collectives; and other agencies and sectors like the Social Sector Trials and Children’s Teams to ensure that a voice of our communities is being heard at a governance and operational level to influence positive change. Reflecting over the past year, we have seen some great achievements in achieving equity between Māori and non-Māori, in particular:

• Engaged in development of a web-based tool for Māori Health Plan performance monitoring, which will be implemented over 2015/16. This innovative tool will give all of us an instant, mobile way of tracking equity, performance, and improvements in Māori health

• Supported the Ngai Tuhoe Service Management Plan (SMP), that enables the establishment of primary care options in Ngai Tuhoe

• Ngati Kahu Hauora GP Clinic have achieved all health targets and are ISO accredited

• Provided smoking cessation advice to 94% of Māori who smoke and are seen by their General Practitioner (GP). This rate is the same as that of non-Māori

• Achieved a significant lift (28%) in our Cardiovascular Risk Assessment rates for Māori and reduced disparity

• Facilitated employment of Māori Nurse Practitioners in Primary Care with potentially more to be qualified in the coming year. These leaders will help us drive and continue to improve Māori health outcomes.

Despite these remarkable improvements there is much more work to be done in increasing the number of Māori women screened for cervical and breast cancer; ensuring Māori are getting along to attend their doctor and/or hospital appointments; improving health literacy; and to lift our oral health and immunisation rates.


Punohu McCausland

Chair

Te Rūnanga Hauora Māori ō te Moana ā Toi

Date: August 2015

Working together for our people

““Ko koe tena, ko ahau tenei, kiwai te kete Toi Ora, Ka mahitahi tatou”

We must work together to achieve optimum wellbeing for our people and ourselves.


Message – from the Chief Executive Officer “Lead transformation from the edge. Go out to your edges, explore the possibilities, because you will find more opportunity in the edges, where you will be able to imagine, invent and thrive.“ - Ayelet Baron In the 2015/16 year, the Bay of Plenty District Health Board (BOPDHB) will continue to build the foundations for a more integrated health system. It will be through all our hospital, primary and community partners working together that we will achieve our vision of healthy thriving communities and ensuring that in whatever we do, the focus of care is on the needs of people, their families and whanau. Achievements in 2014/15 The DHB has been focused on the actions that were identified in the Bay of Plenty DHBs Integrated Healthcare Strategy (IHS) that identifies how providers in the Bay of Plenty DHB region can work as one health system to improve the health of our population. We have started this journey by focusing on providing greater access to health information across all of our provider networks and we have been looking at how some health services such as community nursing can be provided in a more coordinated way across our hospital and primary care settings. Keeping all decisions that we make focussed on the needs of the patient, their family and whanau is critical to ensuring people are empowered to manage their own health and to share in decision making that affects their health. This approach is further supported through the Board’s Whanau Ora position statement which summarises how we can improve health and other social outcomes for Whānau and their individual members through specific service delivery programmes, improved pathways of care for patients, improved health literacy and navigation of the health system, and more culturally appropriate care within both Māori and mainstream providers. The 2014/15 year also saw the opening in November of the Kathleen Kilgour Centre (KKC) which is the Bay of Plenty’s new radiation treatment centre. This is a significant local service for the population of the Bay of Plenty who have up until this point had to travel out of this district for essential care and treatment away from their families and whanau and were often unable to maintain their employment or normal routines due to the travel involved. The Bethlehem Birthing Centre was also opened by the Prime Minister in September and provides another option for mothers with uncomplicated births to deliver their baby in a community setting. Both new services are consistent with the Government’s desire for health services to be provided closer to home.


We have made good progress against most of our Health Targets notably achieving the Shorter Stays in Emergency Departments and exceeding our target in providing Better Help for Smokers to Quit in quarter two of 2014/15. We are committed to closing the gap with the Increased Immunisations target and refocusing our efforts on the new health targets. Under pinning whatever we do as an organisation is our Health Excellence Quality Framework. This framework sits firmly aligned to the New Zealand Triple Aim; the IHS; and was adopted to assist us to manage all the components of the organisation as a unified whole, so that our plans, processes, measures, and actions are consistent. Our Opportunities for 2015/16 More and more we are seeing the effects of an aging population and the impacts associated with supporting more people with complex health needs in the community. This is also reflecting on our hospitals, which are experiencing unprecedented acute demand on our Emergency Departments, Hospital beds and Community Services. How we respond to this as a system and look to ensure that services are provided in the most appropriate setting by the most appropriate health professional and in the most joined up way will ensure that we manage demand in the most effective way. We will continue to balance the books in an environment of increasing demand, patients with greater health need and complexity and an aging and growing population. In 2015/16, we will focus on delivering the vision of the IHS with a particular focus on Coordinated Care, Health Literacy and Access to Patient Information underpinned by a patient and family centred approach. We will work with our Primary Care partners through the Bay of Plenty Alliance Leadership Team to progress our integration agenda and actions to ensure we develop a more joined up health system. Reducing Health Inequalities through the delivery of our Māori Health Plan and closing the disparity gap will be a key focus for the Board and Rūnanga in 2015/16. We have made good gains but need to continue to focus on those areas where we have the greatest disparities in health outcomes for our population across the Bay of Plenty. We are committed to building effective working relationships with other Government Agencies through initiatives such as the implementation of the Vulnerable Children’s Team in Eastern Bay of Plenty and the Social Sector Trails in Kawerau and Whakatane and in other areas where greater coordination between agencies will improve outcomes for our population. We will continue to focus on meeting the needs of the Minister, Ministry of Health, Board and our population with a specific focus on:

• Health Targets • Ministers Priorities • Māori Health – achieving equity • Health of Older People


• Wellness and Chronic conditions • Child and Youth.

Our values of Compassion, Attitude, Responsiveness and Excellence (CARE) are core to what we do and we want to ensure that these continue to be embedded in our culture and within our wider provider network.

Phil Cammish Chief Executive Officer Bay of Plenty DHB Date: August 2015


Signatories - Primary Care Board Chairs

The following sections of the annual plan have been jointly developed between our organisations and the BOPDHB. We are committed to working in partnership with the DHB to ensure achievement of the outcomes described in this plan and the Māori Health Plan:

• Module 2.1.1 Shorter Stays in Emergency Departments • Module 2.1.4 Increased Infant Immunisations • Module 2.1.5 Better Help for Smokers to Quit • Module 2.1.6 More Heart and Diabetes Checks • Module 2.2.1 Reduced incidence of Rheumatic fever • Module 2.2.2 Children’s Action Plan • Module 2.2.3 Prime Ministers Youth Mental Health

Project • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.3 Improving Access to Diagnostics • Module 2.3.4 Rising to the Challenge • Module 2.3.5 Long Term Conditions • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.3.9 Cardiac Services • Module 2.3.10 Whanau Ora • Module 2.3.11 Maternal and Child Health • Module 2.4 Māori Health – Achieving equity.

Bryan Gould Chairperson Eastern Bay Primary Health Alliance

Bev Flavell Chairperson Ngā Mataapuna Oranga

Date: August 2015

Date: August 2015

Dr John Gemming Chairperson Western Bay of Plenty Primary Health Organisation

Colleen Te Arihi Co-Chairperson Western Bay of Plenty Primary Health Organisation

Date: August 2015 Date: August 2015

http://www.wboppho.org.nz/



Signatories - Primary Care Chief Executive Officers

Signatories - Primary Care Board Chairs

Michelle Murray Chief Executive Officer Eastern Bay Primary Health Alliance

Janice Kuka Managing Director Ngā Mataapuna Oranga

Roger Taylor Chief Executive Officer Western Bay of Plenty Primary Health Organisation

Date: August 2015 Date: August 2015 Date: August 2015



Executive Summary As we enter the 2015/16 planning round, we see a New Zealand public health system that continues to face challenges. With challenges, however, come opportunities and this plan details many of the opportunities and interventions we believe will have positive impacts on the health status of our population. The challenges that affect us all are both global and local.

The burden of disease is unfairly distributed in our society; long-term conditions and risk factors such as smoking, obesity and diabetes contribute to serious health disparity. The health of Māori remains an area in which we must do better, and more detail is to be found in the Te Māhere Māori o Te Hauora a Toi - Māori Health Plan.

Integrated Healthcare Strategy 2020 (IHS) Our response to the challenge requires us to work together in partnership with people and our community, as one system. This year’s Annual Plan further reflects our commitment to fulfilling the promises we have made in the IHS to work together with our primary care partners, through our Bay of Plenty Alliance Leadership Team, to make changes to the health system, for the benefit of our population.

BOPDHB’s Population Priorities The Board continues to support four key strategic population priorities for the coming year.

1. Child and youth. 2. Health of older people. 3. Māori health – Achieving equity. 4. Chronic conditions.

For each population priority, the Board has identified why each strategic priority is important for the Bay of Plenty population and what they want to achieve (see Module 2 for further details): The way we work together is important in meeting the expectations of our community and the Ministers’. It is reinforced through our approach, which is as follows:

• We set our priorities by determining what matters to people, family, whanau and our healthcare workforce

• We lead by example • We are building a connected

healthcare system • Whanau Ora is our approach to

improving whanau health and well-being

• We work towards the New Zealand Triple Aim for quality improvement.

Our approach is reflected throughout our strategic documents in particular the IHS (See Module 2.3.1).


1. Child and Youth Healthier children and youth lead to healthier adults. Through the implementation of our Child and Youth Strategy (CYS), we should be able to fulfil our mission and vision. The CYS is a positive example of multi agencies such as the District Health Board (DHB), Ministry of Health; and Ministry of Social Development working together and more cohesively to improve the health outcomes of our children and youth. We continue to be proactive participants and will implement the actions derived from the Childrens Team and Social Sector Trials.

2. Health of Older People The Health of Older People Strategy has an emphasis on wellness, encouraging healthy, independent living with access to quality services. We are continuing to support more people to live in their own homes through increasing our investment in Home Based Support Services (HBSS). This allows people to live longer in their own homes, with support rather than moving into care. Please refer to Module 2, 2.3.9 for our key activities for 2015/16.

3. Māori Health –Achieving Equity The long-term goal is for Māori within the Bay of Plenty to have the same level of wellness as non-Māori. Key actions in this area are listed below.

• Continue with leading He Pou Oranga1, He Ritenga2 and the Māori Health Plan as they are important in ensuring mainstream services are responsive to meeting the needs of Māori and to address and reduce inequalities between Māori and non-Māori. DHBs across the Midland region have adopted the unique Māori tools and frameworks developed by the BOPDHB to monitor how effectively DHBs are reducing inequalities for Māori.

• Roll out of the Māori Health Excellence series of seminars, that brings together local, regional and national champions to share what works from their experience and help others learn from those experiences to improve Maori health.

See Module 2, in particular Module’s 2.3.10 Whanau Ora and 2.4 Māori Health – Achieving Equity for our key activities for 2015/16.

4. Long Term Conditions The BOPDHB will support services that enable people to become healthier and reduce the need for treatment. This will include reduced obesity, smoking cessation, increasing immunisation rates and services that focus on improving physical health outcomes for those with mental health & addiction problems. For those people who have a chronic condition, we will:

• reduce cancer wait-times

1 He Pou Oranga Tangata Whenua is a framework built upon principles that underpin Maori determinants of health 2 He Ritenga is the BOPDHB Cultural Audit tool to ensure services are responsive to the needs and aspirations of Maori


• improve the management of stroke rehabilitation and reduce waiting times for cardiac services

• maintain and improve the diabetes care improvement package (DCIP)

• support patients to navigate their own care across multiple providers (refer to Module 2.3.1)

• implement models of care that provide greater coordination of health services (refer to Module 2.3.1)

• increase metabolic monitoring opportunities for a defined group of people using mental health services (refer to Module 2.3.4).

See Module 2, for further information and activities on our key activities for improving and addressing long-term conditions. Health Excellence Strategy 2015 – 2017 To assist us in reaching our goals, improving results, and living within our means while still delivering the highest quality and safest health care we have adopted the Criteria for Performance Excellence as our quality framework. The framework sits firmly aligned to the New Zealand Triple Aim; the IHS; and was adopted to assist us to manage all the components of the organisation as a unified whole, so that our plans, processes, measures, and actions are consistent.

Shifting Services Closer To Home Building on the IHS, the Bay of Plenty DHB will continue to seek opportunities to shift services closer to home where we can demonstrate that it will have a benefit for our population and their health outcomes. To date we have made good progress. Since 2007/08 the DHB has shifted a range of services to either a Primary or Community settings including some community radiology services, diabetes management and nursing services, primary birthing, and minor skin procedures to name a few. In 2015/16, we will continue to seek out these opportunities as part of our Bay of Plenty Alliance Leadership Team (BOPALT) integration work programme.

Summary Further work on better integrating and combining care in our health system is paramount to delivering a quality experience journey through our healthcare system. For the coming year, we will be looking to build upon the great work we do, and implementing activities from our key strategic documents such as the IHS. The BOPDHB will receive annual revenue of approximately $706 million to provide and fund a full range of health and disability support services in the most efficient and effective ways possible. To live within our means in the coming years will require innovation, redesign and reconfiguration to continue to provide a high level of service within financial constraints.

We are continuing to face a number of cost and funding pressures.3 Our wero (our challenge) is to turn this Plan into a living and thriving

3 See Module 1.7, Key risks and opportunities


document of action that meets the expectations of all who look to the BOPDHB to deliver health services for the people of the Bay of Plenty.

This document expresses our continued commitment to our Boards vision of Healthy Thriving Communities – Kia momoho te hāpori oranga. It also articulates our commitment to meeting the Minister’s expectations, including the Health Targets; and how we will achieve this; as well, as how we will work with our Midland DHB partners to deliver on care closer to home for our local people.

Health is about People

“He aha te mea nui o te Ao? He tangata, he tangata, he tangata.

What is the most important thing in the world? It is people, it is people, it is people.”

Health is very much about people – the people receiving health services and the people providing them.


Kōwae Tahi - Module One: Introduction and Strategic Intentions

1.1 Context – What is the Bay Of Plenty District Health Board?

Bay of Plenty District Health Board (BOPDHB) was established on 1 January 2001 by the New Zealand Public Health and Disability Act 2000 (NZPHD) and is one of 20 DHBs in New Zealand. DHBs were established as vehicles for the public funding and provision of personal health services, public health services and disability support services for a geographically defined population. BOPDHB is a Crown Entity and is accountable to the Minister of Health. We receive funding from Government to undertake our functions. The amount of funding is determined by the size of our population, as well as the population’s age, gender, ethnicity and socio-economic status characteristics. We are both a funder and provider of health services. In 2015/16, we will receive approximately $706 million in funding from the Government and Crown agencies for health and disability services for the Bay of Plenty population. The Ministry of Health and National Health Board also have a role in the planning and funding of some services. Some services are funded and contracted nationally, for example, Public Health Services, breast and cervical screening as well as the provision of Disability Support Services (DSS) for people aged less than 65 years. We are socially responsible and uphold the ethical and quality standards commonly expected of providers of services and public sector organisations. We are responsible for monitoring and evaluating service delivery, including audits of the services we fund. We are also increasingly working with other Government agencies such as the Ministry of Business Innovation and Enterprise (MBIE), Ministry of Social Development (MSD) and the Ministry of Education (MOE) to improve the services we provide, particularly in our most vulnerable populations. The costs of providing services to people living outside of our district are met by the DHB of the patients domicile and are referred to as ‘inter-district’ services or Inter-District Flows (IDFs). Likewise, where we do not provide the service, we have funding arrangements in place enabling our district residents to travel outside the district. We also deliver against service delivery contracts with external funders, such as Accident Compensation Corporation (ACC). We closely monitor IDFs and ACC volumes to ensure our ability to provide for our own population is not adversely affected by demand from outside the district. In order to achieve the planned outputs, impacts and outcomes as outlined in this Annual Plan, we may, pursuant to section 25 of the New Zealand Public Health and Disability Act 2000, negotiate and enter into, or vary any current agreement for the provision or procurement of any health and disability support service. These agreements (or variations) may contain any terms or conditions acceptable to the DHB.


1.1.1 Structure of this Plan

We have followed the national guidance provided by the Ministry of Health for the formatting of this Plan. This Plan is split into eight modules. This modular approach allows us to extract modules from our plan to complete our Statement of Intent4(SOI); and (b) Statement of Performance Expectations (SPE). For the purposes of this document, these modules shall be referred to collectively as “this Plan”.5

We are part of the Midland DHB region6, and have worked together to improve regional consistency across our plans. This collaboration is reflected throughout this Plan.

Navigating this Plan Central to understanding this Plan, is our performance story.7 Our performance story uses intervention logic8 to show how we plan to achieve our high-level goals. It sets out our key outcomes (what we are trying to achieve), impacts (our shorter term contribution to an outcome), outputs (goods and services supplied), and inputs (resources).

The structure of this Plan is largely determined by statute, the national planning guidelines and a number of key influences, the most notable of which is the Minister’s Letter of Expectations9.

1.1.2 Performance Story

The diagrams presented on the following pages provide a high-level summary of our performance story (Intervention Logic).10 These diagrams demonstrate the flow from resources through to, ultimately, our desired outcomes, as well as the links between our national, regional and local strategies.

The right hand column of the diagram indicates the module in this Plan with more information on the relevant part of the performance story.

4 Modules 1, 2, 4, 5, 7 and parts of 8. 5 This plan is also influenced by the Regional Services Plan (RSP) and the Māori Health Plan (MHP). 6 See Module 1, 1.3 for further information on the Midland DHB region 7 See Module 1, 1.1.2. 8 Intervention logic can be explained or shown graphically as a chain of conditions to be achieved 9 See module 1.2.4 for further information on the Minister’s Letter of Expectations 10 See Appendix 8.1 for definitions.


Ministry of Health’s Performance Story:

Midland DHBs Performance Story:

11 As at 2012 health consumed 10.1% of New Zealand’s GDP (gross domestic product). http://www.treasury.govt.nz/government/longterm/externalpanel/pdfs/ltfep-s4-01.pdf

Health and Disability System

O

utcomes

All New Zealanders lead longer, healthier and more independent lives

New Zealand’s Health system is cost effective and supports a productive

economy11

Strategic Direction - Module 1

Strategic purpose and role

Improve and protect the health of New Zealanders

Ministry of Health

Intermediate

Outcom

es

New Zealanders are healthier and more

independent

High quality health and disability services are

delivered in a timely and accessible manner

The future sustainability of the health system is

assured

Policy Drivers

Regional Collaboration

Strong governance and clinical leadership

Integration between Primary and Secondary

Care

Living within our means

Midland

Vision

All residents of Midland District Health Boards lead longer, healthier and more independent lives

Midland Regional Service Plan ( RSP) – M

odule 1

Regional Strategic

Outcom

es

To improve the health of our population To reduce or eliminate health inequalities

Regional O

utcome

Indicators

To increase our average life expectancy

To reduce premature death rates

To improve our amenable mortality rate

Regional Strategic

Objectives

To improve Māori Health

outcomes

Integrate across the

continuum of care

To improve quality across

agreed regional services

To improve clinical

information systems

To build the workforce

Efficiently allocate public health

system resources

By focusing on these objectives, we will be able to drive change that enables us to live within our means.

http://www.treasury.govt.nz/government/longterm/externalpanel/pdfs/ltfep-s4-01.pdf


BOPDHB’s Performance Story:

5-10 Year Outcom

es

BAY OF PLENTY DISTRICT HEALTH BOARD

Vision : Kia momoho te hāpori oranga - Healthy, thriving communities Mission : Enabling communities to achieve good health, independence and access to quality

services Values: CARE (Compassion, Attitude, Responsiveness and Excellence)

CARE is aligned to He Pou Oranga Tangata Whenua Māori Determinants of Health

Strategic Direction M

odule 1

People take greater responsibility for their health

People stay well in their homes and communities

People receive timely and appropriate care

3-5 Year Impacts

Fewer people smoke Reduction in vaccine

preventable diseases Improving health

behaviours

Children and adolescents

have better oral health Early detection of treatable

conditions People better manage their

long term conditions Fewer people are admitted

to hospital for avoidable conditions

People maintain functional independence

People are seen promptly for

acute care People have appropriate

access to elective services Improved health status for

people with a severe mental illness

More people with end stage conditions are supported

Modules 1, 2 and 3

Focus Areas

Māori Health - Achieving

equity Health of Older People Chronic

Conditions Child and Youth

Priorities and Targets M

odule 2

Resources/ Inputs

People Performance Management

Clinical Integration / Collaboration /

Partnerships Information

Stewardship

Module 5

(sample outputs listed only – for a full list see Module 3 – Statement of Performance Expectations)

Outputs

• Providing Smokers who access Primary and Secondary Services with Smoking Cessation advice and support

• Children are fully immunised at eight months

• % of population enrolled with a Primary Health Organisation

• No. of children enrolled in Well Child/Tamariki Ora (WCTO) Programme

• No. of acute inpatient presentations

• Elective and arranged Day of Surgery rate is achieved

• Shorter wait times for non-urgent mental health and addiction services

Statement of perform

ance expectations

Module 3


1.2 Strategic Intentions 1.2.1 Our vision – Tā Mātou Moemoea “Healthy, thriving communities” – “Kia Momoho Te Hāpori Oranga”.

1.2.2 Our mission – Tā Mātou Matakite

Enabling communities to achieve good health, independence and access to quality services. 1.2.3 Our values – Ā Mātou Uara

CARE

Our CARE values underpin the way we work together to provide a better-connected health system that is patient and whanau centred. CARE stands for:

Compassion Attitude Responsiveness Excellence

The CARE values are aligned to our He Pou Oranga Tangata Whenua Māori determinants of health principles. He Pou Oranga Tangata Whenua Māori determinants of health principles

Wairuatanga Understanding and engaging in a spiritual existence Rangatiratanga Positive leadership Manaakitanga Show of respect or kindness and support Kotahitanga Maintaining unity of purpose and direction Ukaipotanga Place of belonging, purpose and importance Kaitiakitanga Guardianship/stewardship over people, land and resource Whanaungatanga Being part of and contributing collectively Pukengatanga Teaching, preserving and creating knowledge

1.2.4 Local Strategic Priorities Local priorities have been included in the Performance Story to ensure items important to us that are not explicitly covered in the regional strategic intent, nevertheless inform this Plan. The IHS is key to the way we work for the next six years and underpins the way we will deliver upon our priorities outlined below: Minister’s Priorities

• Living within our means (See Module 2.6 Living within our means)

• Leadership – Strong governance and clinical leadership (See Module 5.1.7 – Clinical Governance)

• Integration between Primary and Secondary Care • National Health Targets • Tackling key drivers of Morbidity • Refreshed New Zealand Health Strategy • Whanau Ora • Reducing the prevalence of obesity • Social Sector Trials.


Our Population Priorities • Child and youth. • Health of older people. • Māori health – Achieving equity. • Long-term conditions.

Our Approach

• We set our priorities by determining what matters to people, family, whanau and our healthcare workforce.

• We lead by example. • We are building a connected healthcare system. • Whanau Ora is our approach to improving whanau health and

well-being. • We work towards the New Zealand Triple Aim for quality

improvement.

1.2.5 Integrated Healthcare in the Bay of Plenty – Bringing together Primary, Secondary and Community care

Our vision is that by 2020 Bay of Plenty health services will be centred on the needs of people, their families and Whānau. People will be able to easily access services when required and healthcare workers will be able to seamlessly transfer care between settings when needed. People will be empowered to manage their own health and to share in decision making. Achieving our vision requires us to work together in partnership with people and our community, as one system. We are committed to fulfilling the promises we have made in the BOP Integrated Healthcare Strategy 2020 by working together with our primary care and community partners to make the changes required. The purpose of the Strategy is to:

1. be a lens that can be applied to all healthcare related activity, both current and future, so we can be certain that activity is systematically and deliberately building towards an integrated healthcare system

2. identify specific actions that will build foundations for developing integrated healthcare consistently throughout the Bay of Plenty


3. support and enhance critical decision-making within, and provide direction to, the BOPALT.

Last year was pivotal in the development of the strategy however for the coming year it is about making gains towards implementing the actions in the IHS. Together with our community and primary care partners, through the BOPALT we will focus on implementing the actions. Whilst gains will be made across all areas of the IHS, we will deliberately focus on Theme 2: Health literacy; Theme 3: Access to Patient Information, and Theme 4: Co-ordinating Care.

Please see Module 2, 2.3.1 Integrated Healthcare in the Bay of Plenty for key actions on a better-connected healthcare system in the Bay of Plenty.

1.2.6 Position Statements

The BOPDHB has prepared a set of position statements on key health issues. They are purposefully set so that they are brief, high level documents that reflect Government policy where it has been laid out, and current best-evidenced practice, with an indication of how BOPDHB services deliver in that area. These have been placed on the DHB’s website where they are available to the public, as well as DHB staff and providers, and are listed below.

• Alcohol and Other Drugs • Child Youth Health • Community Water Fluoridation • Disability Responsiveness • Immunisation • Health Inequalities • Liveable Environments • Physical Activity and Nutrition • Tobacco Control • Whanau Ora.

1.2.7 Treaty of Waitangi

The Treaty of Waitangi (Te Tiriti o Waitangi) is widely acknowledged as New Zealand’s founding constitutional document and is often referred to in overarching strategies and plans throughout all sectors. The BOPDHB is one of many organisations that value the importance of the Treaty. This is clearly visible as we participate and work in partnership at the governance, strategic and operational levels. Central to the Treaty relationship and implementation of Treaty principles is a shared understanding that health is a ‘taonga’ (treasure) and that we will adhere to the principles of Partnership, Protection and Participation (PPP).

1.2.8 The Health Sector Challenges and Pressures

Major, long-term systematic pressures are shaping the way health services will be delivered in the future. These pressures not only impact on New Zealand, but on a majority of health systems across the world. The following table summarises the key challenges and pressures.


Summary of health sector challenges and pressures12 Challenge Health Sector Pressures

Population is changing

Urban growth Rural decline Increasing ethnic diversity Evolving family structure Ageing population

Increasing burden of chronic conditions

Growth in the number of people living with chronic conditions Increased incidence of multiple, complex symptoms and co-morbidities Greater chance of chronic conditions linked to lifestyle choices

Rate of funding growth is unsustainable

New technologies and models of care A decrease in the rate of funding growth (after a recent period of increases)

Substantial inequalities in health status persist

Inequalities in health status continue, with potential for disparities to worsen Long term and inter-generational inequalities

Health system workforce shortages are worsening

International demand and an ageing workforce Decreased hours / availability as a result of:

• regulated maximum working hours • changing lifestyle preferences • super specialisation of some medical professions • rural workforce shortages.

Multiple new technologies are being developed

Ongoing introduction of new diagnostic tools / tests and new therapeutics More access to information for patients and clinicians Increased communication options and speed for patients and clinicians Continued growth in research and knowledge Increased understanding of need and service impacts

Public expectations are rising

Patients will be better informed Ongoing expectations of highly personalised services and extensive choices Increased diversity in service expectations as the population becomes more multi-cultural

1.3 Regional Operating Environment BOPDHB is one of five DHBs that make up the Midland Region. Collectively the Midland DHBs have agreed a strategic response to assist the region to move forward in the same direction. This direction is articulated in the Midland DHB Regional Services Plan13 (RSP). In 2015/16, all five Midland DHBs will continue to progress activities towards regional cooperation in a planned manner. Composition of Midland region is as follows:

12 Trends in Service Design and New Models of Care : A Review (Ministry of Health New Zealand), 2010. 13 Key information on our region is available in this plan which is available on the Midland DHBs / HealthShare website


Source: Population estimates Statistics NZ for Ministry of Health population based funding formula 2012 release The health sector challenges and pressures (see table in section 1.2.8) all have implications at the regional level. Some distinguishing features of our region include:

• high proportion of population identifying as Māori • low proportion of the population identifying as Asian or

Pacific peoples • higher number of people living in rural areas • higher proportion of people living in areas identified as

higher deprivation quintiles four and five • lower life expectancy than the New Zealand average • higher smoking rates than the New Zealand average.

There is great need and desire to improve the health outcomes of our most vulnerable populations, in particular Māori; older people; and our children and youth.

1.4 Local Operating Environment

1.4.1 Nature and Scope of Functions – Our Role and Purpose

As a DHB we: • Plan, in partnership with key stakeholders and our community

(i.e. clinical leaders, Iwi, Primary Health Organisations and non-Government organisations); and in collaboration with other DHBs and the National Health Board, regional and national work. the strategic direction for health and disability services in the Bay of Plenty

• Fund the provision of the majority of the public health and disability services in our district, through the contracts we have with providers (see also Modules 4 and7)

Logo Midland DHB Website

Forecast Population 2015

Bay of Plenty www.bopdhb.govt.nz

221,000 54,910 Māori (25%)

Lakes www.lakesdhb.govt.nz

103,920

35,975 Māori (35%)

Tairawhiti www.tdh.org.nz 46,753 23,235 Māori (49%)

Taranaki www.tdhb.org.nz 110,258 21,435 Māori (18%)

Waikato www.waikatodhb.govt.nz

375,910

88,295 Māori (23%)


http://www.lakesdhb.govt.nz/

http://www.tdh.org.nz/

http://www.tdhb.org.nz/

http://www.waikatodhb.govt.nz/


• Provide hospital and specialist services primarily for our population of 221,000 people but also for people referred from other DHBs

• Promote, protect and improve our population’s health and wellbeing through health promotion, health protection, health education and the provision of evidence-based public health initiatives.

1.4.2 Our Geography and Population Covering 9,666 square kilometres, our DHB serves a population of 221,000 and stretches from Waihi Beach in the North West to Whangaparaoa on the East Cape and inland to the Urewera, Kaimai and Mamaku ranges. These boundaries take in the major population centres of Tauranga, Katikati, Te Puke, Whakatane, Kawerau and Opotiki. Eighteen Iwi are located within the BOPDHB area.

Iwi within BOPDHB There are multiple Iwi that lie within or across BOPDHB’s borders including:

• Ngai Te Rangi • Ngāti Ranginui • Te Whānau ā Te Ēhutu • Ngāti Rangitihi • Te Whānau ā Apanui • Ngāti Awa • Tūhoe • Ngāti Mākino • Ngāti Whakaue ki Maketū • Ngāti Manawa • Ngāti Whare • Waitahā • Tapuika • Whakatōhea • Ngāti Pūkenga

• Ngai Tai • Ngāti Whakahemo • Tūwharetoa ki Kawerau.


Comparing the total Bay of Plenty Population with the total Māori Bay of Plenty

Population by age group for 2015

Age Group Total BOP Population Forecast 2015 Total BOP Māori Population Forecast 2015

Number % Number %

0-14 45,430 20.6% 18,310 33.3%

15-24 26,070 11.8% 9,350 17.0%

25-44 48,925 22.1% 12,540 22.8%

45-64 58,490 26.5% 10,870 19.8%

65-74 23,540 10.7% 2,570 4.8%

75+ 18,650 8.3% 1,270 2.3%

Total 221,000 100.0% 54,910 100.0% For the total BOP population, 32.4% are under 25 (50.3% for Māori), compared with 33.8% for New Zealand as a whole (51.9% for Māori). A quarter of the Bay of Plenty DHB population identify as having Māori ethnicity, almost all of whom have Māori descent. The Bay of Plenty Māori population is young compared to the non-Māori population, and is over-represented in socio-economically deprived areas. Māori are less likely to live in main urban areas than non-Māori and are more likely to live in smaller urban areas or rural areas than non-Māori. The Māori population is projected to grow faster than the non-Māori population from 2006 to 2026, with the greatest percentage growth to occur in the 65 year and over age group. BOPDHB has more people who live in the two most deprived NZDep categories compared with the national average (21% versus 18%). Deprivation increases toward the east of the DHB where Māori make up a greater proportion of the population. Over 60% of Māori in BOPDHB live in the three most deprived deciles.14 Key socio-economic indicators include:

• Approximately 51,500 people in the BOPDHB area live in New Zealand Deprivation (NZDep) 9 and 10 areas (most deprived) – approximately 46% of this population are Māori

• Approximately 48% of the total Māori population lives in NZDep 9 and 10 areas, while approximately 15% of all non-Māori are in NZDep 9 and 10 areas.

Overall, the BOPDHB population is over-represented in high deprivation score categories and under-represented in low deprivation categories compared to New Zealand as a whole. Like the national population, our population is ageing, with the highest percentage projected increase from 2006 to 2026 occurring in the 65+ group. While our growth rate for the 65+ population is lower than New

14 .Statistics New Zealand. Regional Summary Tables. Statistics New Zealand. [Online] 2014


Zealand as a whole, because it is currently high, our proportion of older people will remain higher than for New Zealand as a whole by 2026 (BOPDHB: 23.9%, National: 19.1%). Our ageing population has obvious and very serious implications for health services into the future, particularly in terms of workforce sustainability and demand on services. [1]

1.4.3 Health Profile Understanding our health profile plays an important part in our decision-making processes. This information helps us focus on where we can make the greatest gains in terms of our strategic outcomes, as well as for planning and prioritising programmes at an operational level. Analysis of the health needs of people of the Bay of Plenty has indicated the following priorities:15

• smoking in pregnancy, with 25% of total pregnant women and 48% of Māori pregnant women being recorded as smoking two weeks after birth

• avoidable hospitalisations • disease of the respiratory system • oral health concerns, with only 9% of the BOPDHB population

living in fluoridated water supply areas and generally poor oral health outcomes

• chronic obstructive airways disease amongst adults that is 10% higher than national rates

• acute bronchitis among infants and young children, especially Māori infants

• diabetes and chronic renal disease (including diabetes renal failure), that disproportionately affects Māori

• cardiovascular disease, including ischaemic heart disease and strokes that disproportionately affects Māori.

Māori children and youth in the Bay of Plenty also have substantially worse indicators for asthma, oral health and teenage pregnancy. For acute rheumatic fever (and chronic rheumatic heart disease), Māori rates are among the highest in the world. To improve our health service delivery, and reduce health inequalities for Māori, we have focused our attention on the Māori Health Plan (MHP) indicators set out in Module 2 and the SPE. These indicators were generated by the Ministry of Health’s Operational Policy Framework (OPF); are linked to the leading causes of mortality and morbidity for Māori; and arose as a result of a process identifying all health issues where Māori experience the greatest inequalities and which lead to the greatest number of hospitalisations for Māori. Module Three - Statement of Performance Expectations identifies a number of measures broken down by ethnicity where we can see those measures where there is the greatest level of disparity for Māori. Please refer to the MHP16 for key actions we propose to take to close the gap for Māori.

15 These health needs have translated into 11 key impacts for our population that are highlighted in Module 1.8 Key Measures of Performance 16 See Module 2 for further actions on the Māori Health Plan


To help drive performance on the MHP national indicators, the Midland DHBs have collaborated on the development of a monitoring framework to compare performance. This will enable Midland DHBs to learn from the best performers within our region and the best performers nationally. The BOPDHB aims to accelerate performance improvement through the continued rollout of the Māori Health Excellence Seminar series supported by the Ministry of Health. The seminars showcase best-practice presentations from lead organisations that have eliminated or reduced inequalities between Māori and non-Māori. Learning from these organisations will enable the BOPDHB and other Midland DHBs to implement successful service delivery models. The seminar audience comprises Māori and mainstream community providers, general practice and PHO staff, and representatives from BOPDHB and the Provider Arm. The BOPDHB intends to be proactive in the management of services for the impending population increase in older people, particularly given the associated high cost of care for this population. The emphasis will be on wellness, encouraging healthy, independent living with access to quality services. Older people represent the fastest growing sector of the population in the Bay of Plenty.

Older people account for one of the largest increases in health expenditure, are at the highest risk of acquired disability, cognitive decline, and admission to residential care. Older people’s needs are more complex with potentially co-existent medical, functional, psychological and social needs. It is critical that we manage the increasing demand for these services by supporting older people to maintain their independence for as long as possible, in their own homes.

1.5 Nature and Scope of Functions As a DHB, we will:

• plan the strategic direction for health and disability services in partnership with key stakeholders


• plan regional and national work in collaboration with the National Health Board and other DHBs

• fund the provision of the majority of the public health and disability services in our district, through the agreements we have with providers

• provide hospital and specialist services primarily for our population and also for people referred from other DHBs

• promote, protect and improve our population’s health and wellbeing through health promotion, health protection, health education and the provision of evidence-based public health initiatives.

1.6 National, Regional and Local Strategic Outcomes This section presents an overview of the “what” – what we are striving to achieve for our population. Our aim will be achieved by the delivery of services that are accessible, safe, individual- and family-centred, clinically effective and cost-effective. The actions, activities and initiatives outlined in this Plan are expected to directly, or indirectly, impact on our strategic outcomes.

1.6.1 National Strategic Outcomes

There are two identified health system outcomes for New Zealand17 as detailed in our performance story diagram. Further detail relating to these outcomes can be found in the Ministry of Health Statement of Intent 2014 to 2018. The outcomes are:

• New Zealanders live longer, healthier, more independent lives • the health system is cost effective and supports a productive

economy.

The Ministry of Health and DHBs are charged with giving effect to the overarching goal for the health sector of care being delivered closer to home.

1.6.2 Minister’s Letter of Expectations

The Minister of Health has outlined his expectations for 2015/16, which enables us to plan and prioritise activity for the coming year. The Minister’s expectations reinforce the Government’s commitment to a public health system that delivers care closer to home and improving health outcomes for patients within constrained funding increases. For the 2015/16 year the Minister’s expectations are:18

• Living within our means • Leadership – Strong governance

and clinical leadership • Integration between Primary and

Secondary Care • National Health Targets • Tackling key drivers of Morbidity • Refreshed New Zealand Health

Strategy.

17 Sourced from: Statement of Intent 2013 to 2016 – Ministry of Health 18 Letter of Expectation, 17 December 2014. See Module 2 for actions and measures.

Care closer to home

“I expect DHBs to move services closer to home in 2015/2016, and

DHBs need to have clear evidence of how they are going to do this”

Minister of Health - Jonathan Coleman


1.6.3 Non-financial Monitoring Framework

Another mechanism used to monitor performance is the DHB non-financial monitoring framework. It is a key tool to provide assurance that DHBs deliver19 in terms of the legislative requirements, and in terms of Government priorities. A summary of the monitoring framework, including our targets (where appropriate) has been included in Module 7.1.

1.6.4 Regional Strategic Outcomes

The Midland DHBs have produced an RSP, which describes the strategic intent for the Midland DHB Region. Our DHB is committed to being an active participant in the regional planning process. The Midland DHBs have agreed two strategic outcomes. Strategic Outcome 1: To improve the health of our population

Taking positive steps about how we live and what decisions we make right now is very important to our future health and wellbeing. Our services, programmes and initiatives will enable people to increase their skills and confidence to maintain good health or manage their health problems.

Strategic Outcome 2: To eliminate health inequalities

We are committed to moderating the effects of disparity through, firstly, identifying health disparities and, secondly, funding and providing programmes that target inequalities and improve access to services. To improve health outcomes we will need a concerted effort and leadership at all levels to achieve the Midland vision that all residents lead longer, healthier and more independent lives.

There are six key regional indicators that the Midland DHB’s have agreed to focus on in the coming year.

1. Life expectancy – life expectancy is a calculation of life expectancy at birth based on the mortality rates of the population in each age in a given year.

2. Premature death –death before the age of 75 years. 3. Amenable mortality –deaths that could in theory be averted

by good healthcare. 4. Fewer people smoke – the percentage of year 10 high school

students who have indicated they have never smoked, and reductions in the current and daily smoking rate for adults (aged 15 and over).

5. Reduction in vaccine-preventable diseases – the 3 year average crude rate per 100,000 of vaccine preventable diseases in hospitalised 0-14 year olds.

6. Improving health behaviours – the percentage of obese people aged 2-14 years and the percentage of obese people aged15+ years population. (Obesity is defined as a body mass index (BMI) of 30 or more – calculated by dividing a person’s weight in kilograms by the square of their height in metres. Measure 6 is a national measure taken from the New Zealand Health Survey.)

19 “to the extent they are reasonably achievable within the funds provided” (NZPH&D Act 2000 S3(2)


We have identified six regional strategic objectives our region will work towards:

• improve Māori health outcomes • integrate across continuums of care • improve quality across all regional services • build the workforce • improve clinical information systems • efficiently allocate public health system resources.

For further information on any of the regional outcomes, indicators or strategies please refer to the Midland RSP and Module 1.8 Key measures of performance within this plan.


1.6.5 Local Strategic Outcomes To contribute to achieving the outcomes at a national and regional level, we have identified our local strategic intent for 2015/16. Our strategic intent represents a continuation from previous years, as the goals are not short-term issues easily resolved within a 12-month period. There is a strong alignment between the strategic intent at the regional and local levels.

Our local strategic outcomes align directly to the regional strategic outcomes and will be infused by our IHS. We will continue to monitor the following outcome performance indicators and provide a greater “line of sight” to regional work as and when appropriate.

1.7 Key Risks and Opportunities By its nature, the health sector is complex and challenging. We have identified the following risks and opportunities as being particularly relevant for 2015/16:

1.7.1 Achieving health equity

We are committed to eliminating the effects of health disparities through, first, identifying them, and second, addressing them by working collaboratively, providing programmes and/or activities and improving access to services. It should be noted, that long term conditions, particularly those that are exacerbated by tobacco use, and

5-10 Year Outcom

es

BAY OF PLENTY DHB



Strategic Direction - Module 1




Population priorities

Māori Health -

Achieving equity

Health of Older People Chronic Conditions Child and Youth

Priorities and Targets - Module 2


maternal smoking (particularly in the third trimester20) are significant contributors to health disparity.

The approach we take includes:

• implementing the Bay of Plenty Māori Health Plan • realising the IHS for the Bay of Plenty • implementing the Toi Te Ora – Public Health Service Plan

2015/16 • delivering services that target communities with identified

health inequalities • setting targets by ethnicity or by high needs • supporting kaupapa Māori services and ‘for Pacific by Pacific’

services where appropriate • Proportionate universalism – allocating resources to areas of

greatest need • increasing the capability of the Māori and Pacific workforce

across our district • using an equity lens as part of decision-making processes • engaging with our combined Community and Disability

Support Advisory Committee to provide advice and inform decision making

• continuing engagement with iwi governance bodies to provide advice and inform decision making

• engaging with community health forums and expert advisory groups to provide and receive advice - this will include alliance mechanisms and service level alliance teams representing community/primary/DHB perspectives.

Our challenge is to configure health service delivery in a way that takes account of the complex relationships between the key social determinants of health inequalities (e.g. housing quality and employment), while recognising that a number of public and private agencies influence health outcomes.

1.7.2 Living within our means21

The ongoing pressure of the financial environment is driving a need to be more disciplined, improve efficiency, reduce waste and improve healthcare. This, together with the Government’s goal of returning to surplus has created a strong focus on improving fiscal management.

1.7.3 Health System Workforce Shortages

It is estimated that salaries represent approximately 70%22 of our health expenditure. We are also competing internationally for clinicians, with the challenge of placing clinicians in more remote areas in the Eastern BOP. We are seeing an increasing focus on addressing our workforce challenges both regionally and locally (see Module 5).

20 Smoking during pregnancy causes double strand DNA break damage to the placenta,

Tania L. Slatter et al -Dept of Pathology, Dunedin School of Medicine, NZ. 21 See Module 2.6. 22 Estimated based on Hospital Provider Arm expenditure. Recent increases in the BOPDHB’s contribution to KiwiSaver have resulted in an additional cost pressure.


1.7.4 Regional Collaboration

There are potentially significant gains to be made from DHBs working together in new and innovative ways, both in cost savings and improved patient wellbeing. Regional services’ planning is a vehicle to progress regional system integration and regional service development opportunities. It is vital that this is a whole of system approach and as such, it is vital for primary care to be engaged in developments in this arena. 1.8 Key Measures of Performance In the table below, we have provided a summary of our key impacts and how we will measure them.23 Monitoring the impact measures will provide us with medium term results to inform decision-making, and highlight areas for further attention.

23 While the BOPDHB has a significant role to play, contribution to these impacts is made by a number of other agencies. 24 Please note that these are not fully inclusive of all impacts/measures

5-10 Year O

utcomes

People take greater responsibility for their

health



Modules 1 and 3

3-5 Year Impacts 24


preventable diseases Improving healthy

behaviours

Children and adolescents have

better oral health Early detection of treatable

conditions People are better at managing

their long term conditions Fewer people are admitted to

hospital for avoidable conditions People maintain functional

independence






Increased support services

Key Impact M

easures Increase the percentage of

youth never smoking Reduction in smoking

rates Reduction communicable

diseases More people eating at

least 5 fruit and vegetables a day

Fewer obese people

Increase in percentage of 5 year

olds caries free A decrease in the number of

children at year 8 with decayed missing or filled teeth

Increase the proportion of people with well managed diabetes

Decrease the Cardiovascular disease hospitalisation rate

Ambulatory Sensitive Hospitalisation rates are reduced

Increase in the average age of entry into subsidised Aged Related Residential Care

Increase in percentage of

people who visit Emergency Department seen within six hours.

The Standardised Intervention Rates for Cardiac, Coronary angiography and Percutaneous Revascularisation to meet National expectations

• Improved access to Mental health services

Modules 2 and 3


Note: Throughout this document, reference is made to measures reported on to the Ministry of Health – see Appendix 7.1 Performance Measures 2015/16. These measures are prefaced with an alphanumeric code. For example, “PP6” refers to improving the health status of people with a severe mental illness.

Outcome One – People are supported to take greater responsibility for their health Expectation Population health and prevention programmes ensure people are better protected from harm, more informed of the signs and symptoms of ill health and supported to reduce risk behaviours and modify lifestyles in order to maintain good health. These programmes create health-promoting physical and social environments, which support people to take more responsibility for their own health and make healthier choices. Why is this outcome a priority? New Zealand is experiencing a growing prevalence of long-term conditions such as diabetes and cardiovascular disease, which are major causes of poor health and account for a significant number of presentations in primary care and admissions to hospital and specialist services. We are more likely to develop long-term conditions as we age, and with an ageing population, the burden of long-term conditions will increase. The World Health Organisation (WHO) estimates more than 70% of all health funding is spent on long-term conditions. Tobacco smoking, inactivity, poor nutrition and rising obesity rates are major and common contributors to a number of the most prevalent long-term conditions. These are avoidable risk factors, preventable through a supportive environment, improved awareness and personal responsibility for health and wellbeing. Supporting people to make healthy choices will enable our population to thrive and provide healthier communities.


1.8.1 Fewer People Smoke Why is this important? In this district we have approximately 24,000 smokers25 of which 10,000 (41%) are Māori. To achieve the Midland DHB’s aspirational smokefree status by 2025, more work will need to be done particularly in population groups with high smoking prevalence rates, such as, Māori, in order to drive down their rates and decrease their burden of disease. This will require continued combined efforts across government, schools, communities and families. How will we know we are succeeding? In order to have the greatest impact, ideally we will prevent people from taking up smoking in the first place, working our way through the continuum from prevention, to detection (identifying adults who smoke and offering them cessation advice – see Health Targets), and ultimately increasing the proportion of adults who do not smoke. Increasing the percentage of youth never smoking Our foremost opportunity to reduce the number of youth smokers is by increasing the proportion of ‘never smokers’ among Year 10 students.26 Reduction in smoking rates Nationally, New Zealand smoking rates are continuing to decline. Tobacco smoking kills an estimated 5,000 people in New Zealand every year, including deaths due to second hand smoke exposure. The BOPDHB’s current rate is approximately 300 per year.

Measure Baseline Target 14/15 Target 15/16

Increased % of Year 10 students never smoked 72.1%27 74.6% 76.6%

Decreased % people who identify as current smokers (based on our smoking prevalence data from our hospitalised patient admission data) 21% 17% 15%

25 Report available online: http://www.health.govt.nz/system/files/documents/publications/review-of-tobacco-control-services-nov14.docx 26 While the inclusion of pregnant women as a specific subset in the national Health Target will make a significant contribution, it will take two or more years before we can present historical trends. 27 Data as reported by ASH for Year 10 Survey 2013

71.7% 70.6%

71.8%

78.0%

73.9%

Bay of Plenty Lakes Tairawhiti Taranaki Waikato

Midlands Regional Comparison - Students aged 14-15 who have never smoked 2014

[Source: National Year 10 Action on Smoking and Health Snapshot Survey]

DHB Midlands

Figure 1 – ASH year 10 Smoking Survey

http://www.health.govt.nz/system/files/documents/publications/review-of-tobacco-control-services-nov14.docx

http://www.health.govt.nz/system/files/documents/publications/review-of-tobacco-control-services-nov14.docx


1.8.2 Reduction in vaccine preventable diseases Why is this important? Immunisation can prevent a number of diseases and is a very cost-effective health intervention. Immunisation provides protection not only for individuals, but for the whole population by reducing the incidence of diseases and preventing them from spreading to vulnerable people or population groups.

Population benefits only arise with high immunisation rates, and New Zealand’s current rates are low by international standards and insufficient to prevent or reduce the impact of preventable diseases such as measles or pertussis (whooping cough). These diseases are almost entirely preventable.

