Counties Manukau District Health Board Community ......2014/10/22 · (Mr Ezekiel Robson arrived...

Counties Manukau District Health