How will we know we are succeeding? There is a direct correlation between decreasing the incidence of communicable diseases and increasing our immunisation rates. We will succeed when we meet (or exceed) the Health Target28, for both Māori and non-Māori. See Health Targets – Module 3. Immunisation is also an indicator of children’s access to primary care.

Measure Baseline29 Target 14/15 Target 15/16

95% of eight month olds have completed their scheduled vaccinations (6 weeks, 3 months and 5 months) to be achieved in stages by the end of 2014)

87% 95% 95%

Measure 3 year average (2009-2012)

Baseline 11/12 Target 15/16

3 Year average Crude Rate per 100,000 of vaccine preventable diseases in hospitalised 0-14 year old 23.31 29.33 Decrease

28 National research indicates a direct co-relation between vaccine preventable diseases and immunisation. For this reason, we believe that immunisation is a good surrogate measure for this impact. 29 Baseline is based on the 2013/14 BOPDHB Annual Report

0

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Rate

per

100

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3 year average Crude Rate per 100,000 of vaccine preventable diseases in hospitalised 0-14 year old

Figure 2 - 3 Year average Crude Rate per 100,000 of vaccine preventable diseases in hospitalised 0-14 year old


1.8.3 Improving health behaviours Why is this important? An increasing focus will be placed on obesity by the BOPDHB as a measure to reduce the incidence and impact of long term conditions such as diabetes, cardiovascular disease and some cancers, as well as on maternal and child health. We have set a target of reducing childhood obesity by one-third over 10 years from 2013. While increasing physical activity and reducing “screen time” may contribute to reducing childhood obesity, the key to preventing childhood obesity is likely to be in reducing the intake of added sugars in the diet. Other factors that impact on childhood obesity are maternal nutrition, smoking in pregnancy, and breastfeeding, and these will also be a focus of public health activity. How will we know we are succeeding? By seeing an increase in fruit and vegetable consumption and a reduction in obesity, these are seen as proxy measures of successful health promotion and engagement and a change in the social and environmental factors that influence people to make healthier choices. Fewer obese30 people will result in a reduction in chronic conditions like CVD/Diabetes31.

Measure Baseline 13/14 Target 14/15 Target 15/16

Percentage of Obese of New Zealand 2-14 years population Total 10.8% 10.4 % 10.2% Māori 15.5% 15.0% 14.5%

Pacific 24.8% 24.0% 23.5%

Percentage of Obese of New Zealand 15+ years population Baseline 13/14 Target 14/15 Target 15/16

Total 29.9% 28.0 % 27.0%

Māori 45.5% 44.0% 43.0%

Pacific 66.7% 65.5% 64.0%

30 Obese is defined as a body mass index (BMI) of 30 or more (calculated by dividing a person’s weight in kilograms by the square of their height in metres). Survey interviewers measured respondents’ height and weight, from which BMI could be calculated. 31 Source: 2013/14 New Zealand Health Survey aged standardised rate from Ministry of Health synthetic results. Obesity is classed according to the World Health Organisation as a Body mass Index cutoff of >30 kg/m2.

0

10

20

30

40

50

60

70

80

Māori Pacific Total Māori Pacific Total

Obese (2–14 years) Obese (15+ years)

% O

bese

Obesity rates for child and adults across New Zealand as reported in the NZ Health Surveys

2006/07 2011/12 2012/13 2013/14

Figure 3- 2013/14 New Zealand Health Survey.


Outcome Two - People stay well in their homes and communities Expectation Primary and community services support people to stay well by providing earlier intervention, diagnostics and treatment leading to better management of their illness or long-term conditions. These services assist people to detect health conditions and risk factors earlier, making treatment and interventions easier and reducing the complications of injury and illness. They also support people to regain their functionality after illness and to remain healthy and independent. Why is this outcome a priority? For most people, their general practice team is their first point of contact with health services. Primary care can deliver services sooner and closer to home and prevent disease through education, screening, early detection and timely provision of treatment. Primary care is also vital as a point of continuity and effective coordination across the continuum of care, particularly in improving the management of care for people with long-term conditions. Supporting primary care is a range of other health professionals including midwives, community nurses, social workers, aged residential care providers, personal health providers and pharmacists. These providers have prevention and early intervention perspectives that link people with other health and social services and support them to stay well. Studies show countries with strong primary and community care systems have lower rates of death from heart disease, cancer and stroke, and achieve better health outcomes for lower cost than countries with systems that focus on specialist level care. With an ageing population, the Midland region will require a strong base of primary care and community support, including residential care, respite and home-based support. If long-term conditions are managed effectively, crises and deterioration can be reduced and health outcomes improved. Even where returning to full health is not possible, access to responsive, needs-based services helps people to maximise function with the least restriction and dependence. If people are well they need fewer hospital-level or long-stay interventions and, those who do, have a greater chance of returning to a state of good health or slowing the progression of disease. This is not only a better health outcome for our population, but it reduces the rate of acute and unplanned hospital admissions and frees up health resources.


1.8.4 Children and adolescents have better oral health Why is this important? Good oral health demonstrates early contact with health promotion and prevention services and reduced risk factors, such as poor diet, which has lasting benefits in terms of improved nutrition and healthier body weights. Oral health is also an integral component of lifelong health and impacts a person’s comfort in eating (and ability to maintain good nutrition in old age), self-esteem and quality of life. Māori children are three times more likely to have decayed, missing or filled teeth, and improved oral health is a proxy measure of equity of access and the effectiveness of mainstream services in targeting those most in need. While water fluoridation can significantly reduce tooth decay across all population groups, less than 9%32 of children in the Bay of Plenty have access to fluoridated water. How will we know we are succeeding? When the percentage of Bay of Plenty children (total and Māori) caries-free33 (no holes or fillings) at age 5 increases and the number of the mean decayed, missing and filled teeth (DMFT34) at year eight decreases. Data source – Ministry of Health proposals for setting 2013/14 oral health targets.

32BOP 0-4 population projection 2011/12 – 14,995 (0-4 years). Whakatane and Ohope towns on fluoridated water supply (0-4 years) 1,230 (8.5%). 33 Dental caries, also known as tooth decay or a cavity, is widely accepted as an infectious disease induced by diet, the lack of caries in children at 5 years is an early indication of lifelong good dental hygiene. 34 DMFT is a count of Decayed, Missing or Filled Teeth in permanent dentition (permanent teeth) in a person’s mouth. By Year 8, children’s teeth should be their permanent teeth and any damage at this stage is lifelong, so the lower a child’s DMFT, the more likely that their teeth will last a lifetime.

[5] Subject to Ministry of Health approval. [6] This information is reported annually for the school (calendar) year.

Measure Baseline

13/14 Target 14/15 Target 15/16[5]

Mean DMFT Year 8 [6] • Māori • All

<2.44 <1.74

1.6 1.6

<1.6 <1.6

-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Mean DMFT score at Year 8 (12 year olds) Midland Region Maori New Zealand Maori Midland Region All

New Zealand All Bay of Plenty Maori Bay of Plenty All

Figure 4- Mean Decayed Missing and Filled Teeth (DMFT) score at Year 8 from 2003 - 2013


1.8.5 Early detection of treatable conditions

Why is this important? If we are to empower people to take greater responsibility for their health, to improve the health of our population and if we are to ensure we are living within our means we have a significant opportunity by detecting conditions early. Early detection will lead to either successful treatment, or delay or reduce the need for secondary and specialist care, enabling more people to stay well in their homes and communities for longer. How will we know we are succeeding? Breast and cervical cancer statistics indicate early detection through screening greatly increases the chances of surviving breast35 or cervical36 cancer. Detection methods are improving, with predictive genetic diagnosis currently the ultimate in early detection. Survival rates are a reasonable indicator and regular pap tests and treatments such as Herceptin may help by reducing the risk of cancer after surgery if diagnosed early. Screening coverage Key to this picture is that it highlights the need to drive an emphasis on reducing the inequalities between Māori and non-Māori in the BOPDHB

Measure Baseline 13/1437 Target 15/16 Target 16/17

Increased rate for breast screening for eligible women aged 45-69 years with a 24 month period:

• Total • Māori

66% 54%

70% 70%

70% 70%

Measure Actual 10/11 Target 15/16 Target 16/17

Cervical Cancer Mortality in New Zealand – Aged standardised rate for NZ

• Total • Māori

1.7 3.2

Decrease Decrease

35 Breast Cancer Research Trust website – www.breastcancercure.org.nz. 36 National Cancer Institute website - www.cancer.gov/cancertopics/pdq/screening/cervical/Patient 37 Baseline 2013/14 was derived from the 2013/14 BOPDHB Annual Report

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1972

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1978

1981

1984

1987

1990

1993

1996

1999

2002

2005

2008

rate

per

100

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peo

ple

Cervical Cancer mortality in New Zealand All Maori

Figure 5- Female Cervical Cancer mortality in New Zealand 1948 to 2010. Ministry of Health. 2013. Cancer: New registrations and deaths 2010. Wellington: Ministry of Health. August 2013


1.8.6 Fewer people are admitted to hospital for avoidable conditions

Why is this important? There are a number of admissions to hospital for conditions which are seen as avoidable through appropriate early intervention and a reduction in risk factors. A reduction in these admissions will reflect better management and treatment of people across the whole system, will free up hospital resources for more complex and urgent cases and deliver on the Government’s priority of “Better, Sooner, More Convenient” healthcare. The key factor in reducing avoidable hospital admissions is through better integration between primary and secondary services.38 How will we know we are succeeding? When we reduce the ratio of actual to expected ambulatory sensitive hospitalisation (ASH) or avoidable hospital admissions for our population (Total and Māori). In the graph below, the green marker indicates annual improvement has been made, and the red markers are for an ASH rate that has deteriorated. We report the movement in ASH rate, with a positive number indicating our ASH rate has improved, and a negative figure in brackets meaning our ASH rate has declined during the period.

38 The DHB’s Population Health Advisory Group (POPAG) has prepared an HNA (health needs assessment) on cellulitis and skin infections in children. This is a major contributor to ASH admissions in the 0-4 age group. A series of recommendations have been adopted for implementation, including improving effectiveness of primary and community health services in preventing and managing skin infections in the community and the interface with secondary care.

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2009/10 2010/11 2011/12 2012/13 Year ended Sep2013

Age

Stan

dard

ised

per 1

00,0

00

Ambulatory Sensitive Hospitalisations (ASH) Rates per 100,000 (0-74 year olds)

Maori - National Other - National All - NationalMaori - Bay of Plenty DHB All - Bay of Plenty DHB Other - Bay of Plenty DHB

Figure 6- BOPDHB Rate of Ambulatory Sensitive Hospitalisations for 0-74yrs, and National Total,. Source: Ministry of Health.


Measure Baseline39 Target 15/16

Reduced ASH rates - SI1 0-4 years

• Māori • Total

154 123

111 111

45-64 years • Māori • Total

236 130

106 106

0-74 years • Māori • Total

192 118

111 111

1.8.7 People maintain functional independence

Why is this important? Our aim is to focus home and community support services into identifying when an older person is at risk and provide access to community rehabilitation, restorative home based support services and meaningful activities. This will ensure that older people are made aware of the benefits of remaining active, to making use of aids and equipment around the home and to encourage social participation. How will we know we are succeeding? The overall impact will be to prevent an increase in the percentage of older people requiring admission to residential care.

Measure Baseline 12/13 Target 14/15 Target 15/16 Average age to entry to Aged Related Residential Care40:

• Rest home • Dementia • Hospital

85.63 81.39 84.46

85.63 81.39 84.46

85.63 81.39 84.46

39 ASH Detail SI1 Report – v1.00 Year ended Sep-14 40 Data sourced from Client Claims Processing System (CCPS).

78 79 80 81 82 83 84 85 86 87

NZ Midland Bay ofPlenty



RESTHOME HOSPITAL DEMENTIA

Average Age at entry to ARRC

09/10

10/11

11/12

12/13

Figure 7 - Average age at entry to residential care facilities in each of the last 4 years for people under the Health of Older People funding stream.


Outcome Three - People receive timely and appropriate specialist care Expectation Secondary-level hospital and specialist services meet people’s complex health needs, are responsive to episodic events and support community-based care providers. By providing appropriate and timely access to high quality complex services, people’s health outcomes and quality of life can be improved. Why is this outcome a priority? Clinicians, in collaboration with patients and their families, make decisions concerning complex treatment and care. Not all decisions result in interventions to prolong life, but may focus on patient care such as pain management or palliative services to improve the quality of life. For those who do need a higher level of intervention, timely access to high quality complex care improves health outcomes by restoring functionality, slowing the progression of illness and disease and improving the quality of life. The timeliness and availability of complex treatment and care is crucial in supporting people to recover from illness and/or maximise their quality of life. Shorter waiting lists and wait times are also indicative of a well-functioning system that matches capacity with demand. This can be achieved by managing the flow of patients through services and reducing demand by moving the point of intervention earlier in the path of illness. As providers of hospital and specialist services, DHBs are operating under increasing demand and workforce pressures, and Government is concerned that patients wait too long for diagnostic tests, cancer treatment and elective surgery. The expectations around reducing waiting times, coupled with the current fiscal situation, mean DHBs need to develop innovative ways of treating more people and reducing waiting times with limited resources. This goal reflects the importance of ensuring that hospital and specialist services are sustainable and that the Midland region has the capacity to provide for the complex needs of its population now and into the future.


1.8.8 People are seen promptly for acute care Why is this important?

Long stays in Emergency Departments (ED) are linked to overcrowding of the ED, negative clinical outcomes and compromised standards of privacy and dignity for patients. Less time spent waiting and receiving treatment in an ED improves the health services DHBs are able to provide.

How will we know we are succeeding?

When we see an increase in the percentage of people who visit our ED are admitted, discharged or transferred within six hours.

Increased percentage of people who visit ED are seen within six hours

Improved performance against this measure will not only improve outcomes for our population, but will improve the public’s confidence in being able to access services when they need to. (See also Module 3 – Priorities and Targets).

75%

80%

85%

90%

95%

100%

Bay of Plenty Lakes Tairawhiti Taranaki Waikato National

Percentage of patients admitted, discharged or transferred from emergency departments within 6 hours

2009/10 2010/11 2011/12 2012/13 2013/14

Measure Baseline 13/14

Target 14/15 Target 15/16

Increase in the percentage of people who visit ED are seen within 6 hours 92% 95% 95%

Figure 8- Emergency Department Waiting Times


1.8.9 People have appropriate access to elective services

Why is this important? Elective41 services are an important part of the health system, as they improve a patient’s quality of life by reducing pain or discomfort and improving independence and wellbeing. The measure SI4 relates directly to intervention rates. Improved performance against this measure is also indicative of improved hospital productivity to ensure the most effective use of resources so that wait times can be minimised and year-on-year growth is achieved. How will we know we are succeeding? To meet the appropriate level of access, we want to ensure that our standard intervention rates (SIRs) for our elective specialties’ cardiac, percutaneous revascularisation, cataract, major joint replacement procedures and coronary angiography surgery meet national expectations; that we achieve the Electives Health Target for number of surgical discharges– SI4; that people wait no longer than 4 months for an assessment in 2015/2016; that all elective service performance indicators are met.

41 Defined as Elective and Arranged discharges from a surgical purchase unit; Elective and Arranged discharges with a surgical diagnosis-related group (DRG) from a non-surgical purchase unit (excluding maternity); and skin lesion or intraocular injections, where these are reported to the National Minimum Dataset.

Measure Baseline

13/14 Target 14/15 Target 15/16

Our SIRs meet national expectations (per 10,000) for: • Coronary angiography

29.57

34.7

34.7

• Percutaneous revascularisation 12.39 12.5 12.5 • Cardiac procedures (surgery) 6.73 6.5 6.5 • Major joint replacement 25.71 21.0 21.0 • Cataract procedures 21.31 27.0 27.0

Figure 9-Standardised discharge rates per 10,000 publicly funded Cardiac Surgery discharges for Patients


1.8.10 Improved access to mental health services Why is this important? It is estimated that at any one time, 20% of the New Zealand population will have a mental illness or addiction, and 3% are severely affected by mental illness. With high suicide rates in some of our communities, we are working to reduce this rate and support our communities with Whānau Ora initiatives (see Module 3). There is also a high prevalence of depression with the economic downturn and other pressures. The World Health Organisation (WHO) predicts that depression will be the second leading cause of disability by 2020. We have an ageing population, which places increased demand from people over 65 for mental health services appropriate to their life stage.

How will we know we are succeeding? By (1) improving access; and (2) reducing hospital readmissions. Access is the key to improving health status for people with a severe mental illness. We can reduce hospital readmissions by having a responsive community support system for people who have experienced an acute psychiatric episode requiring hospitalisation.

42 The latest figures we have for this indicator have been taken from the 2013/14 Annual Report

Measure Baseline 13/1442

Target 2015/16

Improving the health status of people with severe mental illness through improved access(≤19 years old) – PP6


6.35% 5.39%

6.5% 5.5%

Improving the health status of people with severe mental illness through improved access (20 – 64 years old) – PP6


5.48% 9.74%

9.7% 5.5%

Improving the health status of people with severe mental illness through improved access (65+ years old) – PP6


4.14% 3.34%

4.00% 3.45%

0%

5%

10%

15%

20%

25%

Bay of Plenty Lakes Tairawhiti Taranaki Waikato

28 day acute readmission rates - Mental Health

2009/10 2010/11 2011/12 2012/13 2013/14


1.8.11 More people with end stage conditions are supported

Why is this important? Early identification and recognition of end-of-life choices heavily influence the quality of life an individual experiences during the dying process. For people who have an end of life care need (whether due to cancer, non-cancer related disease or old age) it is important that they, their family/whānau are given choices, feel well supported and receive palliative care that meets their needs. Our focus is on ensuring that the patient is able to live comfortably, without undue pain or suffering. Early identification and recognition of end-of-life choices heavily influence the quality of life an individual experiences during the dying process. Rehabilitation and support services contribute to this impact. How will we know we are succeeding? Historically, the majority of specialist palliative care has been provided for people with cancer and end stage renal failure, but often not for people with other end stage conditions like COPD, heart failure and dementia. Increasing access for people with a broader range of end stage conditions requires a change to the model of care that is more flexible and dynamic, where specialist and generalist palliative care may be required at different stages of a patient’s journey. We will know we are succeeding by increasing the percentage of people that have end stage conditions other than cancer or renal failure, that access specialist palliative care. We will develop a system for capturing and measuring this information and service specifications for specialist palliative care.

Measure Baseline

13/14 Target 14/15 Target 15/16

Increased number of people accessing specialist palliative care 723 711 739


Kōwae Rua - Module Two: Delivering on Priorities and Targets

This module outlines the actions that will improve the performance of the health system in 2015/16 as well as how we will measure success. These actions highlight what the health system will be doing to give effect to the overarching goal of Better Sooner More Convenient Health Services for all New Zealanders. Sections of this module have been developed in collaboration with our primary care partners. Many of the actions highlighted in this module are infused with the themes of the IHS. The actions and measures presented in this module show:

• how we are implementing Government priorities • how we are contributing to the activities in the Midland

Region Service Plan, Toi Te Ora – Public Health Service Annual Plan 2015/16 and the Māori Health Plan

• how we plan to improve performance in terms of our local priorities.

Sections of this module have been developed in collaboration with key stakeholders both internal to the health sector and external. This helps us to ensure service planning is not done in silos. The methods we utilise include:

• an alliancing approach to service planning with our primary care partners

• active engagement of clinical leaders / champions • working with other DHBs from the Midland region • delivery of public and population health interventions, in

particular actions through Toi Te Ora – Public Health Service Annual Plan 2015/16

• a collaborative cross-sector approach to working with vulnerable children and their families where information, services, resources are coordinated and shared to improve outcomes

• working with NGOs and other Community Providers with a view to including them in alliance arrangements in the future

• utilising the expertise of community clinicians working across the service continuum with an educative and capacity building focus

• expanding implementation of clinical pathways via Map of Medicine and Bay Navigator both locally and regionally to promote clinical collaboration and consistency

• participating in the Social Sector Trials and Children’s teams work streams with cross agency partners.

The narrative and tables in this module are clustered into the following topics.

• Health Targets o Shorter Stays in Emergency Departments o Improved Access to Elective Surgery o Faster Cancer Treatment o Increased Immunisation o Better Help for Smokers to Quit o More Heart and Diabetes Checks


• Better Public Health Services o Reducing the incidence of Rheumatic Fever o Children’s Action Plan (CAP) o Prime Minister’s Youth Mental Health Project o Reduce the prevalence of Obesity o Healthy Families NZ o Social Sector Trials (SST)

• System Integration o Integrated Healthcare in the Bay of Plenty o Primary Care o Improving access to Diagnostics o Rising to the Challenge o Long Term Conditions o Diabetes Care Improvement Packages o Stroke o Cardiac – Secondary Services o Health of Older People o Whānau Ora o Maternal and Child Health

• Māori Health – Achieving Equity • National Entity Priority Initiatives • Living Within Our Means • Improving Quality • Actions to Support Regional Delivery of Regional Priorities • Spinal Cord Impairment Action Plan

For further performance measures on the Government’s priorities and the Health targets refer to Module 3 Statement of Performance Expectations and Module 7 Performance Measures.


2.1 Health Targets

2.1.1 Shorter Stays in Emergency Departments Our Approach

The growth in acute demand in our district can only be managed through initiatives focused across the whole of the health system, which include:

• working with primary care services to reduce demand for unplanned care such as our work with the Primary Health Organisations on Acute Demand Management

• integrated and improved long-term health conditions care and management across the health system

• efficient/effective utilisation of resource to match demand across the whole health system

• ensuring hospital flow, reducing gridlock and improving community based discharge services and rehabilitation for example, continued review and development of care pathways.

Linkages • Midland District Health Boards Regional Services Plan 2015/16 • Bay of Plenty IHS • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.6 Diabetes and Long Term Conditions • Module 2.6 Living Within Our Means • System Integration expectations and measures • OS 3 (inpatient length of stay) and OS 8 (acute readmissions)

Objective Actions to deliver improved performance Measured by Reporting requirements

Shorter Stays in Emergency Departments (ED)

We will continue to review streaming initiatives at both campuses (Tauranga and Whakatane). For example, the Admission Planning Unit (APU) will look to implement delirium screening to ensure that patients are held in the most appropriate unit. Also APU will be trialling Acute Clinics from 1 July 2015.

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

• Performance against the Health Target.

• Progress on specific actions

We will analyse and review rosters for all staff to meet forecast demands.

We will implement the Accredited Registrar Programme (ARP).

ARP will be a programme recognised by the Australasia College of Emergency Medicine.


Acute Demand Management Programme

Refer to all actions on the ADM programme in Module 2.3.2 Primary Care.

Accelerated Chest Pain Pathway

We will continue the introduction of Accelerated Chest Pain Pathways43 (ACPPs) in Emergency Departments which began in 2014/15.

Regional approach to a standardised ACCP to be agreed upon and rolled out across the region by 31 December 2015. See the Regional Services Plan for further information

ED Quality Framework

We will continue to implement the ED Quality Framework to monitor quality improvement, including measuring and responding to the mandatory measures (monthly or annually). We will implement the following non-mandatory measures within quarter one: (i) Time to ED completion (referral or discharge); (ii) Time from bed request to bed allocation; and (iii) Time from bed allocation to departure from ED to the bed. Then in quarter three we will learn from our findings and commence the identification of future non-mandatory measures to monitor. We will also continue to work with the National Emergency Department Group on the areas where data can be electronically generated and those where a manual process is necessary (majority relate to quarterly or year audits). The BOPDHB is committed to providing the appropriate data and working to minimise manual data collection.

The DHB is committed to report against all measurable data in the ED Quality Framework.

2.1.2 Improved Access to Elective Surgery Our Approach Managing patient length of stay is important in sustaining our elective service in terms of capacity. It is also important for good patient health outcomes; high length of stay is a quality issue and usually linked to high surgical infection rates.

Reducing length of stay is critical to providing an efficient service and making optimal use of our health budget. Linked to sustainable and efficient service delivery is reducing delays in delivering diagnostic services, (see Module 2.3.4 Improving Access to Diagnostics).

43 Accelerated Chest Pain Pathways (ACPPs) are patient assessment pathways that speed up the diagnostic process for patients with chest pain, without compromising patient safety. ACPPs have significant potential as diagnostic tools to improve patient outcomes and save time and resources in Emergency Departments.


We are working reg ionally with other Midland DHBs to identify opportunities for greater integration of elective services and purchasing appropriate regional volumes to allow for sustainable service improvement. Service improvement will be further supported by agreed regional referral pathways, functional clinical networks and consistently applied access criteria. Linkages

• Midland District Health Boards Regional Services Plan 2015/16 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.4 Improving Access to Diagnostics • Module 2.3.8 Cardiac – Secondary services

Objectives Actions to deliver improved performance Measured by Reporting Requirements

Improved access to Elective Surgery

We will complete the Elective Services Productivity and Workforce Programme Round Three: Management of General Surgery and Vascular Elective Surgery Stream Project.

• All elective general and vascular surgical patients will be seen within the 4 month timeframe

• All elective general and vascular surgical patients will have timely access to diagnostics

• Standard pathways for the top 3 DRG elective general and vascular surgical patients will be developed

• All elective general and vascular surgical patients will receive information that clearly outlines their treatment pathway

• All elective general and vascular surgical patients are admitted on day of surgery (unless specific exemption is made on clinical grounds)

• Preassessment processes for urgent and non-urgent elective general and vascular surgical patients are enhanced to support optimal patient preparation

Reporting will be on a quarterly basis

Volume of electives We will deliver elective services as per contracted volumes

100 per cent compliance with Elective performance indicators Number of inpatient surgical discharges under elective initiative (includes all elective discharges regardless of whether they are discharged from surgical or medical specialty) Target 10,136


Electives funding We will allocate electives funding in line with funding provided.

Standardised Intervention Rates (SIR)

We will use elective services standardised intervention rates and other factors such as demand analysis to inform decisions

Alignment to national SIR rates



around funding to support improved equity of access.

Patient flow management

We will work with each specialty to ensure production plans match resourced capacity within four month time frames.

Plans developed and implemented from 1 July 2015


Patient pathway prioritisation

We will treat patients in accordance with assigned priorities and waiting times. We will continue to use implemented national clinical prioritisation (CPAC) tools for Otolaryngology, Gynaecology and Bariatric Surgery. We will support the implementation of national CPAC tools for General Surgery, Orthopaedics and Ophthalmology.

CPAC tools will be implemented in line with Ministry timeframes


National Patient Flow System

We agree with the concepts and are committed to achieving the objectives for the National Patient Flow collection.

Implementation will be in line with Ministry timeframes unless an extension has been negotiated and agreed.


2.1.3 Shorter waits for Cancer treatment - Faster Cancer Treatment

Our Approach The Bay of Plenty is a provider of cancer services with the commissioning of the Kathleen Kilgour Centre (KKC) in October 2014. The KKC provides a state-of-the-art facility offering services and support to people in the Bay of Plenty and beyond. It provides both public and privately funded patients with a caring and safe environment that utilises world-class radiation technology and expertise. It is also part of a network of Cancer Services across the Midland DHBs. The Regional Cancer Centre, located at Waikato Hospital, Hamilton comprises an inpatient ward, day care and chemotherapy suite, outpatient department, and radiation treatment facility. Cancer control planning and service improvement is complex involving multiple organisations, services and stakeholders. The Midland Cancer Network is a managed service network working alongside Midland DHBs and other constituent organisations to implement the prioritised national work programme and identified regional initiatives. The infrastructure to support the work programme is a Midland Cancer Network Executive Group that provides leadership and oversees the work programme. Working alongside the work programme is a Midland Cancer Network Consumer/Carer Work Group and the Midland Hei Pā Harakeke (Māori Cancer Work Group). The majority of the network’s resource is dedicated to supporting regional tumour and service improvement work groups. BOPDHB sub-groups are linked into the regional work programme. Clinical Leadership is seen as a key enabler of the work programme. The work groups are chaired by a clinician or person outside of the network management team with the focus being clinical frameworks/pathways, service planning and quality improvement. Linkages • Our Performance Story Impact: People receive timely and

appropriate specialist care • Midland District Health Boards Regional Services Plan 2015/16 • Module 2.3.1 Integrated Health in the Bay of Plenty


Faster Cancer Treatment (FCT)

• We will review patient pathways and identify key barriers to target achievement and manage through the FCT project management team.

• We will work with Primary Care to identify and implement tumour stream specific e – Referrals.

• We will identify High Suspicion of Cancer referrals to Radiology.

• We will work alongside regional cancer network to ensure tumour stream analysis and implementation.

• Improved performance against the Faster cancer treatment health target – 85% of patients receive their first treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016.

Reporting against these measures will occur as part of the quarterly reporting to the Ministry



We will work with external providers (Venturo & KKC) to ensure FCT data is provided in a timely manner in the required format. We will continue to work with the regional cancer network to ensure receipt of tertiary data specifying treatment details are received in a timely manner and entered into the regional database. We will support the implementation of the Cancer Health Information Strategy when it is finalised.

• Improvements in the number of records being submitted to reduce the number of records being declined for the policy priority (PP30) faster cancer treatment indicators.

• Improved or maintained performance against the policy priority (PP30) faster cancer treatment indicators: o 31 day indicator – < 10 % of

the records submitted by the DHB are declined.

o 100% - Shorter waits for cancer treatment (the previous health target) – all patients, ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy

• Monitor through policy priority (PP24) improving waiting times – cancer multidisciplinary meetings improvements to the coverage and functionality of multidisciplinary meetings.

• Monitor through service improvement fund contract reporting.

• Appropriate clinicians such as urologists and radiation oncologists receive the guidance on the use of active surveillance treatment for prostate cancer.

We will recruit to those positions identified in the services plan (social worker and psychological support).

Progress against actions will reported quarterly

Improving quality of data and data collection

We will continue to work with the regional data group. For further information please refer to the RSP.

Implementing tumour standard review findings

We will continue to work alongside the regional cancer network to ensure tumour stream analysis and implementation.

Support the implementation of Budget 2014

We will continue with actions required to ensure the sustainability of the Faster Cancer Diagnostic Certainty Project outcomes.

Reporting against these measures will occur as part of the quarterly reporting to the Ministry Progress against actions will reported quarterly

We are committed to implementing the supportive care services for cancer patients as part of the strategy outlined in the Midlands Psychological and Social Support Services Plan 2015-18.

Implement the guidelines of the use of active surveillance treatment for prostate cancer44

Awaiting further guidance

Care pathways and MDM proformas are updated to include the guidance on the use of active surveillance treatment for prostate cancer.

Timeliness and quality of care of the cancer pathway

We will continue to monitor and report on timeliness indicators on a monthly basis to the Ministry. If there are variances, we will develop actions plans as appropriate.

Three tumour streams – Lung, Lower GI and Gynaecology have been reviewed regionally against the National Standards. Action plans in place to support improvement across services

We will continue to work alongside the regional cancer network to ensure tumour stream analysis and implementation.

44 Guidance on the use of active surveillance for men with low grade prostate cancer is being developed. Further information about active surveillance and the guidance will be provided to DHBs and clinicians providing prostate cancer care



We will continue to apply the Equity of Health Care For Maori: A framework resource as one of the underpinning frameworks with all cancer patient pathway.

Round one funding

We will complete the FCT Diagnostic Certainty Project by 30 June 2015. From 1 July we will undertake a review of how this service can be rolled out further.

Monitor through service improvement fund contract reporting.

Improved functionality and coverage of multidisciplinary meetings (MDMs)

The MDM workgroup has been put in place to develop strategic action and support policy priority PP24. The workgroup is aligned with regionally agreed MDM priorities, and part of its primary role is to work with the tumour streams to identify core barriers. We are an active member of the Midland regional cancer network and contribute to and support the MDM implementation plan.

Monitor through policy priority (PP24) improving waiting times – cancer multidisciplinary meetings improvements to the coverage and functionality of multidisciplinary meetings.

Māori Health Plan actions

Breast screening rates (50-69 years)

We will identify GP practices within BOPDHB with the highest Māori enrolments and lowest enrolment and/or screening rates (i.e eligible women not screened or under-screened) and aim to increase these by providing dedicated resources i.e. champions. Breastscreen Midland (BSM) GP data coordinator to identify practices by data match reports.

Screening rates for Māori women (50-69 years) in BOPDHB will have reached the national target of 70%. Numbers of Māori women who booked an appointment as a result of additional input eg an outward bound telephone call.

Progress against actions will reported quarterly

EBPHA will work with Breast Screen Midland (BSM), East Bay Radiology, Te Puna Ora o Mataatua, Whakatohea Health & Social Services and other key stakeholders to improve breast screening appointments and service delivery in the Eastern Bay of Plenty.

Screening rates for Māori women (50-69 years) in BOPDHB will have reached the national target of 70%. Increase in breast screening rates in EBOP

Independent Service Providers (ISPs) will increase participation in mobile breast screening units. Involvement in the enrolment of women, booking of appointments and providing support to service is likely to increase participation due to ISPs connectedness to their communities. Key activities to increase participation specifically in the Opotiki region will be:

● ISPs to be actively involved in key stakeholder meeting at least 3 months before mobile visit.

● Mobile Support Guidelines to be followed – pre, during and post mobile (meetings, awareness, resources, evaluation, post mobile report)

● Promotion of breast screening through media campaign, advertising, BSA resources.

Screening rates for Māori women (50-69 years) in BOPDHB will have reached the national target of 70%. Use of mobile unit is optimised and an increase in screening from the previous mobile screening round

We will support collaborative working relationships between providers across the breast screening pathway by meeting every six months with relevant regional stakeholders. The stakeholders include Breast Screen Midland, PHO’s, Radiology Provider, Independent Service Providers, and representatives from neighbouring DHBs. Standard agenda items include update on Midland screening coverage rates, progress against the Midland Breast Screening Regional Plan, the mobile screening unit schedule, issues and challenges, successes and an update from stakeholders.

Screening rates for Māori women (50-69 years) in BOPDHB will have reached the national target of 70%. Two regional hui held per annum and outcomes reported in NSU six-monthly reports.

We will monitor performance on a monthly basis within Screening performance is monitored



the BOPDHB Māori Health Planning and Funding team. Monitor screening performance on a quarterly basis through the MHSG.

monthly and quarterly and key actions to lift performance are identified.

Cervical screening rates (25-69 years)

We will identify six GP practices (three in WBoP and three in EBoP) within BOPDHB who have a high eligible Māori population that have not been screened or under screened (not screened in the last 5 years) and aim to increase these by providing dedicated resource i.e. champions to contact these women and book them for a cervical smear.

Cervical screening rates for Māori women will have reached the national target of 80%. Numbers of Māori women who booked an appointment because of additional input eg an outward bound telephone call.

We will develop and circulate a clear set of instructions for each General Practice manager on how its Practice Management System MedTech32 should be set up so that the correct ethnicity is captured on the MedTech lab form.

Every GP clinic is circulated the information on how to capture ethnicity correctly for a cervical screening smear test.

EBPHA will work collaboratively with the Independent Service Provider- Te Puna Ora o Mataatua (TPOOM) to establish an effective e-referral process throughout the eastern Bay of Plenty.

Cervical screening rates for Māori women will have reached the national target of 80%. Number of eligible Māori women who were referred and completed a cervical smear.

Nga Matapuna Oranga PHO will implement a cervical screening project based on a successful Hawkes Bay DHB model - Taku Wahine Puroto, entailing provision of outreach and after hours cervical screening services. Eligible women will also be encouraged to enrol and book a breast screening appointment at the time of screening.

Cervical screening rates for Māori women will have reached the national target of 80%. Number of women screened as a direct result of the project.

We will implement strategies as developed by the DHB Action Group (Colposcopy, ISPs, PHOs, Toi te Ora, BOPDHB Māori Health Plan Champion) to reduce number of colposcopy clinic DNAs for assessment and treatment. Strategies developed will aim to improve the timeliness and experience of colposcopy for Māori women.

Cervical screening rates for Māori women will have reached the national target of 80%. Reduction in DNA rates.

We will support collaborative working relationships between providers across the cervical screening pathway. Toi Te Ora will hold two regional hui per annum with Independent Service Providers, PHOs, Colposcopy Services and Planning and Funding portfolio managers to review progress against the BOP/Lakes Regional Cervical Screening Plan and consider new initiatives. DHB action group hui are held within the Bay of Plenty and Lakes districts to review progress, provide advice and assist resolution of any issues. Each action group includes Toi Te Ora, Independent Service Providers, PHOs, Colposcopy and Planning and Funding.

Cervical screening rates for Māori women will have reached the national target of 80%. Two regional hui held per annum and outcomes reported in NSU six monthly reports. Three DHB Action Group hui held per annum and outcomes reported in NSU six monthly reports.


2.1.4 Increased Immunisations Our Approach

During 2015/16, we will continue our focus on increasing immunisation in our district. There are many stakeholders from across the sector whose individual work forms part of the ‘greater whole’ in terms of the approach to supporting children in this district. We are committed to working collaboratively on improving immunisation. The following groups and linkages are utilised by the DHB to improve vaccination coverage:

1. BOP Immunisation Advisory Group (BOPIAG). This steering group has oversight of all immunisation matters in the BOP. It provides advice to the CEO through Planning and Funding on strategic direction and planning of immunisation services, surveillance of vaccine-preventable diseases, and monitoring of vaccination performance across the life course under Terms of Reference last reviewed in 2013. The Immunisation Advisory Group works toward achieving its Strategic Plan 2013-2018, with a membership made up of representatives from:

• Planning and Funding • Maori Health Planning and Funding • Toi Te Ora-Public Health • BOPDHB Community Child and Youth Health Services • NIR team • All PHOs • BOP Immunisation Facilitator • BOPDHB Midwife Leader • Maori Women’s Welfare League (MWWL) • Plunket Society • Immunisation Advisory Centre (IMAC) • Asthma and Respiratory Management BOP.

This group meets quarterly. There is also a separate BOP Influenza Group, which plans and monitors actions for the annual influenza campaign, and reports to BOPIAG during autumn/winter.

2. Western and Eastern BOP Immunisation Forums. These are

operational groups who meet monthly with membership from local PHOs, Outreach Immunisation Services (OIS), National Immunisation Register (NIR), Lead Maternity Carer (LMC), IMAC, MWWL, Immunisation Facilitator, Public Health Nurses.

3. NIR Operational Group. This group meets quarterly and

focuses on examining the data required to meet targets. Membership includes Immunisation Coordinators, Immunisation Facilitator, Toi Te Ora - Public Health Service and NIR.

4. Immunisation Health Target Forum. This group meets monthly

and focuses on target performance at the senior management level. Membership includes CEOs of the three PHOs, GM


Planning and Funding, GM Maori Health Planning and Funding, and Portfolio Managers in Planning and Funding.

BOPDHB and PHO staff also attend national and Midland regional immunisation teleconferences.

The utilisation of appropriate data and direct engagement across PHOs continues to be primary opportunities for engagement and encouragement to work towards ongoing achievement of the Health Target.

The DHB continually seeks to identify new options to re-energise this area of activity to maximise every opportunity to increase performance and build a platform for sustained performance.

We will be working with our primary care partners to make progress against this priority.

Linkages

• Māori Health Plan 15/16 • Child and Youth Strategy • Our Performance Story Impact: People take greater

responsibility for their health • Better Public Services: Children’s Action Plan • Module 2.3.1 Integrated Healthcare in the Bay of

Plenty • Module 2.3.2 Primary Care • Module 2.4 Māori Health – Achieving Equity • Module 2.3.11 Maternal and Child Health

Objectives Actions to deliver improved performance

Measured by: Reporting

Requirements

Maintain infants fully immunised by six weeks, three months and five months

Primary Care, facilitated through our three Primary Health Organisations (PHOs), will take a leadership role in the drive to improve our performance against this national Health Target. BOPDHB will provide agreed resourcing and system supports as necessary to assist in achieving fully immunised, on time, every time, outcomes for our target populations. Activities will include:

• re-orienting the service provider focus from eligible children being fully immunised by 8 months to having completed all three immunisations (6 week, 3 months and 5 months) by 6 months

• continually review and adopt new and alternative processes that ensure timely, accurate and appropriate data is made available across our provider networks via the National Immunisation Register and our local NIR Operational Working Group.

• build on our media campaigns, utilising local immunisation champions that focus getting the right messages to the various target audiences across the BOP and improving health literacy in line with initiatives under our IHS

• progress a regional forum of those contributing to the provision of immunisation services across the BOP to review the current systems and processes

This will be measured by NIR through Datamart reports at 6 months. 95% of infants will be fully immunised by 8 months of age

Progress against these actions will provided on a quarterly basis


to ensure they remain fit for purpose. This work will build off the outcomes of the national review of Outreach Immunisation Services (OIS) facilitated through the MOH

• strengthen existing OIS referral guidelines and adherence to same across general practice

• continue to strengthen existing and develop additional opportunistic immunisation capability within our Emergency and Outpatient Departments and Paediatric Wards to maximise every opportunity to achieve fully immunised status for children presenting through; increased liaison between our primary immunisation teams and secondary care staff; progress initiatives to develop immunisation champions within our Emergency Departments through provision of vaccinator training and regular liaison between the NIR Operational Working Group and key secondary personnel.

• continue to participate in local, regional and national forums that support demonstration of best practice, sharing of information and peer review and support

• explore opportunities for implementation of Multi-disciplinary Teams (MDT) within the primary/community setting to ensure effective utilisation of all existing resources in the identification and timely immunisation of eligible children

• develop and implement a Memorandum of Understanding (MOU) with central Government agencies as appropriate (MSD initially) to support appropriate data matching and information share to assist in locating eligible children for the purposes of achieving fully immunised status.

This will measured by NIR through Datamart reports at 6 months. 95% of infants will be fully immunised by 8 months of age

Increasing children’s immunisations for two years and five years

Achievement against this Clinical Indicator will largely be reflected in our success in achieving the 8 month immunisation target. Systems and processes set out within the 8 month immunisation activities will also be utilised to support achievement against these outcomes. Additionally, we will seek to:

• identify opportunities that support greater liaison and integration between community-based providers to maximise opportunistic immunisation outcomes. These include; Well Child/Tamariki Ora providers and Kohanga Reo centres

• identify how existing service models may be enhanced to better meet the needs of families including; provision of in-home immunisation services and improving access to facility-based immunisation services outside normal business hours.

95% of infants will be fully immunised

Progress against these actions will provided on a quarterly basis

Increasing Human Papilloma Virus (HPV) immunisation rates

We will increase parent education on the benefits and safety of HPV vaccination, including use of online learning tools and videos available nationally.

65% of eligible girls are fully immunised with three doses of HPV vaccine (Gardasil)

Progress against these actions will provided on a quarterly basis We will increase follow-up with GPs where parents have

indicated preference for GP rather than school-based vaccination.

Seasonal Influenza See Māori Health Plan actions below for additional


information.

Māori Health Plan Actions

Percentage of infants fully immunised by eight months of age

We will provide funding to support a media campaign promoting immunisation through utilisation of key clinical and other appropriate Immunisation champions, targeting specific community groups, ensuring key messages are heard.

95% of infants will be fully immunised by eight months of age

Reporting to the Ministry will be on a quarterly basis

We will convene a Bay of Plenty Immunisation Provider’s Forum to reassess effectiveness of existing strategies, identify areas where performance could be improved and progress opportunities to address specific areas of concern. We will reorient our focus of efforts from actual 8 month achievement against the Health Target to that of achieving fully immunised status for children by 6 months as an opportunity to influence attitudes and behaviours of parents/carers in respect to immunisation. We will participate in local, regional and national forums that focus overall immunisation health target performance and information-sharing to support systems and service improvement where appropriate. We will monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning immunisation champion. Monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group.

Seasonal influenza immunisation rates (65 years and over)

Koroua/kuia health service providers will facilitate higher immunisation rates by:

• Facilitating education on the seasonal influenza vaccination for group attendees using IMAC-trained educators from the Māori Women’s Welfare League;

• Providing free vaccination to group attendees using accredited local vaccinators.

In parallel the three PHOs within BOPDHB will track vaccination rates by ethnicity and clinic to focus performance improvement for this indicator. This information will be monitored by the indicator champion.

Number of education sessions delivered as a proportion of kuia and kaumatua groups funded by BOPDHB.

Reporting to the Ministry will be on a quarterly basis

A health education resource in te reo is prepared locally and used across all settings appropriate for Maori aged 65+ (there is no national resource in te reo). Experience has shown that Maori, particularly older Maori, prefer receiving health information in their own language and context. Feedback to be provided by educators on acceptability by Māori and whether it leads to increased vaccination rates, particularly amongst those who are vaccinated for the first time.

All Maori Women’s Welfare League branches in the BOPDHB district are supported to promote influenza vaccination to Maori 65+ in their communities by receiving initial training and resources on influenza and the vaccine. Training to be provided by IMAC personnel in March/April 2015, who will report on training attendances. Impact measured by vaccinations delivered.

75% of Māori in the eligible population will have received the seasonal influenza vaccination in the period January to July 2015.

We will monitor immunisation performance on a monthly basis within the BOPDHB Māori Health Planning


and Funding team and via the BOPDHB Funding and Planning immunisation champion. We will monitor immunisation performance on a quarterly basis through the Māori Health Plan Steering Group. Planning and Funding will work with local PHOs to identify clinics willing to participate in a pilot project in early 2016 to test improved identification and recall systems/procedures for Māori clients within general practice for influenza immunisation. THE DHB will aim to work with clinics with a high proportion of Māori in the eligible age group. BOPDHB’s Māori Health Planning and Funding Team will use the vaccination rates and PHO/clinic performance results from 2015 to plan more effective interventions for implementation in general practice in 2016. The interventions listed above will lead to better outcomes and reduced disparities by 1) increasing access to influenza vaccination in the Māori community, 2) improving the identification and recall of the eligible population in clinics with high Māori populations.

2.1.5 Better help for Smokers to Quit Our Approach

Our children and tamariki need to grow up free of the risk of becoming addicted to tobacco and the effects of second-hand smoke. For 2015/16, we are committing further investment into shifting more services closer to home and having more of the coordination role of the tobacco control sector situated in primary care. The allocation of funding for 2015/16 reflects the need to maintain achievement of Primary Health Targets; better integrate primary and secondary smokefree outcomes; and contribute towards the wider Government goal of achieving Smokefree Aotearoa 2025. We meet regularly with our primary care partners and share information about the health target as well as monitoring actual performance against planned performance. Our Tobacco Control Advisory Group (TCAG) alongside the DHB consists of our key stakeholders including our PHOs, Aukati Kaipaipa Providers and Toi Te Ora Public Health Service. Our Tobacco Control Plan for the district is being reviewed and will have a stronger community and primary care lens. Our local Western Bay of Plenty and Eastern Bay of Plenty Smokefree Coalitions remain to provide community support and health promotion activity to denormalise smoking in our communities. We are active participants in the regional smokefree network and will be implementing the actions from our current Midland Region Tobacco Control Smokefree 2025 Plan.


Our focus on smoking during pregnancy is part of our Maternity Quality and Safety (MQSP) programme and the Well Child Tamariki Ora (WCTO) Quality Improvement Framework (QIF) measure for smoking status at two weeks postpartum. Linkages

• Health Target – Better Help for Smokers to Quit • Māori Health Plan 15/16 • Minister’s Letter of Expectations • Our Performance Story Impact: People stay well in their

homes and communities • Our Performance Story Impact: People receive timely and

appropriate specialist care • Toi Te Ora Public Health Service plan – Goal 3: To reduce the

proportion of Year 10 students smoking by 2/3 in five years • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.4 Māori Health – Achieving Equity • Module 2.3.11 Maternal and Child Health

Objectives Actions to deliver improved performance Measured by Reporting requirements

Embedded routine care of ABC’s in the hospital setting

We will ensure that the better help for smokers to quit health target is embedded in hospitals’ routine care pathways. In particular we will: • provide monthly reports to ward/department

managers on their health target performance. 'Failure to Document' reports will continue to be sent to clinicians who miss opportunities to carry out ABCs in hospital settings

• ensure that 100% of clinical staff who assess and record smoking status and ABCs, and refer to cessation providers have completed a current on-line form of ABC training, either through the national providers or via Midland DHBs shared Moodle e-learning platform

• require that before all patients are discharged, a pre-discharge checklist will be completed including that smoking status and ABCs are recorded, and referrals made to smoking cessation providers

• improve the referral process and pathway for hospitalised Māori smokers to cessation services (Refer to Midland RSP).

• 95% of patients who smoke and are seen by a health practitioner in public hospitals will be offered brief advice and support to quit smoking.

• By 2025, less than 5 % of the DHB’s population will be a current smoker.

• Uptake of e-learning programme for ABC delivery in secondary care by new staff is monitored, with 80% of relevant new DHB staff completing training within first three months.

• Work towards 95% of hospitalised Māori smokers being offered NRT as part of ABC process, and 80% of hospitalised Māori smokers being appropriately referred to a cessation service.

• Both hospitals’ ED services have mandatory reporting in electronic discharge summaries by 1 July and ongoing.


We will continue the Smokefree Hospitals programme and extending it to all patient service areas including community-based services.

Providing NRT to secondary patients

We will provide effective Nicotine Replacement Therapy during all smoking patients’ admission to encourage maintaining smokefree status post-discharge. Aukati Kaipaipa service to visit Tauranga Hospital wards twice weekly to provide smoking cessation support while in hospital, and provide effective and timely cessation continuation services post-discharge.



• Work towards 95% of hospitalised Māori



smokers being offered NRT as part of ABC process, and 80% of hospitalised Māori smokers being appropriately referred to a cessation service.

Increased ABCs’ in Primary Care

We will increase access to culturally appropriate training and training aimed at specific populations for the entire smoking cessation workforce to enable greater reach to Priority Populations.

• 90% of patients who smoke and are seen by a health practitioner in primary care will be offered brief advice and support to quit smoking.


• Relevant practice staff are trained and supported by PHO smokefree champions to use audit and prompting tools by 30 September 2015.


During the transitional year in 2015/16 for the Ministry’s realignment of smoking cessation services, we will explore shifting of services and associated funding to those service models that have the greatest reach into priority populations, and the best quitting rates.

• Increased successful quit attempts at three months through funded smoking cessation services.

We will provide ABC Training to all clinical staff in poor performing wards/departments in Tauranga and Whakatane Hospitals to give them confidence to undertake and report accurately smoking status, provide brief advice and support cessation referrals.



• Relevant practice staff are trained and supported by PHO smokefree champions to use audit and prompting tools by 30 September 2015.

Supporting our community

We will increase engagement with national smokefree programmes and events sponsored by Smokefree Auahi Kore e.g. Stoptober, WERO, Smokefree Rockquest, WSFD, Healthy Families NZ. We will increase engagement with local events to promote smokefree behaviours and quitting e.g. AIMS Games, kapa haka events, Well Child expos.

• More normalisation of smokefree environments and greater opportunities and support for smokers to quit.

Increased ABCs’ for pregnant women

We will enhance existing programmes to promote quitting for pregnant women, and parents of children under five. We will increase engagement with LMCs through the Healthy Pregnancies programme to address smoking in pregnancy. We will offer 100% of hospital midwives and LMCs with ABC training that is specific to pregnant women.

Increased smoking cessation services for priority populations through settings such as ECE, Kohanga reo. 90 % of pregnant women (who identify as smokers at confirmation of pregnancy in general practice or booking with a Lead Maternity Carer) will be offered advice and support to quit smoking.

Reporting will be on a quarterly basis We are working intrasectorally with a number of

providers to deliver a Healthy Pregnancies project. Amongst a number of public health outcomes sought, the reduction of smoking in pregnancy is key. A number of short and long term outcomes can be achieved through this component of the project including:

• reduction in numbers of low birth weight babies

• reduction in complications during pregnancy

90 % of pregnant women (who identify as smokers at confirmation of pregnancy in general practice or booking with a Lead Maternity Carer) will be offered advice and support to quit smoking.


• reduction in respiratory infections in infants, a major contributor to 0-4 ASH rates and Māori inequities

• prevention of SUDI • reduction in child obesity.

We will deliver the smokefree pregnancy component of the Healthy Pregnancies project.

Social environments and Smokefree Councils

We will review and update the current Tobacco Control Plan to reflect national, regional and district drivers, priorities, plans and targets. Actions will focus on those activities at a district level that will advance society towards a Smokefree Midland and Smokefree Aotearoa by 2025. All five BOPDHB district councils have a smokefree open spaces policy. We will take opportunities to advocate for more open spaces in Council policy.

• BOPDHB Tobacco Control Plan reviewed and updated by 1 July 2015, with copy forwarded to Ministry of Health.


• The prevalence of Māori smokers is reduced to 18% by 2018.

• A calendar of district wide rangatahi events is drawn up by the western and eastern BOP Smokefree Coalitions by 1 July 2015.

• A comprehensive Smokefree Tupeka Kore promotions and awareness campaign implemented for each event.


We will require, as part of the contractual process, that all BOPDHB contracted health providers must have internal policies to prevent harm to non-smoking visitors and clients of their service from second-hand smoke.

We will support Kohanga Reo, early childhood centres and Kura to adopt the Tupeka Kore (tobacco free) philosophy as tikanga (best practice). (Refer to Midland RSP).

• The prevalence of Māori smokers is reduced to 18% by 2018.

• A framework to competently engage with Kohanga Reo, early childhood centres and Kura is in place by 30 June 2015.

Midland Smokefree 2020

We will work with our Midland partners on a time-framed programme to address smoking cessation for mental health and maternity clients. This would require additional dedicated smokefree coordinator hours within mental health in particular.

Increased cessation attempts in Mental Health and Maternity.

We will explore the options for developing better integration, networking, coordination and support for Bay of Plenty tobacco control planning, funding and services, perhaps in conjunction with Lakes DHB and/or all Midland DHBs.

Improved cost efficiencies and better service integration.


E-referral pathways

We will ensure that effective referral processes, preferably e-referral, are in place for Māori smokers wishing to quit post-discharge to Aukati Kaipaipa, Quitline and general practice –based specialist smoking cessation services.




• E-referral pathways have been implemented

Better coordination and collaboration of the sector

We will consolidate the BOP Tobacco Control Coordination service, established in March 2015, to deliver contracted outcomes. We will ensure effective referral systems are in place between all referrers and smoking cessation services. We will reinstate the BOP Tobacco Steering Group with all key providers required to drive BOP Tobacco Control




Plan 2015-2017 to achieve Smokefree Aotearoa 2025 and equity between Māori and non-Māori.


Supporting innovation

We will develop innovative solutions to improve quit rates amongst Māori smokers undergoing BOP-based smoking cessation programmes. We will make greater use of larger scale smoking cessation programmes such as Group-Based Therapy, WERO Challenge, Stoptober, and World Smokefree Month in May to reduce smoking rates amongst Māori and make referrals more meaningful for both patients and referrers.

Ongoing monitoring

We will monitor performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. We will monitor screening performance on a quarterly basis through the Māori Health Plan Steering Group.


Smoking cessation in pregnancy

By 30 September 2015, we will enhance referral processes and increase referral volumes from LMCs, DHB Maternity Services, Whanau Ora, Well Child Tamariki Ora (WCTO) services, community dentists etc to specialist smoking cessation providers such as Quitline, Aukati Kaipaipa, or PHO/General Practice services. Agency responsible: BOP Tobacco Control Coordination Service.





We will continue to offer Innovate-provided smokefree training to LMCs and DHB midwives in BOP. Agency responsible: BOP Maternity Services.

We will deliver ABC to pregnant women and young mothers at first registration with a midwife, two weeks post-partum and at 5 months well child check as these are trigger points where Maori women may be conducive/vulnerable to changes in smoking status. Agencies responsible: LMCs/GPs and WCTO providers. We will ensure that specialist smoking services for Maori pregnant women and young mothers offer smoking cessation services to partners and other whanau as well as the woman. Agencies responsible: All smoking cessation specialist services. We will consider carrying out ABC process at second and third notification appointments through DHB or private radiology services. Agency responsible: Planning and Funding, BOPDHB. We will monitor smoking cessation advice provision performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. Monitor smoking cessation advice provision and smokefree rates at two weeks postnatal on a quarterly basis through the Māori Health Plan Steering Group.


2.1.6 More Heart and Diabetes Checks Our Approach We will continue to work with our primary care partners to reduce the impact of cardiovascular disease and diabetes. Our primary care partners are leading the development of a Diabetes Care Improvement Package (DCIP) to improve the health outcomes for the people in their populations with diabetes. We will work with our PHO’s and the Ministry of Health to continue delivering Green Prescription (GRx) programmes with greater linkages with Cardio Vascular Disease Risk Assessment (CVDRA) Health Target interventions and Diabetes Self Care Management Programmes. The focus will be on High Needs populations. There will also be linkages with smoking cessation activity. Linkages

• Minister’s Letter of Expectations • Health Target – More Heart and Diabetes Checks • Māori Health Plan • Section developed and agreed with our primary care

partners • Our Performance Story Impact: People stay well in their

homes and communities • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.4 Māori Health – Achieving Equity



More heart and Diabetes Checks

Achievement against this National Health Target will be led by our Primary Care partners. To support this activity, we will contribute to maintaining and strengthening current capacity and capability within primary care through:

• continuing provision of agreed resourcing within our Long Term Conditions Service Agreement

• on-flowing dedicated MoH funding to PHOs, provided to assist in resourcing general practice activities associated with increasing performance

• maintaining the focus on CVD risk management through driving an expected 3% reduction in the number of patients assessed as having a CVD risk greater than 15%

• strengthening health promotion capability within primary care to improve patient awareness and promote improve health literacy across communities

• promoting referral and public awareness of self-management groups

• evaluating the effectiveness of existing service initiatives and enablers to ensure maximum benefits and patient outcomes are being achieved, including use of the Telehealth initiative operating within the BOP

• continuing the acquisition/provision of system enablers for general practice including the existing enhanced range of IT resources (BPAC and Dr Info) to ensure:

o effective patient status reporting is available at a practice-level (BPI)

o alert mechanisms exist to support timely assessments (Patient Prompt)

o effective decision-support tools exist in the management of those patients identified as being at risk (Common Form)

o effective audit tools are being utilised to provide system integrity confidence (Dr Info).

• supporting activities through our PHOs to drive improvement in IS resources to ensure accuracy of data capture and reporting of actual performance.

90% of the eligible population will have had their cardiovascular risk assessed in the last five years. Evaluation to be completed by March 2016 Improved health literacy Increased health promotion and awareness Improved data integrity


EBPHA will also utilise local resources under their Programmes to improve Access funding initiatives to support general practice in increasing and maintaining performance against this target.

Kaupapa Māori We will encourage Māori men aged 35-44 to get CVD checks through promotion of “Hauora Hint” on the radio and creation of a health promotion poster for GP clinics.

90% of the eligible population will have had their cardiovascular risk



We will work with Māori rugby clubs to promote health checks with an emphasis on CVD/Diabetes.

assessed in the last five years. Improved health literacy

We will explore male usage/engagement for CVR and investigate barriers for males.

90% of the eligible population will have had their cardiovascular risk assessed in the last five years. Increased health promotion and awareness Improved health literacy

We will encourage closer liaison between community nursing and general practice.

We will raise awareness in the workplace, along with workplace based assessments where it is not practical for that to be performed within the worker’s general practice.

We will address barriers that limit effective flow of information (i.e. blood results etc.) resulting from workplace assessments and worker’s GP.

We will maintain links at hapu monthly hui, annual Iwi hui, sports, recreation, Hauora, Kapa Haka festivals, Kohanga Reo, Kura Kaupapa, Kura Waka Hourua, Whare Wananga, and Maori media.

The lead coordinator will continue with the process of reviewing the monthly eligibility data, emphasising on Māori Men 35-44 years.

The lead coordinator will continue with the process of reviewing the monthly eligibility data, emphasising on Māori Men 35-44 years.


We will have in place agreements with PHOs to fund the delivery of CVRA to eligible populations with an emphasis on High Needs patients by 1 July 2015.

Reduced cardiovascular disease mortality and morbidity through cardiovascular risk assessment (CVRA) and appropriate management

We will release an online learning module for improved CVRA performance to GP clinic staff based on the 2014 Māori Health Excellence Seminar on this topic by 30 September 2015.

90% of Māori in the eligible age group will have reached the national CVRA target by 30 June 2015. 90% of the eligible population will have had their cardiovascular risk assessed in the last five years.


We will secure access to data for CVRA rates in the 35-44 year age group by 30 October 2015.

We will provide reporting to stakeholders categorised by PHO, ethnicity, gender, along with rates for the 35-44 year Māori male subset by 30 November 2015. Activities specific to EBPHA include:

● Develop reporting capability through BPI to separately track this cohort by 30 September 2015

● Provide workshops with GPs to identify ways of encouraging patient engagement by 31 December 2015

● Promote positive outcomes from CVD risk assessment including self-management options by 1 January 2016.

We will monitor CVRA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team. We will monitor CVRA results on a quarterly basis through the Māori Health Plan Steering Group. This group involves representatives from the three PHOs and is used as a forum to review new initiatives implemented by primary care, and to plan other interventions.


2.2 Better Public Services: Better Results for New Zealanders

2.2.1 Reduce the incidence of Rheumatic Fever Our Approach The BOPDHB is committed to achieving the Better Public Services goal to reduce the incidence of acute rheumatic fever by two-thirds by June 2017. It has prepared the BOP Rheumatic Fever Prevention Plan 2013-17 that was approved by the Minister/Ministry and is progressively working through the actions. The DHB is grateful for the support from the Ministry for additional funding to address crowded housing and access for children aged 0-19 to free rapid response clinics as part of the national and local solution to this issue. The DHB will consolidate and refine existing programmes and initiatives that have been set in place in the period from 2013 to 2015, in order for them to achieve the medium term outcome. By 20 October 2015, the DHB will review and update its BOP Rheumatic Fever Prevention Plan, and incorporate newly funded programmes, and local, regional and national learnings that will inform future effective service delivery. The DHB (and Ministry) is now funding throat-swabbing programmes in 28 decile 1-3 schools. With the rapid response clinic service in place by 1 July 2015, this should provide access to 80% of the at risk population. Meeting the set targets for acute rheumatic fever initial hospitalisations for 2015/16 2015/16 Target rheumatic fever number and rate reductions 55% reduction from baseline level (2009/10-11/12) Area Rate Number Bay of Plenty DHB 1.7 4 Midland region 1.8 16 New Zealand 1.8 83 The Ministry will supply DHB with data, and the DHB will comment on progress towards targets in its quarterly reporting.

Key elements of the BOP Rheumatic Fever Prevention Plan 2013-17 are outlined below. Linkages

• Toi Te Ora Public Health Service plan – Goal 1: To reduce childhood admission to hospital from acute rheumatic fever, respiratory infections and skin infections, each by 2/3 in five years

• Our Performance Story Impact: Fewer people admitted to hospital for avoidable conditions

• Better Public Services: Better results for New Zealanders • Bay of Plenty Rheumatic Fever Plan 2013-2017 • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.4 Māori Health – Achieving Equity



BOP Rheumatic Fever Register

We have contracted Rotorua Area Primary Health Services to establish and operate the BOP component of the rheumatic fever register alongside the Lakes component. By 1 July 2015 all existing cases who have been enrolled on the Bicillin programme will have been entered onto the register. The register can then be used to monitor the quality of the Bicillin programme by measuring performance against the best practice standards for completeness and timeliness of injections. We have also funded our District Nursing Service to employ a Rheumatic Fever Clinical Coordinator to monitor the register, and use its functions to:

• provide training to nursing staff on secondary rheumatic fever prevention

• provide education to patients, appropriate to their age, and their families/whanau on rheumatic fever, emphasising the need to maintain adherence to the Bicillin programme, and care in relation to oral health

• monitor follow-up care to ensure that paediatric appointments are kept, and that there is a smooth transition to adult medical and cardiac care

• liaise with general practice, community dentists and others as necessary to ensure the optimum care of patients.

Number of recurrent cases of acute rheumatic fever of patients on the Bicillin programme

Provided in quarterly reports to Ministry

School based throat swabbing programmes

Should a strong gender disparity in numbers of children and young people presenting with sore throats be confirmed, school-based and rapid response clinic programmes will respond through community awareness raising, advertising and other proactive measures.

Increased promotion on school based throat programmes

We will extend the skin infection prevention programme to more schools and increase nursing support.

Increase in skin infection programmes in schools

System failure review

We will continue to review all notified cases of acute rheumatic fever to determine any risk factors and system failure points that may have occurred. Learnings from these reviews will inform future service delivery.

100% of all cases are reviewed

Reported in quarterly reports to the Ministry

Rapid response clinics

By 1 July 2015, we will establish rapid response clinics in those parts of the BOP where school-based programmes are not in place. The introduction of free services for under 13’s at the same date will assist. We will monitor uptake by families and adapt services as necessary to maximise outputs.

Rapid response clinics to be established by 1 July 2015

Healthy Housing System

By 1 July 2015, the service will have received and processed 75 referrals so that systems will be well-embedded. Relationships with Housing NZ and Work and Income will be critical. We will develop capacity to deliver a wide range of interventions during 2015/16 as community-based services are strengthened and supported to meet needs. We will deliver on family/whanau agreed intervention plans based on 275 referrals.

Number of referrals of whanau/family agreed plan


Reduced rates of rheumatic fever

We will deliver 275 Healthy Homes System home assessments with intervention plans agreed by whanau and a range of interventions delivered against those plans. Quarterly target is 69 completed assessments delivered by BOPDHB’s two subcontractors : Tauranga Community Housing Trust and Sustainability Options.

Number of Healthy Homes System home assessments Target is 275 Reduced rate of rheumatic fever cases - 1.7 per 100,000 per year


2.2.2 Children’s Action Plan (CAP) Our Approach We are committed to implementing activities across our population for getting better outcomes for our most at-risk children. We will reorient the way we work, to a collaborative cross sector multi-agency approach in working with vulnerable children and their families. Alongside our participation in this new way of working, we have been planning and remodelling maternal and child health services to improve health outcomes for these children. This includes addressing integration, quality, gaps in service delivery and the capacity of providers to deliver to the children’s action plan. The implementation of the Children’s Action Plan will occur across the whole Eastern Bay of Plenty from 1 July 2015. The BOPDHB will utilise Midland Regional networks to keep abreast of the progress made by the demonstration sites and we will explore and scope areas where our support and assistance can be best used.

(Total population crude rate, all ethnicities). This target results from a 55% reduction in the baseline rate of 3.8 per 100,000 per year (2009/10-2011/12).

We have established rapid response clinics in Whakatane, Edgecumbe and Tauranga to provide easy access to sore throat assessment and treatment for 80% of 4-19 year old Maori (and Pacific) children and young people living in high deprivation quintile 5 areas. Ministry of Health funding provided for rapid response clinics in areas not currently served by school-based throat swabbing programmes. Of the 41 cases of acute rheumatic fever aged 0-19 in the BOPDHB district in the six years from 2009 to 2014, 15 or 37% occurred in communities not covered presently by a school-based service.

Improved incidence of rheumatic fever cases Rapid response clinics to be established

We have loaded all retrospective cases of acute rheumatic fever on to the BOP rheumatic fever register operated by Rotorua Area Primary Health Services, and use the register to monitor and improve timeliness of injections given under the Bicillin programme.

We will carry out systems failure analysis of all new notifications of acute rheumatic fever, and put into place all recommendations arising from that analysis.

Analysis to be completed by 31 December 2015 and recommendations implemented on an ongoing basis

We will deliver actions for 2015/16 outlined in the BOP Rheumatic Fever Prevention Plan 2013-2017. This plan will be reviewed during 2015/16 to update for initiatives and lessons learned from work undertaken to date. http://docman/planfund/Planning/20131003_bopdhb_rf_plan_final.pdf

We will monitor performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team.

We will monitor screening performance on a quarterly basis through the Māori Health Plan Steering Group.

http://docman/planfund/Planning/20131003_bopdhb_rf_plan_final.pdf

http://docman/planfund/Planning/20131003_bopdhb_rf_plan_final.pdf


Linkages • Minister’s Letter of Expectations • Midland DHBs Regional Services Plan 2015/16 • Bay of Plenty IHS 2020 • Toi Te Ora - Public Health Service Annual Plan 2015/16 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.10 Whanau Ora • Module 2.3.11 Maternal and Child Health • Module 2.4 Māori Health – Achieving Equity • Module 5.3.2 Safe and Competent Workforce • Module 5.3.3 Child Protection Policies • Module 5.3.4 Children’s Worker Safety Checking

Objectives Actions to deliver improved performance Measured by: Reporting Requirements

Support the implementation of regional Children’s Teams

A DHB representative will continue to be an active member of the CT Governance Group. A Local Action Plan will be signed off by Directorate. DHB and NGO health professionals will be involved in establishment and implementation planning. The go live date will be 1 September 2015 with processes in place for implementation.

• DHB reports exceptions and remedial actions to audit scores less than 80/100 for each of the child and partner abuse components of their VIP programme.

• DHB monitors implementation of NCPAS and other child protection information systems by 30 June 2016.

• DHB reports actions to reduce deaths and hospitalisations due to assault, neglect or maltreatment of children 0-14.

• DHBs support establishment of Children’s Teams.

• DHB has internal governance/engagement arrangements and with primary and community partners to provide services for: o vulnerable children and their

families/whānau o pregnant women with complex

needs o children referred to Gateway.

• DHB supports implementation of Rising to the Challenge (eg, COPMIA).

• Healthy Beginnings: Developing perinatal and Infant Mental Health Services in NZ.

We will establish and review an effective pathway. We will continue to provide Antenatal Education Service with a primary focus on pregnant women with complex needs and vulnerable. We will continue to deliver the Gateway assessment service for children with high risk.

We will implement the requirements of the Vulnerable Childrens Act (VCA), and meet workforce requirements as per Modules 5.3.2; 5.3.3; and 5.3.4.

Multi agency collaboration

DHB and NGO health professionals will continue to be actively involved in referrals to the Children’s Team. We will enable health professionals to participate as Lead Professionals, as necessary.

Referral pathways We will develop referral pathways and ensure there are regular reviews to help improve effectiveness.

Monitoring of these pathways will occur on an ongoing basis from 1 July 2015.

Reducing the number of assaults on children:

We will implement key actions and recommendations from the MOH funded audit completed in December 2014.

Quarterly reporting to Ministry



Maintain the National Child Protection Alerts System.


2.2.3 Prime Ministers Youth Mental Health Project Our Approach We will be working with our primary care partners to make progress against this priority. Our activities in this area are expected to mean young people will be able to access the services they require before their condition escalates to being a severe mental health disorder. One of our principal goals is that Primary Mental Health and Addiction services reach all youth with mental health and alcohol and drugs (AOD) needs through the availability of education and screening at all appropriate youth friendly venues and occasions. Linkages

• Minister’s Letter of Expectations • PP25 - Delivery of the Prime Minister’s Youth Mental Health

initiative • Our Performance Story impact – People stay well in their

homes and communities • Module 2.3.2 Primary Care • Module 2.3.4 Rising to the Challenge • Module 2.3.11 Maternal and Child Health


Improve the responsiveness of primary care to youth

Child and Youth Strategic Alliance will continue to implement the BOP Child and Youth Health and Well Being Strategy. The key foci are:

1. to implement the Youth Mental Health Integration Project (Mental Health and Drug and Alcohol)

2. first 2000 days of lives from conception including teenage pregnancy (Healthy Pregnancy).

Youth Mental Health Integration Project will report on actions through a narrative on a quarterly basis

Progress against actions and performance against measures will be reported on a six monthly basis to the Ministry

1. Stage 1 Locality planning and demand/need analysis 2. Stage 2 Model of care options 3. Stage 3 Detailing the preferred option

763 interventions provided in schools Increase in numbers of youth aged 12 – 19 years seen

We will continue to strengthen current relationships between School Based Health Services (SBHS) and youth primary mental health providers.

Number of interventions provided in schools Increase in numbers of youth aged 12 – 19 years seen

Improve and strengthen youth primary mental health

We will evaluate all primary mental health services (including youth) undertaken in 2014/15. Recommendations to be implemented in 2015/16.

Child and Youth Primary/secondary integration initiative to be piloted

Review and improve the follow-up care for those discharged from CAMHS and Youth AOD services:

We will report against new KPIs and use information to improve discharge and follow-up processes. See above proposed Child & Youth Primary/Secondary Integration initiative – Improve and strengthen youth primary mental health.

• PP8: 80 % of youth to access

services within three weeks

• PP8: 95 % to access services within eight weeks.

• Youth AOD Pathway will be developed

• 20 high need youth in the Whakatane Social Sector Trial site receive AOD/mental health assessment and treatment where necessary as part of inter-agency approach.

• Review of supports for young

Improve access to CAMHS and Youth AOD services through wait times targets and integrated case management

We will continue to review PRIMHD data to ensure that it is robust and appropriately reflects BOPDHB situation Use data to improve performance See above proposed Child & Youth Primary/Secondary Integration initiative – Improve and strengthen youth primary mental health


people and their families post-residential AOD treatment

• Identify available supports

Implement Youth Healthcare in Secondary Schools: A Framework for Continuous Quality Improvement

BOPDHB is in the process of incorporating the new service specifications in all SBHS provider’s terms and conditions. The expectation from the Youth Healthcare in Secondary Schools: A framework for continuous quality improvement will become part of the quality improvement plan from each SBHS providers.


2.2.4 Reduce the Prevalence of Obesity Our Approach An increasing focus will be placed on obesity by the BOPDHB as a measure to reduce the incidence and impact of long-term conditions such as diabetes, cardiovascular disease and some cancers, as well as on maternal and child health. The DHB will continue to deliver or support programmes such as Adult Green Prescription, Active Families and the newly established Healthy Families NZ programme in Opotiki District: Horouta Whanaunga – East Cape and in Rotorua. In addition, new activity will begin in 2015/16 to meet the Minister’s obesity target. Linkages

• Minister’s Letter of Expectations • Health Target – More Heart and Diabetes Checks • Māori Health plan • Section developed and agreed with our primary care

partners • Our Performance Story Impact: People stay well in their

homes and communities • Toi Te Ora’s Annual Plan • Module 2.2.5 Healthy Families NZ • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.4 Māori Health – Achieving Eequity


Improving healthy behaviours

We will deliver the Healthy Pregnancies project within the maternity and public health sectors.

We will establish a policy for the sale of food and beverages on BOPDHB premises.

Green prescription We will deliver Adult Green Prescription services in both BOPDHB and Rotorua districts.

2,977 total referrals, including an additional 463 scripts for diabetes and pre-diabetes patients.

Reducing obesity with Primary Care

We will roll out the WBOP PHO weight management project if the evaluation indicates the project has been successful.

The weight management project will be undergoing a formal evaluation from Planning and Funding utilising the validated BOPDHB evaluation tool. This should be completed by the end of 2015.

Bay Navigator weight management pathway has commenced and is expected to be completed by October 2015. The group is well represented and includes two consumers (one older and one youth) to ensure a broad perspective as well as representatives from GPs, nursing, Toi Te Ora and BOPDHB. This ensures alignment with other local obesity management activities such as “Healthy Pregnancy’.

Bay Navigator KPIs include the number of hits to the specific weight management pathway and the number of children referred to the community dietitian.

We will commence community dietitian led weight management group sessions and healthy cooking classes for those patients with low health literacy and limited cooking skills.

The number of group weight management session and group healthy cooking classes provided together with the number of attendees will be measured. Attendee evaluation of the education session will take place.


2.2.5 Healthy Families New Zealand Our Approach The Horouta Whanaunga – East Cape programme includes the Opotiki District as well as all of the Tairawhiti DHB district. The programme is delivered by Te Whare Hauora o Te Aitanga a Hauiti based in Uawa, Tolaga Bay. The BOPDHB is a member of the governance group for the programme. It will ensure that linkages are made to existing DHB delivered or funded programmes delivered in Opotiki District such as Health Promoting Schools, Hapu Hauora, smoking cessation and promotion of smokefree environments, monitoring of liquor licensing, and Green Prescription. In addition, the DHB will contribute to the better coordination of existing services and development of new lifestyle programmes developed through the Healthy Families programme in response to community needs as the project consolidates and matures throughout 15/16. The BOPDHB-owned regional public health unit, Toi Te Ora-Public Health Service, also delivers services in Lakes DHB and will be an important linked provider for the Healthy Families Rotorua project. Services delivered by Toi Te Ora in relation to physical activity, nutrition, tobacco control and alcohol moderation will form part of the range of services that the project will coordinate with other services and build on. Linkages


partners • Our Performance Story Impact: People take greater

responsibility for their health • Module 2.2.3 Reducing the prevalence of obesity • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.4 Māori Health – Achieving Equity


Healthy Families NZ

We will support Healthy Families NZ projects in the BOP and Lakes Districts, with improved coordination and enhanced service delivery of DHB delivered or funded programmes.

Membership on governance group to provide linkage with DHB delivered or funded programmes.

Reporting will be done a six monthly basis

We will align Healthy Families NZ initiatives with DHB delivered or funded programmes to strengthen co-ordination between agencies to enhance service delivery as appropriate-to include health promoting schools, Work well, smoking cessation, B4 Schools, WCTO and TTO health promotion programmes.

Toi Te Ora’s health promotion programmes are aligned to Healthy Families NZ.

We will support planning, implementation and evaluation of Healthy Families NZ plans to ensure an evidence based approach to health promotion.

Planning and implementation demonstrates an evidence based health promotion approach.


2.2.6 Social Sector Trials Our Approach The Social Sector Trials (SST) are focused on improving outcomes for young people, specifically by lowering youth crime, alcohol and drug consumption and truancy, and by increasing engagement with education and employment. We are currently working on activities that focus on two high priority locations, Kawerau and Whakatane. The trial leads, together with their communities, will:

• plan social service delivery • manage relevant service provision contracts and funding • oversee resources in kind • develop networks, engage with community • influence social services outside of their direct control.

The model aims to support decision making at the local level, build on existing networks and strengthen coordination at every level of government and within community. Linkages


partners • Our Performance Story Impact: People take greater

responsibility for their health • Module 2.2.3 Prime Ministers Youth Mental Health

Project • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.4 Rising to the Challenge • Module 2.4 Māori Health – Achieving Equity


Prime Ministers Youth Mental Health Project

We will continue to attend SST Advisory Group meetings where improved access to mental health and youth AOD services forms a workstream. *Please refer to Module 2.2.3 for further information

PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds 3 weeks: 80% 8 weeks: 95%

Quarterly reporting

Youth Service Level Alliance

We will continue membership on the Child and Youth Strategic Alliance (CYSA) to ensure SST input in to the implementation of the BOP Child and Youth Health and Well Being Strategy. We will regularly attend the SST Advisory Group meetings to enable greater SST input into decision making. We will continue on the Youth Addiction and Other Drugs prevention forum to increase networking and feedback.

• Actively participates in forums and projects

• Regularly attends meetings • Evidence of community consultation

Quarterly reporting

Alliance leadership

We will improve primary/secondary integration for child & youth through the IHS and BOP Child and Youth Health and Well Being Strategy. We will strengthen current vehicles for involvement of the NGO, PHO and Government agencies.

• DHB continues to fund AOD initiatives via the SST mechanism

• Positive early intervention and prevention activities are offered to youth


Building capacity and capability

We will seek from SST, their perspective on service gaps, service type and skills needed and, a perspective on the capability and capacity of local providers to deliver those services.

Evidence of community engagement/consultation/needs DHB will seek SST perspective on capability and perspective of providers delivering AOD initiatives

Independent advice We will have regular meetings with SST trial leads to ensure independent advice sought.

Regular meetings with SST trial leads to ensure independent advice sought

Quarterly reporting

2.3 System Integration As the population grows and changes the health needs of New Zealanders change. This requires services to change or develop and new priorities will emerge.

2.3.1 Integrated Healthcare in the Bay of Plenty Our Approach The Bay of Plenty, with a population that features higher than average proportions of Māori, older people, people living in rural areas and areas of high deprivation45 presents unique challenges to improve the overall health of our population, improve quality and achieve best value for public health system resources. Integrated healthcare is seen as essential to transforming the way care is provided for people with long-term chronic health conditions. It will enable people with complex medical and social needs to live healthy, fulfilling, independent lives46. People living with multiple health and social care needs often experience highly fragmented services, which are complex to navigate, leading to less than optimal experiences of care and outcomes. Our response to the challenge requires a strong re-orientation away from the current emphasis on episodic and acute care towards prevention, self-care, better co-ordination, and care that addresses social determinants of health. Our approach to integrated healthcare is captured in the IHS. The purpose of the Strategy is to:

1. Be a lens that can be applied to all healthcare related activity, both current and future, so we can be certain that activity is systematically and deliberately building towards an integrated healthcare system.

2. Identify specific actions that will build foundations for developing integrated healthcare consistently throughout the Bay of Plenty;

45 BOPDHB Annual Plan 2013/14 46

A report to the Department of Health and the NHS Future Forum: Integrated care for patients and populations: Improving outcomes by working together http://www.kingsfund.org.uk/publications/integrated-care-patients-and-populations-improving-outcomes-working-together

Figure 1: IHS Themes

http://www.kingsfund.org.uk/publications/integrated-care-patients-and-populations-improving-outcomes-working-together

http://www.kingsfund.org.uk/publications/integrated-care-patients-and-populations-improving-outcomes-working-together


3. Support and enhance critical decision-making within, and provide direction to, the BOPALT.

Achieving the objectives of the IHS is founded on seven core themes as depicted in Figure 1 and their associated action plans for change over the period 2014 to 2020. Governance of IHS is the responsibility of the Bay of Plenty Alliance Leadership Team, BOPALT. For the purposes of this Annual Plan, actions identified below are those we are aiming to implement in the 2015/16 year. Many of these activities are on-going or concurrent. For completeness, they should be considered in the context of the full Action Plan set out in the IHS. See Module 1.2.5 for further information on the IHS and 5.1.7 for further information on our Primary Health Partnerships Linkages

• Minister’s Letter of Expectations • Bay Of Plenty Integrated Healthcare Strategy 2020 • Midland DHBs Regional Services Plan 2015/16 • Module 2.1 Health Targets • Module 2.2 Better Public Services: Better Results for New

Zealanders • Module 2.3 System Integration • Module 2.4 Māori Health – Achieving Equity • Module 2.6 Living Within Our Means • Module 2.7 Improving Quality • Module 2.8 Actions to Supporting Delivery of Regional

Priorities

IHS Key theme

Link to IHS

Action point

Actions to deliver improved performance Measured by Outcomes Reporting Requirements

Theme 1: Patient and family centred care/Whānau Ora

1.1.1

We will identify or develop training for providing patient and family centred care (PFCC). We will continue to implement the Patient Experience survey throughout the hospitals. We will support and work with PHOs on the roll out of HQSC Patient Experience Survey in General Practice.

Improved patient experience scores across all survey questions for hospital inpatients. General Practices begin to implement HQSC Patient Experience Survey. BOPALT and DHB Executive members have completed the Whanau Tū Whanau Ora training. by Ngā Mataapuna Oranga (NMO).

1. ‘What matters to you

and/or your family and Whānau’ is the underpinning approach of all health service delivery.

2. Those who experience health services will have a say and a role in how services are designed and delivered/ during the design process there is an opportunity for a patient voice.

3. Patients’ and family/Whānau take greater responsibility for their health

4. Patients’ and family/Whānau decisions are respected.

Progress will be provided on a six monthly basis 1.2.1

We will promote Whanau Tū Whanau Ora Training.

1.3.1 We will identify and develop care planning approaches that include patient’s preferences and goals.

Care planning approaches are identified.

1.3.3 We will develop policies and protocols that support and embed care planning approaches that include and support

All providers have policies and protocols in place.


IHS Key theme

Link to IHS

Action point


patient’s preferences and goals for all providers.

1.5.1

We will enhance systems and processes to incorporate the patient’s voice and view into all future service design and development.

All service design processes include patient advisors and/or develop a process to capture the patient’s view. All Bay Navigator pathways have method of capturing the patients view. All SLATs have methods of incorporating the patients view.

Patient and family engagement

1.5

We will evaluate existing resources for collecting patient experience stories and feedback, coordinate and develop any other required tools and resources.

Evidence of availability and use of tools and resources for collecting and using patient experience feedback.

1. ‘What matters to you

and/or your family and Whānau’ is the underpinning approach of all health service delivery.

2. Those who experience health services will have a say and a role in how services are designed and delivered/ during the design process there is an opportunity for a patient voice.

3. Patients’ and family/Whānau take greater responsibility for their health

4. Patients’ and family/Whānau decisions are respected

Progress will be provided on a quarterly basis

1.5

We will work collaboratively with patients to develop and coordinate patient and family participation in committees, planning, focus groups and co-design projects etc.

Number of patient and family members who have a say in how services are designed and delivered.

Staff Engagement and training

1.1

We will ensure new staff members learn about the organisation’s patient experience vision as part of recruitment process and the induction / orientation process.

All staff’s performance around patient experience is evaluated as part of their annual appraisal.


1.1

We will review training courses content and consider why key aspects of the patient experience are not covered and how they can be included in existing training packages.

All training resources include a patient perspective.

1.3

We will ensure staff understand that feedback and measurement of patient experience are carried out to effect change and are empowered to make quality improvements at the point of care.

Number of quality improvements at the point of care to improve a patient’s experience.

Patient Experience measures and reporting

1.3

We will triangulate patient experience data with other data sources in all reporting to get a more complete picture, e.g. outcome measures, patient safety and patient experience.

Reporting at all levels includes patient experience information.


Providers 1.4

We will work collaboratively with providers to set targets and measures to improve patient experience in a sustainable way.

Contracted outcome measures include patient experience measures.

Progress will be provided on a six monthly basis

Theme 2: Health Literacy

2.1.1

The Health Literacy working group will undertake an evaluation and gap analysis of the current services in the Bay of Plenty that provide electronic health information to meet the needs of populations and maximise technology. We will work with Health Navigator to align

Evaluation and gap analysis complete.

1. Our population is better informed about their health and health services.

2. Providers are better informed about health services and the value and importance of



IHS Key theme

Link to IHS

Action point


our web-based health information with national initiatives. We will trial the Patient Education Resource Centre in the Emergency department and general practice and evaluate the effectiveness of the trial for wider roll out.

health literacy. 3. Patients are able to

easily access quality, reliable, appropriate and local information.

4. Patients understand the options that are available to them and are able to make informed decisions about their health.

5. People are clear about what the health system can provide.

6. People are supported in the decision-making process.

2.2.1

We will identify best practice approaches that effectively promote and improve health literacy for different age groups and populations. We will help prepare the workforce of the DHB to build a health literacy knowledge base by:

a. working with the IHS Health Literacy Working Group to develop guidelines, key messages, presentations and training modules on health literacy

b. raising awareness about the importance of health literacy for the Bay of Plenty healthcare workforce

c. working with the Rural Health Immersion Programme in Whakatane on improving health literacy

d. supporting the PHOs to build a health literacy knowledge base for the General Practice workforce, for example, taking a ‘training the trainer’ approach and contributing to CME/CNE education sessions if requested.

2.3.1

We will establish expected competencies for health literacy for all health care workers. We will work with the DHB Education Committee to investigate options for training the Bay of Plenty health workforce to improve their skills.

Competencies identified

2.4

We will create expectations for all providers to review their processes to ensure a health literacy approach is incorporated in service delivery.

All providers incorporate health literacy approach to service delivery

Theme 3: Access to patient information

3.1.1

Through the Bay of Plenty Information Systems Group, we will identify systems and protocols for information sharing, identify minimum standards of IT capability desired for all providers and develop appropriate contractual clauses.

Systems and protocols for sharing agreed to.

1. Healthcare providers will have systems and protocols in place to enable the sharing of patient information.

2. Patients can grant access to and can interact with their records to better support self-management.


3.3

We will continue work on developing a set of core clinical information for all patients available electronically to providers. In addition, define those providers that have

Core clinical electronic information defined and agreed.


IHS Key theme

Link to IHS

Action point


access. 3. A core set of information is readily accessible to the clinicians involved in a patient’s care, regardless of setting, to better support that patient’s care.

4. Clinicians can communicate quickly and securely using electronic means.

3.4

We will establish a Bay of Plenty Information Systems Group (BOPIS) to provide data governance and oversight projects and initiatives that involve information sharing.

Data governance group agreed and Terms Of Reference established. Annual work plan established.

3.5.1

We will provide training on the Privacy Act and Health Privacy Code to improve knowledge of rights and obligations of health care workers with respect to protection of privacy.

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

3.5.2

We will socialise key messages through media and other mechanisms to increase public’s awareness and understanding of sharing patient information.

Theme 4: Co-ordinated Care

4.2.1

We will identify appropriate predictive risk assessment tools to identify specified patient groups for co-ordinated care planning implementation in priority population groups.

Predictive Risk Assessment Tools are identified in priority population groups.

1 BOP health system functions as one system, working together.

2 Transitions are improved with a co-ordinated care response.

3 Patients’ experience is seamless.


4.2.2

We will embed use of tools in a range of settings to inform service mix and allocation and maximise efficiencies of resource allocation.

Predictive risk methodologies underpin all service assessment and allocation.

4.3.1

We will develop processes and practices that identify clinical co-ordinators for adults with complex health needs that cross specialties.

All care plans identify a clinical care co-ordinator. Reduced re-admission rates.

4.4

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

All care plans identify a lead navigator.

Theme 5: Creating an environment for integration

5.1.2 We will explore access to the Clinical School education programmes and resources by primary and community providers.

Whole of system approach developed.

1. The BOP health system functions as one system, working together.

2. The BOP health workforce has the skills and competencies required to deliver high quality integrated healthcare.

3. There is an agreed, systematic approach to education and training requirements to support integrated healthcare, innovation and improvement across the Bay of Plenty health system.

4. Integrated healthcare is supported, communicated and promoted by all people who work in the BOP health system.


5.2.1

We will review local and regional workforce training and education strategies to identify training requirements needed to embody the vision and principles of integrated healthcare. We will develop or identify ways to raise awareness and train the workforce on the principles of healthcare improvement and integrated care.

Review completed and recommendations considered.

5.3.1

We will develop clinical leadership required to engage staff in the vision and principles of integrated healthcare and support the change management required. We will continue to support clinical leaders to undertake leadership training through the Midland Advanced Leadership Course.

Clinical leads are identified, supported and trained.

5.3.2 We will provide resources, training to support the change management process required to implement actions identified in

Change management is undertaken and able to be demonstrated.


IHS Key theme

Link to IHS

Action point


this Strategy. We will promote and support the IHI Open School Model for Improvement programmes to embed healthcare improvement methodology throughout the DHB and primary care.

All people involved in service improvement projects have completed the IHI Open School Model for Improvement.

5.5.1

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

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

5.5.3

We will identify mechanisms that incentivise collaboration and create expectations for providers to formally collaborate. We will provide training on collaboration and develop a toolkit of resources for staff and providers to use when undertaking collaborations.

Contracted outcome measures include the outcome of the collaboration/alliance e.g. reduced admissions to hospital. Toolkit and resources developed.

5.6.1 We will develop a communications plan to promote integrated healthcare.

Communications Plan developed.

5.6.2

We will identify and promote a common language, based on international best practice, which supports the communications plan.

Common language identified.

5.7

We will complete the stock take and review of existing committees and advisory groups (excluding those that are required by legislation) including interagency groups, to determine optimum structures to: • support progression of the

governments’ priorities and local priorities and initiatives

• clarify roles and functions • reduce duplication and streamline

accountabilities.

Review completed and recommendations agreed.

Theme 6: Contracting for outcomes and flexibility of funding

6.1.1

Every Bay Navigator pathway aligns with the Bay Navigator Framework.

1. All contracts are outcome focussed.

2. Funding, contracting, monitoring and reporting structures promote and support integrated healthcare.

3. Funding and contracting structures are flexible and enable agreed outcomes to be achieved.

4. Inappropriate duplication is reduced.

5. Reporting is meaningful and aligned with agreed outcomes.

6. System capacity and


6.1.2

We will continue our review local purchasing and contracting mechanisms and strategies to promote integrated care. Develop systems to incorporate the Results Based Accountability framework into service specification design for locally identified contracts. We will trial the use of the MBIE Streamlined Contracting Framework for local contracts. We will trial the use of the Capstone Framework for assessing provider

Strategies and policies promote and enable integrated healthcare.


IHS Key theme

Link to IHS

Action point


performance with specified provider groups.

capability is strengthened.

7. Risks and benefits are shared.

6.1.3 We will explore alternatives to the price volume method of purchasing services.

Alternatives are identified Pilot services are identified and agreed.


Theme 7: Health in all policies

7.1

We will advocate and promote the key messages of the NZMA Position Statement on ‘Health Equity’ and the Helsinki Statement of ‘Health in all Policies’. Together with Toi Te Ora Public Health we will help raise awareness and build the knowledge base across the DHB and PHOs of the concepts and principles of ‘Health in All Policies’ e.g. development of a Board Position Statement. We will assist other sectors in developing mechanisms to assess health impacts of their policies (e.g. Health Impact Assessment and/or Health Equity Assessment Tool). We will focus on:

a. supporting full implementation of the DHB’s policy on smoking

b. providing input to the DHB policy development on stopping the sale of sugar sweetened beverages on DHB facilities

c. supporting the implementation of the DHB’s ‘Work Well’ Programme

d. promoting and supporting the DHB’s policies relating to rubbish, recycling and transport planning

e. continuing regular meetings with Toi Te Ora and senior staff of all councils in the DHB district and provide advice and input to the Council’s long term plan and annual planning process.

Increased awareness and overt promotion of the key messages.

1. Cross sector partnerships are established to reduce inequalities and address social determinants of health.

2. Government agencies develop policies that seek to minimise negative impacts on the health of the Bay of Plenty population.

3. All health service development and redesign considers impacts on social determinants of health.

4. All health professionals in the BOP act, advise and advocate for action on social determinants of health in addition to supporting individual patients.

5. BOP populations have improved health and equity



2.3.2 Primary Care Our Approach We will continue to work in partnership with our primary care partners and at a strategic level, will use our Bay of Plenty Alliance Leadership Team (BOPALT), and any Service Level Alliance Teams to jointly develop an annual work programme. This includes Primary Care (including Rural Health), the Prime Minister’s Youth Mental Health Project – Youth Services, and other areas of work as supported by BOPALT. BOP ALT membership consists of the CEOs and Clinical representatives from each of our three PHOs, the BOPDHB CEO, GMs, Planning and Funding / Maori Health Planning and Funding, and Clinical representation from our Provider Arm. BOP ALT remains central to the development of and committed to the service expectations and associated deliverables as set out within our Annual Plan. Our commitment to working together is evidenced by the signing up to this Plan in the front section by our Primary Care partners. The following chart provides a snapshot of the BOPALT work programme:

We will take an integrative approach in the first instance, and will develop, on a case-by-case basis, any potential shifting of services to primary care based on a robust agreed model of care. This wll be done in collaboration with our Primary Care partners. Ideally, our stance is to ensure a seamless journey across the health system to ensure that we are consistently people, whanau and family centred. As referenced in the Executive Summary the Bay of Plenty DHB has made good progress to date in shifting services closer to home where we have been able to demonstrate that it has had a benefit for our population and their health outcomes. Since 2007/08 we have shifted the following services, which collectively are worth over $4.0million per annum:

• minor skin surgery


• direct access to some radiology procedures e.g. mammography and some procedures through the Community Primary Options contract

• retinal Screening • diabetes management • diabetes nursing • sexual Health Education • tobacco coordination • primary maternity services.

In 2015/16, we will continue to seek out these opportunities as part of our BOPALT and integration work programme. A number of pieces of work are already underway that may result in services being reconfigured closer to home. These include the current work looking at how we can achieve a more integrated community nursing service across the Bay of Plenty, looking at the range and mix of health services in Opotiki in the Opotiki Locality Planning Project and how the East Coast could be optimally configured in the future, looking at a wider range of diagnostics being managed in the community, and assessing how we can improve the acute flow of patients across the health system, especially in times of high demand. The BOPDHB will support these opportunities where it will benefit the BOP population and its health outcomes. Linkages

• Minister’s Letter of Expectations • Midland DHBs Regional Services Plan 2015/16 • Toi Te Ora - Public Health Service Annual Plan 2015/16 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.1.2 Improved access to Elective Surgery • Module 2.1.5 Better Help for Smokers to Quit • Module 2.1.6 More Heart and Diabetes Checks • Module 2.2.2 Children’s Action Plan • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.3 Improving Access to Diagnostics • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.3.10 Whanau Ora • Module 2.4 Māori Health – Achieving Equity • Module 5.2.4 Collaboration


Shifting services to Primary Care

We will collectively continue to review opportunities for shifting of services into primary care where these align with the IHS and the aims of the NZ Triple Aim. Those services that will be further considered include:

• Review of sexual health services – in the absence of any clear direction nationally, we will review and progress local options by 30 June 2016 to achieve optimum service delivery including; access, timeliness, appropriateness removal of existing barriers, while supporting care closer

Quarter 1: Service prioritised by BOPALT for review and Project Initiation Document (PID) completed. Quarter 2: Engagement with current providers and initiate process for the development of the desired Model of

Narrative reporting will be provided on six monthly. basis


to home. The existing investment in these services across settings is approximately $1.5 million.

• Improve the quality of primary care referred diagnostic radiology through transferring responsibility for management of 73,000 community radiology referrals through our PHOs. Shift DEXA Scanning into primary care management. (Volumes to be determined.)

• Review of Dietetic and Nutrition

services to identify opportunities to better align services between primary and secondary care.

• Identify opportunities to shift dermatology services into community-based management and delivery.

Care. Quarter 3: Implementation and change process agreed. Quarter 4: Procurement process initiated as required. Service change discussed with National Health Board as appropriate. Indicative volume and value of this work is not know at this stage and would be identified as part of the PID. Quarter 1: Develop and agree scope of further radiology services that could be shifted into a primary. Quarter 2: Develop an implementation plan for identified radiological investigations. Quarter 3: Implementation and change process agreed. Quarter 4: Implementation and change management. Quarter 1: Identify scope of Dietetics and Nutrition Services to be considered and gain prioritisation through BOPALT. Quarter 2: Initiate process for the development of the desired Model of Care. Quarter 3: Agree model of care development and recommendations regarding desired future state developed and reported back to BOPALT. Quarter 4: Implementation and change management. Indicative volume and value of this work is not know at this stage and would be identified as part of the PID. Quarter 1: Identify scope of Dermatology Services to be considered and seek service prioritised via BOPALT. Quarter 2: Initiate process for the development of the desired Model of Care. Quarter 3: Outcomes from MOC development and recommendations regarding desired future state developed and reported back to BOPALT. Quarter 4: Implementation and change management and procurement process initiated as required. Indicative volume and value of this work is not know at this stage and would be identified as part of the PID. Quarter 1: Revised service specification completed for Acute Demand Management with WBOP PHO and service in


• Implement acute demand/acute flow

service management arrangements through enhancement of existing Co-ordinated Primary Options service framework.

• Develop at least three high demand

clinical pathways which may include: Upper GI Endoscopy, Temporal Arteritis, Renal Colic and Podiatry Vascular.

• Integrate Hepatitis C clinical services delivered in the Bay of Plenty district from 1 July 2016. The transition of Hepatitis C patients from the pilot programme undertaken by the Hepatitis Foundation up to 30 June 2016, to provide a new service across secondary, primary and community-based services. This new service will be rolled out across the Midland Region by 1 July 2017. BOPDHB will work with the Hepatitis Foundation and our Primary and Secondary Care partners to develop a Transition Plan.

place from 1 July 2015. Whole of system measure in place to determine the impact of improved management of frequent flyers and reduced ASH presentations for identified target populations. Quarter 2 – Quarter 4: Monitoring of whole of system measures. Quarterly engagement with the ED and Hospital regarding trends, service demands and service effectiveness. Estimated value of the service $800,000 and 2750 packages of care. Quarter 1: Identify high priority pathways to be developed and prioritised via BOPALT. Quarter 2: Pathway scoping and development through the Bay Navigator SLAT. Development of Pathways to support the desired Model of Care. Quarter 3: Implementation and change process agreed for new pathways. Quarter 4: Implementation and change management. Indicative volume and value of this work is not know at this stage and would be identified as part of the work up of the Pathways. Quarter 1: Develop project plan for delivery of integrated hepatitis c services across the region Quarter 2: Develop a sustainable service including a health pathway through engagement across the Midland Region and the Hepatitis Foundation Quarter 3: Prepare implementation Quarter 4: Implementation.

Where opportunities to progress significant service change initiatives are identified, we will liaise with the Ministry of Health and National Health Board as appropriate


Free Under 13’s GP visits

From 1 July 2015, we will implement free access to primary care and pharmacy for all children under the age of 13 years (U13s) through: • agreed uptake of U13s capitation subsidy

across all non-VLCA general practices • confirming provision of free access to

primary care services for U13s within general practices currently receiving Very Low Cost Access (VLCA) subsidies

• implementing supportive arrangements through General Practice and Accident and Medical Centre to ensure U13s have free access to primary care services outside normal business hours

• supporting local Pharmacies to implement the free access to pharmaceuticals component of the U13s initiative during normal business hours.

We will agree provisions through existing contractual arrangements with BOP Pharmacies that provide after-hours services, to remove any existing afterhours charges, enabling free access to pharmaceuticals outside normal business hours.

Access to free visits and prescriptions for Under 13s during both daytime and outside normal hours for 95% of our enrolled population, within 60 minutes of travel.

Narrative quarterly reporting to MOH.

Greater collaboration between Public Health services and Primary Care

We will work collaboratively to achieve the closer alignment and integration of Toi Te Ora Public Health services with Primary Care.

Collective agreement on of what activities can be better aligned by 30 June 2016.

Narrative reporting will be provided on six monthly basis

Improving access to diagnostics

For further information on increasing the volume of direct referrals from primary care for flat x-rays and ultrasounds please refer to Module 2.3.3 Improving Access to diagnostics – Midland Primary Access Criteria.

Closer integration of Pharmacy within primary care settings

We will progress a range of associated activities that will seek to more closely align and integrate Pharmacy into the Health Care Home. Initiatives will include:

• integrate Pharmacy Long Term Condition plans into a shared electronic record, accessible across primary/secondary settings will be progressed

• actively involve community pharmacists in a range of collaborative forums such as SLATs to strengthen patient-centred outcomes

• review effective medicine management and medicine administration across the primary and community settings to ensure optimum utilisation of available resources and best outcomes for patients will be undertaken by 31 March 2016.

Narrative reporting will be provided on six monthly. basis

Bay of Plenty Alliance Leadership Team (BOPALT)


BOPALT Work Plan

BOP ALT was formed in the latter part of 2013 with its first meeting being held early April 2014. BOP ALT has progressed the development of a Work Plan that seeking to identify and address key strategic opportunities across the primary / secondary service continuum with a focus on service integration and enhancement; ensuring outcomes align with the NZ Triple Aim and remain focused on patient-centeredness. The work through BOP ALT is underpinned by the BOPDHB Integrated Healthcare Strategy 2020. The key activities in the BOP ALT work plan for 2015/16 are described below.

BOPALT Plan - System Enablers:

Bay Navigator (Bay Nav)

It was agreed in early 2015 that Bay Navigator (pathway programme) be reformed as a Service Level Alliance Team of BOPALT as predominantly its work programme aligned to the broader work plan of BOPALT. Work within Bay Navigator will continue to focus on collaborative development of new whole of system clinical pathways while also using the same processes for review and enhancement of existing pathways already available . During 2015/16, it is proposed that support will be sought to develop at least three high demand clinical pathways through BOP ALT. These could include; Upper GI Endoscopy, Temporal Arteritis, Renal Colic and Podiatry Vascular but are subject to confirmation by BOPALT as part of their 15/16 work programme.

Implementation of the IPIF

Please refer to Module 2.1.3 Shorter Waits for Cancer Treatment – Faster Cancer Treatment Please refer to Module 2.3.11 Maternal and Child Health

Early registration with an LMC within the first 12 weeks of pregnancy - 80% of women who register with an LMC do so in their first trimester.

Quarterly reporting

Early enrolment with a PHO within 4 weeks of birth (target TBC) - 98% of newborns are enrolled with a PHO, general practice, WCTO provider and COHS by three months.

Please refer to Module 2.1.4 Increased immunisations.

• 95% of newborns receive all scheduled immunisations by 8 months of age.

• 95% of children have received all scheduled immunisations by 2 years of age.

Quarterly reporting

We have created a newly established role of Clinical Quality Facilitator to work with ARC around identified audit and compliance issues such as medication mismanagement. We are currently recruiting for a new Clinical Nurse Specialist role to support ARC in clinical workforce development issues that arise.

There will be no increase in the number of people aged 65 years or older who are prescribed 11 or more medications

Quarterly reporting

Please refer to Module 2.1.5 Better Help for Smokers to Quit.


• By 2025, less than 5 % of the DHB’s population will be

Quarterly reporting


a current smoker.

Please refer to Module 2.1.6 More Heart and Diabetes Checks.

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

Quarterly reporting

Information Systems Service Level Alliance Team (Bay IS Group)

The Bay IS Group was endorsed for development through BOPALT in March 2015. This group was given the responsibility for IS development / oversight and data governance across the whole system and reports to BOPALT as a mandated Service Level Alliance Team. Initial activities will include:

• progress development of the Bay IS Group Work Plan for 2015

• initiate system scan of current capabilities and capacity • develop stocktake on current associated activities and

identify areas that the Bay IS Group could exercise effective input.

BOPALT Plan - Service and System focused activities.

Rural SLAT (RSLAT)

The Rural Service Level Alliance Team was formed through BOPALT mid-2014. Its membership is heavily reflective of rural General Practice providers and Primary Care management. Responsibilities of the Rural SLAT include:

• reviewing existing funding allocations and give consideration to / formulate recommendations for appropriate utilisation of any unallocated devolved funding through BOPALT

• identifying, reporting and proposing solutions or initiatives to address rural issues at the strategic level

• providing advice to address unique locality specific issues. The key focus areas for 2015/16 will be:

• to progress engagement and support for any proposed change to current funding arrangements

• development of guiding principles to support recommendations and BOPALT decision-making drafted; and

• undertaking workforce survey across rural and isolated primary care and community providers

• undertake a service stocktake and gap analysis across rural communities

• make key recommendations to BOPALT on opportunities to address identified issues and service gaps.

Acute Demand Management in the community, including those with Long Term Conditions

A number of forums with our primary and secondary clinical teams have been facilitated since August 2014, in attempts to better understand the drivers for the unprecedented increases in acute demand experienced across the BOP system. This has been and continues as an interactive process to identify a range of strategies that can be developed to assist in the better management of acute demand across the system. Activities supporting the Acute Demand Management (ADM) initiative are continually being progressed across a number of fronts. These include:

• redesign of the former Coordinated Primary Option (CPO) service into a responsive ADM service framework that supports improving access to community-based services as delivered through our primary care networks. Better management of patients with COPD and improved utilisation of community-delivered IV therapies and improved cellulitus management will be an early focus. We will also be targeted ASH conditions where we know we have high rates of preventable hospitalisations. We will seek to extend coverage into the Eastern Bay of Plenty

• reviewing whole of system service demands leading up to

Reduction in Ambulatory Sensitive Admissions to Hospital (ASH) rates and ED attendances for target cohort Reduced disparity of ASH rates between Māori and Non-Māori. Evaluation of effectiveness of individual components of service integration and redesign to be undertaken as part of a PDSA cycle.

Quarterly narrative on progress and initiatives. Progress against previously identified actions.


significant holiday and seasonal periods throughout the year and planning for those periods of high demand

• targeting populations – identifying target populations for case management / coordinated care with an initial focus on ED frequent flyers

• Nursing workforce developments – better utilisation of the nursing workforce to manage acute demand through initiatives such as community nurse led clinics, primary care triaging, extending nursing scope

• integrated patient records – continuing to build on the electronic sharing of information between primary and secondary clinical teams such as improving access to interai data, real time access to diagnostics

• exploring integrated appointment systems to better manage walk in capacity in ED and across primary care

• developing a community dashboard to provide real time access to acute demand on the system across ED and acute walk-in clinics in primary care

• working closely with our community-based services including the WBOP PHO Health and Wellness Centre to manage better services for the homeless, those with mental health issues and those access refuge centres

• improving access to and flow of appropriate data to assist in identifying areas of peak demand and mitigation options across the system

Community Nursing Service level Alliance Team (CNSLAT)

The Community Nursing Service Level Alliance Team is charged with the responsibility for identifying optimum service-level integration of nursing services across the primary / community settings. The CNSLAT will develop a plan and recommendations for BOPALT for more patient-focussed, integrated community nursing services. The plan will be developed with patient/stakeholder input. The initial aims include better co-ordinated care for people in their homes, improving the capability of primary care based teams, and strengthening general practice as the patient’s medical home. The work of the CNSLAT is around identifying opportunities for service enhancement and integration. Any considerations associated with implementation of agreed outcomes will be progressed through BOP ALT and, as appropriate.

Plan and recommendations developed for consideration by BOPALT by July 2015. Progress agreed outcomes from the initial work of the CNSLAT.

Reporting will be on a six monthly basis

Opotiki and East Coast Locality Planning Project

Sapere Research Group was selected to support the BOPDHB with a locality planning process in Opotiki to explore the opportunities for greater cooperation and collaboration between health, Iwi and Social Services in the Opotiki and East Coast region. The focus on their project is to conduct locality planning and explore options that build primary care capacity, capability and sustainability across the Opotiki / East Coast region. This will also act as a foundation for service integration through new models of care and the strengthening of critical relationships.

The outcomes from this work will be a preferred model of services for the Opotiki and East Coast region that provides a plan for more integrated and connected health and potentially social services. Specific actions and priorities for health care services will be produced, describing strategies and processes that will lead to improved patient outcomes, better value for money, improved quality and timeliness, and higher levels of patient satisfaction for the population of the eastern Bay of Plenty. The key deliverables through this project are due to be completed by 31 July 2015. Based on that final report, agreed actions will be identified and progressed through to implementation in a shared and collaborative environment and will carry forward into the 2015/16 year.

The key milestone from the initial work will be the production / receipt of the Final Report by 31 July 2015. This will inform further implementation activities in association with this project throughout 2015/16.

Reporting will be on a three monthly basis


2.3.3 Improving Access to Diagnostics Our Approach Optimising care requires consideration of both primary and secondary sectors and of patients’ transition between the two. Exploring new ways of interacting with secondary care is also important in the context of the evolution of general practitioners with a special interest and the role of general practice in commissioning services. The aim is to develop an integrated care model and assess its impact on timely and accessible patient care. As part of this development in 2014, we have:

• implemented the Midland Primary Access Criteria for Community Radiology to provide regionally consistent appropriate diagnostic criteria to ensure equitable access across the Midland DHBs and improving management of referrals through better integration between the interface of Primary and Secondary;

• developed e-referrals to radiology which is an enabler of the Midland Primary Access Criteria for Community Radiology

• shifted the budget holding for some community-referred tests from secondary to primary care to improve access and efficiency.

Linkages

• Minister’s Letter of Expectations • Midland DHBs Regional Services Plan 2015/16 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.1.2 Improving Access to Elective Surgery • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.3 Improved Access to Diagnostics • Module 2.3.5 Long Term Conditions • Māori Health Plan 2015/16


National Patient Flow

We will participate in activity relating to development and implementation of the National Patient Flow (NPF) system, including adapting data collection and submission to allow reporting to the NPF as required.

Refer PP29: Improving waiting times for diagnostic services: • coronary angiography – 95% of accepted

referrals for elective coronary angiography will receive their procedure within 3 months (90 days)

• CT and MRI – 95% of accepted referrals for CT scans, and 85% of accepted referrals for MRI scans will receive their scan within six weeks (42 days)

• diagnostic colonoscopy: o 75% of people accepted for an urgent

diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days, inclusive), 100% within 30 days

o 65% of people accepted for a non-urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 120 days.

• Surveillance colonoscopy – 65% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks

Radiology

We will us analysis of historic and current activity, determine radiology service capacity that best meets the average demand for ED and IP and ascertain the capacity for other elective imaging. We will introduce daily and weekly operational meetings to assess and implement variance response management and optimise resources. We will investigate with IS system to help align imaging appointment times with other services. We will implement electronic receiving of GP referrals. We are focusing on a number of key areas to improve service delivery for colonoscopy and endoscopy in general.

Progress against actions will reported quarterly to the Ministry.



• GRS – working in conjunction with the Ministry of Health National Endoscopy Quality Improvement Programme and utilising the UK developed Global Rating System for improving quality coordination. The BOPDHB Endoscopy unit has improved on a majority of ratings.

• The unit has also commenced a number of initiatives to improve service delivery quality. The key ones being nurse initiated consent, standardised prioritisation/grade, endoscopy unit utilisation. These initiatives will be operational by June 2015.

(84 days) beyond the planned date, 100% within 120 days

• Representation, attendance and participation in national and regional clinical group activities.

• Reduction in inappropriate referrals • Agreed system changes are implemented.

We will manage and monitor the Midland Primary Access Criteria and e-referrals from 1 July 2015.

National and Regional Networks

We will manage the shifting to National Criteria from 1 July 2015 over the coming 18 months.

As part of the National Radiology Service Improvement Project we will look to improve the effectiveness, efficiency and sustainability of radiology services in order that they achieve sustainable reductions in waiting times through the following key actions:

• review of demand • review of capacity • production planning • workforce availability.

We will continue to participate in the Midland Radiology Advisory Group as it is a prime vehicle for:

• ongoing collaboration at regional and national levels

• continued development and collaboration of referral pathways.

• Representation, attendance and participation in national and regional clinical group activities.

• Reduction in inappropriate referrals.

• Regional benchmarking. We will continue regional benchmarking.

Whanau Ora Access pathways

We will implement the Whanau Ora Access Pathway by 31 December 2015.

Pathway will be implemented by 31 December 2015.

Health equality We will identify and provide a report comparing Māori versus non-Māori access rates to diagnostic services.

Equitable access for Māori. Utilisation of whanau ora access pathways post 31 December 2015.


2.3.4 Rising to the Challenge Our Approach We will continue to work collaboratively with other Government agencies, our Non-Governmental Organisations (NGO), Primary Care partners and Regional colleagues to assist in delivering the outcomes in Rising to the Challenge - Mental Health and Addiction Service Development Plan 2012-2017.

Objectives • Actively using our resources more effectively • Building infrastructure for integration between primary and

specialist services • Cementing and building on gains in resilience and recovery

Linkages • Minister’s Letter of Expectations • Rising to the Challenge - Mental Health and Addiction Service

Development Plan 2012-2017 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.3.2 Primary Care • Module 2.3.11 Maternal and Child Health

2015/16 Priority area Actions to deliver improved performance Measured by Reporting requirements

Rising to the challenge: (1) Actively using our current resources more effectively

We will continue the use of the Shared Mental Health & Addiction Governance Group, involvement in Social Sector trial site groups, the local Youth Offending Teams, Corrections/Alcohol and Other Drugs (AOD) Advisory group and the Midland Regional group.

Better use of resources/value for money

Progress against actions will be reported on a six monthly basis

Equally Well – We will prioritise the improvement in the physical health of those with low prevalence disorders.

Physical Health Working Group set up in first 6 months of 15/16 to develop measures. Social Enterprise Group to grow employment and work options.

We will ensure accurate data collection informs national reporting. BOPDHB Clinical Director to provide quarterly report on the use of section 29 in the BOPDHB.

95% of patients subject to section 29 Mental Health Act will have received appropriate cultural assessment and support

We will implement the COPMIA Guidance as soon as it is received.

Rising to the challenge: (2) Building infrastructure for integration between primary and specialist services (i)


We will improve primary/secondary integration for child & youth through the Integration initiative and Youth AOD Integrated Model.

We will identify all opportunities to work alongside primary care and NGOs to monitor the physical health



of people with low prevalence disorders. Rising to the challenge: (3) Cementing and building on gains in resilience and recovery for people with low prevalence conditions and/or high needs


Rising to the challenge: (3) Cementing and building on gains in resilience and recovery for Māori and for Pacific people’s and refugees, people with disabilities and other groups

We will support service users in their role as parents (see actions to implement COPMIA guidance). We will improve physical health & wellbeing. We will enhance co-ordination between mental health and addiction and disability support services.

Development of Physical Health Working party to determine measures. 100% of mental health & addiction providers have accessed Quit Smoking training. Work alongside DSS to develop a service for those with complex needs spanning mental health, addiction and disability.

Progress against actions will be reported on a quarterly basis


Rising to the Challenge: (4) Deliver increased access across all age groups

We will strengthen current vehicles for involvement of the NGO, PHO and justice sectors (Governance groups) and involvement in Social Sector Trial sites.

Specialist perinatal and maternal mental health services develop a pathway with community providers for these families Review of primary mental health services identifies opportunities to expand access to evidence-informed psychological therapies in primary care.

Progress against actions will be reported on a six monthly basis

Equally Well We will strengthen reporting on physical health measures for people with low prevalence disorders.

Physical Health Working Group set up in first six months of 15/16 to develop measures. Social Enterprise Group to grow employment and work options.


Implementation of the New Zealand Suicide Prevention Strategy 2006 – 2016 and the New Zealand Suicide Prevention Action Plan 2013 – 2016

BOPDHB Suicide Prevention Plan – The final plan is due by 20 July 2015. Key actions from this plan are:

• institute a Suicide Prevention Coordinator position

• establish inter-agency governance group • implement standard immediate response &

follow up processes to suspected suicides across the district

• continue National Certificate in Social Service Work in Suicide Intervention Level 6 training.

Key measures will be: • Suicide Prevention Coordinator

will be in place by mid-September 2015

• the inter-agency governance group to be established by September 2015

• implementation of the standards will occur by 31 December 2015

• number of participants that have completed the National Certificate in Social Service Work in Suicide Intervention Level 6 training.

QPR training licences will be made available for 2015/16. Anamata Private Training Establishment will continue to provide training.

Number of licences available % of people complete National Certificate in Social Service Work.



Non-Governmental Organisation Sustainability

We will work alongside smaller mainstream providers to develop options for sustainability and explore funding vehicles to facilitate the chosen processes. Kaupapa NGO hauora align with BOPDHB policy of either:

• Kaupapa PHO • Maori development organisation • Iwi organisation.

Mental health and addiction service provision ring-fence

We will continue to ensure that the Mental Health and Addiction ring fence is fully allocated in support of the service delivery requirements of the Annual Plan. Our system and processes ensures that the Portfolio Managers are able to monitor and inform. This is an ongoing process.

Achievement of annual plan budget 2015/16.

Performance against budget will be monitored monthly by management, and reported on a quarterly basis to the Ministry of Health.


2.3.5 Long Term Conditions Our Approach We will continue to work with our primary care partners to reduce the impact of long term conditions. There will be a focus on ensuring the care of people with long term conditions takes place in the most appropriate setting (particularly community and primary settings), with primary care nurses and allied health professionals taking wider responsibility for helping people manage their ongoing health needs. We will support people with long term conditions to undertake a process to plan for their future (Advanced Care Planning (ACP)) to support them to make decisions about their wishes and preferences for their future healthcare needs and life goals so that they can be active partners in their healthcare. Linkages


appropriate specialist care • Module 2.1.6 More Heart and Diabetes Checks • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.6 Diabetes Care Improvement Packages • Module 2.3.10 Whanau Ora • Module 2.7 Improving Quality • Module 5.2.5 Service Improvement


Prevention

We will continue to resource and support existing services delivered through our Primary Care partners in the prevention of Long term Conditions including:

• maximising the availability and utilisation of Health Promotion resources across the primary setting and as aligned to Toi Te Ora (our Public Health Unit)

• actively work to strengthen existing relationships between our Public Health Unit and primary care service environments

• support community-based Smoking Cessation activities and initiatives as devolved and delivered through our Primary Care partners

• strengthen the adoption and implementation of the Whanau Ora models of care and support to those most vulnerable within our communities.

Please also refer to Modules 2.1.6 and 2.3.6 as they relate to prevention initiatives and activities in relation to Cardiovascular Risk and Diabetes identification.

Improved integration of health services Improved access to whanau ora models of care Reduced rates of ASH


Identification

We will continue to resource and promote utilisation of the range of IT products procured through BPAC on behalf of our Primary Care partners including Best Practice Intelligence (BPI), Patient Prompt and the Common Form. Additionally, we will support our Primary Care partners in the continued access to and utilisation of Dr Info as

Improved integration of health services Reduced rates of ASH




an effective Patient Management System audit tool for General Practice.

Management and Enablers

We will continue to resource and support existing programmes delivered through our Primary Care partners that focus on the effective management of Long Term Conditions within the community including:

• Chronic Obstructive Pulmonary Disease (COPD) Self-management programmes

• cardio-vascular self-management programmes • Integrated Case Management (ICM) programme

delivered through EBPHA to its enrolled population

• Acute Demand management (ADM) as delivered through WBOP PHO for the enrolled populations within the WBOP and expanded to include EBOP for agreed conditions and diagnoses

• closer alignment of the services delivered through the WBOP PHO Health and Wellness Centre to other local initiatives including effective management of acute demand and Ambulatory Sensitive Hospitalisation (ASH) presentations to our Emergency Departments

• based on ASH analysis in the EBOP, BOPDHB and EBPHA implement targeted approaches to prevent ASH presentations

• Maori health is exploring the possibility of a Kaupapa Maori ED outreach nurse for EBOP to assist with the management of acute demand.

Please also refer to Modules 2.1.6 More Heart and Diabetes Checks and 2.3.6 Diabetes Care Improvement Packages as they relate to prevention initiatives and activities in relation to Cardiovascular Risk and Diabetes identification.

Improved integration of health services Reduced rates of ASH


2.3.6 Diabetes Care Improvement Packages Our Approach We will continue to work with our primary care partners to reduce the impact of diabetes. There will be a focus on ensuring people living with diabetes are regarded as leading partners in their own care within systems that ensure they can manage their own condition effectively with appropriate support. Linkages


appropriate specialist care • Module 2.1.6 More Heart and Diabetes Checks • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.101 Whanau Ora • Module 2.7 Improving Quality • Module 5.2.5 Service Improvement



Prevention

We will continue to support and promote effective utilisation of the Greens Prescription programmes offered through Sport BOP.

Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol.

Reporting will be on a quarterly basis to the Ministry

Our Primary Care partners will continue to further invest in these and other enhanced lifestyle and activity based programmes to maximise access and availability for those within their enrolled populations that fall outside normal access criteria.

We will remain active participants in the Project Group providing oversight of the Pre-diabetes Programme being operated through Sport BOP.

Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol.

We will explore and progress identified opportunities to better deliver Screening, Diagnosis and Management of Gestational Diabetes within the community, in line with the national guidelines, published in December 2014. Through our Child and Youth streams we will undertake a stocktake to analyse what service provision looks like across the BOP.

Stocktake to be completed by 28 February 2016.

We will undertake an evaluation on the current Diabetes Management Programme. The evaluation will be conducted by 30 September 2015.

Evaluation to be completed by 30 September 2015.

Identification

We will continue to invest, through our primary care partners, in Community-based Diabetic Podiatry and Foot Management services, and primary care management of the devolved Retinal Screening programme, enabling GP-direct referral and access to community-based services as appropriate to their enrolled population.

Increased investment into primary care Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol


Management

From 1 July we will explore the utilisation of the Specialist Nursing resource to work within HOP services.

Narrative report will be completed by 31 March 2016


We will progress, through clinical education sessions, the adoption and adherence to the 20 Quality Standards for Diabetes Care, using the Diabetes Care Toolkit, 2014.

Quality standards for diabetes care will implemented Improved diabetes care is in practice Number of clinical education sessions

We will incorporate the adoption and observation of the 20 Quality Standards for Diabetes Care, using the Diabetes Care Toolkit, 2014, in existing and new contractual arrangements we have or enter into with our Primary Care partners. We will ensure that self-management courses are available for Maori and that these align with the 20 quality standards and are culturally appropriate. We will provide diabetes self-management courses for Indians as there is a significant and growing cohort of Indians who have diabetes within WBOP. We will review and identify any opportunities to better integrate services for people with Type 1 Diabetes across the service continuum, enabling optimum care in the most appropriate environment.

Review report to be completed by 30 June 2016

We will continue to resource, through our Primary Care partners, the provision of Dietetic and Diabetes Nurse Specialist Services to our enrolled populations.

Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol



We will continue to resource community-based Diabetes Self-management programmes as currently delivered through our Primary Care partners, ensuring alignment with the 20 Quality Standard within the Diabetes Care Toolkit, 2014.

Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol. Programmes to be aligned to the Diabetes Care toolkit 2014 by 30 June 2016.

We will undertake an evaluation of the current Diabetes Care Improvement Programme, utilising the BOPDHB evaluation template, to identify potential areas for service and system enhancement. The evaluation will be conducted by 31 December 2015.

Evaluation will be completed by 31 December 2015.

Management and enablers

We will support patients to identify their own key co-ordinator or navigator of care to co-ordinate services among multiple providers of care including social and support services. Refer to Modules 2.3.2, 2.3.10 Whanau Ora and IHS Action’s 4.3.1, 4.4.

We will provide a narrative report on our progress against the actions Key highlights will include:

• Collaboration • Integration of the

delivery of services • Improved enablers • Improved practice and

diabetes care Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol


We will continue to support and provide the suite of IT products utilised within General Practice to support effective and timely patient pre-call / recall and optimum disease management. We will actively support and progress a data–matching process through our general practice patient management systems against the national Virtual Diabetes Register to enable a more accurate understanding of the of prevalence of diabetes within our enrolled populations. We will regularly review where BOPDHB sits against the NZ Diabetes Atlas of Variation and actively work to correct any identified variances, within reason, as they are occur. We will continue to ensure closer integration of our community and hospital-based diabetes services through strengthening clinical pathways and closer collaboration between secondary specialist and primary clinicians. We will provide insulin education general practice through Continuous Medical Education (CME) and Continuous Nursing Education (CNE).

We will promote participation in level 8 diabetes education for nurses funded through HWNZ and offer a course locally if there are sufficient numbers.

We will work with the chair of the former Local Diabetes Team and the local Diabetes Society to develop a strategy for greater consumer involvement. The following milestones have been planned:

Strategy meeting 30 September 2015 Funding submission 30 November 2015 Service planning 31 January 2016 Consumer input reflected in AP 2016/17

30 April 2016


2.3.7 Stroke Our Approach Our organised stroke service unit has a 'whole team' approach, which has been embraced by the service, as well as the staff who have made it happen. It brings together nursing, allied health and medical staff from both acute and rehabilitation services. The focus of the service is about getting the best outcome for each stroke patient, bringing together all the resources we have to ensure they get the best care. Over the coming year we will continue to explore the development of an Acute Stroke service in the Eastern Bay of Plenty. The Midland Stroke Action Group is leading on regional actions to improve DHB’s ability to provide acute and post-acute stroke care in appropriately configured organised stroke services. Linkages

• Our Performance Story Impact: People receive timely and appropriate specialist care

• Midland DHB Regional Services Plan 2015/16 • Module 2.1.2 Improved Access to Elective Surgery • Module 2.3.5 Long Term Conditions • Module 2.3.8 Cardiac- Secondary Services


Stroke services

We will continue to provide a dedicated stroke unit and areas for management of people with stroke, thrombolysis, and transient ischaemic attack (TIA) services supported by ongoing education and training for lead clinicians, Clinical Nurse Specialist and full Multi-disciplinary Team membership.

Targets to measure improvement in organised stroke services: • 6 % of potentially eligible stroke

patients thrombolysed Baseline: 0%

• 80% of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway.

Baseline: 89% • Proportion of patients with acute

stroke who are transferred to in-patient rehabilitation service.

• Proportion of patients with acute stroke who are transferred to in-patient rehabilitation service within 10 days of acute stroke admission. Target: 60%.


Access to stroke thrombolysis pathways and processes

We will continue targeted ED assessment – all stroke patients triaged at minimum of Australasian Triage Scale (ATS) Category 2 and Risk of Stroke in ED (Rosier) scored; fast track access to diagnostic CT scan and use of stroke thrombolysis kit to facilitate thrombolysis in ED. Data collection related to rehabilitation outcomes (using INTERia) is in place within rehabilitation phase of stroke pathway. Stroke service is engaged with regional and national work streams and will contribute to thrombolysis register (when available) – however this is likely to require duplicate reporting as we already record thrombolysis and other outcomes on internal data base and audit tool for quarterly reporting purposes.

Reporting will be on a quarterly basis. Thrombolysis achievement against MOH baseline target is reported to MOH and regional stroke clinical network quarterly

We will support the development of Acute Stroke services in Eastern Bay of Plenty. We will support community based education – ongoing liaison with Stroke Organisation (BOP).


Stroke Multidisciplinary Teams (MDT)

We will continue to use daily board rounding methodology for MDT review and rehabilitation

Reporting will be on a quarterly


planning/care. basis

Stroke Thrombolysis Quality Assurance

We will continue to educate within the Acute Stroke (AS) team – participation in 6 week education programme; completion of on-line stroke education and attendance at regional and national learning opportunities. Led by CNS – Stroke and Neurology and lead Physician. We will provide ongoing access to thrombolysis across both Western and Eastern BOP to be sustained by introduction of stroke thrombolysis kits and ongoing education.

Targets to measure improvement in organised stroke services • 6 % of potentially eligible stroke

patients thrombolysed Baseline: 0%

• 80 % of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway.

Baseline: 89% • Proportion of patients with acute

stroke who are transferred to in-patient rehabilitation service.

• Proportion of patients with acute stroke who are transferred to in-patient rehabilitation service within 10 days of acute stroke admission.

Target: 60%.


Care management plans

As above. Ongoing work on refining and reviewing stroke standards of care and auditing against standards.


Clinical Leadership

We have recently recruited a lead clinician to continue ongoing monitoring and championing. We will be monitoring the retention and support of this role.


Support national and regional clinical stroke networks

We will continue to attend and support the Midland Clinical Stroke Network to implement actions to improve outcomes for people who have had a stroke. We will also support through our involvement on national groups and through groups such as the Clinical Nurse Specialists forum.


Refer to the Midland Regional Services Plan 2015/16 for more information on the regional actions.

2.3.8 Cardiac – Secondary Services Our Approach In 2015/16, we will be continuing the work regionally to better help utilise resources and ensure that the development of appropriate clinical pathways continues. We will continue to engage with our primary care partners in the planning and implementation activities that occur in this area. Objectives A health system that functions well for Cardiac – Secondary Services is one that is:

• increasing cardiac surgery discharges • improving access to cardiac diagnostics and specialist

assessment • reducing waiting times for people requiring cardiac services • improving prioritisation and selection of cardiac surgery

patients. Linkages

• Minister’s Letter of Expectations • Midland DHBs Regional Services Plan 2014/15 • Midland Cardiac Network • Module 2.1.2 Improved Access to Elective Surgery • Module 2.3.5 Long Term Conditions • Module 2.3.7 Stroke • Our Performance Story Impact: People receive timely and

appropriate specialist care



Cardiac Services

We will continue to work regionally to coordinate resources. To facilitate a review of the management of acute heart failure patients at Tauranga and Whakatane hospitals the BOPDHB has enrolled to participate in the National New Zealand Heart Failure registry. This will provide a clear picture of local areas for improvement and give us comparable data nationally. Please see the Midland Regional Services Plan for further information.

• Agreement to and provision of a minimum of 176 total cardiac surgery discharges for your local population in 2015/16

• Refer PP29: Improved access to diagnostics. 95% of people will receive elective coronary angiograms within 90 days. Expected for DHBs who provide angiography services only

• Elective Services Patient Flow Indicators: all patients wait four months or less during 2015/2016.

Refer SI4: Standardised Intervention Rates • Cardiac surgery: 6.5 per 10,000 of population • Percutaneous revascularisation: 12.5 per

10,000 of population • Coronary angiography: 34.7 per 10,000 of

population

Reporting will be conducted on a quarterly basis

We are looking at a co-location of cardiac services into one geographic location. We will utilise the ANZACS-QI data repository to report against standard intervention rates. Through our clinical pathways we will continue to ensure appropriate access to cardiac diagnostics to facilitate appropriate treatment referrals, including angiography, echocardiograms and exercise tolerance. The chest pain pathway locally utilised at BOPDHB has been submitted to the Regional Network who are looking to standardise across the Midland Region.

We will continue to develop CT Angiography pathways.

A recent audit has been presented to the Cardiology BOPDHB forum looking specifically at the ACS discharge medications. The conclusion from the audit was that patients are receiving the appropriate medications for their Acute Cardiac event.

Specialists are continuing to work with Primary Care physicians to improve referrals through the Bay Navigator.

Complete Bay Navigator referral pathway for Cardiac services

Reporting will be conducted on a quarterly basis

We will review the effectiveness of the referral pathways that have been implemented through Bay Navigator in conjunction with our primary care partners.

Review report will be completed by 31 May 2015 Refer SI4: Standardised Intervention Rates • Cardiac surgery: 6.5 per 10,000 of population • Percutaneous revascularisation: 12.5 per

10,000 of population • Coronary angiography: 34.7 per 10,000 of

population Review access criteria to CT Angiography to improve access to Cardiac services.

New access criteria will be developed and supported by CME education sessions for referrers


2.3.9 Health of Older People Our Approach

We will continue to support the regional model of home and community support services. Initiatives designed to improve the quality of care in aged residential care are also a high priority.

We will continue to support primary care to identify people with dementia and make early referral to support, information/advice through the clinical pathway development for Dementia through Bay Navigator and Map of Medicine. We will develop clinical pathways relating to delirium, fracture liaison services and wound care. During 2014, we implemented the following:

• a pathway for the diagnosis and treatment of uncomplicated dementia through Bay Navigator and Map of Medicine

• reconfigured the management of access to two residential respite beds to maximise occupancy and avoid admissions to hospital

• continued to develop a regional approach to service delivery for Home and Community Support Services working towards implementation of the regional approach in 2015

• continued to strengthen working with community and secondary providers

• worked collaboratively with other sectors ACC falls prevention • supported aged residential care to implement comprehensive

geriatric assessment using the interRAI Long Term Care Tool • through the Population Ageing Technical Advisory Group

(PATAG), had input to local government’s long-term strategic plans and development of Tauranga City Council’s Age-Friendly City Strategy.

Linkages • Minister’s Letter of Expectations • Midland DHBs Regional Services Plan 2015/16 • Our Performance Story Impact: People stay well in their

homes and communities • Our Performance Story Impact: People receive timely and

appropriate specialist care • BOPDHB Health of Older People Strategy 2012-2017. • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.5 Long Term Conditions



Dementia Care and Pathways

We will continue to support the regional roll out of the Map of Medicine dementia care pathway. There is still concurrent development with Bay Navigator. The Bay Navigator early dementia pathway, which provides a resource for primary practice to diagnose and manage early dementia within the community, has seen a reduction in inappropriate referrals to secondary service MH for the older person services, e.g. memory clinic. The pathway continues to be supported by a full time RN coordinator who has provided education to >80% of GPs and practices within the Bay of Plenty. This role is now supporting clinical care delivery within practices to further develop assessment and primary management skills.

Implementation and roll out of the dementia care pathway through Map of Medicine and Bay Navigator

Advance Care Planning (ACP)/Future Care Planning (FCP)

We will foster future/advance care planning across the DHB (rather than just within the early dementia pathway) – however it is included as one of the patient /clinician education resources within the pathway (and is included in other pathways related to chronic disease). We will continue to implement the Advance Care Planning options paper developed for the BOPDHB. There will be dedicated resource to undertake these actions, the key actions will be:

• targeted level 2 ACP Co-operative training across Primary, Secondary and Residential care sectors

• to work with primary and residential sectors to socialise and implement Future Care Planning (FCP) and to roll out the FCP document.

Number of ACP Co-operative level 2 training sessions completed and number of attendees

Progress will be reported on a quarterly basis

Rapid response and discharge management services (wrap around services)

We will look to improve the coordination of specific current HOP services such as Acute Care of the Elderly (ACE) Unit and the Community Response Team to ensure a seamless patient journey. This is aligned to Theme 4 of the Co-ordinated Care Integrated Healthcare Strategy 2020. We will continue to monitor the BOPDHB’s rapid response and discharge management services.

A narrative report will be provided against these actions


Home and Community Support Services for Older People

We will implement the in-between travel arrangement from 1 July 2015. We will commit all funding that is provided by the Ministry to this.

In-between travel arrangements are implemented by 1 July 2015 as per settlement ratification


We will implement aspects of the regionally agreed model of care of Home Based Support Services.

We will collect and collate the interRAI measures to provide for comparison of other DHBs.

A narrative and quantitative report will be provided against these actions

Fracture Prevention Service (FPS)

This service has been implemented and we will provide reports on:

• number of people with fragility fractures identified within service (X)

• Number of people with fragility fractures identified within service (X) ;

• % of this group ( X = people



• % of this group ( X = people with fragility fracture) who meet criteria for DEXA scan and who proceed to scan (Y = Dexa scans)

• % of people who have a DEXA scan (Y) which indicates requirement for osteoporosis treatment who receive referral to GP for bone health management (e.g. medication)

• We will do one follow up with primary provider that bone health treatment has been initiated.

with fragility fracture) who meet criteria for DEXA scan and who proceed to scan (Y = Dexa scans);

• % of people who have a DEXA scan (Y) which indicates requirement for osteoporosis treatment who receive referral to GP for bone health management (e.g. medication)

Comprehensive Clinical Assessment in residential care (interRAI)

We will continue to provide data on older people who have received long-term support services. This is provided via interRAI.

Quantitative report will be provided Progress will be reported on a quarterly basis

We will report on how many facilities are trained or engaged in training in the use of interRAI. We will improve our critical mass, so that we can appropriately measure the use of interRAI as a primary assessment tool to inform the integrated care plan. We will measure the time taken from referral to completion in interRAI. We will report on the percentage of people in ARC who have a second LTCF assessment 230 days after admission.

Health of Older People’s (HOP) specialists

There will be ongoing reporting of community based and ARC education provision by SMO and Gerontology nurse specialists.

Narrative and quantitative reporting will be provided


2.3.10 Whānau Ora Our Approach

There are two Whānau Ora Provider Collectives implementing Programmes of Action within the Bay of Plenty. Nga Mataapuna Oranga based in Tauranga (Western Bay of Plenty) and Te Ao Mārama based in Opotiki (Eastern Bay of Plenty). We will continue to support the implementation of the national Whānau Ora initiative and work closely with the two Whānau Ora Provider Collectives to grow their capacity and capability.

BOPDHB will socialise the district health board and Rūnanga Whānau Ora framework and position paper defining health’s contribution to Whānau Ora. Where possible we will influence the transformation of BOPDHB staff and health providers towards Whānau – centred practice through education.

Inter-agency relationships will continue to be built and nurtured with Te Puni Kokiri, the Ministry of Health, the Ministry of Social Development and Te Pou Matakana (North Island Commissioning Agency) to ensure that Whānau Ora remains on everyone’s agenda.

This year, Whānau Ora within the Bay of Plenty is intended to improve the health and social outcomes of Whānau through targeted service delivery, outcomes based contracting, pathway of care development, health literacy, navigation and education.

Linkages • Minister’s Letter of Expectations • Our Performance Story Impact: People stay well in their

homes and communities


• Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.4 Māori Health – Achieving Equity • Module 5.2.2 Streamlined Contracting


Whānau Ora Collectives

We will continue to maintain strong relationships with the Whānau Ora Collectives. We will align Te Ao Mārama’s Whānau Ora navigator activity with the Māori Health Plan targets ie: advice to quit smoking and pre-school dental clinic enrolment rates by July 2015. We will review and update the BOPDHB Whānau Ora Needs Assessment by October 2015.

Reporting will be provided on a six monthly basis

Opportunities to collaborate with Whanau Ora Commissioning Agencies

Te Pou Matakana has nominated Nga Mataapuna Oranga as an approved provider of the Whānau Direct Funding. We will support implementation and collaborate with Te Pou Matakana by exploring joint planning, co-funding and investment opportunities.


Whanau Ora Implementation and Whanau Ora Information System

We will increase participation on the ‘Whānau Tū Whānau Ora’ training provided by Nga Mataapuna Oranga WO Collective by 50%. We will explore and implement health literacy approaches that will influence better health outcomes for Whānau by August 2015. We will progress the development of a Whānau Ora Access Pathway by December 2015. We will establish an interagency Whānau Ora governance group to monitor and support interagency collaborative initiatives such as the Social Sector trials and the Children’s Team to ensure they align with the Whānau Ora philosophy and model. NB: Te Ao Marama and Nga Mataapuna Oranga currently use independent information systems.


Improved contracting

We will conduct an evaluation of the outcomes focused Whānau Ora Community Service contracts by March 2016. We will trial initiatives that further refine the integrated contracting and reporting process.

Evaluation to be completed by March 2016


Whanau Ora Access Pathways

Te Pou Matakana has nominated Nga Mataapuna Oranga as an approved provider of the Whanau Direct Funding. We will support implementation and explore joint ventures with Te Pou Matakana. There will be parallel development occurring through the clinical pathways in Bay Navigator. These pathways are broader than Bay Navigator.

Pathways will be developed by 31 December 2015



2.3.11 Maternal and Child Health Our Approach

Our overriding approach is to ensure a continuum of maternal and child health services from prenatal to 18 years of age across community, primary and secondary care. In addition, we want our population engaged in services that are integrated, easy to access and of high quality. The key to developing a strong Community Child and Youth Health Service that sits alongside primary and secondary care with all newborn babies enrolled in child health services at birth. Underpinning our approach is the Child and Youth Strategy which is being monitored and driven by the Child and Youth Strategic Alliance (CYSA), a multi-agency/cross sector stakeholder group. One of our key drivers is the Maternity Quality and Safety Programme (MQSP). The purpose of establishing the MQSP was to find effective ways to deliver appropriate maternity services with maternity providers and consumers; working together at the local level in a way that builds the workforce; and improves safety and quality of maternity services for women and their babies. We are focused on improving the integration of hospital and community services. The MQSP is aligned to local, regional and national priorities. Linkages

• Minister’s Letter of Expectations • Toi Te Ora - Public Health Service Annual Plan 2015/16 • Well Child Tamariki Ora Quality Improvement Plan (WCTO

QIF) • Māori Health Plan 2015/16 • Maternity Quality Plan • Module 2.1.4 Increased Immunisations • Module 2.2.1 Reduce the incidence of Rheumatic Fever • Module 2.1.5 Better Help for Smokers to Quit • Module 2.2.2 Children’s Action Plan • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.4 Rising to the Challenge • Module 2.5 National Entity Initiatives • Our Performance Story Impact: People stay well in their

homes and communities • Our Performance Story Impact: People take greater

responsibility for their health


Implementing the Child and Youth and Strategy - Integration

We will gain a comprehensive understanding of where the populations of greatest concern are living and the capacity of local services to provide coordinated, timely, and culturally responsive engagement and services; especially to those who tend not to use current mainstream systems.

Joint list of common goals for all agencies to address

Progress against actions will be on a quarterly basis

We will establish joint plans and terms of reference for the Bay of Plenty Child and Youth Alliance (CYSA).

Joint Terms of Reference Joint work plan

Six monthly reports will be submitted to Ministry


We will set up an interagency mechanism to monitor policies and service delivery models to ensure that they are coherent and contribute to a comprehensive approach to supporting pregnant women, children and young people.

Joint service level agreement


We will ensure that models of care are evidence-based or based on promising practices and are fit-for-purpose.

Joint service level agreement template

We will continue to implement the Children’s team – See Module 2.2.2 Children’s Action Plan for further information.

Implementing the Child and Youth and Strategy – Targeted Investment

We will shift appropriate resources to children, especially antenatal to age five, and the other vulnerable population groups, within the existing funding pool as defined by the model of care.

Sustainable and effective service model that support peak demand management


We will explore opportunities to optimise primary and secondary acute management and Emergency Department events. We will be actively involved in developing a fit-for-purpose maternity and early childhood workforce, including attendance on the SSHW maternity working party, getting Trendcare updated to match the work that is done in the Maternity Units, and providing relevant educational opportunities.

Implementing the Child and Youth and Strategy – Workforce

The Bay of Plenty DHB Maternity Quality and Safety programme will continue to provide oversight of the programme – the Governance Group is a multi-disciplined team and includes consumers.

Increase number and the scope of practice for Māori community health workers.


Maternity Quality and Safety Programme (MQSP)

We will continue to review the annual work plan and roll out the initiatives by 1 July 2015. Progress against these actions will be reported to the Ministry.

• 95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC.

• 80% of women who register with an LMC do so in their first trimester.

• 30% of Māori, Pacific and teen pregnant women complete DHB funded pregnancy and parenting education.

• 98% of newborns are enrolled with a PHO, general practice, WCTO provider and COHS by three months.

• 90% of four-year-olds receive a B4 School Check, including 90% of Māori and Pacific children and children living in areas of high deprivation.


The MQSP Governance Group, consisting of consumers and Maori health representatives, will continue to monitor, identify and review any areas of concern. The findings will be shared amongst the various stakeholders and then we will convene to draw up actions plan to address. Key areas of focus relate to the assessment of the woman and the proposed management plan for her pregnancy, labour and delivery. The MQSP Governance group will be reviewing 2012 Clinical indicators data released recently by the Ministry in November 2014. Audits are currently underway on three clinical indicators. The findings of these audits will be implemented from 1 July 2015 to ensure that they are consistent with the national guidelines.

Progress against actions will be on a quarterly basis We will continue the ASAP project – As Soon as

You’re Pregnant campaign which promotes early booking with midwife.

Continuity of Primary Maternity Care

With the recent establishment of the Bethlehem Birthing Centre (BBC) we will review and analyse the impact on services and volumes of the Provider Arm’s Tauranga Maternity Services.

95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC.


We will conduct locality analysis, including population and service use analysis and forecasting, to identify current and future service demand.


Healthy Pregnancies

We will identify possible future models of care, with a dual focus on exploring possibility for increased vertical and horizontal integration. The primary focus is to develop patient journeys (across public service agencies) and review how the various systems work for those patients and where issues exist. We will detail the practical issues with stakeholder’s preferred option. This will involve working with agencies interested in increasing integration. We will improve the linkages between health and support service providers by using integrated needs assessment. Improved information sharing is a key focus area for the BOPDHB Maternity Quality and Safety Governance Group.

Services for pregnant women, babies, children and families deliver best possible outcomes and support equity of outcomes

All primary care in the BOPDHB is provided by Lead Maternity Carers (LMC). All LMCs have access to the maternity facilities in Tauranga, Whakatane and Opotiki and Bethlehem via an access agreement. The MQSP Governance Group has decided to continue with the “As Soon As You’re Pregnant” campaign. Following feedback from providers - some changes have been made to the campaign. Early registration with LMC numbers for BOPDHB has increased from 67% in 2012 to 73% in 2014. In addition to this, we will work closely with PHOs (as done in the past) to organise workshops for GPs around the Section 88 service specifications.

• 95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC.

• 80% of women who register with an LMC do so in their first trimester.

• 30% of Māori, Pacific and teen pregnant women complete DHB funded pregnancy and parenting education

Increased registration with a Lead Maternity Carer

We will implement the recommendations from the Gestational Diabetes Mellitus National Clinical Guidelines.

• Within the next two years, 80% of women who register with an LMC do so in their first trimester.

• 98% of newborns are enrolled with a PHO, general practice, WCTO provider and COHS by three months.

Gestational Diabetes Mellitus National Clinical Guidelines

Through our various services and providers we will continue to work collaboratively and in an integrated way, to ensure that all newborn babies are registered with a PHO and registered with a GP, WCTO provider. All families are given enrolment forms for GPs and Oral Health prior to leaving the Maternity Unit. If they do not have a current GP they are given information about the GPs in their area.

Recommendations to be implemented by 30 June 2016

Newborn enrolment

We will ensure continuous quality improvement of current B4SC initiatives to increase and/or maintain B4SC coverage.

B4 School Checks (B4SC)

We will ensure continuous quality improvement of current B4SC initiatives to increase and/or maintain B4SC coverage.

90% of four-year-olds receive a B4 School Check, including 90% of Māori and Pacific children and children living in areas of high deprivation.


Negotiate with relevant stakeholders in BOPDHB to implement the Baby Friendly Community Initiative.


47 "The Well Child / Tamariki Ora Quality Improvement Framework ." 2013. 12 Mar. 2014 <http://www.health.govt.nz/publication/well-child-tamariki-ora-quality-improvement-framework> 48 Baby Friendly Community Initiative Evaluation. 2014. 13 May 2015. http://www.whariki.ac.nz/massey/learning/departments/centres-research/shore/projects/baby-friendly-community-initiative-evaluation.cfm 49 Manaena-Biddle, H, J Waldon, and M Glover. "Influences that affect Māori women breastfeeding." Breastfeeding Review 15.2 (2007): 5. 50 "The Well Child / Tamariki Ora Quality Improvement Framework ." 2013. 12 Mar. 2014 <http://www.health.govt.nz/publication/well-child-tamariki-ora-quality-improvement-framework>

Full and exclusive breastfeeding rates at 6 weeks, 3 months, and 6 months

We will review and prioritise recommendations from the evaluation of breastfeeding friendly spaces initiative in BOPDHB and Lakes DHB.

Māori infants will have attained breastfeeding rates consistent with the age-related targets set by the Ministry of Health in the Well Child Tamariki Ora Quality Improvement Framework.47

• 68% at 6 weeks (full or exclusive)

• 54% at 3 months (full or exclusive)

• 59% at 6 months (full, exclusive, or partial)


We will progressively increase the number of accredited breastfeeding friendly public spaces in BOPDHB and Lakes DHB to 260 by June 2016. ‘Breastfeeding friendly public spaces’ is the local implementation of elements of the BFCI. In particular, the program aims to increase the number and distribution of public spaces which are conducive to mother’s needs for breastfeeding. A New Zealand based evaluation noted that the BFCI had the potential to raise breastfeeding rates and improve community support for breastfeeding.48

This initiative may contribute to reduced disparities by increasing the acceptability of breastfeeding in public – a perceived barrier for Māori women noted in past research49.

Māori infants will have attained breastfeeding rates consistent with the age-related targets set by the Ministry of Health in the Well Child Tamariki Ora Quality Improvement Framework.50

• 68% at 6 weeks (full or exclusive)

• 54% at 3 months (full or exclusive)

• 59% at 6 months (full, exclusive, or partial)

We will establish a sustainable forum of breastfeeding stakeholders in the western Bay of Plenty (similar to that functioning in the eastern Bay of Plenty). Key activities of the group will be to establish a stocktake of breastfeeding promotion and support activities being performed by the various stakeholders, and then to integrate the activities and breastfeeding targets of stakeholders. The forum will complete a work plan for the year. Areas to address will include improving the interface between lead maternity carers and Well Child Tamariki Ora services, integrating the roles of stakeholders, and providing more information to providers to educate and support mothers to continue breastfeeding. To be facilitated by BOPDHB Funding and Planning in collaboration with Toi Te Ora - Regional Public Health Service.

We will implement a general practice based reminder system in collaboration with PHOs to remind staff to encourage breastfeeding at six-week and three month vaccination visits.

http://www.health.govt.nz/publication/well-child-tamariki-ora-quality-improvement-framework


http://www.whariki.ac.nz/massey/learning/departments/centres-research/shore/projects/baby-friendly-community-initiative-evaluation.cfm

http://www.whariki.ac.nz/massey/learning/departments/centres-research/shore/projects/baby-friendly-community-initiative-evaluation.cfm




We will monitor the breastfeeding indicator each month within the Māori Health Planning and Funding Team; on a quarterly basis through the Māori Health Plan Steering Group.

By 31 August 2015, we will complete a comprehensive process map of the enrolment pathway in order to identify all barriers to oral health patient management along the pathway. To be completed by oral health champion, in association with 1) DHB Planning and Funding and MoH (data matching), 2) Community oral health services, 3) PHOs within BOPDHB.

Oral health

We will reconcile preschool PHO enrolments against the Titanium dental enrolment database. Identify any clusters of dental non-enrolment by hospital, geography, PHO, and ethnicity within the DHB. This should be completed by 31 August 2015.

95% of Māori preschool children will be enrolled in a dental clinic.


We will develop, prioritise, and implement interventions to increase Māori preschool dental clinic enrolment rates based on the assessment of patterns of non-enrolment described in the aforementioned activity by 30 September 2015. In parallel, identify gaps in the enrolment process and develop interventions to address these. We will monitor dental clinic enrolment performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the BOPDHB Funding and Planning oral health champion. We will monitor dental clinic enrolment performance on a quarterly basis through the Māori Health Plan Steering Group.


2.4 Māori Health – Achieving Equity – Key actions from Māori Health Plan

Our Approach Over the coming year we will continue to take a population health approach on Māori health. We will continue to work with our partner organisations to address the primordial causes of health inequality, and work directly with our health sector stakeholders to address the indicators listed in this plan. As in the past, we will monitor progress through our Māori Health Plan Steering Group; this quarterly forum comprises representatives from the various organisations involved in achieving the targets listed in this plan. We will also seek to refine our monitoring tools so that the DHB and stakeholders have timely, accurate, and relevant information on progress towards our shared targets. With regular performance monitoring and the engagement of key stakeholders we will seek to improve performance throughout the year. In addition, we will continue to learn from high performing organisations that have eliminated or reduced inequalities. We have included specific actions from our Māori Health Plan to support and escalate our focus on reducing Māori health inequities and provided links to specific sections in the Annual Plan. Linkages

• Māori Health Plan 15/16 • Midland Regional Services Plan 15/16 • Toi Te Ora - Public Health Service Annual Plan 2015/16 • BOP Integrated Healthcare Strategy 2020 • Module 2.1 Health Targets • Module 2.2 Better Public Services • Module 2.3 System Integration


Accuracy of ethnicity reporting in PHO registers

We will implement the ethnicity data auditing tool (EDAT) in 80% of BOPDHB’s clinics in association with the three PHOs in the area by 30 November 2015.

100% of Māori in BOPDHB will be enrolled with a PHO.

We will report to the Ministry on a six monthly basis

We will collate EDAT scores and ethnicity data accuracy for 80% of clinics in BOPDHB by 31 December 2015. We will facilitate sharing of best practice processes from high scoring clinics to others with low EDAT results within the three BOPDHB PHOs by 28 February 2016. We will complete a register of clinic EDAT scores and performance in order to track implementation and repetition in 1-3 years (depending on initial results) by 28 February 2016. We will report results of the initial primary care ethnicity data audit to the quarterly meeting of the Māori Health Plan Steering Group. This group comprises representatives from each of the PHOs in BOPDHB. This forum will be used to collaborate with the PHOs on ways to improve the baseline results. Audit results will be provided to all general practices in keeping with the current performance feedback activities already performed by PHOs by 31 January 2016.

Percentage of Māori enrolled with PHOs

We will compare PHO enrolment (numerator) with the 2013 Census (denominator) to identify enrolment gaps stratified by geography, ethnicity, gender, and other variables by 1 July 2015.


We will report to the Ministry


We will provide PHO enrolment deficit analyses to PHOs in BOPDHB in order to help PHOs target enrolment improvement initiatives to specific populations by 31 August 2015.


on a six monthly basis

We will track PHO enrolment on a quarterly basis. We will complete an audit of ethnicity data accuracy in BOPDHB (see Indicator 1: Accuracy of ethnicity reporting in PHO registers) by 30 November 2015. The audit will enable the Māori Health Planning and Funding Team to reconcile the impact of underreported or misclassified Māori ethnicity on reported PHO enrolment rates. Multiple studies have reported misclassification rates as high as 35%.51 52 We will monitor indicator performance on a monthly basis through the Māori Health Planning and Funding Team, and on a quarterly basis through the Māori Health Plan Steering Group.

Ambulatory sensitive hospitalisation rate (0-4, 45-64, 0-74years)

The contract with the WBOP PHO (74% of BOP population) is to provide primary care management of ASH conditions, in particular those ASH conditions that impact upon Māori including management of pneumonia, heart failure, cellulitis, DVT and gastroenteritis in adults and skin infections and otitis media in children by 31 July 2015.

Indirectly standardised ASH rates for Māori will be the same as those for the total population of New Zealand. 0-4 years: to be confirmed (TBC) 45-64 years: TBC 0-74 years: TBC


We will provide a nurse specialist and nurse practitioner in cardiology-led education for primary and community nurses to enable better management and reduced readmissions for patients with heart failure by 30 September 2015. The WBOP PHO Health and Wellness community services plan to work in partnership with general practice to ensure patients with heart failure develop self-management plans by 31 July 2015.

We will provide insulin-start education and ongoing management of insulin therapy by 30 September 2015.

Toi Te Ora Public Health Unit provision of education to primary care health care professionals relating to management of skin infection in children.

We will provide train the trainer packages to Hauora and Māori Health contractors, including those with BOPDHB Whanau Ora contracts, Tamariki Ora contracts, Korua Kuia contracts. This work will be completed by 31 August 2015. These train the trainer packages include education from nurses, clinical pharmacists and community dietitians.

Oral health

The indicators listed above for ASH will be monitored for implementation via the indicator champion, the Māori Health Planning and Funding Team, and on a quarterly basis via the Māori Health Plan Steering Group. ASH indicator results will be tracked on a monthly basis through the Māori Health Planning and Funding Team. The Māori Health Plan Steering Group will track ASH indicator results on a quarterly basis.


Cardiovascular and diabetes See Module 2.3.11 Maternal and Child Health.


51 Bramley, Dale, and Sandy Latimer. "The accuracy of ethnicity data in primary care." Journal of the New Zealand Medical Association 120.1264 (2007). 52 Swan, Judith, Steven Lillis, and David Simmons. "Investigating the accuracy of ethnicity data in New Zealand hospital records: still room for improvement." New Zealand Medical Journal (2006).


Acute Coronary Syndrome

See Module 2.1.6 More Heart and Diabetes Checks. 70% of high-risk Acute Coronary Syndrome patients accepted for coronary angiography have it within 3 days of admission (Day of admission=Day 0). 95% of patients presenting with Acute Coronary Syndrome who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days.


We will maintain current performance on these indicators (the BOPDHB has already reached the national targets for these two CV indicators for its Māori population).

We will provide quarterly reporting to the MHPSG. If performance drops below national targets investigate the reasons for this change in consultation with the MHP cardiovascular champion.

Cancer – Breast and Cervical Screening

We will monitor indicator activity performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team in collaboration with the BOPDHB cardiac indicator champion, and on a quarterly basis through the Māori Health Plan Steering Group.

Progress against actions will be on a quarterly basis Better Help for Smokers

to quit See Module 2.1.3 Faster cancer treatment- Māori Health Plan actions.

Increased Immunisation See Module 2.1.5 Better help for Smokers to quit – Māori Health Plan actions.

Mental Health

See Module 2.1.4 Increased Immunisations- Māori Health Plan actions.

Number of clients that have undergone a community treatment order • Māori 74 clients • Non Māori 53

clients


We will identify variance in the use of section 29 (s29) across the BOPDHB by establishing consistent data collection processes for this indicator. We will analyse the degree of variance in the use of section 29 within the BOPDHB by reviewing the rationale for its use in samples of Māori patients seen by different practitioners in different parts of the BOPDHB. We will compare Māori and non-Māori patients. We will report findings of analyses to practitioners and a clinically-led multidisciplinary mental health forum. We will develop guidelines and regular auditing processes to support standardised application of section 29 throughout the BOPDHB. We will monitor the impact of the implementation of guidelines and auditing processes.

Rheumatic Fever We will monitor indicator performance on a quarterly basis through the Māori Health Plan Steering Group. Progress against

actions will be on a quarterly basis Oral health See Module 2.2.1 Reduced incidence of Rheumatic fever- Māori Health

Plan actions.

Asthma hospitalisation rate (0-14 years)

See Module 2.3.11 Maternal and Child Health- Māori Health Plan actions. We will implement acute demand service intervention. This new intervention will be deployed in BOPDHB in collaboration with the two public hospitals in the area, the three PHOs, GP clinics, and a range of other stakeholders. This intervention will provide free appointments for selected conditions for the high needs population where ambulatory care would successfully avoid hospital admission. The intervention will also cover the costs of acute pharmaceutical requirements.


We will complete development of a query tool to report monthly asthma hospitalisations to BOPDHB hospitals by 1 July 2015.

We will identify any individuals with high asthma hospitalisation rates and assess their needs. We will ensure those who are regularly admitted are enrolled with a PHO. We will link these individuals with support services such as asthma educators and healthy homes providers.

We will assess the feasibility and impact of implementing the SMART asthma management programme in the BOPDHB based on admission


patterns and patient needs.53 We will provide baseline and quarterly asthma hospitalisation figures to PHOs at quarterly Māori Health Steering Group meetings.

We will monitor asthma hospitalisations on a quarterly basis through the Māori Health Plan Steering Group. This will be on an ongoing basis.

Reduction in DNA rates Target: 5%

Did-Not-Attend (DNA) rate for outpatient appointments

We will ensure appointment information is provided in a way that meets patients’ literacy levels.

Reduction in DNA rates Target: 5%

We will form partnerships with GPs and NGOs to support patients and outpatient clinic attendance by February 2016.

We will optimise administrative processes and systems to support timely scheduling and communication processes.

We will understand, and address where possible barriers that impact on attendance lie, with a special focus on three specialties that have the highest DNA rates.

We will monitor DNA performance on a monthly basis within the BOPDHB Māori Health Planning and Funding team and via the provider arm DNA champion. We will monitor DNA performance on a quarterly basis through the Māori Health Plan Steering Group.

2.5 National Entity Priority Initiatives Our Approach We are expected to align our planning with the planning intentions of key national agencies. Each of these national agencies has initiatives for the 2015/16 year, which will affect our DHB. The national agencies and aligning activities of support are included in the below action plan. Linkages

• Midland Regional Services Plan 2015/16 • Letter of Expectations • Toi Te Ora Public Health Service plan • Module 2.1.6 More Heart and Diabetes Checks • Module 2.3.4 Improving Access to Diagnostics • Module 2.6 Living Within Our Means • Module 2.7 Improving Quality • Module 4 Financial Performance Summary • Module 5 Stewardship


Health Shared Services (HSS)

Finance, Procurement & Supply Chain (FPSC)

We will await further advice before allocating resources to the implementation of HSS’s FPSC initiative, and fully factor in expected budget benefit impacts.

Food We will await further advice before allocating resources to progress the

53 "SMART for Māori with Asthma - Asthma Foundation New Zealand" 2014. 5 Mar. 2015 <http://asthmafoundation.org.nz/wp-content/uploads/2014/11/MatireHarwoodSMART.pdf>

http://asthmafoundation.org.nz/wp-content/uploads/2014/11/MatireHarwoodSMART.pdf

http://asthmafoundation.org.nz/wp-content/uploads/2014/11/MatireHarwoodSMART.pdf



Food Services, Linen and Laundry Services and National Infrastructure Platform business cases. We will look at resources pending the decision reached in relation to these detailed business cases.

Linen and Laundry We will look at resources pending the decision reached in relation to the detailed business case.

National Infrastructure Platform (NIP)

We will look at resources pending the decision reached in relation to the detailed business case.

National Health Committee (NHC) Pull model prioritisation (proactive work programme)

We will work collaboratively with the NHC to solve sector issues by: • referring technologies that are driving fast-growing expenditure to

the NHC for prioritisation and assessment where appropriate • engaging with and providing advice on prioritisation and

assessments including through the National Prioritisation Reference Group

• introducing consistently or not introducing emerging technologies based on the NHC recommendations

• holding technologies, which may be useful, but for which there is insufficient evidence, or which the NHC is assessing for further diffusing or out of business as usual

• providing clinical and business expertise and research time to design and run field evaluations where possible.

Reporting will be done on a six monthly basis

Push model prioritisation (reactive work programme)

Innovation fund evidence generation activity

Health Quality and Safety Commission (HQSC) Surgical site infection programme (SSIP) - National Infection Surveillance Data Warehouse

We will commit to meeting infection control expectations in accordance with Operational Policy Framework - Section 9.8.

Surgical site infection programme (SSIP) - DHB Infections Management systems (ICNet NG system)

We will continue development of infection management systems at our local DHB level.

National inpatient patient experience survey and reporting system - Patient experience indicators

We will commit to surveying patient experience of the care they received using the national core survey, at least quarterly.

Capability and Leadership We will meet expectations in accordance with Operational Policy Framework Section 9.3 & 9.4.6.

Primary Care - patient experience survey and reporting system

There will be linkages to IPIF as well as the work occurring under Module 2.7 Improving quality.

National Health Information Technology Board

eMedicines Reconciliation (eMR) with eDischarge Summary

This is being addressed via the Regional Medications Management Programme the first stage of which is the CSC ePharmacy system. The regional ePharmacy system will be live across all DHBs by the start of 2015/16 and will form the basis for the Regional Medications Management programme (refer Regional IS Plan). The integration of discharge medications into discharge summaries will be delivered via a Regional Clinical Workstation programme. Until BOPDHB goes live with Regional CWS, integration of medication data into BOP’s tactical discharge summary solution will be delivered. We have completed a pilot project to incorporate Community Pharmacy medication data into the shared Éclair data repository and this will roll out during 2015/16.

Tactical integration by December 2015.

Regional Clinical Workstation (CWS) and Clinical Data Repository (CDR)

See Module 2.8 Actions to supporting Regional delivery of Regional Priorities for actions on how the BOPDHB will be meeting this requirement.

National Patient Flow MoH contribution to National

We will commit to collecting Phase 2 information from July 2015 and to collecting Phase 3 information from July 2016.



Patient Flow

Patient and Provider Portals (formerly self care portals)

We will develop an implementation plan with relevant PHOs to enable individuals to have access to their own health information and allow hospital-based services, in particular, ED, to have access to a summary view of primary care information.

Health Promotion Agency (HPA) Campaign support for health targets

1. Rheumatic fever public awareness

2. Immunisation

We will support national health promotion activities around the health targets. See Module 2.1.4 Increased Immunisations and Module 2.2.1 Reduced Incidence of Rheumatic Fever.

Alcohol Pregnancy and Alcohol Screening and Brief Intervention

We will support work undertaken by the HPA to reduce alcohol consumption during pregnancy. This will include encouraging primary and secondary care health professionals to engage with and support alcohol and pregnancy initiatives and working with HPA to identify and support innovative local practice that supports women to reduce alcohol consumption during pregnancy. This has linkages to our As Soon As Your Pregnant (ASAP) programme and other initiatives rolled out by Toi Te Ora.

Health Workforce New Zealand (HWNZ)

Increasing the number of sonographers

We will continue to address key workforce requirements with respect to the sonography workforce. See Module 2.3.3 Improving access to diagnostics and Module 5 Stewardship for further information.

Expanding the role of nurse practitioners, clinical nurse specialists and palliative care nurses

We will support the regional approach to expanding the role of nurse practitioners, clinical nurse specialists and palliative care nurses.

Create new nurse specialist palliative care educator and support roles

We will support the regional approach to implementing nurse specialist palliative care educator and support roles.

Expanding the role of specialist nurses to perform colonoscopies

We will support the regional approach to expanding the role of specialist nurses to perform colonoscopies.

Increasing the number of medical physicists

We will support the regional approach to addressing key workforce requirements with regard to the medical physicist workforce.

Increasing the number of medical community based training places and providing access to primary care/community settings for prevocational trainees

We will support the regional approach to providing access to community-based placements.

PHARMAC

National contracting of medical devices

We will continue to support PHARMAC's national contracting activity for hospital medical devices. This includes committing to implement new national medical device contracts, when appropriate and assisting with product evaluations where possible.

National contracting towards steady state - which includes assessment of new devices, health technology assessment, active category management, category reviews and tendering

We will support effective implementation of any product standardisation undertaken by PHARMAC during 2015/16.


2.6 Living Within Our Means Our Approach We will be focusing on the following initiatives to enable us to live within our means: • people, whanau, family centred care • Productive Wards, Communities and Radiology Programmes

(engages front line staff in improving quality and productivity through redesign and streamlining the working environment and daily processes)

• a structured programme using lean methodologies to reduce cost through reducing waste and minimising variation

• evidence based best practice models of care. These initiatives will all have a role to play in ensuring we operate in a financially responsible manner (which means ensuring delivery on agreed financial forecasts within available funding). This is important for the health of the organisation generally and to meet the significant demands that arise from our building programme. We still await final guidance from the Ministry of Health on this. Linkages

• Minister’s Letter of Expectations • Strategic aim for the Midland DHB region • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.3 Improving Access to Diagnostics • Module 5: Stewardship


Operate within agreed financial plans

We will continue the implementation of Shared Services actions as agreed between the BOPDHB and the Ministry.

• System Integration 3: Ensuring delivery of Service Coverage

• Ownership OS3: Inpatient Length of Stay

• Ownership OS8: Reducing Acute Readmissions to Hospital

• Output 1: Output Delivery Against Plan.


Improve integration across the sector

See Module 2.3.1, Integrated Healthcare in the Bay of Plenty. • System Integration 3: Ensuring delivery of Service Coverage


• System Integration 1: Ambulatory Sensitive (Avoidable) Hospital Admissions


We will proactively manage employment cost growth and improved use of the workforce. We will reconfigure and rationalise current service delivery models.

We will increase service outputs delivered within a primary care and/or community setting, relative to hospital delivery, to reduce demand for acute hospital services.

Implement integrated healthcare strategy

See Module 2.3.1, Integrated Healthcare in the Bay of Plenty.

• System Integration 3: Ensuring delivery of Service Coverage



2.7 Improving Quality Our Approach Our DHB recognises provision of comprehensive risk management processes and systems, which provide the foundation for patient safety. ‘Health Excellence’ is our organisational commitment to performance excellence utilising an internationally recognised framework, namely Business Excellence Criteria for Performance Excellence Health Care. The purpose for Health Excellence is ‘Striving to achieve the highest quality health care.’ The framework is a practical tool to guide continuous improvement and our journey to a culture based on quality outcomes. It also enables our DHB performance to be measured against other high performing organisations, not necessarily in health. The BOPDHB will continue to align its patient safety programme with the HQSC’s (Health Quality and Safety Commission) Campaign “Open to Care”. In doing this we will work collaboratively with the other Midland DHB’s to share resouces and ideas. Specifically in 2015/16 we will: • reduce harm from falls through a range of prevention initiatives

that will be monitored through compliance with HQSC markers - falls risk assessment and care planning

• reduce healthcare associated infections through improved hand hygiene

• reduce perioperative harm through conisitent use of the surgical checklist compliance will be monitored and reported through the HQSC markers

• commit to sustaining achievement of the identified Quality Safety Marker threshold as specified by the Surgical Site Infection Improvement Programme.

The Quality Accounts will continue to be developed and implemented by the project team, which is representative of the whole organisation including a representative from our consumers which is drawn from the Volunteer Patient Advisory Group. The project team will continue to ensure that the indicators are inclusive of a whole of system focus. Continuous improvement is an underpinning foundation of the project team. The DHB has several representatives on the Bay of Plenty Child and Youth Mortality Review Group that is chaired by a DHB Paediatrician and coordinated by the DHB Coordinator for Child and Youth Mortality Review and Injury Prevention. Reports are generated by this group to the DHB Child and Youth Strategic Alliance and recommendations are submitted relating to improving the quality of services for children and young people in the Bay of Plenty. Through reporting and monitoring adverse events we share learnings to ensure “no one else has this experience”. We will strengthen our framework to capture the consumer experience; the consumer voice will be integral to ongoing service development and continuous quality improvement. Linkages

• BOPDHB Quality Account • Module 2.3.6 Long Term Conditions


• Module 2.3.9 Health of Older People • Module 2.3.11 Maternal and Child Health • Module 2.5 National Entities Priorities Initiatives • Module 5 Stewardship.


Falls prevention and planning

A FLO (front line ownership) approach will be taken to review and implement user-friendly tools and monitor compliance. We will continue to review all falls in hospital and analyse the data in pursuit of ongoing improvement. With a focus on older people, we will make linkages with the provider arm falls group and other care providers to ensure best practice is implemented across the sector.

90 percent of older patients are given a falls risk assessment

Reporting will occur on a quarterly/six month basis

98 percent of older patients assessed as at risk of falling receive an individualised care plan addressing these risks

Hand Hygiene

We will sustain recent improvement through on going education and FLO initiatives. The Hand Hygiene Steering Group has an action plan that continues to promote and support the principles of front line ownership with staff and a focus on promoting patient and family engagement. The steering group will continue to oversee the programme to ensure adequate resources and education is provided. This includes overseeing the number of trained auditors and recruitment as required.

80 percent compliance with good hand hygiene practice

Perioperative harm

We have submitted an EOI for the implementation of the proof of concept project. Therefore, for 2015/16, we will, as part of the national rollout, have theatres across both sites, revisit the current SSC process and align with national requirements. We will refocus the use of the checklist as a teamwork and communication tool (rather than an audit tool) We will introduce briefing and debriefing for each theatre list We will continue to use a Plan Do Study Act methodology for continuous quality improvement. The perioperative quality improvement programme will monitor compliance and implement interventions as required.

All three parts of the WHO surgical safety checklist used in 90 percent of operations.


Surgical Site Infections (SSI)

The infection control quality improvement programme will monitor compliance and implement interventions as required. We will continue to use a Plan Do Study Act methodology for continuous quality improvement.

95 percent of hip and knee replacement patients receive Cefazolin ≥ 2g as surgical prophylaxis 100 percent of hip and knee replacement patients have recommended skin antisepsis in surgery using alcohol/chlorhexidine or alcohol/povidone iodine. 100 percent of hip and knee replacement patients receive prophylactic antibiotics 0-60 minutes before incision


Medication Safety We will continue to commit to implementing electronic medicine reconciliation, including a specific plan and funding allocated.

Implementation of the electronic medicine

Reporting will occur on a



Further actions can be seen in Module 2.8 Actions to support Regional delivery of Regional priorities and Module 5.2.1 Information Communications Technology We will develop actions to spread medicine reconciliation at admission, transfer and discharge through both paper-based and/or electronic solutions. Pharmacy will continue to roll out paper based medication reconciliation with all of Whakatane inpatient services, Tauranga APU, Medical and Health of the older person areas receiving MR on admission. Work is being done on establishing this service within surgical and orthopaedic wards (especially in Ortho-geriatric patient cohort). We have launched an e-platform for community dispensing information across both primary and secondary services which will make the sharing of individual patient medication information across the sector more efficient.

This is linked to Delivery of Regional Information Technology (IT) priorities.

reconciliation platform quarterly/six month basis

Patient Experience

We will continue to undertake the national patient survey fortnightly in addition to the mandatory quarterly requirement. We will provide access to the Patient Experience dashboard through the Clinical Intranet allowing real time information to be available for the Releasing Time to Care programme and other organisational reporting as required. We will monitor the Contact Request Register, respond in a timely fashion and refer to the appropriate person(s)/ward/department. We will ensure projects related to patient information include a KPI around capturing email addresses.

The national inpatient experience survey data is part of the DHB system for capturing consumer feedback.

Reporting will occur on a fortnightly and quarterly basis

Continued implementation of quality accounts

Quality Accounts will continue to be developed and implemented by the project team, which is representative of the whole organisation including the Volunteer Patient Advisory Group. We will develop a project plan with milestones and monitor it to ensure the Quality Account is delivered within required timeframes and meets the HQSC guidelines.

Adherence to timeframes Account delivered by due date


Mortality and Morbidity review

Services undertake regular Mortality and Morbidity review and report learning outcomes to the BOPDHB and to the BOPDHB Mortality Review Committee. We will submit data to all national mortality review committees, explore national trends and make improvements as required. The Bay of Plenty Child and Youth Mortality Review group regularly reviews the cases of deceased children and young people aged 28 days to 25 years. Issues are defined and recommendations for action are made to improve outcomes for children and young people, locally and nationally. We will submit data to the perinatal maternal mortality review committee. Any variation to national trends will be explored and improvements made as required. This is done at a local and regional level. We will ensure ongoing review and improvement based on Perioperative Mortality Review Committee findings and attendance at Perioperative Mortality Review Committee workshops.



2.8 Actions to Support Regional Delivery of Regional Priorities

Our Approach Within the Midland Regional Plan, we aim to develop the principles of culture, capability, capacity and change leadership. In 2015/16 the overarching imperative for BOPDHB in order to meet our goals, is collaboration and development of good relationships locally, regionally and nationally.

We recognise that there are longstanding gaps and weaknesses in our knowledge around the current workforce, particularly relating to the capability and capacity. Workforce and training plans illustrate the collaborative work of the Midland Regional Training Network (MRTN), Regional Director of Training and General Managers of Human Resources building whole of health solutions and working alongside the regional clinical networks and regional groups to meet key deliverables that pertain to workforce and training.

Linkages • Our Performance Story Impacts • Module 2.1 Health Targets • Module 2.2 Better Public Services • Module 2.3 System Integration • Midland District Health Boards Regional Services Plan 2015/18


Workforce

The key workforce priorities the BOPDHB will be progressing alongside our Midland partners in 2015/16 are:

• To ensure that there are strategies for Care assistant development (HCAs, orderlies, therapy assistants)

• To review and improve strategies around the management of the ageing workforce

• To review and improve recruitment and retention strategies for rural vulnerable workforces

• To implement the Midland Training Network (MRTN) action plan

• To continue to work with Kia Ora Hauora for the promotion of health as a career to Māori

• To develop key strategies around alternative workforces that add value and cost less or are cost neutral.

Strategies and actions will be developed and implemented


Major Trauma

We will participate in the Midland Regional Trauma System training network.

Attendance at regional trauma meetings


We will provide bi-monthly scenario training for staff to ensure staff competency in the event of major trauma. Training is currently directed to staff in the disciplines of Emergency Department, Orthopaedics, General Surgery and/or Anaesthetics.

Number of scenario training sessions delivered to ED staff

We will continue to provide a dedicated trauma Clinical Nurse Specialist and Trauma Oriented Consultant. We will work towards Royal Australasian College of Surgeons (RACS) Trauma Accreditation (level III). We will work towards Regional Trauma guidelines to ensure consistency throughout the Midland region. We will participate and engage with community agencies to work towards injury prevention.

Monitoring key trauma performance indicators to track improvements made


We will continue mortality and morbidity reviews of every major trauma associated death and highlight learning/action points to achieve loop closure. The trauma mortality report findings will be forwarded on to the BOPDHB Mortality Review Committee. Clinical focussed research will be based on the Midland Trauma Registry.

Delivery of Regional Information Technology (IT) priorities

The Midland Regional Information Service will implement the Midland Region Information Services Plan and advance National Health IT Board priorities, specifically the implementation of the National Health IT Plan priority areas. Work in this area is done within the context of the affordability envelope of the Midland DHBs.

Actions will be implemented Reporting will be on a quarterly basis

The regional platform will be transitioned to the National Infrastructure Programme (NIP) at a similar time to BOPDHB’s transition enabling BOPDHB to utilise the regional platform for ePharmacy, Clinical Work Station (CWS), Clinical Data Repository (CDR).

The CSC ePharmacy programme will be implemented from 31 August 2015.

Programme to be implemented by 31 August 2015

We will implement the Orion CWS and this should be completed by 30 June 2016.

Orion CWS to be implemented by 30 June 2016

2.9 Spinal Cord Impairment Action Plan

The New Zealand Spinal Cord Impairment Action Plan 2014-2019 outlines a vision, purpose, priorities and eight overarching objectives to help ensure the best possible health and wellbeing outcomes for people with spinal cord impairment (SCI), enhancing their quality of life and ability to participate in society.

In March 2012, ACC and the Ministry of Health jointly led a project to review New Zealand’s SCI services and develop a national implementation plan for improving them.

Linkages • Midland District Health Boards Regional Services Plan 2015/16 • Our Performance Story Impact: People receive timely and

appropriate specialist care • Module 2.3.1 Integrated Healthcare in the Bay of Plenty • Module 2.3.2 Primary Care • Module 2.3.3 Improving Access to Diagnostics • Module 2.3.8 Cardiac – Secondary services

Objective Actions to deliver improved performance Measured by Reporting

requirements

Spinal Cord Impairment Action Plan

We will ensure information and actions outlined in the plan are disseminated to clinicians via its clinical governance mechanism and will ensure pathways that explicitly outline process and align with the action plan are developed. The BOPDHB intends to engage with ambulance and other providers to implement the SCI pre-hospital destination and referral pathway.

A confirmation and exception report in the second quarter of 2015/16 on progress made against actions in the Spinal Cord Impairment Action Plan in 2014/15 and to date in 2015/16. A confirmation and exception report in the fourth quarter of 2015/16 on actions identified in the DHB’s 2015/16 Annual Plan.

We will report on a six monthly basis


Kōwae Toru - Module Three: Statement of Performance Expectations

3.1 Statement of Performance Expectations We have worked with other DHBs in the Midland region, our primary care partners as well as other key stakeholders to develop the Statement of Performance Expectations (SPE) in which we provide measures and forecast standards of our output delivery performance. The actual results against these measures and standards will be presented in our Annual Report 2014/15. The performance measures chosen are not an exhaustive list of all of our activity, but they do reflect a good representation of the full range of outputs that we fund and / or provide. They also have been chosen to show the outputs that contribute to the achievement of national, regional and local outcomes (see modules two and three). Where possible, we have included with each measure past performance as baseline data. Activity not mentioned in this module will continue to be planned, funded and provided to a high standard. We do report quarterly to the Ministry of Health and / or our Board on our performance related to this activity.

3.2 Output Classes

DHBs must provide measures and standards of output delivery performance under aggregated output classes. Outputs are goods and services that are supplied to someone outside our DHB. Output classes are an aggregation of outputs, or groups of similar outputs of a similar nature. The output classes used in our statement of forecast service performance are also reflected in our financial measures. The four output classes that have been agreed nationally are described below. They represent a continuum of care, as follows:

General population living healthy and well

At risk population Focus: Keeping healthy

Population developing early conditions

Focus: Managing health

Population with long-term conditions

Focus: Preventing deterioration/complications

Population with end-stage conditions

Focus: Support

Population Health Continuum of Care

Output Class 1: Public Health Services

Output Class 2: Primary and Community Services

Output Class 3: Hospital Services

Output Class 4: Support Services

Services and products delivered and provided to the population - DHB Output Classes

Activ

ities

alo

ng th

e Co

ntin

uum

of C

are

Public Health • Social and environments (eg. Housing, transport,

water quality, communicable disease)• Lifestyle (eg. Tobacco, Alcohol, Sexual Health,

Mental Health, Injury prevention, nutrition)• Primary Care (eg. Access, Immunisation, Screening)

Community Services Primary Health Care Community Health NGO (Non-government) Supportive Care

Primary Care General PractitionerPractice NurseNurse PractitionerAllied HealthPharmacists

Expert / Specialist CareMultidisciplinary TeamsSecondary CareTertiary CareCondition-Specific Care

Promotion/Prevention

Detection / Screening

Diagnosis and Treatment – Cure/

MaintenanceRecovery/

Rehabilitation

Supportive Care

Research & Evaluation

Support for Family/Whānau

Palliative Care

Adapted from The Bay of Plenty District Health Board’s Journey towards “Healthy Thriving Communities”, Conceptual Frameworks developed by the Planning & Service Development Unit, Planning & Funding Group, April 2003 and Hawkes Bay DHB’s 2010-13 Statement of Intent


A definition for each of these output classes is provided below. For each measure, we have indicated the appropriate dimension of performance (quality, quantity, timeliness or coverage). Some measures may cover multiple dimensions (for example quality and timeliness). Output Class Funding Allocation

The following table outlines the funding and expenditure associated with the allocation of the output classes described above.

Prospective Summary of Revenues and Expenses by Output Class

2015/16 2016/17 2017/18

$M $M $M Plan Plan Plan

Early Detection

Total Revenue

181.1 186.0 190.9

Total Expenditure

180.8 185.7 190.5 Net Surplus / (Deficit)

0.3 0.3 0.4

Rehabilitation & Support

Total Revenue

108.1 111.0 113.8 Total Expenditure

107.9 110.7 113.6

Net Surplus / (Deficit)

0.2 0.3 0.2

Prevention

Total Revenue

15.0 15.4 15.8

Total Expenditure


0.1 0.1 0.1

Intensive Assessment & Treatment

Total Revenue


402.3 413.2 424.0

Net Surplus / (Deficit) 0.8 0.7 0.7 Consolidated Surplus/(Deficit) 1.4 1.4 1.4


Over the next three years, we will fund and provide outputs (goods and services) which will make a positive impact on the health and wellbeing of our population. Our key impacts are as follows:

For more details on each impact, please refer to Module 1, 1.8-1.10 Long Term Impact Measures.

3.3 Measures of DHB performance by output class There are four output classes as follows:

3.3.1 Prevention services

3.3.2 Early detection and management

3.3.3 Intensive assessment and treatment

3.3.4 Rehabilitation and support

For details on these output classes, please refer to the tables in Appendix 8.3 Output Classes and Output Categories.

Guide to understanding this section:

The following points provided should be kept in mind when reading the rest of this module: • represents a measure that is a priority and output in the Māori Health Plan • Further detail of the performance story logic and rationale is contained in Module 1.8 • Baseline figures for the output performance measures are mainly taken from the 2013/14 Annual Report

unless otherwise stated • In the performance measures table and where available the average column presents the national or

regional average for the output performance measure • Most measures have been adopted regionally • Some measures fall across more than one impact (e.g. XX). Where this is the case they have only been

included once • Measurement type key: qn = Quantity t = Timeliness ql = Quality

5-10 Year Outcom

es

BAY OF PLENTY DISTRICT HEALTH BOARD



Strategic Direction M

odule 1




3-5 Year Impacts


preventable diseases Improving healthy

behaviours

Children and adolescents

have better oral health Early detection of treatable

conditions People are better at

managing their long term conditions

Fewer people are admitted to hospital for avoidable conditions

People maintain functional independence






Modules 2 and 5


• There are some services we provide that support the rest of the health system so we have included these in a “Support Services” section of our performance story

• Detailed information about the rationale for each output measure is provided in Appendix 8.3 Terms explained and defined:

Quantity – measures that are purely quantitative in nature help establish baselines and provide useful comparisons.

Timeliness – we have included measures that demonstrate delivering services in a more timely way, consistent with the philosophy of care being closer to home, and recognising that providing health services sooner (eg “within 28 days”) or regularly (eg “every three years”), is more likely to eliminate or reduce either the onset or impact of conditions. Another dimension to timeliness is represented by our desire to improve health outcomes at certain life stages, for example “at age two” or “12-18”.

Quality – where possible, we have included measures that are qualitative in nature. For example, increasing the Percentage of the population who receive a particular service, targeting a service towards a particular population group (eg by age, ethnicity or deprivation) to reduce health disparities, or focusing on outcomes-based measures, rather than outputs.

Baseline – this represents 2013/14 data, extracted from the most recent Annual Report unless indicated otherwise.

Target 2015/16 – this represents our goal for 2015/16.

Regional Average – where possible, we have included an indication of the current regional average, based on information to hand at the time this Plan was written.

National Average – where possible, we have included an indication of the current national average, based on information to hand at the time this Plan was written.


3.4 People are supported to take greater responsibility for their health

3.4.1 Fewer people smoke

Outputs Output Class

Measure Type Baseline Target

2015/16

National/Regional Average

Providing Smokers who access Primary and Secondary services with Smoking Cessation advice and support – see also Module 2.1.4 Hospitalised smokers

• Total Population • Māori

1 qn/t

92% 91%

95% 95%

Midland

96% 97%

National

96% 96%

Primary care • Total Population • High needs

1 qn/t

88%

90% 90%

TBC

TBC

Percentage of pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit - See also Health Target and Māori Health Plan(MHP) 54

• Māori • Non-Māori • Total

1 qn/t

88% 90% 90%

90% 90% 90%

92% 95% 93%

91% 93% 92%

3.4.2 Reduction in vaccine preventable diseases



2015/16 Regional/

National Average

Children are fully immunised at eight months – see Health Target55and MHP


1 q/qn/t

83%56 89%

95% 95%

Midland

TBC

National

89%

54 As at the quarter two Inter District Health Board Performance (IDP) report, 2014/15 55 ibid 56 ibid

Long

-ter

m

Impa

ct


Inte

rmed

iate

Impa

cts


preventable diseases Improving health behaviours




2015/16 Regional/

National Average

Percentage of the population (>65 years) who have had the seasonal influenza immunisation57 See also the PHO Performance Programme(PPP) and Māori Health Plan

• Total Population • High Needs

1 qn/t

67% 64%

75% 75%

TBC

TBC

3.4.3 Improving Health Behaviours


Measure Type Baseline Target 2015/16 Regional/

National Average

Number of schools engaged in the Health Promoting Schools programme58 1 qn/t

43 48 Midland

National

The number of referrals to adult GRx (Green Prescription) programmes59 Māori Non-Māori

1 qn/t

950 1298

223360

712 2054

Percentage of infants fully and exclusively breastfed 61 at six months- See also the PHO Performance Programme(PPP) and Māori Health Plan


1 qn/t

20% 28%

>27% >27%

57 The volume target is significant, as we are seeing an increase in the percentage of our population aged 65+. See also the Māori Health Plan (MHP). 58 This programme supports healthy school environments, aims to improve students’ health and wellbeing and contributes to learning outcomes. See www.healthed.govt.nz. 59 This excludes people enrolled on the Active Families Programme 60 Target is to be determined and in conjunction with Toi Te Ora Public Health Unit 61 This is a quality measure because breastfeeding helps lay the foundations of a healthy life for a baby and also makes a positive contribution to the health and wider wellbeing of mothers and whānau. Key actions include health promotion activities and the baby friendly hospital initiative (BFHI) accreditation.

http://www.healthed.govt.nz/


3.5 People stay well in their homes and communities

3.5.1 An improvement in childhood oral health62



2015/16 Regional/

National Average

Percentage of children who are caries free at age five PP1163 • Māori • Total

2 qn

23% 44%

64% 64%

Midland National

Percentage of adolescent utilisation of DHB funded dental services - PP12 2 qn 74% 85% 70% 72%

Percentage of Children (0-4 years - % year 1) enrolled in DHB funded dental service - PP13 (measure 1)


2 qn

62% 99% 84%

90% 90% 90%

Percentage of enrolled64 pre-school and primary school children (0-12) overdue for their scheduled dental examination - PP13 (measure 2)

2 qn/t 14% 10%

9%

12%

62 Note baseline data for oral health measures as at 2013/14 Annual Report This is a quality measure because as well as ensuring that pre and primary school children will receive education, assistance or dental treatment in a more timely manner, we can also expect to see improvements not just in the oral health of children aged 0-12 but also as the cohort reaches adolescence and adulthood. By reducing the number of children who are overdue (the baseline) to the target of 10%, we will provide a more timely and quality service. 63 This information is reported annually for the school calendar year 64 The number is calculated and reported as a percentage and aligns to the Module 7 Performance Measures

Long

-ter

m

Impa

ct


Inte

rmed

iate

Impa

cts An improvement

in childhood oral

health

Long term conditions

are detected early and

managed well

Fewer people are admitted

to hospital for avoidable

conditions

More people maintain

their functional

independence


3.5.2 Long-term conditions are detected early and

managed well



2015/16

Regional National Average

Percentage of population enrolled with a Primary Health Organisation (PHO)65

• Māori • Total Population

2 qn

94% 98%

100% 100%

Midland

94% 98%

National

88% 96%

Percentage of eligible population who have their cardiovascular disease (CVD) risk assessed completed in the last 5 years – see Health Targets and Māori Health Plan.


2 qn/t

81% 88% 83%

90% 90% 90%

61% 74% 71%

63% 67% 67%

Eligible women (25-69) have a cervical cancer screen every three years.

• Māori • Non-Māori • Total Population

1 qn/t

64% 84% 80%

80% 80% 80%

TBC 63% 77% 80%

Eligible women (20-69) have a cervical cancer screen every three years. See Māori Health plan66

• Māori • Non-Māori • Total Population

1 qn/t

63% 84% 80%

80% 80% 80%

TBC TBC

Eligible women (50-69) have a breast screen examination every three years.67 See Māori Health Plan


1 qn/t

60% 69% 69%

70% 70% 70%

TBC

TBC

Focus area 2 - Diabetes Management (HbA1c) Improve the proportion of patients with good or acceptable glycaemic control– PP20

2 qn/t 78% 85% TBC TBC

Focus area 4 – Stroke services Percentage of potentially eligible stroke patients thrombolysed – PP20

3 qn/t New 6%

Focus area 4 – Stroke services Percentage of Stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway – PP20

3 qn/t 89% 80%

65 Access to primary care has been shown to have positive benefits in maintaining good health, including early detection and managing long term conditions. It also reduces the economic cost of ill health and is key in reducing disparities in health. 66 The Māori Health plan indicator is calculated between the ages of 25-69 years as opposed to 20-69 years of age. We have adjusted the Annual Plan measure to better align with the MHP. 67 Breast screening has been included as a measure to reflect appropriately the commitment indicated in the Māori Health Plan


3.5.3 Fewer people are admitted to hospital for avoidable conditions

Outputs

Output Class


2015/16 Regional/National

Average Percentage of eligible population who have had their Before School Checks68 (B4SC) completed

• Total Population • High Needs

1 qn/t

92% 90%

90% 90%

Midland

83%

National

80%

Incidence number of acute rheumatic fever cases 2,3 qn 869 4

Hospitalisation rates per 100,000 for acute rheumatic fever – PP28 2,3 qn/t 3.870 1.7 4

Percentage of Rest Home residents receiving vitamin D supplement from their GP71 1, 2 qn 67% 70%

Percentage of triage level 4 and 5s presenting to the Emergency Department (ED)72 3 qn 50% ≤65%

Number of presentations to Emergency Department – Triage Level 4 and 5 as a percentage of the total population 3 qn/t 15% 12% 15%

Increased numbers of Year 9 students receiving HEEADSSS73 assessment in decile 1-3 schools 1 qn/t 198 250 N/A

68 It is a nationwide programme offering a free health and development check for four year olds. It aims to identify and address any health, behavioural, social or developmental concerns which could affect a child’s ability to get the most benefit from school. Health checks include vision, hearing and oral. This service is provided by CCYHS (Community Child and Youth Health Service through the Provider Arm and Nga Mataapuna Oranga PHO. 69 Baseline has been calculated using a three year average 70

71 Vitamin D strengthens bones, and reduces the negative impact of falls. While we would prefer to include data for the at risk population (ie over 75 years), we can only access data for rest home residents. 72 ED services in New Zealand utilise a scale of 1-5 triage, with 1 being the most urgent. These principally determine who should be seen first. This is a quality measure because triage categories 4 and 5 may be more appropriately seen in the primary sector and poor performance in this area impacts on our capacity to provide quality services for triage 1-3. 73 Home. Education. Employment. Activities. Drugs and Alcohol. Sexuality. Suicide. Spirituality (HEEADSSS) assessments


3.5.4 People maintain functional independence



2015/16 National Average

Maintain current percentage of population over 65 years who have accessed aged residential care (ARC) 4 qn 5.03% 5.03%

Percentage of the population 65+ years that access Home Based Support Services (HBSS)74 4 qn 11.66% <12.15%

Increase in occupancy rate for Residential Respite Bed Days75 4 qn 68% 82% 77% Increased number of dementia specific day programme attendances for clients with dementia 4 qn TBD 2692

Percentage of older people receiving long term home support who have had a comprehensive clinical assessment and a completed care plan in the last twelve months – PP1876

4 qn/t/ql 100% 100% 100%

74 Lifelong supports for people under 65 years with a disability are funded by the Ministry of Health. 75 Residential respite care provides carers with rest opportunities, which enables them to maintain the functional independence of the person being cared for in their own home. 76 This is a quality measure because older people have complex needs. By providing a comprehensive clinical assessment and a completed care plan, older people will have better outcomes in terms of treatment, and will be better able to access a range of coordinated services. These assessments are based on a robust international, clinically verified assessment tool (interRAI). Target set nationally.


3.6 People Receive Timely and Appropriate Care Lo

ng T

erm

Impa

ct


Inte

rmed

iate

Impa

cts

• People receive prompt and appropriate acute and arranged care

• People have appropriate access to elective services

• Improved health status for people with a severe mental health illness and/or addiction

• More people with end-stage conditions are appropriately supported

• Support services

3.6.1 People receive prompt and appropriate acute and arranged care



2015/16 National Average

Percentage of patients admitted, discharged or transferred from an ED within six hours – Health Target 3 qn/t 92% 95% 92%

Focus area 3 – Acute coronary syndrome services > 70% of high-risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’)– PP20

3 qn/t 83% 70%

Focus area 3 – Acute coronary syndrome services >95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days - PP20

3 qn/t New >95%

Standardised Elective Inpatient length of stay (LOS) reduced (days)– OS3 (i) 3 qn/t 1.69 1.59

Standardised Acute Inpatient length of stay (LOS) reduced (days)– OS3 (ii) 3 qn/t 2.9 <2.9

Part A Faster Cancer Treatment – 31-day indicator - proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment (or other management) within 31 days of decision-to-treat.). < 10 % of the records submitted by the DHB are declined - PP30

3 qn/t New <10%

Part B Faster Cancer Treatment – Shorter waits for cancer treatment – radiotherapy and chemotherapy - All patients’ ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy

3 qn/t 100% 100%


3.6.2 People have appropriate access to elective77 services



2015/16 Number of inpatient surgical discharges under elective initiative (includes all discharges regardless of whether they are discharged from surgical or medical specialty) - Total

3 qn 9,845 10,136

Standardised Intervention Rates as per 10,000 of population – SI4 • Coronary Angiography • Cardiac • Percutaneous revascularisation • Major joint replacement • Cataract procedures

3 qn

30.37 6.73

13.91 25.71 21.31

34.7 6.5

12.5 21.0 27.0

ESPIs (Elective Services Performance Indicators)78 – • ESPI 1 – timely processing of referrals within 10 working days • ESPI2 - Percentage of patients waiting longer than four months

for their first specialist assessment • ESPI 3 – patients waiting without a commitment to treatment • ESPI 5 – patients given a commitment to treatment but not

treated within four months • ESPI 8 – proportion of patients treated who were prioritised

using a recognised tools and processes

3 qn/t/ql

100% 0%79

0%

0%

100%

90% 0%

0%

0%

100%

Did-not Attend (DNA) rate for outpatient services80 See also Māori Health plan

• Māori • Non Māori • Total Population

3 qn/ql

15.6% 4.13% 6.9%

5% 5% 5%

77 Defined as including all elective services as well as skin lesions and intraocular. This excludes maternity admissions, non-casemix activity (except skin lesions and intraocular) and Medical admissions without a surgical procedures. This contributes to the impacts “people are seen promptly for acute care” and “people have appropriate access to elective services”. 78 ESPIs are seen as quality measures for elective services because underperformance against any of these indicators has the potential to impact negatively on patient outcomes. For ESPI3 and ESPI6, the target has been set lower than the baseline because we want to reduce the number of patients who are either waiting for a commitment to treat, or who have not received an assessment within six months. 79 This is a quality measure because clinical best practice suggests that timely assessment is likely to lead to better patient outcomes. The reason why the target is lower than the baseline is because we are aiming to have all FSAs undertaken within four months. 80 This is a quality measure because by reducing our DNA rate, we free up a lot of capacity for people who require treatment. The targets are lower than the baseline, because fewer DNAs means less resources are wasted. To improve our DNA rate for Māori, the BOPDHB has created a DNA Action Group. Actions include surveying patients as to the reasons for a DNA and actions that respond to those reasons so that the BOPDHB can lower the rate for Māori.


3.6.3 Improved health status for people with a severe mental illness



2015/16 Regional Average

Improving mental health services using transition (discharge) planning for child and youth - PP781


3 qn/ql

New New

95% 95%

New New

Average length of acute adult (18+ years) inpatient stay – KPI 8 (days) 82 3 qn/t 17 days

14-21 days

Rates of 7 day follow-up in the community post discharge - KPI 19 3 qn/t/ql 74% 90%

A referral of a young person (0-19 years) is seen by Alcohol and Other Drug health professional within 3 weeks of referral being received – PP8

3 qn/t 78% 80% 51.8%

Percentage of people referred for non-urgent mental health or addiction services are seen within 3 weeks Mental Health (Provider Arm)

• % people seen ≤3 weeks o 0-19 yrs.

Addictions (Provider Arm and NGO) • % people seen ≤3 weeks

o 0-19 yrs.

2 qn/t/ql

77%

84%

80%

80%

Percentage of people referred for non-urgent mental health or addiction services are seen within 8 weeks Mental Health (Provider Arm)

• % people seen ≤8 weeks o 0-19 yrs.

Addictions (Provider Arm and NGO) • % people seen ≤8 weeks

o 0-19 yrs.

2 qn/t/ql

96%

95%

95%

95%

81 This is a quality measure because relapse prevent plans are client-centred, and reflect their individual needs and contribute to a quality treatment. The same also applies for child clients. 82 The target of 14-21 days is a national target set as a result of the KPI project.


3.6.4 People with end stage conditions are supported



2015/16

Number of clients supported by specialist palliative care83 4 qn 723 695

Percentage of people supported by specialist palliative care, other than cancer or end stage renal failure84 4 qn/ql 23% 23%

3.6.5 Support Services We also fund and deliver services, which contribute towards a range of the impacts above:


Measure Type Baseline Target 2015/16

Number of community pharmacy prescriptions 2 qn/ql 3,331,341 3,408,11885

Improved wait times for diagnostic services – accepted referrals receive their scan for - PP29

• Coronary Angiography (within 90 days) • Diagnostic Colonoscopy (within six weeks) • Surveillance Colonoscopy (within 84 days) • Computing Tomography (CT) (within six weeks) • Magnetic Response Imaging (MRI) (within six

weeks)

2 qn/t

94% 36% 28% 80% 70%

95% 60% 60% 95% 85%

Total number of community referred radiology Relative Value Units (RVUs)86

2 qn 67,660 73,680

Total number of community laboratory tests 2 qn 1,255,63787 1,280,000

Non-urgent community laboratory tests are completed and communicated to practitioners within the relevant category timeframes:

• Category 1: Within 24 hours • Category 2: Within 96 hours • Category 3: Within 72 hours

2 ql/t Work in progress

95% 100% 100%

83 Once our providers have changed to a new data system, we are hoping that we can access a broader range of data, including automating reports by ethnicity etc. 84 This is a quality measure because typically, most people who receive specialist palliative care have either cancer or end stage renal failure. By identifying the proportion of people who do not have either of these two conditions, we will also be broadening the scope of our service and ensuring greater equity of access. 85 This calculation is based on the current intent of the new community pharmacy service model with zero growth in total dispensing items. It is expected to have initial items growth between 2.5% and 5% with a significant reduction in repeats dispensing. As the service model is expected to change, the actual volume will vary from the target. Note this is also a quality measure, as by managing demand / volume to this level, it demonstrates effectiveness in implementation of the new pharmacy service model. 86 An individual operative / diagnostic / assessment according to the Royal Australian and New Zealand College of Radiologists. 87 Baseline is calculated on actual delivery in the community



Measure Type Baseline Target 2015/16

Percentage of community laboratory tests completed : • Within 48 hours for routine tests; and • Within 3 hours for urgent tests;

from receipt of the specimen at the laboratory88

2 qn/t/ql

100% 99%

90% 80%

Patient Experience Survey89 All qn/t/ql new 80%

88 This is a quality measure because timely laboratory tests can improve the likelihood of a positive health outcome. 89 This is a quality measure because the survey will measure the quality of our services from the patient’s perspective. It is aligned to the NZ Triple Aim and the HQSC QSM. Note that this work is currently being developed, so the precise scope of the survey has yet to be determined and, it is hoped, that we will be in a position to implement the survey regionally. For this reason, the scope of the survey will, in part, be determined in collaboration with our Midland colleagues.


Kōwae Whā - Module Four: Financial Performance

4.1 Introduction The Bay of Plenty District Health Board (BOPDHB) has displayed a strong commitment in the last few years to operating within its budget whilst delivering its operational commitments, the Government’s expectations and the Board’s priorities. The past few years have seen BOPDHB absorb a number of significant cost increases that were well in excess of increases in revenue. In this context, delivery to budget has been a significant achievement which the DHB is committed to continuing. Living within our means A fundamental requirement of the DHB is to live within its means. This is a key commitment for the DHB as stated and the BOPDHB has a strong record of financial delivery whilst remaining focussed on good patient outcomes. 2015/16 will bring new challenges which the DHB is in good shape to face. The BOPDHB is committed to meeting this challenge and is submitting a minimum breakeven budget for the three year period 1 July 2015 to 30 June 2018. The risks to achieving this position, changes that must be made and challenges to overcome are outlined through this section of the Annual Plan. Regional and National Collaboration An important expectation of DHBs is for them to work together and collaborate nationally and with our regional neighbours. Regionally we continue with the implementation of the regional services planning. Its outcomes are fully reflected in this plan. Many IS projects, under guidance from the National Health IT Board (NHITB) are being delivered as regional projects. Health Benefits Limited (HBL) was set up to help DHBs find ways of saving money through more efficient back office functions. HBL has put forward four Business Cases to the sector and the future implementation for these cases is now being planned. The DHB is committed to supporting the process of handover of HBL’s work and implementation of the cases. Estimates have been included in the finances in respect of these projects.


4.2 Financial Performance Summary The BOPDHB is committed to living within its means by delivering a minimum of breakeven. PROSPECTIVE STATEMENT OF FINANCIAL PERFORMANCE (COMPREHENSIVE INCOME) FOR THE THREE YEARS ENDED 30 JUNE 2016, 2017 AND 2018 Consolidated Statement of Comprehensive Income

2013/14

2014/ 15

2015/16

2016/17

2017/18

$M $M $M $M $M Actual Forecast Plan Plan Plan

Revenue Ministry of Health Revenue 637.6 662.1 678.6 696.8

715.0

Other Government Revenue 21.9 23.2 22.4 23.1 23.6 Finance Income

Other Revenue

7.6

7.2

6.3

6.4

6.6

667.1 692.5

707.3 726.3

745.2 Expenditure Employee Costs 212.8 220.0 224.4 230.5 236.5 Outsourced Costs 23.8 25.5 23.3 24.4 26.0 Clinical Supplies 48.3 54.3 53.7 55.1 56.6 Infrastructure and Non Clinical 34.5 29.8 34.3 35.2 36.2 Payments to Non DHB Providers 315.8 329.2 337.0 346.1 355.0 Interest 6.3 7.2 6.5 6.5 6.5 Depreciation and Amortisation 18.2 19.6 20.1 20.5 20.4 Capital Charge 6.6 6.6 6.6 6.6 6.6 Total Expenditure 666.3 692.2 705.9 724.9 743.8 Share of Profit of Associates 0 0 0 0 0 Net Surplus/(Deficit) 0.8 0.3 1.4 1.4 1.4 Other Comprehensive Income Revaluation of Land and Building 0.1 0 0 0 0 Total Comprehensive Income/(Deficit) 0.9 0.3 1.4 1.4 1.4 Financial Performance by Division and Output Class The BOPDHB operates through three divisions for the purposes of reporting on its Annual Plan to the Ministry of Health. Funding The BOPDHB receives, within the Funding division, a Crown appropriation for the purchase of health and disability services. This funding revenue is used to purchase services from the Non-Government Organisation (NGO) sector and the DHB itself.


Governance and Funder Administration Governance and Funder Administration is the division that includes the Board and governance costs of the BOPDHB along with the costs of administrating the ‘Funds’ output class by the Planning and Funding division. Provider Arm This division includes the health and disability services directly provided by the BOPDHB in the two hospitals under its control and various community services along with the necessary support functions. PROSPECTIVE FINANCIAL PERFORMANCE BY ANNUAL PLAN DIVISION FOR THE THREE YEARS ENDED 30 JUNE 2016, 2017 AND 2018

$m Actual

2014 Estimate

2015 2016

2017

2018 Provider Arm 5.3 3.4 0.5 0.5 0.6 Gov. & Funder Admin 1.7 (0.2) 0.1 0.1 0.1 Funds (7.8) (3.5) (2.0) (2.0) (2.1) (0.8) (0.3) (1.4) (1.4) (1.4) National prices, as calculated and advised by the Ministry of Health, have been used to generate the Production Schedule between Planning and Funding and the Provider Arm. For the purposes of the Statement of Intent, the BOPDHB operates the following output classes:

• prevention • early detection and management • Intensive assessment and treatment services • rehabilitation and support.

These output classes are defined in Module 3 of this Plan.


PROSPECTIVE FINANCIAL PERFORMANCE BY STATEMENT OF INTENT OUTPUT CLASS FOR THE THREE YEARS ENDED 30 JUNE 2016, 2017 AND 2018 Prospective Summary of Revenues and Expenses by Output Class

2015/16 2016/17 2017/18

$M $M $M Plan Plan Plan

Early Detection

Total Revenue

181.1 186.0 190.9

Total Expenditure


0.3 0.3 0.4

Rehabilitation & Support

Total Revenue


107.9 110.7 113.6

Net Surplus / (Deficit)

0.2 0.3 0.2

Prevention

Total Revenue

15.0 15.4 15.8

Total Expenditure


0.1 0.1 0.1

Intensive Assessment & Treatment

Total Revenue


402.3 413.2 424.0

Net Surplus / (Deficit) 0.8 0.7 0.7 Consolidated Surplus/(Deficit) 1.4 1.4 1.4 Financial Assumptions The BOPDHB has made a number of significant assumptions in arriving at its Prospective Financial Performance Statements as summarised in the following table: The following further assumptions have been made by the BOPDHB: Assumption 2016 2017 2018 Revenue $19.1m $19.1m $19.1m Staff Costs (average movement) 1.000% 1.000% 1.000% Interest Rate - Crown 4.600% 4.600% 4.600%

• The cap on Management and Administration Full Time Equivalents has been reflected in the forecasts

• Cost challenges, contract changes and exits, and service changes developed across the range of DHB funded and provided services are achieved and delivered

• Further assumptions have been made anticipating successful mitigation of the risks in the section following, and introductory remarks to this Module


Significant Financial Risks and Cost Pressures All DHBs face pressure to meet additional expenditure which must be managed within allocated funding. The following Financial Risks and Cost Pressures exist within the budgets outlined in this section. Crown Revenue The BOPDHB will continue to operate within the long term revenue provided by Government.

Risk Mitigation Outer year forecast revenue may change as a result of government policy, new initiatives and other factors.

Estimates of future revenue have been based on information supplied from the Ministry of Health. Level of service to be provided for that funding is not specifically known in the outer year forecasts.

Increases in Government revenue fail to adequately compensate for the population growth of the Bay of Plenty and step increases in costs.

Revenue is allocated using a Population Based Funding approach and this is updated as census information becomes available. Adjustments are generally made over a 2-3 year period but are not included in the Ministry of Health’s demographic adjuster estimates until they occur. The delay in conducting the census has heightened this risk for BOPDHB as our population increase is usually at a rate higher than the New Zealand average; therefore our ability to mitigate the impact of any shortfall is limited to increasing efficiency.

Other Revenue Other revenue is earned from a variety of sources and is expected to continue to grow at a rate approximately equal to inflation:

Risk Mitigation The BOPDHB has no long term undertakings for much of this revenue.

The revenue has multiple sources and the risk of significant change is minimised although it is clear that pressure on funding for other Government agencies such as ACC impacts BOPDHB.

Net Inter-District Flows (IDFs) All DHBs have some instances where people who are resident within their district receive services in other districts. The BOPDHB has significant outflows throughout the year to Auckland City Hospital, Auckland City Children’s Hospital and Waikato Hospital for tertiary services and some upper level secondary services. Outflows also occur to Lakes DHB for some persons resident in the Murupara/Urewera areas who may access services at Rotorua Hospital rather than travelling to Tauranga or Whakatane hospitals. A similar inflow occurs to Tauranga Hospital for people residing in the Waihi area (which is within the Waikato DHB region). The BOPDHB’s major inflow is through holiday makers over the Christmas and New Year period in particular.


The management of IDFs has been a significant cost pressure for BOPDHB in recent financial years and successfully ensuring that only appropriate IDF flows are incurred will be key to achieving the budgeted 2015/16 and following years’ financial position.

Risk Mitigation New or additional inter-district flows are identified by other DHBs.

There is an established national process for identification and wash-up of IDFs.

Some DHBs provide services that are not prioritised for purchase by the BOPDHB.

Where possible efforts are made to minimise outflows to other DHBs and access criteria are agreed.

Other DHBs may no longer be able to deliver IDF volumes to Bay of Plenty residents due to change in their services or population/volume growth.

There is an established national process for changes to IDFs.

Payments to Providers Payments are made to health and disability service providers in both the Non-Government Organisation (NGO) sector and the BOPDHB’s own Provider Arm. The BOPDHB allocates funding received through a Crown appropriation and uses a robust process to prioritise funding to ensure the greatest benefit in meeting health needs. Contracts placed are evaluated on a regular basis to ensure value for money and specified outcomes are achieved. Expenditure on health and disability services within the district is expected to grow in line with long-term revenue growth. The BOPDHB is committed to not expending more funding than it is allocated.

Risk Mitigation Impacts of new government initiatives may result in new services being purchased at additional cost.

The BOPDHB would expect either to receive additional revenue to meet the additional costs associated with particular government initiatives introduced outside the DHB’s prioritisation process or will be required to substitute for existing services.

Delivery of minimum breakeven in the 2015/16 financial year assumes that a number of initiatives are delivered which result in service changes and, in some cases, exits. Failure to deliver these will impact on the financial result.

Close liaison with the Ministry of Health and other stakeholders through the service change process.

Many health and disability services are demand driven and unmanaged increases in volumes result in increased costs.

Wherever possible, services are purchased on a capitated, risk share or fixed basis to reduce the DHB’s exposure to unexpected increases in demand driven volumes.


Employment Costs The largest single cost for the BOPDHB, either directly through its own Provider Arm or indirectly through the Non-Government Organisation sector, is employee costs. The BOPDHB is expected to directly employ 2,451 full time equivalents during the year ended 30 June 2016. Many employee groups are on regional or national Multi-Employer Collective Agreements (MECA) with the consequence that bargaining is conducted in a larger arena than just the DHB.

Risk Mitigation Employee expectations may exceed affordable parameters.

BOPDHB works to clearly explain the funding available to it for pay increases and the cost pressure it faces.

The move to national and regional MECA have made local management of cost growth difficult.

BOPDHB works to clearly explain to all parties the funding available to the DHB for pay increases. Bargaining is carried out within the Health Sector’s ‘good faith’ process. Some agreements are on a partnership basis.

B OPERATING COSTS Operating Costs The BOPDHB operating costs are broken into three classifications: Outsourced costs Costs related to parts of the services that have

been outsourced or subcontracted to third parties.

Clinical costs Costs directly related to the provision of the health and disability services provided by the BOPDHB, including pharmaceuticals and consumables.

Infrastructure Costs Costs indirectly related to the provision of health and disability services by the BOPDHB, including transport, hotel services, interest, depreciation and capital charge costs.

Each classification has different imperatives around cost growth but as an average increases are expected to remain within the long term revenue growth.


Risk Mitigation Cost growth expectations remain high particularly for clinical supplies.

National provider and supplier contracts (including NZ Blood and Pharmac) are often negotiated on a national level.

A significant proportion of purchases are influenced, directly or indirectly, by movements in the exchange rate, the majority in relation to the United States Dollar. The current relative strength of the New Zealand dollar could deteriorate.

Purchasing is in New Zealand Dollars wherever possible. Longer term contracts are used to help minimise short-term fluctuations in price. For significant items, purchased in a foreign currency, foreign exchange hedging is considered and utilised where appropriate.

Fuel prices can have a significant impact on the running costs of around 250 vehicles.

BOPDHB has limited ability to control the direct impact of a fuel price increase. The DHB does encourage efficient use of vehicles including carpooling. Fuel price is negotiated through a multi-agency contract.

Interest rate increases.

BOPDHB manages interest rate risk through the use of interest rate hedging and fixed interest mechanisms if appropriate.

The capital charge rate may change.

No change is expected in the current year. The DHB would expect revenue to be adjusted accordingly to neutralise any change in rate.

The BOPDHB will continue to participate in national and regional purchasing actions and projects as a key mechanism to drive down costs. There remains a risk however that projects are either not delivered on time or with the expected savings, which will impact BOPDHB’s costs. A further pressure on BOPDHB is funding the changes, which is a cost on top of business as usual, until benefits are delivered. A number of efficiency adjustors have been incorporated into cost planning for the DHB, for example, we have assumed a further improvement in patient length of stay over the last financial year. Failure to deliver on the projects, which must provide that improvement, will cause cost overruns.


Prospective Cashflows Operating cashflows remain materially cumulatively positive throughout the forecast period. The operating cashflow surplus along with additional borrowings, if necessary, will be utilised for capital investment. Active cash management uses excess cash balances ahead of borrowing or equity injections to delay and reduce the level of borrowing or equity injections through a national cash pooling arrangement. PROSPECTIVE STATEMENT OF CASHFLOWS FOR THE THREE YEARS ENDED 30 JUNE 2016, 2017 AND 2018

$m Actual

2014 Estimate

2015 2016 2017 2018 Operating 22.3 21.4 27.2 27.0 27.4 Investing (28.5) (23.9) (23.3) (23.1) (23.3) Financing 14.3 1.4 (6.5) (6.5) (6.5) Total Net Cashflow 8.1 (1.1) (2.6) (2.6) (2.4)


4.3 Prospective Statement of Financial Position The BOPDHB remains in a strong financial position, necessary to service the current and upcoming levels of borrowing required for redevelopments. The Statement of Financial Position reflects the increased investment in the building infrastructure of the DHB which is partially supported by increased borrowing and operating cashflow. PROSPECTIVE STATEMENT OF FINANCIAL POSITION AS AT 30 JUNE 2016, 2017 AND 2018

$m Actual

2014 Estimate

2015 2016 2017 2018 Current Assets 37.4 36.5 34.0 31.4 29.1 Current Liabilities 90.0 85.8 66.7 66.4 66.6 Working Capital (52.6) (49.3) (32.7) (35.0) (37.5) Term Assets 263.6 269.6 273.9 277.6 281.5 Term Liabilities 124.6 133.6 153.1 153.1 153.1 Equity 86.4 86.7 88.1 89.5 90.9 Equity and Long-Term Debt Facilities The BOPDHB relies on a mix of debt and equity to fund assets utilised in the delivery of health services. Government policy requires the BOPDHB to source all long-term debt and equity from the Crown through the Ministry of Health. The Ministry of Health facilities are secured by a negative pledge. Bay of Plenty DHB is a party to the DHB Treasury Services Agreement between Health Benefits Limited (HBL) and the participating DHBs. This agreement enables HBL to sweep DHB bank accounts and invest surplus funds on their behalf. The DHB Treasury Services Agreement provides for individual DHBs to have a credit facility with HBL, which will incur interest at on-call interest rates received by HBL plus an administrative margin. The maximum credit facility that is available to any DHB is the value of one month’s Provider Arm funding, less net Inter-District In-Flows, plus GST. As at 31 January 2015, the BOPDHB had the following borrowings: Westpac $nil Ministry Of Health $152.2 million Project LEO (redevelopment of Tauranga Hospital) and Project WAKA (redevelopment of Whakatane Hospital) required increased levels of borrowings and equity support. BOPDHB remains committed to minimising its reliance on additional borrowings or equity support. Increased interest costs and capital charge costs from additional borrowings and equity support are to be affordable and must be met from within the operational budget of the BOPDHB.


PROSPECTIVE ESTIMATES OF DEBT AND EQUITY AS AT 30 JUNE 2016, 2017 AND 2018

$m Actual

2014 Estimate

2015 2016 2017 2018 Long-term Debt 123.7 132.7 152.2 152.2 152.2 Equity from the Crown 86.4 86.7 88.1 89.5 90.9 Current & Long-term debt drawn

20.0 8.5 0.0 0.0 0.0

Current & Long-term debt repaid

0.0 0.0 0.0 0.0 0.0

Net Equity injections 0.4 0.0 0.0 0.0 0.0 All debt is unsecured.

4.4 Asset Management The BOPDHB maintains a long term Asset Management Plan, which delivers a strategic approach to asset maintenance, replacement and investment. The plan was refreshed in 2014/15. The plan reflects the joint approach taken by all DHBs. The plan itself utilises the framework identified as most appropriate by a joint DHB workgroup and was based on the International Infrastructure Management Manual. Currently the Board has allocated funding for investment in normal asset replacement and some new assets. Project LEO, the Tauranga Campus Redevelopment Project, is outside the scope of the normal capital investment and has been funded by a combination of debt, equity and operating cashflows, including cashflows generated from efficiency and effectiveness projects as part of the process reengineering. Project WAKA, the Whakatane Campus redevelopment was funded utilising debt and operating cashflows.

$m Actual

2014 Estimate

2015 2016 2017 2018 Annual Depreciation 18.2 19.6 20.1 20.5 20.4 Strategic 22.2 16.0 16.1 14.1 13.9 Regular Capital Expenditure 7.3 9.5 8.3 10.0 10.5 Total Capital Expenditure 29.5 25.5 24.4 24.1 24.4 Capital Expenditure Business Cases The BOPDHB understands that approval of this Plan is not approval of any specific capital business case. Some business cases will still be subject to a separate approval process that includes Ministry of Health, National Health Board and Treasury officials prior to a recommendation being made to the Minister of Health. The Board also requires Management to obtain final approval in accordance with delegations prior to purchase or construction commencing.


Alternate Funding As business cases are finalised for presentation to the Board or Ministry, managers will review the most appropriate financing option currently available for the particular item. This may result in items being acquired via donation or leasing options and therefore not being purchased via the capital expenditure programme. Strategic Capital Developments Provision has been made in the fixed asset additions for the completion of any strategic capital projects. Asset Disposals The BOPDHB actively reviews assets to ensure that it has no surplus assets. No significant assets are scheduled for disposal during the plan period as a result of being surplus. Some minor asset disposals will occur as part of the regular capital replacement programme. Disposal of Land The approval of the Minister of Health is required prior to the BOPDHB disposing of land. The disposal process is a protective mechanism governed by various legislation and policy requirements. Revaluations All Land and Buildings will be fully revalued during the year ended 30 June 2015, the next such review being due as at 30 June 2018. Procedure for Buying Shares The approval of the Ministers of Health and Finance is required prior to the BOPDHB taking a shareholding interest in any entity. Significant Accounting Policies The following accounting policies have been directly extracted from the BOPDHB Annual Report 2014. There have been no changes to accounting policies since that time and they therefore apply to the prospective financial statements in this Plan: “Reporting entity Bay of Plenty District Health Board (Bay of Plenty DHB) is a District Health Board established by the New Zealand Public Health and Disability Act 2000. Bay of Plenty DHB is a crown entity in terms of the Crown Entities Act 2004, owned by the Crown and domiciled in New Zealand. Bay of Plenty DHB is a reporting entity for the purposes of the New Zealand Public Health and Disability Act 2000, the Financial Reporting Act 1993, the Public Finance Act 1989 and the Crown Entities Act 2004.

Bay of Plenty DHB is a public sector, public benefit entity, as defined under External Reporting Board (XRB) Standard A1.

The financial statements of Bay of Plenty DHB for the year ended 30 June 2014 incorporate Bay of Plenty DHB and Bay of Plenty DHB’s interest in associates and joint ventures.

Bay of Plenty DHB is required under the Crown Entities Act 2004 (the “Act”) to prepare consolidated financial statements in relation to the group for each financial year.


Consolidated financial statements for the group have not been prepared due to the small size of the subsidiaries which means that the parent and group amounts are not materially different. The following are the Bay of Plenty DHB subsidiaries which have not been consolidated in the financial statements:

Tauranga Community Health Trust (Inc.) and Whakatane Community Health Trust (Inc.) are charitable trusts which administer donations received which are tagged for specific use within the Bay of Plenty DHB. The Bay of Plenty DHB has no financial interest in either of these trusts. The trusts are controlled by the Bay of Plenty DHB in accordance with NZ IAS 27 as the Bay of Plenty DHB is able to appoint the majority of the Trustees of the Charitable Trusts. The objective for which the Charitable Trusts are established is entirely charitable. Bay of Plenty DHB’s activities involve funding and delivering health and disability services and mental health services in a variety of ways to the community.

The financial statements were authorised for issue by the Board on 22 October 2014.

Statement of compliance

The financial statements have been prepared in accordance with Generally Accepted Accounting Practice in New Zealand (NZGAAP). They comply with New Zealand equivalents to International Financial Reporting Standards (NZIFRS), and other applicable Financial Reporting Standards, as appropriate for public benefit entities.

Basis of preparation

The financial statements are presented in New Zealand Dollars (NZD), rounded to the nearest thousand. The financial statements are prepared on the historical cost basis except that land and buildings are stated at their fair value.

Non-current assets held for sale and disposal groups held for sale are stated at the lower of carrying amount and fair value less costs to sell.

The following accounting policies have been applied consistently to all periods presented in these financial statements.

The preparation of financial statements in conformity with NZIFRS requires management to make judgements, estimates and assumptions that affect the application of policies and reported amounts of assets and liabilities, income and expenses. The estimates and associated assumptions are based on historical experience and various other factors that are believed to be reasonable under the circumstances, the results of which form the basis of making the judgements about carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates.

The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or


in the period of the revision and future periods if the revision affects both current and future periods.

Judgements made by management in the application of NZIFRS that have significant effect on the financial statements and estimates with a significant risk of material adjustment in the next year are discussed in note 23.

Financial instruments

Non-derivative financial instruments Non-derivative financial instruments comprise available for sale financial assets, instruments at fair value through profit or loss, trade and other receivables, cash and cash equivalents, loans, other financial liabilities, and trade and other payables.

Non-derivative financial instruments are recognised initially at fair value plus, for instruments not at fair value through profit or loss, any directly attributable transaction costs. Subsequent to initial recognition non-derivative financial instruments are measured as described below.

A financial instrument is recognised if the Bay of Plenty DHB becomes a party to the contractual provisions of the instrument. Financial assets are derecognised if the Bay of Plenty DHB’s contractual rights to the cash flows from the financial assets expire, or if the Bay of Plenty DHB transfers the financial asset to another party without retaining control or substantially all risks and rewards of the asset. Regular purchases and sales of financial assets are accounted for at trade date, i.e., the date that the Bay of Plenty DHB commits itself to purchase or sell the asset. Financial liabilities are derecognised if the Bay of Plenty DHB’s obligations specified in the contract expire or are discharged or cancelled.

Cash and cash equivalents Cash and cash equivalents comprise cash balances and call deposits with maturity of no more than three months from the date of acquisition. Bank overdrafts that are repayable on demand and form an integral part of the Bay of Plenty DHB’s cash management are included as a component of cash and cash equivalents for the purpose of the statement of cash flows.

Loans Subsequent to initial recognition, other non-derivative financial instruments are measured at amortised cost using the effective interest method, less any impairment losses. Trade and other receivables Trade and other receivables are initially recognised at historical cost and subsequently assessed for an allowance for doubtful debts (if any). The carrying value of trade and other receivables that are of a short term duration is a reasonable approximation of their fair values. Bad debts are written off during the period in which they are identified.

Trade and other payables Trade and other payables are stated at historical cost.


Property, plant and equipment

Classes of property, plant and equipment The major classes of property, plant and equipment are as follows:

• freehold land • freehold buildings • plant and equipment • work in progress.

Land and buildings are re-valued to fair value as determined by an independent registered valuer, with sufficient regularity to ensure the carrying amount is not materially different to fair value, and at least every three years. Any increase in value of a class of land and buildings is recognised directly to equity unless it offsets a previous decrease in value recognised in the profit or loss. Any decreases in value relating to a class of land and buildings are taken directly to the revaluation reserve, to the extent that they reverse previous surpluses and are otherwise recognised as an expense in the profit or loss. Additions to property, plant and equipment between valuations are recorded at cost. Property that is being constructed or developed for future use as investment property is classified as property, plant and equipment and stated at cost until construction or development is complete, at which time it is reclassified as investment property. Where material parts of an item of property, plant and equipment have different useful lives, they are accounted for as separate components of property, plant and equipment. Property, plant and equipment vested from the hospital and health service Under section 95(3) of the New Zealand Public Health and Disability Act 2000, the assets of Pacific Health Limited (a hospital and health service company) vested in Bay of Plenty DHB on 1 January 2001. Accordingly, assets were transferred to Bay of Plenty DHB at their net book values as recorded in the books of the hospital and health service. In effecting this transfer, the Health Board has recognised the cost and accumulated depreciation amounts from the records of the hospital and health service. The vested assets will continue to be depreciated over their remaining useful lives. Disposal of property, plant and equipment Where an item of property, plant and equipment is disposed of, the gain or loss recognised in the profit or loss is calculated as the difference between the net sales price and the carrying amount of the asset. On the sale or retirement of a re-valued property, the attributed revaluation surplus remaining in the property revaluation reserve is transferred directly to retained earnings. No transfer is made from the revaluation reserve to retained earnings except when an asset is derecognised. Subsequent costs Subsequent costs are added to the carrying amount of an item of property, plant and equipment when that cost is incurred if it is


probable that the service potential or future economic benefits embodied within the new item will flow to Bay of Plenty DHB. All other costs are recognised in the profit or loss as an expense as incurred.

Depreciation Depreciation is charged to the profit or loss using the straight line method. Land is not depreciated. Depreciation is set at rates that will write off the cost or fair value of the assets, less their estimated residual values, over their useful lives. The estimated useful lives of major classes of assets and resulting rates are as follows: Class of asset Estimated life Depreciation rate Buildings 15 to 50 years 2- 6.67% Plant and equipment 5 to 10 years 10 - 20.0% Vehicles 5 to 10 years 10 - 20.0% Fixture and fittings 3 to 25 years 4 - 33.0% The residual value and useful lives of assets is reassessed annually. Freehold land and work in progress are not depreciated. The total cost of a project is transferred to the appropriate class of asset on its completion and then depreciated. Intangible assets

Intangibles Intangible assets that are acquired by Bay of Plenty DHB are stated at cost less accumulated amortisation and impairment losses. HBL (FPSC rights) is an intangible asset recognised at the cost of capital invested by the Bay of Plenty DHB in the Finance Procurement Supply Chain (FPSC) programme being a national initiative undertaken by HBL to deliver sector wide benefits. This represents the DHB’s right to access, under a service level agreement, shared FPSC services provided using assets funded by DHB’s. The rights are considered to have an indefinite life as DHB’s have the ability and intention to review the service level agreement indefinitely and the fund established by HBL through the on-charging of depreciation on the FPSC assets to the DHB’s will be used to, and is sufficient to, maintain the FPSC assets standard of performance or service potential indefinitely. As the FPSC rights are considered to have an indefinite life, the intangible asset is not amortised and will be tested for impairment annually. Subsequent expenditure on intangible assets is capitalised only when it increases the service potential or future economic benefits embodied in the specific asset to which it relates. Amortisation Amortisation is charged to the profit or loss on a straight-line basis over the estimated useful lives of intangible assets unless such lives are indefinite. Intangible assets with an indefinite useful life are tested for impairment at each statement of financial position date. Intangible


assets with a definite useful life are amortised from the date they are available for use. The estimated useful lives are as follows: Type of asset Estimated life Amortisation rate Software 2 to 3 years 33 - 50%

Inventories

Inventories are stated at the lower of cost and net realisable value. Net realisable value is the estimated selling price in the ordinary course of business, less the estimated costs of completion and selling expenses. Cost is based on weighted average cost.

Impairment

The carrying amounts of Bay of Plenty DHB’s assets other than investment property and inventories are reviewed at each balance date to determine whether there is any indication of impairment. If any such indication exists, the assets’ recoverable amounts are estimated. If the estimated recoverable amount of an asset is less than its carrying amount, the asset is written down to its estimated recoverable amount and an impairment loss is recognised in the profit or loss. For intangible assets that have an indefinite useful life and intangible assets that are not yet available for use, the recoverable amount is estimated at each statement of financial position date and was estimated at the date of transition. An impairment loss on property, plant and equipment re-valued on a class of asset basis is recognised directly against any revaluation reserve in respect of the same class of asset to the extent that the impairment loss does not exceed the amount in the revaluation reserve for the same class of asset. Impairment losses on an individual basis are determined by an evaluation of the exposures on an instrument by instrument basis. All individual trade receivables that are considered significant are subject to this approach. For trade receivables which are not significant on an individual basis, collective impairment is assessed on a portfolio basis based on number of days overdue, and taking into account the historical loss experience in portfolios with a similar amount of days overdue. Calculation of recoverable amount Estimated recoverable amount of other assets is the greater of their fair value less costs to sell and value in use. Value in use is calculated differently depending on whether an asset generates cash or not. For an asset that does not generate largely independent cash inflows, the recoverable amount is determined for the cash-generating unit to which the asset belongs. For non-cash generating assets that are not part of a cash generating unit, value in use is based on depreciated replacement cost (DRC). For cash generating assets value in use is determined by estimating future cash flows from the use and ultimate disposal of the asset and


discounting these to their present value using a pre-tax discount rate that reflects current market rates and the risks specific to the asset. Impairment gains and losses, for items of property, plant and equipment that are re-valued on a class of assets basis, are also recognised on a class basis.

Reversals of impairment Impairment losses are reversed when there is a change in the estimates used to determine the recoverable amount. An impairment loss on an equity instrument investment classified as available-for-sale or on items of property, plant and equipment carried at fair value is reversed through the profit or loss, unless the relevant asset is carried at a re-valued amount, in which case the reversal of the impairment loss is reversed through the relevant reserve. All other impairment losses are reversed through the profit or loss. An impairment loss is reversed only to the extent that the asset’s carrying amount does not exceed the carrying amount that would have been determined, net of depreciation or amortisation, if no impairment loss had been recognised. Interest-bearing borrowings Interest-bearing loans and borrowings are classified as other non-derivative financial instruments. Interest-bearing borrowings are recognised initially at fair value less attributed transaction costs. Subsequent to initial recognition, interest-bearing borrowings are stated at amortised cost with any difference between cost and redemption value being recognised in the profit or loss over the period of the borrowings on an effective interest basis. Employee Benefits

Defined contribution schemes

Employer contributions to KiwiSaver, the Government Superannuation Fund, and the State Sector Retirement Savings Scheme are accounted for as defined contribution plans and are recognised as an expense in the profit or loss during the period as they arise. The Bay of Plenty DHB has no legal or constructive obligation to pay future benefits, the Crown guarantees these benefits, and as a result the plans are accounted for as a defined contribution plan. Long service leave, sabbatical leave and retirement gratuities

Bay of Plenty DHB’s net obligation in respect of long service leave, sabbatical leave and retirement gratuities is the amount of future benefit that employees have earned in return for their service in the current and prior periods. The obligation is calculated using the projected unit credit method and is discounted to its present value. The discount rate is the market yield on relevant New Zealand government bonds at the statement of financial position date.


Annual leave, sick leave and medical education leave

Annual leave, sick leave and medical education leave are short-term obligations and are calculated on an actual basis at the amount Bay of Plenty DHB expects to pay. Bay of Plenty DHB accrues the obligation for paid absences when the obligation both relates to employees’ past services and it accumulates.

Other Liabilities

Provisions

A provision is recognised when Bay of Plenty DHB has a present legal or constructive obligation as a result of a past event, and it is probable that an outflow of economic benefits will be required to settle the obligation. If the effect is material, provisions are determined by discounting the expected future cash flows at a pre-tax rate that reflects current market rates and, where appropriate, the risks specific to the liability.

Onerous contracts

A provision for onerous contracts is recognised when the expected benefits to be derived by Bay of Plenty DHB from a contract are lower than the unavoidable cost of meeting its obligations under the contract.

Income tax

Bay of Plenty DHB is a crown entity under the New Zealand Public Health and Disability Act 2000 and is exempt from income tax under section CW38 of the Income Tax Act 2007.

Goods and services tax

All amounts are shown exclusive of Goods and Services Tax (GST), except for receivables and payables that are stated inclusive of GST. Where GST is irrecoverable as an input tax, it is recognised as part of the related asset or expense.

Revenue

Crown funding

The majority of revenue is provided through an appropriation in association with a Crown Funding Agreement. Revenue is recognised monthly in accordance with the Crown Funding Agreement payment schedule, which allocates the appropriation equally throughout the year.

ACC contracted revenue

ACC contract revenue is recognised when eligible services are provided and any contract conditions have been fulfilled.

Goods sold and services rendered

Revenue from goods sold is recognised when Bay of Plenty DHB has transferred to the buyer the significant risks and rewards of ownership of the goods and Bay of Plenty DHB does not retain either continuing managerial involvement to the degree usually associated with ownership nor effective control over the goods sold.


Revenue from services is recognised, to the proportion that a transaction is complete, when it is probable that the payment associated with the transaction will flow to Bay of Plenty DHB and that payment can be measured or estimated reliably, and to the extent that any obligations and all conditions have been satisfied by Bay of Plenty DHB.

Revenue relating to service contracts

Bay of Plenty DHB is required to expend all monies appropriated within certain contracts during the year in which it is appropriated. Should this not be done, the contract may require repayment of the money or Bay of Plenty DHB, with the agreement of the Ministry of Health, may be required to expend it on specific services in subsequent years. The amount unexpended is recognised as a liability.

Financing Revenue

Interest received and receivable on funds invested are calculated using the effective interest rate method and are recognised in the profit or loss. Expenses

Operating lease payments

Payments made under operating leases are recognised in the profit or loss on a straight-line basis over the term of the lease. Lease incentives received are recognised in the profit or loss over the lease term as an integral part of the total lease expense.

Financing costs

Financing costs comprise interest paid and payable on borrowings calculated using the effective interest rate method, are recognised in the profit or loss.

The interest expense component of finance lease payments is recognised in the profit or loss using the effective interest rate method.

Standards, Amendments and Interpretations Effective in the Current Period

All mandatory Standards, Amendments and Interpretations have been adopted in the current year. None had a material impact on these financial statements.

New standards adopted and interpretations not yet adopted

The External Reporting Board (XRB) is currently in the process of establishing a new Accounting Standards Framework based on a multi-sector, reporting tiers approach. The new accounting standards framework consists of two sets of accounting standards, one to be applied by entities with a for-profit objective and the other to be applied by public benefit entities (PBE’s). The Public Sector PBE standards have not yet been released, but will be based largely on International Public Sector Accounting Standards (IPSAS).


In the interim, all new New Zealand equivalents to International Financial Reporting Standards (NZ IFRSs) and amendments to existing NZ IFRSs approved in and subsequent to March 2011 would be applicable to profit-orientated entities only. This means that the financial reporting requirements for public sector PBEs are frozen for the short-term. Consequently, new or amended NZ IFRS released during the year are not applicable to PBEs, hence no disclosure has been made.

Statement of service performance by output class

The statement of service performance by output class, as reported in the statement of service performance, report the net cost of services for the outputs of Bay of Plenty DHB and are represented by the cost of providing the output less all the revenue that can be allocated to these activities.

Cost allocation

Bay of Plenty DHB has arrived at the net cost of service for each significant activity using the cost allocation system outlined below.

Cost allocation policy

Direct costs are charged directly to output classes. Indirect costs are charged to output classes based on cost drivers and related activity and usage information.

Criteria for direct and indirect Costs

Direct costs are those costs directly attributable to an output class.

Indirect costs are those costs that cannot be identified in an economically feasible manner with a specific output class.

Cost drivers for allocation of indirect costs

The cost of internal services not directly charged to outputs is allocated as overheads using appropriate cost drivers such as actual usage, staff numbers and floor area.”


4.5 Prospective Detailed Financial Statements Consolidated Statement of Prospective Financial Performance

2013/14

2014/ 15

2015/16

2016/17

2017/18


Revenue 667.1 692.5 707.3 726.3 745.2 Less operating expenditure

DHB Provider expenditure

316.1 323.1 329.1 338.4 348.3

External provider expenditure

315.8 329.2 337.0 346.1 355.0

Governance & Funding Administration

3.3 6.5 6.6 6.8 7.0

Taxation (may apply to subsidiaries and associates)

- - - - -

Total Operating Expenditure

635.2 658.8 672.7 691.3 710.3

Surplus/(Deficit) before Interest, Depreciation and Capital Charge

31.9 33.7 34.6 35.0 34.9

Interest 6.3 7.2 6.5 6.5 6.5 Depreciation 18.2 19.6 20.1 20.5 20.4 Capital Charge 6.6 6.6 6.6 6.6 6.6 NET SURPLUS/(DEFICIT)

0.8 0.3 1.4 1.4 1.4


Consolidated Statement of Prospective Financial Position

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M

Actual Forecast Plan Plan Plan

CROWN EQUITY

86.4 86.7 88.1 89.5 90.9

CURRENT ASSETS:

Bank balances, deposits and cash

21.1 20.0 17.4 14.9 12.5

Receivables 13.8 13.9 14.0 13.9 14.0 Properties intended for sale

Inventory 2.5 2.6 2.6 2.6 2.6 37.4 36.5 34.0 31.4 29.1 CURRENT LIABILITIES:

Payables and Accruals

90.0 85.8 66.7 66.4 66.6

Net Working Capital

(52.6) (49.3) (32.7) (35.0) (37.5)

NON CURRENT ASSETS:

Fixed Assets 260.9 266.7 271.0 274.7 278.6 Investments 2.7 2.9 2.9 2.9 2.9 263.6 269.6 273.9 277.6 281.5 NON CURRENT LIABILITIES:

Borrowings & Provisions

124.6 133.6 153.1 153.1 153.1

NET ASSETS 86.4 86.7 88.1 89.5 90.9 Consolidated Statement of Prospective Movements in Equity

2013/14

2014/ 15

2015/16

2016/17

2017/18


Crown equity at start of period

85.1 86.4 86.7 88.1 89.5

Surplus/(Deficit) for the period

0.8 0.3 1.4 1.4 1.4

Contributions from Crown

0.4 0.0 0.0 0.0 0.0

Distributions to Crown - Revaluation adjustments

0.1 0.0 0.0 0.0 0.0

Crown equity at end of period

86.4 86.7 88.1 89.5 90.9


Consolidated Statement of Prospective Cash Flows

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M


OPERATING CASHFLOWS

Cash inflows from operating activities

664.9 690.7 706.1 724.7 744.1

Cash outflows for operating activities

642.6 669.3 678.9 697.6 716.7

22.3 21.4 27.2 27.1 27.4 INVESTING CASHFLOWS

Cash inflows from investing activities

1.7 1.8 1.0 1.0 1.1

Cash outflows for investing activities

30.2 25.7 24.3 24.1 24.4

(28.5) (23.9) (23.3) (23.1) (23.3) FINANCING CASHFLOWS

Cash inflows from financing activities

20.4 8.6 0.0 0.0 0.0

Cash outflows for financing activities

6.1 7.2 6.5 6.5 6.5

14.3 1.4 (6.5) (6.5) (6.5) Net increase/(decrease) in cash held

8.1 (1.1) (2.6) (2.5) (2.4)

Add opening cash balance

13.0 21.1 20.0 17.4 14.9

CLOSING CASH BALANCE

21.1 20.0 17.4 14.9 12.5

Made up from: Balance Sheet Bank and Cash

21.1 20.0 17.4 14.9 12.5

Consolidated Statement of Prospective Commitments and Contingent Liabilities

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M


COMMITMENTS Capital commitments

2.2 2.0 2.0 2.5 4.0

Operating lease commitments

2.6 2.6 2.5 2.5 2.5

Other operating 87.3 89.0 90.0 90.0 91.0 TOTAL COMMITMENTS

92.1 93.6 94.5 95.0 97.5

CONTINGENT LIABILITIES

- - - - -


DHB Provider Statement of Prospective Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M


REVENUE Government Revenue 327.1 345.1 354.9 364.4 373.9 Other Revenue 7.5 7.2 6.3 6.4 6.6 334.6 352.3 361.2 370.8 380.5 EXPENSES Personnel Costs 207.8 214.8 219.2 225.0 230.9 Outsourced Services 23.5 25.0 22.8 23.9 25.5 Clinical Supplies 52.9 59.2 58.6 60.1 61.3 Infrastructure and Non Clinical

55.7 56.7 61.1 62.3 63.4

339.9 355.7 361.7 371.3 381.1 SURPLUS/(DEFICIT) (5.3) (3.4) (0.5) (0.5) (0.6) DHB Governance Statement of Prospective Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M


REVENUE Government Revenue

8.8 7.4 7.2 7.4 7.6

Other Revenue 8.8 7.4 7.2 7.4 7.6 EXPENSES Personnel Costs 4.9 5.2 5.3 5.4 5.6 Outsourced Services

0.3 0.4 0.5 0.5 0.5

Clinical Supplies 0.1 0.1 0.1 0.1 0.1 Infrastructure and Non Clinical

5.2 1.5 1.4 1.5 1.5

10.5 7.2 7.3 7.5 7.7 SURPLUS/(DEFICIT) (1.7) 0.2 (0.1) (0.1) (0.1)


DHB Funds Statement of Prospective Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 $M $M $M $M $M


REVENUE Government Revenue

635.1 659.4 674.5 692.6 710.8

EXPENSES Personal Health 458.5 478.2 494.2 507.5 520.8 Mental Health 58.5 61.3 62.7 64.4 66.1 Disability Support Services

95.4 102.2 100.8 103.5 106.3

Public Health 1.7 2.0 2.5 2.6 2.6 Maori Health 4.7 4.8 5.1 5.2 5.3 Governance & Administration

8.5 7.4 7.2 7.4 7.6

627.3 655.9 672.5 690.6 708.7 SURPLUS/(DEFICIT) 7.8 3.5 2.0 2.0 2.1


Kōwae Rima - Module Five: Stewardship In delivering on our functions as a DHB and participating in the health sector, we have a broad set of responsibilities and interact with a diverse range of individuals and groups. To be as effective as possible, we must have capable leadership, an engaged workforce, a healthy organisational culture, sound relationships, robust and rigorous systems and the right infrastructure and assets. This module describes how we intend to perform our functions and conduct our operations to achieve the outputs and impacts we seek to deliver.90 It provides further detail on the resources / inputs portion of our performance story.91 Diagram: Our Performance Story: Resources / Inputs

5.1 Managing Our Business As detailed in Module 1, the environment we are operating in is changing, and there are a number of implications which will affect DHBs. The levels of our success over the next few years will depend on our ability to adapt to the changing environment as we continue to improve the health of the BOPDHB population and reduce or eliminate health inequalities.

5.1.1 Our People

The central part of our capability is our people. Providing health and disability services now and into the future depends on our having a workforce that is well matched to the health needs of the community, and appropriately skilled and located. We will look to create an environment to unleash innovation by staff empowerment.

Local Key points of note about our workforce (as at 31 December 2014) are:

• we employ 3,145 staff[1] in total • 80% of staff are female • the Māori workforce make up 10% of the overall staffing

numbers • New Zealand non-Māori make up the largest single ethnic

group of employees (53%), with the next major ethnicities being European (18%) and Asian/Indian (5%)

• our workforce is older than the average for the New Zealand labour force

90 See Module 1 (impacts) and Module 3 (outputs). 91 See Module 1.1.2. [1] This includes casual employees.

Stewardship

People Performance Management

Clinical Integration/ Collaboration /

Partnerships Information


• 47% of our workforce is over the age of 50 years. The following table highlights the various areas of occupation (as at 31 December 2014):

BOPDHB Staff as at Dec 2014 Occupational Group Head Count Percentage

Admin/Management 571 18%

Allied Health 568 18%

Medical 359 11%

Nursing 1,508 48%

Support 139 5% Total 3,145 100%

Pie Chart: BOPDHB Staff breakdown via Occupational Group

The following graph represents the headcount of number of people employed within our organisation on 1 July each year (from 2003 to 2014).

Graph: Headcount of staff employed at BOPDHB

18%

18%

11%

48%

5%

BOPDHB Staff breakdown via Occupational Group

Admin/Management

Allied Health

Medical

Nursing

Support

2,400

2,600

2,800

3,000

3,200

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

BOPDHB Staff Head Count Source: BOPDHB Health Workforce Information Programme (HWIP) Statistics


Staff Full Time Equivalent (FTE)

Contracted Full Time Equivalent (FTE) is the total FTE that BOPDHB’s employees are contracted to work. An FTE of 1.0 means that the person is equivalent to a full-time worker; while an FTE of 0.5 signals that the worker is only half-time. The below graph excludes hours worked by casual staff and additional hours worked by part-time staff.

Graph: BOPDHB Staff Contracted Full Time Equivalent

Staff Turnover

Staff turnover represents the number of people leaving over a 12-month period. It is presented as a Percentage by dividing those leaving the organisation by the total number of staff at the beginning of the period. Temporary, casual staff and Resident Medical Officers (RMOs) have been removed and the data does not include staff that transfer within the organisation. The figures only include those that left voluntarily (leaving reasons such as death, medical reasons, redundancy and dismissals are excluded). The data, presented in the following graph, indicates a general reduction in turnover, with the largest fall in 2009, which coincides with the global financial crisis.

Graph: Percentage of Staff Turnover

1,800

1,900

2,000

2,100

2,200

2,300

2,400

2006 2007 2008 2009 2010 2011 2012 2013 2014

BOPDHB Staff Contracted FTE (Full Time Equivalents) Source: BOPDHB HWIP Statistics

6%

8%

10%

12%

14%

16%

18%

20%

2001

/02

2002

/03

2003

/04

2004

/05

2005

/06

2006

/07

2007

/08

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

2013

/14

Staff Turnover Source: BOPDHB Human Resources Statistics


Staff Engagement In the organisation’s endeavours to continue to be an employer of choice and in line with its Shared Expectations, the role of Staff Engagement Leader was established in January 2011 to champion initiatives employees identified as requiring improvement from the results of the Pulse Staff Engagement Survey undertaken in 2010 and to nurture the employee’s experience of working at BOPDHB. Priority tasks for the role are:

• employee commencement • organisational orientation • 2 – 3 months follow up letters • CARE Awards • staff recognition ceremonies – annually • monthly 1, 2 and 5 year anniversary letters • pulse survey • pulse follow up actions • retirement acknowledgement • exit surveys / interviews.

Improvement and further development of staff engagement initiatives, such as employee commencement and orientation are important aspects of the role. They also help employees understand how the organisation works and how their role contributes to the successful delivery of optimal health services for the Bay of Plenty. Employee Commencement This process is taken up by the Staff Engagement Leader where the Recruitment process comes to an end. As soon as contractual documentation has been forwarded, advice is given to the Staff Engagement Leader to enable contact with the new employee as a way of welcoming and guiding them into the organisation with advice on commencement and orientation requirements, as well as offering the opportunity to answer any queries there may be. An information pack is also dispatched. Organisational Orientation A half-day organisational orientation is provided on induction and includes the welcoming addresses by the Chief Executive and Chief Operating Officer, Staff Engagement Leader, Quality & Patient Safety Manager and Employee Health & Safety Manager. For further orientation an online learning format has been developed for new employees to complete within four weeks of commencement. The Staff Engagement Leader follows up completion of these modules. Employees moving within the organisation, who have not attended orientation for some time, are also contacted and scheduled to attend the next closest organisational orientation day to their new appointment as a way of updating them on the organisation and its activities. Their training record is reviewed and advice conveyed on update of any organisational requirements Follow up Letters Around three months post orientation, the Staff Engagement Leader sends a letter to touch base with the new employees in their


workplace, to ensure that they are settling in and if they have any queries or need any further assistance. Staff Service Recognition Programme Staff recognition ceremonies for those reaching 10, 15, 20, 25, 30 and 35+ years of service are held on an annual basis. The Board Chair and Chief Executive present certificates and, for 20+ years, a commemorative gift card. Letters personally signed by Chief Executive are sent to employees on their one, two and five year anniversaries. CARE Awards The CARE Awards are a recent introduction based on the organisation’s values, as a means of employees readily conveying recognition of and thanks to their Managers, Peers and Colleagues for deeds which have been observed to be carried out or have assisted them, aligned to the CARE values. The CARE Awards are accessed through the intranet and are in the form of four formal certificates each denoting an aspect of CARE (Compassion, Attitude, Responsiveness and Excellence). There are template spaces to record the name of the recipient and the observed action. There is also an email CARE Awards template should employees wish to send an informal acknowledgement. Pulse Staff Engagement Survey Staff surveys have been undertaken using an independent survey process, since 2001, initially as staff satisfaction, however since 2007, the focus has shifted to that of staff engagement. The last survey was undertaken in November 2013

The Staff Engagement Leader analyses the results of the survey. Feedback reports are compiled and a range of forums are undertaken to present the results, following which the Staff Engagement Leader liaises with and supports Executive Team Members and Cluster leaders to create Service and Team Action Plans to enhance the positive


activities within the organisation, and to address the areas employees perceive could be better, in an ongoing manner Results are analysed by service and down to departmental level so that unit specific action plans to improve staff engagement can be developed. Progress against those plans is regularly assessed.

Note: Changes were made in 2013 to some of the questions in the survey. A 2% improvement (64.3%) was achieved when only reflecting responses to the questions able to be trended against previous survey questions. The result shown above for 2013 is inclusive of new question responses. Pulse Survey Action Plans Results from the Pulse Survey 2013 for BOPDHB continued to show a pattern of improvement. Following presentation of results across all areas, services and teams have compiled their Action Plans which concentrate on the overall areas of continued improvement indicated for the organisation, but also incorporating ideas for their own areas/teams. Having now established their plans as a base, these will be reviewed regularly and updated throughout the year. Sick Leave We have been implementing procedures to support staff that have needed to take long periods of sick leave and those who take regular short term sick leave. The percentage of sick leave over total paid hours has trended down until 2009/10 and has been increasing slightly since then. There continues to be room for improvement for a number of occupational groups.

Unplanned leave can affect productivity and cost when replacement staff are required to maintain service delivery levels. Sick leave is also a barometer of the ability of staff to take annual leave. Most employees are entitled to five weeks annual leave per annum (five weeks leave equates to approximately 10% planned leave over paid hours).

5.1.2 Organisational Performance Management

Our performance is assessed on both non-financial and financial measures. The table in section 5.6.2 of this module provides an overview of the external reporting we produce which incorporates a significant amount of performance reporting. Our planned

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

2001 2003 2005 2007 2009 2010 2013

Staff engagement Source: BOPDHB 'Pulse Survey' Results


performance as a planner, funder and provider of health services is outlined in this plan and our service plans.

Non-financial Performance Reporting Non-financial performance, which relates to volume and performance expectations for health service provision by our Provider Arm (Tauranga and Whakatane Hospitals), PHOs and the NGOs we fund is monitored regularly.

As a funder we monitor the agreements we have with providers through regular performance reports and data analysis. We also monitor the quality of services provided through reporting of adverse incidents, routine audits, service reviews and issues-based audits.

We report (on the indicators due each quarter) to the Ministry of Health on the indicators in the DHB Non-Financial Monitoring Framework and regularly feed into benchmarking and quality programmes to compare our performance with other providers.

We report to our Board through the quarterly narrative reporting process on our performance against all the indicators in this Annual Plan. As part of our narrative reporting process the report is also review by the CEO’s direct reports. These reports are provided and discussed in Board meetings and the reports are available to the public as part of the relevant Board agenda available on our website.

We support the national expectation that the public should be informed about health system performance by publishing our performance against the national health targets. The information on our non-financial performance is one of the tools used by the organisation to identify issues and inform decision-making to improve our performance.

Financial Performance Reporting As part of our annual planning process, we submit a set of financial templates to the Ministry of Health. The templates inform the tables and narrative presented in Module 7. We report monthly to the Ministry of Health against the financial templates. We report on our financial performance monthly to our Board. This report includes commentary and financials as well as actions planned to improve financial performance. As part of our financial reporting we include full time equivalent (FTE) reporting. This covers areas like:

• accrued FTE • management / Administration FTE Capitation • clinical FTE • out-sourced services FTE.

The information on our financial performance is one of the tools used by the organisation to identify issues and inform decision-making to improve our performance.


5.1.3 Funding and Financial Management

We have an objective of strong financial performance and plan to manage and balance our financial position and to minimise cyclical deficits. The following table sets out our key financial information.

2013/14 2014/15 2015/16 2016/17 2017/18

$M $M $M $M $M ACTUAL PLANNED PLANNED PLANNED PLANNED Revenue (after adjustments) 667.1 692.5 707.3 726.3 745.2

Net Surplus/ (Deficit) 0.8 0.3 1.4 1.4 1.4

Total Fixed Assets 260.9 266.7 271.0 274.7 278.6 Net Assets 86.4 86.7 88.1 89.5 90.9 Term Borrowings and Provisions 124.6 133.6 153.1 153.1 153.1

We have met our strong financial performance objective for several years.

5.1.4 National Health Sector Entities

We are expected to align our planning with the planning intentions of key national agencies. Each of these national agencies has initiatives for the 2015/16 year, which will impact on our DHB. The national agencies are:

1. Health Shared Services (HSS) 2. National Health Information Technology Board (NHITB) 3. Health Quality and Safety Commission (HQSC) 4. PHARMAC 5. Health Workforce New Zealand 6. National Health Committee.

For further information and actions that the BOPDHB are supporting in relation to the National Health Sector Agencies to improve performance are notably presented through Modules 2.5 National Entity Initiatives and 2.6 Living Within Our Means of this plan.

5.1.5 Risk Management

The BOPDHB manages strategic, clinical and organisational risks to ensure quality care is provided for patients, a safe environment is maintained and resources are available to achieve organisational objectives. Risk management actions and control measures are traceable, aid continuous learning for the organisation, and can assist with identifying emerging risks and issues. Risk identification and management is the responsibility of all employees and is integral to all DHB processes including strategic planning, project development and change management. BOPDHB has an electronic risk management system which enables the organisation to identify and report and monitor risks. The system is accessible to employees 24/7 for ease of reporting and assists with


creating risk reports and the BOPDHB Risk Register for the organisation. There is a current project to source and purchase a Regional Electronic System to manage risk. This new system will be eventually rolled out to all five of the DHBs in the Midland Region. Once this system is live the Midland region will be able to share information related to risk management and strategies. As the BOPDHB already operates an electronic risk system the introduction of a similar on-line reporting format will be less challenging than the DHBs whom currently have a paper based reporting system. Risk reports are generated periodically to the committees responsible for monitoring risk for the organisation. The Audit Finance and Risk Committee (AFRM) is a sub-committee of the Board and reviews risks regularly as well as internal and external mechanisms for the evaluation of contracted providers, which are conducted on both a planned and ad hoc basis. A full summary of graded organisational risks are viewed by the Board quarterly. Sector Services also provide a range of routine and special audits on behalf of BOPDHB with respect to primary care services and Fee for Service Agreements (including pharmacy, dental, home based support services and aged care). The risk management system is internally audited annually to ensure compliance with the Standard ISO AS/NZS 31000:2009 Risk Management Principles and Guidelines.

5.1.6 Performance92 and Management of Assets

The BOPDHB’s asset management plan financials show the full picture of the capital intentions planned in response to identified service needs and planned configuration of services. The BOPDHB has a robust asset management plan and process in place to ensure timely and appropriate management of:

1. Regular capital expenditure – the replacement of clinical and non-clinical equipment, information technology, and existing building services

2. Strategic capital expenditure - other large-scale building,

information technology and clinical development plans. In addition, the asset management plan process includes a long term ongoing review of the affordability to the BOPDHB of the capital developments set out in the plan. Over the next three years the proposed capital expenditure and funding is summarised as follows:

92 Availability / utilisation / functionality / condition


2014/15 Actual

2015/16 Plan

2016/17 Plan

Capital Expenditure: ($M) ($M) ($M)

Regular Capital Expenditure 9.5 8.3 10.0

Strategic Capital Expenditure 16.0 16.1 14.1

Total Capital Expenditure 25.5 24.4 24.1

Funded by:

Internal (depreciation and free cashflow) 25.5 24.4 24.1

External (MoH Loans) - - -

Total Financing 25.5 24.4 24.1

5.1.7 Shared decision making participation

We engage formally and informally at many levels with Iwi, providers and the community. We observe the Treaty principles within the framework of the NZPHD Act (see Module 1). In our context they are:

Partnership – BOPDHB structure reflects partnership through the Māori Health Rūnanga (Governance); Māori Health Planning and Funding team (Strategic); Regional Health services (Operations); and the Kāhui Kaumātua (Advisors on tikanga and kawa). The DHB has in practice, processes that enable engagement and contribution to decisions at all levels of decision-making, based on mutual understanding and cooperation.

Participation – Iwi are a joint partner in identifying priority areas for health gain and are involved in the overall strategic and operational planning processes as mentioned above.

Protection – BOPDHB is committed to a bi-cultural approach in its delivery of health and disability services, which includes the utilisation of tikanga. We are working with to ensure the protection of cultural concepts, values, practices and other taonga.

At a strategic level, the needs of Iwi are raised through the 18 Iwi representatives on the Rūnanga and help develop and inform the planning and delivery of services. Therefore, outlining the key priorities that should be taken into account to deliver services to and for Māori.

The development of services occurs through the Māori Health Planning and Funding team in conjunction with various stakeholders including Iwi and Hapū Providers. The utilisation of Census data and local Health and Whanau Ora Needs assessments provide a foundation of evidence to reinforce and support the issues driven by Iwi, hapū and whanau.

Tikanga ā iwi is adhered to with bi-culturalism actively promoted and is monitored at a service delivery level through Regional Māori Health services, which in turn informs and takes guidance from Te Kāhui Kaumātua. The Board and staff are trained in bi-cultural approaches to health and disability service funding and provision of an in-house programme entitled Cultural Awareness. This is supplemented for clinical staff by a programme of cultural competence. To ensure we are on track we utilise the He Ritenga Audit Framework to assess and ensure mainstream responsiveness. In the role of funder, BOPDHB is actively fostering processes within all health and disability service providers and consistently applies the Health Equity Assessment tool


(HEAT) to all its funding decisions. See also our Māori Health Plan (MHP) and Governance 5.5.1.

Clinical Governance A commitment to quality and patient safety places responsibility on the DHB to have effective mechanisms in place for planning, monitoring and managing the quality of clinical services provided. Attempting to make the fundamental changes to the health system for the sector to “live within our means” will require strong clinical engagement and leadership. BOPDHB is driven by clinical engagement commitments through a range of initiatives. Clinical input into decision making is facilitated by a model of shared management and clinician leadership at all levels within the DHB. Our Clinical Directors are formally part of the BOPDHB leadership team and fully involved in the financial and clinical management of their services. The BOPDHB Clinical Board is a multidisciplinary clinical forum, whose membership includes representatives from the primary, secondary and community sectors. The Chair is elected by the Clinical Board and is currently the Clinical Director, Mental Health Services. The Clinical Board oversees the DHB’s clinical activity, provides advice to the Chief Executive Officer on clinical issues and takes a proactive role in setting clinical policy and standards, encouraging best practice and innovation. Members support and influence the DHB’s vision and values and play an important clinical leadership role, leading by example to raise the standard of patient care. The Clinical Board as well as other clinical committees are presented with a multitude of reports and dashboards to help inform their decision making. Our most notable data documents are the dashboards for the Board and the Maori Health Plan as well as the Balanced Scorecard and the Chief Operating Officers report presented at BOPHAC. Clinical leaders can view real-time data in the hospital wards through the hospital at a glance visuals. There are several Decision Support Analysts (DSA) across the DHB that are able to extract data from the various internal and external systems to provide analysis reports for clinical leaders to use. Primary Health Partnerships BOPDHB is focused on continuing to build, maintain and strengthen partnerships across the Primary Provider networks. The existing partnerships with the three PHOs/PHA within the district continue to be advanced through initiatives such as BOPALT. The purpose of BOPALT is to lead and guide our Alliance as it seeks to improve health outcomes for our population.

We aim to provide increasingly integrated and coordinated health services through clinically-led service development and its implementation within a “best for patient, best for system” framework. The key priorities of the BOPALT is to progress aspects of the IHS particularly, Theme 2: Patient and family centred care/Whanau Ora; Theme 3: Access to patient information; and Theme 4: Co-ordinated Care (refer to Module 2.3.1).

Community Input We also have links with a number of consumer and community reference groups, advisory groups and working parties. Their advice and input assist in developing our plans and strategies to improve the


delivery of health and disability services and to reduce inequalities within our population. See Collaboration – Local (5.2.4).

5.2 Building Capability This section outlines the capabilities we will need in the next three to five years as well as touching on the approach in the short term to work towards developing these.

5.2.1 Collaboration

We are proactively engaging to collaborate with Government agencies; Primary Care Partners; other health and disability organisations; stakeholders; and our community to decide what health and disability services are needed, and how to best use the funding we receive from Government to improve, promote and protect the health and wellbeing of our population. To help deliver on our vision; and Ministerial priorities such as the Childrens Teams and Social Sector Trials; and driving the IHS we continue to engage and collaborate.

Through these collaborative efforts, we ensure that services are well coordinated and cover the full continuum of care, with the patient at the centre. These collaborative partnerships also allow us to share resources and reduce duplication, variation and wastage across the whole of the health system to achieve the best health outcomes for our community. These principles underline the focus of streamlined contracts.

Our DHB is committed to working with other providers in order to influence the social determinants of health that are external to the health system to achieve the best health outcomes for the population. National At a national level the BOPDHB works with the education, social development and justice sectors to improve outcomes for the Bay of Plenty population through health, nutrition, social wellbeing, physical activity and mental health initiatives; crossing the sectors in an effort to meet shared goals. Similarly, we are committed to a number of national programmes, which will improve the health of the community, including Rheumatic Fever, Newborn Hearing Screening and the Human Papillomavirus Immunisation programme. There are a number of other national programmes such as the National Procurement Programme and Workforce groups that our DHB is focused on to ensure our clinical and financial sustainability. We have been participating in the Whānau Ora integrated agreements and streamlined contracting across the health and social services sectors. This involves bringing together services across agencies (for example MOE, MSD, MBIE and the BOPDHB) to work with a defined population to ensure increased cohesion of service delivery.

We have signalled our intent of integration through the IHS. When making decisions on integration, considerations we will take into account are:

• equitable population coverage • position in the continuum of health services • history of service / contract delivery • Integrating agreements where value is added and do not

create further gaps.


Regional Midland Regional Public Health Network The Midland Regional Public Health Network (the Network) was established in 2010 to provide leadership for and strengthen the performance and sustainability of the Midland public health units. The network provides an avenue for public health units to work together on public health issues affecting the Midland region. Leadership of the network comprises the manager and clinical director from each of the four public health units in the Midlands region: Toi Te Ora - Public Health Service (Bay of Plenty and Lakes District Health Boards); Population Health (Waikato District Health Board); Population Health, Te Puna Waiora (Tairawhiti District Health Board) and Public Health Unit (Taranaki District Health Board). The network continues to develop and/or strengthen relationships with the Midland Regional Clinical Networks to ensure a public health perspective is considered within their planning. At a national level the Network is a member of the National Public Health Clinical Network (NPHCN), whose membership comprises clinical leader and manager from each public health unit and representatives from the Ministry of Health. For further information the Midland Regional Public Health Network please see the Toi Te Ora Annual Plan 2015-2016; and for more information on Midland Clinical Networks refer to the Midland Regional Services Plan 2015-2016 and Module 1.7.4 Regional Collaboration Local We work with other agencies (for example MOE, MOJ, MSD, Police, Tertiary Education Commission, Housing NZ and ACC as well as other central government agencies and local government) to improve the determinants of health. In addition to Whānau Ora; and Integrated and Streamline Contracting, other examples of inter-sector and multi-sector collaboration include:

Bay of Plenty Alliance Leadership Team (BOPALT) Our journey was one of willingness, based on a solid relational foundation that supported a collective and shared vision of what the future may hold. During the forming stage, we developed shared views of what the Alliance could look like then tested those across the various stakeholders. Consequently, it was then agreed in principle that the focus of our Alliance would be, in the first instance recognising that this would be a constantly iterative process as new opportunities and imperatives emerged. The stakeholders then developed an agreed position on how we would collectively manage the various funding flows that currently sat with our primary care partners and how we would look to build on those through DHB investments. In recognising that an Alliance Leadership Team would be formed to progress the work of our Alliance, we considered what the structure may look like and who the members may be. It was then wrapped all up in a nationally consistent Alliance Agreement, which was then signed by all party organisations. Additionally, the members of the Alliance Leadership Team also signed an Alliance Charter that set out how we would work together.


This was all finalised late 2013. BOPALT was formalised and out first meeting took place on the 2nd of April 2014. It was at this time, we agreed that we would also appoint an Independent Chair to support the work of BOPALT. There was an independent Chair invited to take up that appointment. The purpose of BOPALT is:

• To improve health outcomes for our populations • Transforming healthcare services • A “whole-of-system” approach • Providing leadership within our health community • Make the best use of health resources • Balancing a focus on the highest priority needs, while ensuring

appropriate care for all. BOPALT membership currently consists of:

• Clinical leaders - all three PHOs and BOPDHB • Management representatives - all three PHOs • Chief Executive Officer, BOPDHB • GMs Planning and Funding (Māori Health and Mainstream) • Secretariat function is from Te Teo Herenga Waka (TTHW) to

support operationalisation of actions falling out of BOPALT. Service Leadership Alliance Teams (SLAT) SLATs will be developed as determined by BOPALT. Membership is made up of those clinical leaders, key managers and other experts, who can successfully lead and achieve the objectives, set out by the BOPALT. The primary function will be of the SLAT’s to direct and lead a Service Alliance and provide guidance and leadership to the BOPALT with respect to those of Alliance’s activities that are within the scope of that Service Alliance. A SLAT will operate according to any directions, conditions or restrictions established by BOPALT. This may include a direction to work collaboratively with Other Alliances. Tuhoe Service Management Plan The Service Management Plan (SMP) is part of the comprehensive settlement of historic Te Tiriti o Waitangi claims for Ngai Tūhoe. The commitments set out in the plan are made for the purpose of developing, implementing, expanding and renewing from time to time, a plan for the transformation of the social circumstances of the people of Ngāi Tūhoe. In signing up to the Health Sector Chapter in the SMP, the district health boards (Bay of Plenty, Lakes and Hawkes Bay) remain mindful of Tūhoe’s desire for mana motuhake and move towards independence by raising the standards of care to Tūhoe whanau. Ngai Tūhoe genuinely desires a collaborative relationship with the Ministry of Health and district health boards that will support the development of their health infrastructure in each of the four Tūhoe valleys (Waimana, Taneatua, Ruatahuna, and Waikaremoana). We will continue to provide sound advice and support to Ngai Tūhoe through the exchange of ideas, identification of risks, capacity and capability building opportunities and meaningful health investment.


Toi Te Ora - Public Health Service Toi Te Ora – Public Health Service (Toi Te Ora) is the public health unit for the Bay of Plenty and Lakes District Health Boards (DHBs). The two DHBs form the area Toi Te Ora covers. Toi Te Ora provides public health services to protect promote and improve the health of the population living in and visiting its area and aims to reduce inequalities in health status, with a particular focus on Maori. Toi Te Ora provides public health advice and expertise to both Bay of Plenty and Lakes DHBs, primarily through Planning and Funding. The BOP/Lakes Population Health Advisory Group (PopAG) Delivers advice to both DHBs on public health matters, including where the greatest priorities lie, and where opportunities exist to make a greater difference. Following an environment scan, PopAG has determined that the contribution that the public health services in the BOPDHB can best make is improving maternal, child and youth health. These services are primarily focused on: • reducing uptake of tobacco smoking and supporting smoking

cessation in pregnant women and parents • increasing breastfeeding rates • reducing skin infections for preschool and school populations to

assist in reaching Ambulatory Sensitive Hospitalisations targets • increasing immunisation rates for all vaccine–preventable

diseases and at all ages • improving nutrition and physical activity levels in children to

reduce obesity, tooth decay, and set habits into adulthood. • reducing inequalities in social and health outcomes experienced

by Māori, Pacific, migrant, and low income families. This can be achieved through strong linkages to Whānau Ora, Iwi and Māori health plans

• improving access to primary health care, its screening programmes and referral pathways to community-based preventative programmes.

Collaboration Bay of Plenty (COBOP) This is a network of senior managers from local and central Government agencies serving the Bay of Plenty and Lakes districts. The network was initiated in 2005 to promote the achievement of local and regional community wellbeing through effective co-operation and collaboration, and efficient use of resources. Bay of Plenty DHB actively participates in COBOP within a number of different groups. Lakes/Bay of Plenty Rheumatic Fever Steering Group This group provides oversight of the rheumatic fever programme. This is an excellent example of research being converted into action through public funding, community engagement, interagency collaboration and a clear strategic direction. In addition, rheumatic fever is almost exclusively experienced within Māori families, so this work will impact on health inequalities. Health in All Policies Health in All Policies (HiAP) is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas. The goal is to ensure


decision-makers are informed about health, equity and sustainability. HiAP is a public health approach that recognises that health services alone account for only an estimated 10 per cent of variation in life expectancy. Most variation is instead due to lifestyles and environments, and their determinants. HiAP is one of the themes of the BOPDHB Integrated Healthcare Strategy. One of the outcomes sought by the Strategy is “All health professionals in the BOP act, advise and advocate for action on social determinants of health in addition to supporting individual patients”. SmartGrowth is the spatial plan for the Western Bay of Plenty sub-region. Participants include Tauranga City Council Bay of Plenty Regional Council, Western Bay of Plenty District Council, and tangata whenua working in partnership with central government, businesses, education groups, industry and the community. SmartGrowth and the DHB have successfully collaborated since 2007 through the Population Ageing Technical Advisory Group (PATAG) to prepare and plan for population ageing and urbanisation, now reflected through long term and annual plans. In 2015/16 we will build on this successful collaboration to reflect a broader approach to HiAP, including partner Councils across the whole BOP District. Volunteer Patient Advisory Group (VPAG) The VPAG is the core of the Patient and Family Centred Care Initiative at BOPDHB. The Volunteer Patient Advisory Group looks to address patient and family experiences and concerns, and seek care improvement opportunities. The objectives of the VPAG are:

• to promote improved relationships between patients, families, and staff and improve the patient experience

• to open lines of communication between patients, families, and staff

• to offer an opportunity for patients and families to provide input into policy and program development and actively participate in care improvement opportunities and the development of services and programmes.

To ensure that our patients help us inform the way we deliver care, a VPAG member has been included as a member of the BOPDHB Clinical Board.

5.2.2 Information Communications Technology

The Midland Regional Information Service (MRIS) will implement the Midland Region Information Services Plan and advance National Health IT Board priorities, specifically the implementation of the National Health IT Plan priority areas. Work in this area is done within the context of the affordability envelope of the Midland DHBs. The process of prioritising the ICT work effort is done via the IS executive group with is comprised of clinical leaders and business leaders from each of the Midland DHBs. This group reviews the programmes of work and provides recommendations to the regional capital committee for funding decisions. The regional deployment of CSC’s ePharmacy application that underpins the regional medication management programme was planned to be live in early 2014/15. Technical and contractual


challenges have slowed the delivery of the ePharmacy programme and this will be live for the start of the 2015/16 year. The other major programme currently underway is the establishment and deployment of the Orion Clinical Work Station (CWS) application within the Midland region. This project has commenced with the deployment into Lakes DHB and this will be followed by deployment into the remaining Midland DHBs over a two year period. Currently the Midland DHBs are working through the local, regional and national approval processes to support this programme of work. Further information is available in the Midland DHBs RSP for 2015/16.

Local The strategic direction our DHB takes towards its ICT services combines the vision of ‘Healthy, Thriving Communities’ with the Government’s national and regional health and ICT strategies. From a national view point, our approach to ICT services incorporates the strategic direction and requirements of the National Health Board’s “National Health Information Technology Plan” (providing the ICT framework and priorities for delivering the Government’s broad Health Strategies), the ICT service delivery and operational management plans of Health Benefits Limited (delivering shared service improvements to the health sector) and the Department of Internal Affairs’ All of Government initiatives (aimed at improving performance of, and public confidence in, Government services). Explicit within Government policy for the health sector is the expectation that DHBs work collaboratively within their regional groupings and as such, BOPDHB’s strategic direction aims to contribute to three regional information goals:

• Provide integrated/shared information to enhance health care planning and improve population health outcomes

• Collaborate to reduce costs and enhance risk mitigation within information areas

• Provide technical and information support for shared service initiatives in non-IT areas.

Delivering on these regional expectations and goals requires the transition from standalone IT service provision to being part of a regional service delivery capability. The Midland DHBs have developed the Midland Region Information Services Plan (MRISP), which outlines a number of work streams aimed at advancing regional and national capability and ICT service consolidation.


While challenged by the issue of affordability (given other demands on DHB resources), BOPDHB will be progressing the following prioritised national and regional initiatives during 2015/16:

National Priority Initiatives BOPDHB’s 2015/16 Intentions

Clinical Workstation Being addressed via Regional Clinical Workstation initiative - Refer comments below

Clinical Data Repository Being addressed via Regional Clinical Workstation initiative - Refer comments below

Self-Care Portal Current uptake by Primary Care is low. The DHB will work with PHO and GP practices to identify options and for implementation in 2015/16.

Finance Procurement & Supply Chain (FPSC)

The DHB will commit resources to the implementation of HBL’s FPSC initiative, and fully factor in expected budget benefit impacts. Updated financial information is awaited

National Infrastructure Programme BOPDHB is one of the early adopters of the national infrastructure with its transition to occur in early 2015/16.

National Patient Flow Following successful completion of Phase 1 of this programme; Phase 2 commenced in late 2014/15 and is expected to be live for 2015/16.

eMedicines Reconciliation

Being addressed via the Regional Medications Management Programme the first stage of which is the CSC ePharmacy system – refer comments below, Subsequent phases of regional Medication Management Programme are yet to be planned. BOPDHB has completed a pilot project to incorporate Community Pharmacy medication data into the shared Éclair data repository and this will roll out during 2015/16.

Regional Initiatives BOPDHB’s 2015/16 Intentions Delivering the Midland One Health programme – implementing regional platform and service delivery capacity and capability

The regional platform will be transitioned to the NIP programme at a similar time to BOPDHB’s transition enabling BOPDHB to utilise the regional platform for ePharmacy, CWS, CDR.

Implementing the CSC ePharmacy solution across five DHBs as part of the longer term Medications Management Programme

As noted above this regional programme was delayed in 2014/15 but is expected to be live for the 2015/16 year.

Implementing a single instance of the Orion Concerto Clinical Workstation and Sysmex Éclair Clinical Data Repository system across the region via a phased DHB by DHB approach

BOPDHB will migrate its existing Éclair CDR to the regional platform post the NIP transition process. Regional CWS programme roll out will see BOPDHB begin its adoption of Orion in 2015/16. Timeframes are still being worked through in the regional programme. Clinical workflow functionality developed within BOP’s CHIP system is to be used by the region and Orion to define functionality improvements for the Concerto product suite.

While regional initiatives will take a priority, this Plan also includes continuation of a number of key local priorities including:

• ongoing expansion of the primary/secondary information integration initiatives under the IHS programme – eg GP and pharmacist access to community pharmacy data via the Éclair repository, opportunities for DHB access to primary care data, and ongoing use of agreed clinical pathway development tools

• extension of the Integrated Operations Centre to support clinical capacity management and demand forecasting

• integrating communications technology across the DHB – Video Conferencing, and IP based telephony – to support streamlined processes and overcome distance as a barrier to healthcare. A key initiative is the DHB hosting of primary and community providers using video conferencing to provide acute care and communicate between care settings


• development and implementation of e-ordering of laboratory tests in hospital and community

• introduction of an e-referral form for radiology which will be aligned to the Midland Primary Access Criteria

• continued support and delivery of Telehealth services.

5.2.3 Streamlined Contracting

As part of the Better Public Services Programme and our IHS (Theme 6: Contracting for outcomes and flexibility of funding) we will focus on delivering better results and improved services by streamlining contracts that Social Sector ministers identify as a priority for simplified contracting arrangements within the DHB region. We will work with the Ministry of Business Innovation and Enterprise (MBIE) to implement the Streamlined Contracting with Non-Governmental Organisations (NGO) Programme. We recognise that the streamlined contracting framework will benefit funders and NGOs by having a single contract that provides streamlined reporting, audits and contract management. For funders, this will mean resources currently invested in duplicating contract management practices with other funding agencies can be focused on increasing efficiencies and improving results for clients.Capital and Infrastructure Development

Capital expenditure is planned and prioritised at both a Midland regional and local level. DHBs capital intentions, which span 10 years, are consolidated to form a regional view. Large clinical investments are collaborated with the aim of achieving best fit for the region. The Midland region capital committee meets regularly to consider and approve business cases requiring regional sign-off. Business cases are prepared and approved at a local Board level before submission to the regional capital committee for approval. There will be ongoing challenges to ensure that the inpatient and outpatient facilities continue to meet demand and that additional car parking is available to match increasing bed numbers.

5.2.5 Service Improvement

The focus of the Service Improvement Unit (SIU) is to facilitate innovation, service transformation and continuous quality improvement across the BOPDHB in pursuit of the organisation’s mission of healthy thriving communities and performance excellence. This will be delivered in line with the Health Excellence quality framework as described in section 2.7. The SIU is guided by the IHS grounded in the principles of the New Zealand Triple Aim for quality improvement: improved quality, safety and experience of care, improved health and equity for all populations, and best value for public health system resources. A dedicated and diverse team with backgrounds in clinical practice (medical/nursing/allied health), business and management, the SIU work collectively and collaboratively with healthcare staff to develop a culture that accelerates innovation and leads service transformation to improve the health system and better clinical outcomes for our communities.


The functions of the SIU are to:

• provide programme, project and change management to support the delivery of strategic and operational goals and priorities

• provide tools, guidance and organisational standards for programme, project and change management methodology

• provide coaching and mentoring to staff in quality improvement to build capability and capacity in the workforce, empowering staff to improve the effectiveness and efficiency of the health system.

Key areas of work for the 15/16 financial year:

• IHS – In 2013, CIRCA was implemented as the Provider Arm’s quality improvement programme, it was intended to implement long-term sustainable change to improve the design and coordination of care. The SIU will further develop the aspects of better coordination of care, support for self-management, and improving the secondary care interface across the BOPDHB and the health sector under the remit of the IHS. Criteria developed under CIRCA will be consolidated into existing or new programmes of work, as part of business as usual and/or aligned with business reporting. See Module 2.3.1, Integrated Healthcare in the Bay of Plenty for further information

• Acute Demand Management (ADM) – In response to increasing acute patient demand in the community and within hospital services, the programme will focus on creating an integrated forum for the health system to discuss acute flow and develop collective solutions in response to demand. See Module 2.3.2, Primary Care for further information

• Bay Navigator – Aims to improve the collaboration and communication between the community and the hospital services in pursuit of ensuring the very best care, in the timeliest manner, delivered by the most suitable service provider. See Module 2.3 System Integration, for activities related to Bay Navigator

• Improving the Coordination of Care – the development of high-volume DRG care pathways for patients that require secondary care services and improving access to electronic records including medical records, e-ordering, e-referrals, community pharmacy and patient education resources

• Patient, Family and Whanau Centred Care – to improve the process and delivery of care for patients referred to secondary care through the Improving Outpatient Attendance programme

• The Productive Hospital (NHS Productive Series) – There will be continued implementation of the NHS Productive Series including Productive Mental Health Ward across the Bay of Plenty


• Building Workforce Capability and Capacity – We will continue to build organisational capacity for quality improvement, change, leadership, and team working across professional groups and across the health system, this includes the rollout of Institute for Healthcare Improvement (IHI) Open School training course, quality improvement residency for House Officers, and review of administration workforce capability, capacity and demand

5.3 Workforce

5.3.1 Managing our workforce within fiscal restraints

Midland DHBs have taken on board a regional planning approach to addressing workforce capacity and capability as further discussed in this section. Health Workforce New Zealand (HWNZ) has developed an overarching national strategy and guidelines specific to the health sector to support DHBs to meet this requirement within their annual planning process.

Health Workforce New Zealand (HWNZ)

Health Workforce New Zealand (HWNZ) has overall responsibility for planning and development of the health workforce. It aims to ensure that New Zealand has a fit-for-purpose, high quality and motivated health workforce, keeping pace with clinical innovations and the growing needs and expectations of service users and the public. BOPDHB regularly scans HWNZ activities to ensure alignment of our direction and to ensure that there is no duplication of effort and our direction supports the HWNZ work plan. Regional The regional workforce programme will address the workforce change required to meet current and future service need, and address the most commonly raised issues across the region, relating to the future sustainability of the workforce. This includes the need to better anticipate future states and investigate regional cooperative activity that supports this approach. Workforce development activity underpins the collective response required to ensure access to quality, sustainable services across the whole region. Midland DHBs share responsibility for planning and undertaking forward-looking action on workforce development that minimises duplication. This includes regional cooperation to investigate the impact of reducing the rate of growth in health spending on design, capacity, and workforce utilisation in general. The key workforce priorities for the Midland Region in 2015/16 are:

• care assistant development (HCAs, orderlies, therapy assistants)

• strategies around the management of the ageing workforce • recruitment and retention strategies for rural vulnerable

workforces • implementation of the Midland Training Network (MRTN)

action plan • Kia Ora Hauora for the promotion of health as a career to

Māori


• strategies around alternative workforces that add value and cost less or are cost neutral.

Midland Region Training Network (MRTN)

The Midland Regional Public Health Network (the Network) was established in 2010 to provide leadership for and strengthen the performance and sustainability of the Midland public health units. The Network provides an avenue for public health units to work together on public health issues affecting the Midland region.

Leadership of the Network comprises the manager and clinical director from each of the four public health units in the Midlands region: Toi Te Ora - Public Health Service (Bay of Plenty and Lakes District Health Boards); Population Health (Waikato District Health Board); Population Health, Te Puna Waiora (Tairawhiti District Health Board) and Public Health Unit (Taranaki District Health Board).

The Network continues to develop and/or strengthen relationships with the Midland Regional Clinical Networks to ensure a public health perspective is considered within their planning. At a national level the Network is a member of the National Public Health Clinical Network (NPHCN), whose membership comprises clinical leader and manager from each public health unit and representatives from the Ministry of Health.

The goals of the Midland Regional Public Health Network are to:

• enhance the consistency, coordination and quality of public health service delivery across the region

• plan together where there are benefits in doing so. The Network’s work to date has included collaborative annual planning, business continuity planning, supporting the development of Midland position statements on key health issues, setting up a mechanism for a regional approach to health intelligence work, standardising of communicable disease control processes, peer review, staff orientation programmes and support of sole practitioners.

Three key work streams are in place to support a consistent approach to common areas of work:

• workforce development • communicable diseases • public health intelligence.

Future work streams will be determined based on the need to increase the focus on a particular public health issue. For instance, the Network has been discussing its possible approach to climate change. In addition, the NPHCN’s work plan for 2015 will mean a collective focus on the reduction of alcohol related harm.

In determining its direction for 2015/16, the Network will consider alignment to the Ministry of Health’s new five core functions of public health (health assessment and surveillance, public health capacity


development, health promotion, health protection, and preventive interventions) and the following key themes identified in the 2014 Briefing to the Incoming Minister of Health 93: • better integration of services within health and across the sector • the Midland public health units are continuing to explore new

ways to work more closely together to share resources and expertise and to support each other. The Network is also advocating for a stronger public health focus within each of the other Midland clinical networks

• improvement in the way services are purchased and provided • all public health units are moving to contracting with the Ministry

of Health based on the new five core functions which enable great clarity and flexibility around the delivery of services purchased

• lifting of quality and performance • the Network has established a peer review process which enables

a public health unit to request support from others to review an aspect of its work

• supportive leadership and capability for change.

The Network contributes to the NPHCN with formal representation on the steering group rotating annually. The Network has been engaging with HealthShare to bring greater public health influence to regional clinical service planning.

In line with the wider health sector goal of better, sooner, more convenient health services for all New Zealanders, emphasis for the Network will continue to be on effective and efficient working and service delivery.

Local We are proud of our workforce and their achievements and we are committed to ensuring the culture within our DHB supports our workforce to successfully deliver our vision of “healthy, thriving communities”. Our DHB will continue to build on the CARE values and the principles embedded in Shared Expectations and foster an environment that is conducive to adaptability, innovation, quality, openness, transparency and teamwork. These qualities will help the DHB remain successful in delivering our annual plan. We are regarded as a good employer and we are committed to building on that reputation. Leadership of our workforce is a key area for further development and this is consistent with the Minister’s view that DHB’s need to strengthen clinical leadership and networks. The organisation structure has recently been altered to support greater clinical involvement at the executive level. The executive team has been enhanced with the inclusion of the Medical Director, Director of Nursing and Director of Allied Health, these roles support the DHB’s deliberate focus on clinical leadership. Clinical leadership is also

93 Ministry of Health. (2014). Briefing to the Incoming Minister of Health. www.health.govt.nz

http://www.health.govt.nz/


embedded in each of our clinical services; they are led by a management team consisting of a doctor, a nurse or relevant health professional and a business leader. Clinical leaders are also supported by a team of analysts that provide relevant data and reports. Our workforce is highly unionised, we recognise the value of positive engagement with our employees and their unions and overall we have strong union partnerships that enhance our ability to innovate and deliver excellent health services. We will continue to nurture positive engagement with unions through our Joint Union Management Forums (JUMF’s), Joint Action Group (JAG), Joint Consultative Committee (JCC), Local Engagement Group (LEG) and Bipartite Forum and Enterprise meetings. An ongoing challenge for us is to create a health workforce that is better representative of the population we serve. Whilst our workforce is diverse we have a less than desirable distribution of Māori throughout our organisation. We believe a significant part of the solution is to influence young Māori to develop, nurture and maintain their interest in health careers. The Midland DHB Initiative “Kia ora Hauora” is a Māori based workforce development programme that encourages and supports young Māori to pursue a health career. The aim of the programme is to increase the overall number of Māori working in the sector and we have a particular interest in those that wish to work at BOPDHB. A review of recruitment processes and resources is due for completion this year, including amendments to ensure compliance with the Vulnerable Children Act, this review will consider options for improving our approach to recruiting Māori. Professional development is an important element of shaping our workforce for current and future needs, BOPDHB encourages professional devlopment through scholarships, on the job learning, secondments to other organisations, support to attend conferences and a host of in house courses. This year we have launched a project in partnership with PSA to investigate career and qualification development frameworks for administration staff. This is an extension of the work being done for the wider unregulated workforce. We are committed to maintaining our commitment to providing professional development opportunities for our workforce. Our workforce is impacted by changes in legislation; we are committed to anticipating the impact of such changes and to taking an early adoption approach to compliance with such changes. This year we are committed to ensuring we comply with the Vulnerable Children’s Act (VCA) and associated regulations, amendments to the Parental Leave and Employment Protection Act, and Employment Relations Act.

5.3.2 Safe and competent workforce

BOPDHB continues to have a strong focus on safety and importantly the competence for its workforce. Our key employment document is Shared Expectations, this is our code of conduct, and it incorporates and builds on the State Services Standards of Integrity and Conduct. Shared Expectations sets the framework for how staff should conduct themselves; detailed discussion and completion of a mandatory on line training module focused on ensuring new staff understand what is


expected of them in relation to Shared Expectations is a core part of every new employees Orientation. To better deliver services for our children and youth, the DHB has amended contracts so that those services provided as per section 1594 of the VCA have had their contracts updated to include and adopt the updated Child Protection and Worker Safety Checks policies. A comprehensive suite of mandatory training is in place for all new staff, that suite of training provides detailed information about health, safety and wellness and covers topics such as Child Abuse and Neglect, Hand Hygiene, Privacy and Consumer Rights. We remain committed to maintaining tertiary accreditation with the Accident Compensation Corporation (ACC) to test and demonstrate our robust health, safety and wellness systems.

5.3.3 Child Protection Policies

In 2014, we inserted the new Child Protection policy into the contracts for those that deliver services as per section 15. The policy states that the provider must adopt a child protection policy as soon as practicable and they must review this at least every three years; and must be in accordance to the requirements set out in 19(a) and (b) of the VCA and must contain provisions on the identification and reporting of child abuse and neglect in accordance the Children, Young Persons and their Families Act 1989.

The BOPDHB recognises that there is a duty of care to any child/young person especially those with suspected, witnessed, reported or disclosed abuse or neglect that has presented to hospital or who has been referred to and/ or treated by BOPDHB Community staff. The DHB is one of nine DHBs that have reports of concern put onto the national register.

Additionally, the DHB has processes so that the reporting of all abuse or neglect of children/young persons to Child, Youth and Family (CYFS) is mandatory as safety of the child is paramount. To ensure that workers are ably equipped training on Child Abuse and Neglect is mandatory. There is a four step process that workers should go through as outlined below:

1. Identify – See and recognise indicators of abuse and neglect 2. Act – Provide support; assess risk; and plan for safety of the

child/young person 3. Report – Consult with DHB staff such as Manager or Family

Violence Coordinator; accurately record all findings; present concerns and actions taken; and produce a written report of concern to CYFS

4. Debrief – Seek support for yourself.

It is imperative that we take responsibility and help reduce the impacts of child abuse and neglect. Police vetting will continue and all staff that have contact with children as part of their role will be monitored. There has been greater alignment done with our child protection

94 Services as per section 15 of the VCA are those that provide to one or more children; and/or services to adults in respect of one or more children


policies and VCA. The policies can be accessed via our BOPDHB website95. These policies will be reviewed every three years.

5.3.4 Children’s Worker Safety Checking

BOPDHB will implement changes to our internal policies and processes so that they are aligned to the VCA. We have implemented the following:

• recruitment policies include all aspects of safety checking for all core children’s workforce

• safety checking information can be made available to the Director General

• safety checks and three yearly reassessments of existing employees which is in compliance with the requirements in the Act.

At the same time that we included the updated child protection policy we also inserted that the Provider acknowledges there are new requirements under the VCA and that these safety checks are to be introduced and that they will keep up to date with any developments and that any changes be enforced so that the services meet the requirements under the Act.

5.4 Organisational Health We need to make sure that we have the people, relationships, and processes that will enable us to achieve our outcomes, impacts, and outputs. We cannot be successful without well-qualified and motivated staff, sound management of resources and an effective working relationship between staff and stakeholders. The DHB has well developed human resource policies such as the Equal Employment Opportunity policy, where it states that all employment related decisions are made on the basis of relevant merit and not on the basis of factors that have nothing to do with the ability to perform the job. We have many mechanisms to ensure our compliance such as the Health Excellence strategy but importantly, how aligned we are to relevant legislation such as the provisions outlined in the Human Rights Act 1993.

5.4.1 Governance

Our Board assumes the Governance role and is responsible to the Minister of Health for the overall performance and management of the DHB. Its core responsibilities are to set the strategic direction for the DHB and to develop policy that is consistent with Government objectives and improves health outcomes for our population. The Board also ensures compliance with legal and accountability requirements and maintains relationships with the Minister of Health, Parliament and the Bay of Plenty community. We currently have 11 Board members, with seven elected by the Bay of Plenty DHB community and four are appointed by the Minister of Health. As can be seen by our organisational structure (see Appendix 8.5), the BOPDHB is unique in that it shares governance with our Rūnanga.96

95 http://www.bopdhb.govt.nz/your-dhb/a-z-publications/#sthash.xMhK3Dfc.dpbs 96 Maori governance board or assembly.


The BOPDHB Rūnanga affirms the BOPDHB’s commitment to the Treaty of Waitangi principles, and most importantly recognises that Māori have an important role to play in determining their own aspirations and priorities for health. The Board acknowledges the important role of Iwi and looks to the Rūnanga and its 18 mandated Iwi health representatives to provide both strategic direction and connection to the Māori community on issues of importance to Māori. The Rūnanga is integral to providing a mechanism to enable Māori to contribute to decision-making, participate in the planning and delivery of health and disability services as well as providing an effective forum for consultation and engagement with Whānau, Hapu and Iwi. The role of the Rūnanga is to:

• provide input and direction to the BOPDHB on all strategic matters affecting health and disability services for Māori at a governance level

• provide the principal vehicle for consulting with Whānau, Hapu and Iwi throughout the area, to ensure contribute to decision-making at a governance level and participate in planning, purchasing and provision of services

• provide advice on all matters pertaining to the impact of health and disability services.

While individual Iwi representatives are not expected to make decisions on behalf of their constituents, they act as a conduit for information between the Rūnanga and Iwi. We acknowledge the good working relationship between the Rūnanga and the Board, facilitated by their respective Chairs. There are two statutory (mandatory) advisory committees that have been established to assist the Board to meet its responsibilities. - Community & Public Health Advisory Committee/Disability Services Advisory Committee (CPHAC/DSAC) that previously were two separate committees but have now combined; and the Bay of Plenty Public Hospital Advisory Committee (BOPHAC). The Board is also supported by the Audit Finance and Risk Management (AFRM) Committee. The membership of these committees is comprised of a mix of Board members and community representatives who meet regularly throughout the year. It includes both clinical and Māori members who contribute clinical and cultural experience and understanding to decision making. The public is welcome to attend meetings of the Board and its statutory committees. However, for some items during a meeting the Board or Committee may exclude the public. The Official Information Act states the grounds on which the public may be excluded. Such items are clearly noted on the agenda in question. Details of meetings are available on our website – www.bopdhb.govt.nz. There is an increasing regional collaborative effort across the Governance boards of the Midland DHBs. There are members from other Midland DHBs that sit on the BOPDHB statutory committees and there is the Midland Iwi Relationship Board (MIRB) that is attended by the DHB Iwi Relationship Board Chairs and the General Managers of Māori Health. While responsibility for our DHB’s overall performance rests with the Board, operational and management matters have been delegated to



the Chief Executive Officer (CEO). The CEO is supported by an Executive Management Team, which includes: General Manager of Planning and Funding, General Manager of Māori Health Planning and Funding, Chief Financial Officer, General Manager Information Management, General Manager Property Services, General Manager Governance and Quality, Director of Nursing, Chief Medical Advisor and Head of the Clinical School.

5.4.2 Planning and Funding Health and Disability Services

The Planning and Funding Division (Te Teo Herenga Waka(TTHW)) of our DHB is responsible to the Chief Executive Officer for planning and funding health and disability services across the Bay of Plenty district and determining how best to invest the funding we receive from Government to meet the health needs of our population. TTHW is built upon a partnership structure that reflects the DHB’s commitment to working in partnership with local Māori by having two distinct teams Mainstream Planning and Funding; and Māori Health Planning and Funding. The latter working more closely with our Hauora Māori providers. The core responsibilities of TTHW are:

• Assessing our population’s current and future health needs; • Determining the best mix and range of services to be

purchased; • Building partnerships with service providers, Government

agencies and other DHBs; • Engaging with our stakeholders and community; • Leading the development of new service plans and strategies

in health priority areas; • Prioritising and implementing national health and disability

policies and strategies in relation to local need; • Undertaking and managing contractual agreements with

service providers; and • Monitoring, auditing and evaluating service delivery.

Through TTHW, we enter into service agreements or arrangements with the organisations or individuals who can best provide the health and disability services required to meet the needs of our population, achieve the objectives of the DHB and enhance efficiencies across the whole of the health system.

5.4.3 Providing Health and Disability Services

As mentioned above, TTHW works with many providers and organisations that deliver health services on behalf of the BOPDHB and Ministry in Primary and Community care settings. The DHB also provides hospital based services and these are delivered through the Provider Arm. Secondary hospital based services enables co-location of clinical expertise and specialised equipment. Personal health and disability services within the Bay of Plenty are predominantly provided at Tauranga and Whakatane Hospitals, which includes a range of community services. These services are preventative, diagnostic, therapeutic and rehabilitative in nature, and are generally complex. This requires health care professionals to work very closely together. Services are provided in three main settings:


1. Ambulatory services delivered in both outpatient and community settings (including the home)

2. Inpatient hospital services including both acute and elective streams

3. Emergency Department services Services are reviewed annually to ensure the right level of service is provided to the BOP population. There is also a commitment to ensure:

• Improved quality, safety, and experience of care, • Improved health and equity, and • Best value for public health system resources. • Integrated models of care with primary providers are vital to

achieving these outcomes. Tauranga Hospital Tauranga Hospital is a level four to five facility, providing an extensive range of medical and surgical specialties, and mental health services within its 365 inpatient beds. It is also a base for a range of associated clinical support, allied health, and community services. Tauranga Hospital inpatient beds include:

• 204 medical and surgical beds • 25 paediatric beds (incl. 3 child assessment) • 40 health of older persons beds • 20 critical and coronary care beds • 12 neonatal beds • 30 maternity beds • 34 mental health beds (incl. 10 mental health for older

persons) The Tauranga Hospital campus has undergone significant development in recent years to enable the DHB to meet population needs. The Kathleen Kilgour Centre (KKC) opened in 2014 to provide radiotherapy services from the Tauranga Hospital campus, serving our population across Eastern and Western Bay of Plenty communities. Work is underway on the northern end of the campus to construct new premises for a new combined hospital and community laboratory. Tauranga Hospital is also the base for clinical and medical trainees which are coordinated by our own Clinical School. Whakatane Hospital Whakatane Hospital is a level three to four facility providing essential medical and surgical specialties, and mental health services within its 98 inpatient beds. Like Tauranga Hospital, Whakatane Hospital is also a base for a range of associated clinical support, allied health, and community services. The Eastern Bay of Plenty that Whakatane Hospital primarily services is geographically widespread and includes rural and isolated lower socio-economic communities. Whakatane Hospital inpatient beds include:

• 44 medical and surgical beds • 12 paediatric beds (incl. 2 child assessment) • 15 acute care beds • neonatal beds • 14 maternity beds


• 10 mental health beds In 2014, our new Whakatane Hospital facility was opened. This will ensure the continuity of high quality secondary services to the population of the Eastern Bay of Plenty. New developments 2015-2018 During the 2016/17 year construction will commence on the fit out of one of the Building 50 vacant floors to accommodate the co-location of Cardiology Services and the provision of an additional eight general hospital beds. Seismic analysis of Buildings 24 and 34 has identified an unacceptable long term seismic risk. Planning is underway to replace Building 24 with a new building to be completed by 2018. With respect to Building 34 a review of the accommodation options is underway and will be completed during 2015 The site master plan details a co-location of mental health, clinical and administration services into a new building to occur post 2020. Funding We receive funding (Vote Health) from the Government to undertake our role. The amount of funding we receive is determined by the size of our population, our demographics (age, gender, ethnicity and deprivation) and our population’s historic utilisation of health services. The BOPDHB received 5.51% of the total Vote Health funding allocated to DHBs in 2014/15. We are both a funder and provider of health services. In 2015/16, we will receive approximately $706M in funding from the Government for most personal health services (to improve the health of individuals), mental health, Māori health and the health of older people. Our Provider Arm (Tauranga and Whakatane Hospitals) will receive approximately half of the funding, with the remaining being utilised to fund services included those provided by non-government organisations (NGOs), primary care, pharmacy and laboratories.

The National Health Board (NHB) also has a role in the planning and funding of some services. Some services are funded and contracted nationally, for example breast and cervical screening, as well as the provision of disability support services for people aged less than 65 years. We are socially responsible and uphold the ethical and quality standards commonly expected of providers of services and public sector organisations. We are responsible for monitoring and evaluating service delivery, including audits of the services we fund. The costs of providing services to people living outside of our district are met by the DHB in which the patient is domiciled (where they live), and are referred to as Inter District Flows (IDFs). Likewise, where we do not provide the service, we have funding arrangements in place enabling our district residents to travel outside the district. We also deliver services under contract with external funders, such as the Accident Compensation Corporation (ACC). We closely monitor IDFs and ACC volumes to ensure our ability to provide for our own population is not adversely affected by demand outside of either our funding or our district.


5.5 Reporting and Consultation

5.5.1 Consultation with the Minister and Ministry of Health

Implementing health policy is complex and challenging, with a multitude of difficult decisions to be made. There is considerable public pressure to expand public spending on new medical technologies and greater levels of care and interventions. We follow an appropriate planning and consultation processes to avoid adverse financial, resource and clinical impacts on the affected population(s) and avoid unnecessary service instability. A well-managed process provides the confidence that:

• a robust process is followed; • there are sufficient controls in place to avoid unnecessary

service instability; • change is clinically appropriate and public confidence is

managed.

There are a range of matters that we must consult / notify the Minister of Health, the National Health Board and Ministry of Health. These matters are:

• proposed service changes; • acquisition of shares or other interests; • entry into joint ventures and / or collaborative or cooperative

agreements / arrangements; • capital expenditure if required by policy and / or legislation; • otherwise as required by legislation, regulation or contract. •

5.5.2 External Reporting

The Ministry of Health monitors our performance on behalf of the Minister. The mechanisms currently in place to achieve this are outlined in the following table. Table: External Reporting Framework Reporting Frequency

Information Requests Ad Hoc

Financial Reporting Monthly

National Data Collections Monthly

Risk Reporting Quarterly

Health Target reporting Quarterly

Crown Funding Agreement non-financial reporting Quarterly

Indicators of DHB Performance (IDP) Reports Quarterly

Annual Report and audited statements Annually

5.5.3 Ownership Interests

The BOPDHB has two main campuses, being those at Tauranga and Whakatane, with satellite locations at Murupara, Taneatua and Te Kaha:

• The base hospital at Tauranga occupies a 10.4939 hectare site contained in two freehold titles as well as the Learning Centre site further along Cameron Rd which occupies 1.548 hectares on a freehold title.

• Whakatane hospital comprises 7.2824 hectares contained in six freehold titles.


• The Murupara Community Clinic, comprises a land area of 3388 square metres.

• The Taneatua Clinic comprises a land area of 837 square metres.

• The Te Kaha Community Clinic is owned by the BOPDHB, but the BOPDHB does not own the land.

The BOPDHB holds investments in associated companies as follows:

Investment in Associate Holding Principal Activities

HealthShare Limited 20% Provision of health contracting services covering the Midland Region.

Venturo Limited 50% Provision of urology services. Bay Imaging Group Limited

50% Previously provision of CT scanning services; currently not trading.

Our DHB has no subsidiaries.


Kōwae Ono - Module Six: Service Configuration 6.1 Service Coverage and Service Change 6.1.1 Service Coverage All DHBs are required to deliver a minimum of services, as defined in a document called “The Service Coverage Schedule” (SCS). DHBs deliver services in two ways – either by providing a service ourselves, or by paying someone else to deliver it, where it makes sense to do so. Some of the services in the SCS are the responsibility of the Ministry of Health to deliver. In other cases we share responsibility. In the majority of cases, we take sole responsibility for a service being delivered.

The volume of service delivery is determined by a number of factors, including; • the Minister’s and Ministry’s expectations; • national and best practice guidelines; • health needs assessments at a local level; • evidence based data, drawn from other studies.

Our plan is to deliver services in a way that is Better, Sooner, More Convenient for the benefit our community as a whole. Changes to services are always carefully considered, not only for the benefits they can bring, but also the impact they might have on other key stakeholders. The ideal result is a solution that yields the maximum benefit with the least amount of disruption, be it to other providers who may no longer be required to deliver services; clinicians who may find themselves working in a different way; workforce in terms of future employment and workload; infrastructure or the bricks, mortar or other assets impacted by the proposal; and finally, but most importantly, the patients in our, and other, communities.

All service reviews/changes with likely material impacts must be signalled to the National Health Board for an opinion about whether or not they can or should be actioned. Ultimately, if the impact is significant, consultation with key stakeholders, including our community, may be required before Ministerial approval is given.

6.1.2 Service Change

The table below describes all service changes, which are approved or proposed for implementation in the 2015/16 year.97

Table: Service Changes 2015/16

Change Description of change Benefits of change Change due to

Local, regional, or national reasons?

Opotiki Locality Planning Project

We will work with key stakeholder groups to develop a shared vision on what services are required to meet the needs of the Opotiki / East Coast communities and agree an implementation plan that will support the realisation of a preferred service model.

• Ensuring services meet local community’s needs.

• Long-tern sustainability of local services.

• Recruitment and retention of health

Local

97 At the date of submission of this AP, the BOPDHB is presently reviewing service configurations. One possible outcome is resource reallocation and a change in provider mix.


Change Description of change Benefits of change Change due to

Local, regional, or national reasons?

workforce to support service delivery.

• Cost effectiveness of services through optimum resource utilisation.

Renal

We will explore how the DHB might better meet the renal needs of the Bay of Plenty community with a specific focus on EBOP demographics.

Improved access, reduced cost, earlier intervention, improvement of long term outcomes

Local

Interventional Cardiology

We will explore the clinical effectiveness and value for money of interventional cardiology services being provided in the Bay of Plenty with a view to establishing long-term sustainability.

Reduced early mortality, reduced travel, earlier intervention and treatment

Local

Integrated Community Nursing Services

The BOPDHB and the three PHOs are working together to develop a more integrated and patient-focussed community nursing service in the Bay of Plenty. The project’s primary objective is optimal outcomes for patients, and more specifically those receiving their care in the home. Its task will be to identify the best way to arrive at that point through an integrated ‘whole-of-system’ approach. This will include embracing new technology and working models, and exploring the most efficient use of resources. It is envisaged that developing a co-ordinated model of care will result in a streamlined service which would interface with General Practice, as well as hospital-based and other community-based services

• Improving quality, safety and experience of care

• Improving health and equity for all populations

• Achieving best value for public health system resources

• Exploring new ways of addressing growth in demand for acute care

• Embracing and exploring innovations in chronic conditions management of patients in the community.

Local

Home Based Support Services (HBSS) reconfiguration

Midland DHB Region process to consider models of care and contracting for home based support services. This is intended to ensure that maximum value is achieved from funding available. There is the potential for resources to be focussed more on specific groups based on measures of need

• Supports regionalisation

• Regional consistency

• Financial sustainability

• Sustainability of services

Regional

National Entities and changes with Health Benefits Limited

We will await further guidance by the Ministry before we are able to signal the DHB’s intent

Improved cost efficiencies National

6.1.3 Service Issues We have no emerging service issues other than what is already covered in this section or described within the context of the Midland Regional Services Plan.


Kōwae Whitu - Module Seven: Performance Measures

7.1 Performance Measures 2015/16 2015/16 DHB Performance expectations The DHB monitoring framework aims to provide a rounded view of performance using a range of performance markers. Four dimensions have been identified reflecting DHB functions as owners, funders and providers of health and disability services. The four identified dimensions of DHB performance cover:

• achieving Government’s priority goals/objectives and targets or ‘Policy priorities’ • meeting service coverage requirements and Supporting sector inter-connectedness or

‘System Integration’ • providing quality services efficiently or ‘Ownership’ • purchasing the right mix and level of services within acceptable financial performance or

‘Outputs’. Each performance measure has a nomenclature to assist with classification as follows:

Code Dimension PP Policy Priorities SI System Integration OP Outputs OS Ownership DV Developmental – Establishment of baseline (no target/performance

expectation is set) Performance measure 2015/16 Performance expectation/target

PP6: Improving the health status of people with severe mental illness through improved access

Age Māori Total

0-19 6.5% 5.5%

20-64 9.7% 5.5%

65+ 4.00% 3.45%

PP7: Improving mental health services using transition (discharge) planning and employment

Long term clients Provide a report as specified

Child and Youth with a Transition (discharge) plan

At least 95% of clients discharged will have a transition (discharge) plan.

PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds

Mental Health Provider Arm

Age <= 3 weeks <=8 weeks

0-19 80% 95%

Addictions (Provider Arm and NGO)

Age <= 3 weeks <=8 weeks

0-19 80% 95%

PP10: Oral Health- Mean DMFT score at Year 8

Ratio year 1 1.6

Ratio year 2 1.55

PP11: Children caries-free at five years of age

Ratio year 1 64%

Ratio year 2 64%

PP12: Utilisation of DHB-funded dental services by adolescents (School Year 9 up to and including age 17 years)

% year 1 85%

% year 2 85%

PP13: Improving the number of 0-4 years - % year 1 90%


Performance measure 2015/16 Performance expectation/target children enrolled in DHB funded dental services

0-4 years - % year 2 95%

Children not examined 0-12 years % year 1

9%

Children not examined 0-12 years % year 2

8%

PP20: improved management for long term conditions (CVD, diabetes and Stroke)

Focus area 1: Long term conditions

Report on delivery of the actions and milestones identified in the Annual Plan.

Focus area 2: Diabetes Management (HbA1c) Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control

Narrative quarterly report on DHB progress towards meeting its deliverables for Diabetes Care Improvement Packages (DCIP) identified in the 2015/16 annual plans Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control

Increased proportion of patients with good or acceptable glycaemic control 85%

Focus area 3: Acute coronary syndrome services

70 % of high-risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’)

70%

Over 95 % of patients presenting with ACS who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days.

>95%

Over 95 percent of patients undergoing cardiac surgery at the five regional cardiac surgery centres will have completion of Cardiac Surgery registry data collection with 30 days of discharge.

>95%

Report on delivery of the actions and milestones identified in the Annual Plan, including actions and progress in quality improvement initiatives to support the improvement of ACS indicators as reported in ANZACS-QI

Focus area 4: Stroke Services

6 % of potentially eligible stroke patients thrombolysed 6%

80 % of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway

80%



Performance measure 2015/16 Performance expectation/target

PP21: Immunisation coverage

Percentage of two year olds fully immunised 95%

Percentage of five year olds fully immunised

95%

Percentage of eligible girls fully immunised with three doses of HPV vaccine (Gardasil)

65% for dose 3

PP22: Improving system integration Report on delivery of the actions and milestones identified in the Annual Plan. The BOPDHB will provide narrative reporting on the IHS when required and in line with Module 2.3.1.

PP23: Improving Wrap Around Services – Health of Older People


The % of older people receiving long-term home support who have a comprehensive clinical assessment and an individual care plan

PP24: Improving Waiting Times – Cancer Multidisciplinary Meetings Report on delivery of the actions and milestones identified in the Annual Plan.

PP25: Prime Minister’s youth mental health project

Provide quarterly narrative progress reports against the local alliance Service Level Agreement plan to implement named initiatives/actions to improve primary care responsiveness to youth. Include progress on named actions, milestones and measures.

PP26: The Mental Health & Addiction Service Development Plan

Report on the status of quarterly milestones for a minimum of eight actions to be completed in 2015/16 and for any actions which are in progress/ongoing in 2015/16.

PP27: Delivery of the children’s action plan Report on delivery of the actions and milestones identified in the Annual Plan.

PP28: Reducing Rheumatic fever

Provide a progress report against DHBs’ rheumatic fever prevention plan on a quarterly basis

Hospitalisation rates (1.7 per 100,000 DHB total population) for acute rheumatic fever are 55% lower than the average over the last 3 years

1.7 per 100,000 DHB total population



PP29: Improving waiting times for diagnostic services

1. Coronary angiography 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days)

2. Computed Tomography (CT) and Magnetic Response Imaging (MRI)

95% of accepted referrals for CT scans 85% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days)

3. Diagnostic colonoscopy

75% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days inclusive), 100% within 30 days 65% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 120 days

4. Surveillance colonoscopy

65% of people waiting for a surveillance colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date, 100% within 120 days

PP30: Faster cancer treatment

Part A – Faster cancer treatment 31-day indicator - proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment (or other management) within 31 days of decision-to-treat.

Data collection of 31 day target < 10 % of the records submitted by the DHB are declined

Part B – Faster cancer treatment Shorter waits for cancer treatment – radiotherapy and chemotherapy

All patients’ ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy.

SI1: Ambulatory sensitive (avoidable) hospital admissions

Age 0-4 TBA

Age 45-64 TBA

Age 0-74 TBA

SI2: Delivery of Regional Service Plans

Provision of a single progress report on behalf of the region agreed by all DHBs within that region (the report includes local DHB actions that support delivery of regional objectives). This report will delivered by Health Share Limited on behalf of the Midland DHB’s

SI3: Ensuring delivery of Service Coverage

Report progress achieved during the quarter towards resolution of exceptions to service coverage identified in the Annual Plan , and not approved as long term exceptions, and any other gaps in service coverage

SI4: Standardised Intervention Rates (SIRs)

Major joint replacement an intervention rate of 21.0 per 10,000 of population

Cataract procedures An intervention rate of 27.0 per 10,000

Cardiac surgery

A target intervention rate of 6.5 per 10,000 of population

Percutaneous revascularization

a target rate of at least 12.5 per 10,000 of population

Coronary angiography services

a target rate of at least 34.7 per 10,000 of population

SI5: Delivery of Whānau Ora Report progress on planned activities with providers to improve service delivery and develop mature providers.



OS3: Inpatient Length of Stay (LOS)

Elective LOS (Standardised rates) 1.59

Acute LOS (Standardised rates) <2.9

OS8: Reducing Acute Readmissions to Hospital

Total population Provide a commitment on baseline performance 75 plus

OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

Focus area 1: Improving the quality of identity data

New NHI registration in error Group B. Greater than 1% and less than or equal to 3%

>1% and <3%

Recording of non-specific ethnicity Greater than 0.5% and less than or equal to 2%

>0.5% and <2%

Update of specific ethnicity value in existing NHI record with a non-specific value Greater than 0.5% and less than or equal to 2%

0.5% - < 2%

Invalid NHI data updates causing identity confusion %tbc

New – to be confirmed

Focus area 2: Improving the quality of data submitted to National Collections

NBRS links to NNPAC and NMDS Greater than or equal to 97% and less than 99.5%

New > 97% - <99.5%

National collections file load success Greater than or equal to 98% and less than 99.5%

New >98- <99.5%

Standard vs edited descriptors Greater than or equal to 75% and less than 90%

>75% - <90%

NNPAC timeliness Greater than or equal to 95% and less than 98%

New > 95- <98%

Focus area 3: Improving the quality of the programme for Integration of mental health data (PRIMHD)

PRIMHD data quality Routine audits undertaken with appropriate actions where required

Output 1: Mental health output Delivery Against Plan

Volume delivery for specialist Mental Health and Addiction services is within: a) five percent variance (+/-) of planned volumes for services measured by FTE, b) five percent variance (+/-) of a clinically safe occupancy rate of 85% for inpatient services measured by available bed day, and c) actual expenditure on the delivery of programmes or places is within 5% (+/-) of the year-to-date plan

Developmental measure DV4: Improving patient experience No performance target set – To be established from 2014/15 data

SI6: IPIF Healthy Adult - Cervical Screening 80% of eligible women have received cervical screening services within the last 3 years


Kōwae Waru - Module Eight: Appendices ____________________________________________________________________________

The appendices to this Plan are as follows: 8.1 Glossary of Terms98 8.2 Structure of the Health Sector 8.3 Output Classes and Output Categories 8.4 Production Plan 8.5 BOPDHB Organisational Structure99 8.6 BOPDHB CARE Values Table100 8.7 Te Ekenga Hou Summary

98 See Modules 2, 3, 4 and 5 . 99 See Module 5 – Governance and the Management of our DHB 100 See Module 1 – Our values.


8.1 Glossary of Terms Activity What an agency does to convert inputs to outputs.

Alliance Leadership Team (ALT)

The ALT is comprised of key members from the three Primary Health Organisations and the District Health Board.

Capability What an organisation needs (in terms of access to people, resources, systems, structures, culture and relationships), to efficiently deliver the outputs required to achieve the Government's goals.

Crown agent A Crown entity that must give effect to government policy when directed by the responsible Minister. One of the three types of statutory entities (see also Crown entity; autonomous Crown entity and independent Crown entity)

Crown entity A generic term for a diverse range of entities within one of the five categories referred to in section 7(1) of the Crown Entities Act 2004, namely: statutory entities, Crown entity companies, Crown entity subsidiaries, school boards of trustees, and tertiary education institutions. Crown entities are legally separate from the Crown and operate at arms-length from the responsible or shareholding Minister(s); they are included in the annual financial statements of the Government.

Cost containment Reducing costs or cost growth in general, whether through improved efficiency, or other means such as contract negotiation/consolidation, changes to budget management, changes in structure etc.

Deprivation A state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs. For the purposes of this plan, mentions of deprivation relate to the NZDep2006. It is a relative measure, and refers to the average level of deprivation of people living in an area at a particular point in time, relative to the whole of New Zealand. An individual residing in that area cannot be assumed to have that level of deprivation. Areas are often not homogenous in terms of the socio-economic status of the inhabitants. NZDep2006 was created from data from the 2006 Census of Population and Dwellings. The index describes the deprivation experienced by groups of people in small areas. Nine deprivation variables were used in the construction of the index. The index gives a score on a scale between 1 and 10 to each identified geographic area. The scale is a ten category ordinal scale from 1 (assigned to the 10% of areas with the least deprived NZDep2006 scores) to 10 (assigned to the 10% of areas with the most deprived NZDep2006 scores). It is important to note that deprivation is based on a geographic location rather than an individual. For further information see www.health.govt.nz/system/files/documents/.../nzdep2006-report.pdf.

Efficiency Reducing the cost of inputs relative to the value of outputs.

Effectiveness The extent to which objectives are being achieved. Effectiveness is determined by the relationship between an organisation and its external environment. Effectiveness indicators relate outputs to impacts and to outcomes. They can measure the steps along the way to achieving an overall objective or an outcome and test whether outputs have the characteristics required for achieving a desired objective or government outcome.

Home and Community

These are services that are services funded by the Ministry of Health to help people live at home. They can help with both household management and personal care

http://www.learningstate.govt.nz/display/glossaryitem.asp?id=140


http://www.health.govt.nz/system/files/documents/.../nzdep2006-report.pdf


Support Service (HCSS) Impact Means the contribution made to an outcome by a specified set of goods and services

(outputs), or actions, or both. It normally describes results that are directly attributable to the activity of an agency. For example, the change in the life expectancy of infants at birth and age one as a direct result of the increased uptake of immunisations. (Public Finance Act 1989).

Impact measures Impact measures are attributed to agency (DHBs) outputs in a credible way. Impact measures represent near-term results expected from the goods and services you deliver; can often be measured soon after delivery, promoting timely decisions; and may reveal specific ways in which managers can remedy performance shortfalls. (http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf page 13)

Input The resources such as labour, materials, money, people, information technology used by departments to produce outputs, that will achieve the Government's stated outcomes. (http://www.ssc.govt.nz/glossary/)

Intervention An action or activity intended to enhance outcomes or otherwise benefit an agency or group. (Refer (http://www.ssc.govt.nz/glossary/)

Intervention logic model

A framework for describing the relationships between resources, activities and results. It provides a common approach for integrating planning, implementation, evaluation and reporting. Intervention logic also focuses on being accountable for what matters – impacts and outcomes. (Refer State Services Commission ‘Performance Measurement – Advice and examples on how to develop effective frameworks: www.ssc.govt.nz)

Intermediate outcome

See Outcomes

‘Living within our means’

Providing the expected level of outputs within a minimum break even budget or National Health Board (NHB) agreed deficit step toward break even by a specific time.

Management systems

The supporting systems and policies used by the DHB in conducting its business.

Measure A measure identifies the focus for measurement: it specifies what is to be measured

Objectives Is not defined in the legislation. The use of this term recognises that not all outputs and activities are intended to achieve “outputs”. For example, increasing the take-up of programmes; improving the retention of key staff; improving performance; improving Governance etc. are ‘internal to the organisation and enable the achievement of ‘outputs’.

Outcome Outcomes are the impacts on or the consequences for, the community of the outputs or activities of government. In common usage, however, the term 'outcomes' is often used more generally to mean results, regardless of whether they are produced by government action or other means. An intermediate outcome is expected to lead to a end outcome, but, in itself, is not the desired result. An end outcome is the final result desired from delivering outputs. An output may have more than one end outcome; or several outputs may contribute to a single end outcome. (Refer http://www.ssc.govt.nz/glossary/) A state or condition of society, the economy or the environment and includes a change in that state or condition. (Public Finance Act 1989).

Output agreement Output agreement/output plan - See Purchase Agreement (refer to http://www.ssc.govt.nz/glossary/) An output agreement is to assist a Minister and a Crown entity (DHB) to clarify, align,

http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf


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


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







and manage their respective expectations and responsibilities in relation to the funding and production of certain outputs, including the particular standards, terms, and conditions under which the Crown entity will deliver and be paid for the specified outputs (see s170 (2) Crown Entities Act 2004.

Output classes An aggregation of outputs, or groups of similar outputs. (Public Finance Act 1989) Outputs can be grouped if they are of a similar nature. The output classes selected in your non-financial measures must also be reflected in your financial measures (s 142 (2) (b) Crown Entities Act 2004).

Outputs Final goods and services, that is, they are supplied to someone outside the entity. They should not be confused with goods and services produced entirely for consumption within the DHB group (Crown Entities Act 2004).

Ownership The Crown's core interests as 'owner' can be thought of as: Strategy - the Crown's interest is that each state sector organisation contributes to the public policy objectives recognised by the Crown; Capability - the Crown's interest is that each state sector organisation has, or is able to access, the appropriate combination of resources, systems and structures necessary to deliver the organisation's outputs to customer specified levels of performance on an ongoing basis into the future; Performance - the Crown's interest is that each organisation is delivering products and services (outputs) that achieve the intended results (outcomes), and that in doing so, each organisation complies with its legislative mandate and obligations, including those arising from the Crown's obligations under the Treaty of Waitangi, and operates fairly, ethically and responsively. (Refer http://www.ssc.govt.nz/glossary/).

Performance measures

Selected measures must align with the DHBs Regional Service Plan and Annual Plan. Four or five key outcomes with associated outputs for non-financial forecast service performance are considered adequate. Appropriate measures should be selected and should consider quality, quantity, effectiveness and timeliness. These measures should cover three years beginning with targets for the first financial year (2012/13) and show intended results for the two subsequent financial years. (Refer to www.ssc.govt.nz/performance-info-measures)

Priorities Statements of medium term policy priorities.

Productivity Increasing outputs relative to inputs (ie: either more outputs produced with the same inputs, or the same output produced using fewer inputs)

Purchase agreement

A purchase agreement is a documented arrangement between a Minister and a department, or other organisation, for the supply of outputs. Some departments piloting new accountability and reporting arrangements now prepare an output agreement. An output agreement extends a purchase agreement to include any outputs paid for by third parties where the Minister still has some responsibility for setting fee levels or service specifications. The Review of the Centre has recommended the development of output plans to replace departmental purchase and output agreements. (Refer http://www.ssc.govt.nz/glossary/)

Quintile Deprivation quintiles divide areas in fifths according to NZDep2006. Each quintile relates to: Quintile 1 – NZDep2006 scores of 1 and 2 Quintile 2 – NZDep2006 scores of 3 and 4 Quintile 3 – NZDep2006 scores of 5 and 6 Quintile 4 – NZDep2006 scores of 7 and 8 Quintile 5 – NZDep2006 scores of 9 and 10


http://www.ssc.govt.nz/performance-info-measures



Quintile 1 is assigned to the 20% of areas with the least deprived NZDep2006 scores. Quintile 5 is assigned to the 20% of areas with the most deprived NZDep2006 scores.

Regional collaboration

Regional collaboration refers to DHBs across geographical ‘regions’ for the purposes of planning and delivering services (clinical and non-clinical) together. Four regions exist. • Northern: Northland DHB, Auckland DHB, Waitemata DHB and Counties Manukau

DHB • Midland: Bay of Plenty DHB, Lakes DHB, Tairawhiti DHB, Taranaki DHB and

Waikato DHB • Central: Capital and Coast DHB, Hawkes Bay DHB, Hutt Valley DHB, MidCentral

DHB, Waitemata DHB and Whanganui DHB • Southern: Canterbury DHB, Nelson Marlborough DHB, South Canterbury DHB,

Southern DHB and West Coast DHB Regional collaboration for some clinical networks may vary slightly. For example Central Cancer Network contains eight DHBs, Taranaki DHB and Tairawhiti DHB in addition to the Central Region DHBs.

Results Sometimes used as a synonym for 'Outcomes'; sometimes to denote the degree to which an organisation successfully delivers its outputs; and sometimes with both meanings at once. (http://www.ssc.govt.nz/glossary/)

Standards of Service Measures

Measures of the quality of service to clients which focus on aspects such as client satisfaction with the way they are treated; comparison of current standards of service with past standards; and appropriateness of the standard of service to client needs.

Statement of service performance (SSP)

Government departments, and those Crown entities from which the Government purchases a significant quantity of goods and services, are required to include audited statements of objectives and statements of service performance with their financial statements. These statements report whether the organisation has met its service objectives for the year. (http://www.ssc.govt.nz/glossary/)

Strategy See Ownership (http://www.ssc.govt.nz/glossary/)

Sub regional collaboration

Sub regional collaboration refers to DHBs working together in a smaller grouping to the regional grouping, typically in groupings of two or three DHBs and may be formalised with an agreement. For example a Memorandum of Understanding. Examples of sub regional collaboration include DHBs in the Auckland Metropolitan area, MidCentral and Whanganui DHBs (CentralAlliance), Capital and Coast, Hutt Valley and Wairarapa DHBs and Canterbury and West Coast DHBs.

Targets Targets are agreed levels of performance to be achieved within a specified period of time. Targets are usually specified in terms of the actual quantitative results to be achieved or in terms of productivity, service volume, service-quality levels or cost effectiveness gains. Agencies are expected to assess progress and manage performance against targets. A target can also be in the form of a standard or benchmark.

Values

The collectively shared principles that guide judgment about what is good and proper. The standards of integrity and conduct expected of public sector officials in concrete situations are often derived from a nation's core values which, in turn, tend to be drawn from social norms, democratic principles and professional ethos. (http://www.ssc.govt.nz/glossary/)

Value for money The assessment of benefits relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.










8.2 Structure of the Health Sector


8.3 Output Classes and Output Categories # Output Class # Output Category

1

Prevention Services

Preventative services are publicly funded services that protect and promote health in the whole population or identifiable sub-populations comprising services designed to enhance the health status of the population as distinct from treatment services that repair/support health and disability dysfunction. Preventative services address individual behaviours by targeting population wide physical and social environments to influence health and wellbeing. Preventative services include health promotion to ensure that illness is prevented and unequal outcomes are reduced; statutorily mandated health protection services to protect the public from toxic environmental risk and communicable diseases; and, population health protection services such as immunisation and screening services. On a continuum of care these services are public wide preventative services.

1

Health Promotion and Education These services inform people, populations, settings and environments about risks, encourage them to self-manage, become healthier and, as a result, live longer. Success is measured by a continuum from awareness and engagement, reinforcing the message by specific programmes and support, through to seeing behaviours changing for the better.

2

Statutory Regulation These services sustainably manage environments to support people and communities to make healthier choices and maintain health and safety. They include: compliance monitoring with liquor licensing and smoke free environment legislation, assurance of safe drinking water, proper management of hazardous substances and effective quarantine and bio-security procedures. Success is measured by compliance with legislation.

3

Population Based Screening These services are mostly funded and provided through the National Screening Unit and help to identify either (a) people at risk of illness; or (b) conditions at an earlier stage. They include breast and cervical cancer screening and antenatal HIV screening. Success is measured by high coverage rates.

4

Immunisation These services reduce the transmission and impact of vaccine-preventable diseases. The DHB works with primary care and allied health professionals to improve the rate of immunisations across all age groups, both routinely and in response to specific risk. Success is measured by a high coverage rate.

5

Well Child Services These services are aimed at our most vulnerable group – our children. Services and programmes targeted towards our children today will significantly impact upon our adult population of tomorrow. Success is measured by (a) a comprehensive range of services, including immunisation, assessment of children before they start school and (b) services provided to a broad range of children, including a focus on Māori and those children of high deprivation, to reduce health disparities.

2

Early Detection and Management Early detection and management services are delivered by a range of health and allied health professionals in various private, not-for-profit and government service settings, including general practice, community and Māori health services, pharmacist services,

6

Primary Healthcare and GP Services These services are offered in local community settings by teams of general practitioners (GPs), registered nurses, nurse practitioners and other primary healthcare professionals, aimed at delivering Better, Sooner, More Convenient services and improving, maintaining or restoring our population’s health. Success is measured by high levels of enrolment with our PHOs (Primary Health Organisations) as it indicates engagement, accessibility and responsiveness of primary healthcare services.

7

Oral Health Services These services are provided by registered oral health professionals to assist people in maintaining healthy teeth and gums. While high levels of enrolment, timely access and treatment are important, ultimately success


# Output Class # Output Category community pharmaceuticals (the Schedule), child and adolescent oral health and dental services.

These services are by their nature more generalist, usually accessible from multiple health providers and from a number of different locations within the DHB. On a continuum of care these services are preventative and treatment services focused on individuals and smaller groups of individuals.

is measured by results – children who are caries-free, and reducing the number of decayed, missing or filled teeth.

8

Primary Community Care Programmes These services are offered in local community settings by teams of healthcare professionals (other than general practitioners (GPs), registered nurses, nurse practitioners) aimed at delivering Better, Sooner, More Convenient services and improving, maintaining or restoring our population’s health. Success is measured by rates of participation.

9

Pharmacy Services These services include the provision and dispensing of medicines and are demand-driven, ie by patients and prescribers (nurse specialists, GPs, Community Pharmacists and Specialists). As long term conditions become more prevalent, we are likely to see an increased dispensing of medicines. Success is measured by (a) medication management for people on multiple medications to reduce potential negative interactive effects and (b) maintaining or reduction the level of prescribed medicines.

10

Community Referred Testing and Diagnosis These are services to which a health professional may refer a patient to help diagnose a health condition, or as part of treatment. They are provided by health personnel such as laboratory technicians, medical radiation technologists and nurses. Success is measured by timely access to diagnostics to improve clinical referral processes and decision-making.

11

Mental Health Services These services are provided to people who are affected by mental illness or addictions. They include assessment, diagnosis, treatment and rehabilitation, as well as crisis response when needed. Success is measured by timely access to services, particularly for our children and youth, so that we can eliminate, or reduce the severity of, mental health conditions and addictions.

3

Intensive Assessment and Treatment Intensive assessment and treatment services are delivered by a range of secondary, tertiary and quaternary providers using public funds. These services are usually integrated into facilities that enable co-location of clinical expertise and specialised

12

Specialist Mental Health Services These services are provided to people who are most severely affected by mental illness or addictions. They include assessment, diagnosis, treatment and rehabilitation, as well as crisis response when needed. Success is measured by (a) timely access to services, particularly for our children and youth, so that we can eliminate, or reduce the severity of, mental health conditions and addictions; and (b) a reduction in relapses.

13

Elective (inpatient/outpatient) Services These are assessment and treatment services that are provided to people who do not need immediate hospital treatment and who require booked or arranged services. This includes elective surgery, but also non-surgical interventions (such as coronary angioplasty) and specialist assessments (either first assessments, follow-ups or


# Output Class # Output Category equipment such as a ‘hospital’. These services are generally complex, more costly and provided by health care professionals that work closely together. They include:

Ambulatory services (including outpatient, district nursing and day services across the range of secondary preventive, diagnostic, therapeutic, and rehabilitative services.

Inpatient services (acute and elective streams) including diagnostic, therapeutic and rehabilitative services.

Emergency Department services including triage, diagnostic, therapeutic and disposition services.

On a continuum of care these services are at the complex end of treatment services and focused on individuals, rather than groups.

pre-admission assessments). Success is measured by (a) timely services; (b) services that are provided in an effective and efficient way and (c) that we make the best use of our resources.101

14

Acute (Emergency Department/Inpatient/Outpatient) Services These are services that have an abrupt onset, are often short in duration and rapidly progressive, for which the need for care is urgent. Hospital-based services include Emergency Departments (ED), short-stay acute assessments and intensive care services. Success is measured by (a) timeliness (waiting times), (b) productivity (length of stay), (c) outcome measures such as readmission rates, to indicate quality of service provision, and (d) managing demand by either maintaining or reducing the number of ED presentations, which is indicative of a strong primary/secondary integration.

15

Maternity Services These services are provided to women and their families through pre-conception, pregnancy, childbirth and for the first months of a baby’s life. These services are provided in the home, community and hospital settings by a range of health professionals, including midwives, GPs and obstetricians and include specialist obstetric, lactation, anaesthetic, paediatric and radiology services. Success is measured by (a) ensuring that our proportion of caesarean deliveries102 is consistent with the national average; and (b) that we maintain our post natal length of stay (days).

16

Assessment Treatment and Rehabilitation These are services provided to restore functional ability and enable people to live as independently as possible. Services are delivered in specialist inpatient units, outpatient clinics and also in home and work environments. Specialist geriatric and allied health expertise and advice is also provided to GPs, home and community care providers, aged residential care (ARC) facilities and voluntary groups. Success is measured by an increase in the rate of people discharged home with support, rather than to ARC or hospital environments (where appropriate).

4 Rehabilitation and Support

Rehabilitation and support services are 17

Needs Assessment and Service Coordination These are services that determine a person’s eligibility and need for publicly-funded support services and then assist the person to determine the best mix of support services, based on their strengths, resources and goals. The support is delivered by an integrated team in the person’s own home or community. Success is measured

101 While the OAG (Office of the Auditor-General) has indicated a preference for patient satisfaction survey results to be included as a qualitative measure, the Midland DHBs have elected not to include them because there are some questions regarding the reliability and validity of data, and the requirement to implement them nationally has been discontinued. See the NZ Medical Journal, 7 August 2009, Vol 122 No 1300. 102 While some caesarians are necessary on either an arranged or acute basis, overall we want to see as many babies delivered with no surgical intervention as possible, particularly as surgery introduces an element of risk to either the mother or her baby.


# Output Class # Output Category delivered following a ‘needs assessment’ process and coordination input by Needs Assessment and Service Coordination (NASC) Services for a range of services including palliative care services, home-based support services and residential care services.

On a continuum of care these services provide support for individuals following a health-related event.

by (a) increasing the number of assessments completed using a clinically accepted assessment tool, (b) providing timely assessments and (c) increasing the number of assessments provided to those who are most likely to require an assessment (ie people 65+ and people who have entered ARC).

18

Palliative Care Services These are services that improve the quality of life of patients and their families facing the problems associated with life-threatening or long term conditions, through the relief of suffering by early intervention, assessment, treatment of pain and other supports. Success is measured by providing timely and appropriate palliative care that is patient-driven, and avoids unnecessary and/or painful treatment which does not positively impact on either the patient’s quality or length of life.

19

Rehabilitation Services These are services that restore or maximise people’s health or functional ability, following a health-related event. They include mental health community support, physical or occupational therapy, treatment of pain or inflammation and retraining to compensate for specific lost functions. Success is measured through increased referral of the right people to the right service.

20

Aged Related Residential Care (ARC) Services These services are provided to meet the needs of a person who has been assessed as requiring long term residential care in a hospital or rest home indefinitely. Success is measured, particularly with our ageing population and a decrease in the number of subsidised bed days, by (a) more people being successfully supported to continue living in their own homes, (b) balancing our level of home-based support and (c) the quality of ARC.

21

Home Based Support Services These are services designed to support people to continue living in their own homes and to restore functional independence. They may be short or longer-term in nature. Success is measured by (a) an increase in the number of people being supported as indicative of an increased capacity in the system (b) a decreased or delayed entry into ARC or hospital services.

22

Life Long Disability These are services designed to support people who have a lifelong disability to continue living in their own homes and to retain as much independence as possible. Success is measured by an increase in the number of people being supported as indicative of an increased capacity in the system.


# Output Class # Output Category

23

Respite Care and Day Care Services These services provide people who suffer from dementia or a long term condition with a break, so that a crisis can be averted or so that a specific health need can be addressed. Services are provided by specialised organisations and are usually short-term in nature. They may also include support and respite for families, caregivers and others affected. Success is measured by an increase in the level of services provided over time, so that more people are supported and able to remain in their own homes.


8.4 Production Plan


DHB Board

Four appointed and seven elected

Board members

Community & Public Health

Advisory / Disability Services Advisory

Committee (CPHAC / DSAC)

Bay of Plenty Hospital Advisory Committee

(BOPHAC)

Audit, Finance & Risk

Management Committee (AFRM)

Māori Health

RunangaComprised of 18 Iwi representatives

Chief Executive

Officer

8.5 BOPDHB Organisational Structure

Board and Committees


Executive Management

CEO

DHB Board & Committees

Māori Health

Rūnanga

Chief Operating

Officer

GM Property Services

GM Governance

& Quality

GM Information

Management

CFO & GM Corporate Services

Head ofClinical School

GMPlanning &

Funding

GM Planning &

Funding Maori Health

Planning / FundingCorporate ManagementService Provision

Executive Assistant

Chief Medical Adviser/Officer


8.6 BOPDHB CARE Values Table

Value Value Statement Action Outcome

Compassion show compassion

• We will treat everyone with empathy and compassion.

• We will respect everyone. • We will recognise the suffering of

others and take action to help. • We will preserve people’s dignity.

• Everyone we come into contact with will feel cared for and respected

• Positive culture and environment

Attitude have a ”will-do” attitude

• We will work constructively with people.

• We will lead by example. • We will promote positive attitudes

to healthy living. • We will support patients to make

choices that will improve their health.

• Partnership model • High levels of staff

engagement • Positive behavioural

modelling • An employer of choice.

Responsiveness be responsive

• We will respond to people’s needs in a timely and appropriate way.

• We will recognise and respect individual needs and requirements.

• We will interact in ways which are culturally sensitive, and responsive, to our communities.

• Cultural sensitivity and responsiveness

• Adaptability • Flexibility

Excellence strive for excellence with diligence

• We will strive to do the right thing in the right way, each and every time.

• We will do the best we can, with the resources we have, at the time.

• We will encourage and support all to participate in educational opportunities and to up skill.

• We will recognise and celebrate when people deliver on excellence.

• We recognise that excellence is a dynamic concept, and will continuously strive for improvement.

• Consistently high achievement

• Resource prioritisation

• Continuous improvement


8.7 Te Ekenga Hou Māori Health Strategic Plan Summary


8.8 Minister of Health’s Letter of Approval

BOPDHB 2015-16 Annual Plan - Final with signatures 26 Aug · BOPDHB Annual Plan and Statement of...

Documents

Transcript of BOPDHB 2015-16 Annual Plan - Final with signatures 26 Aug · BOPDHB Annual Plan and Statement of...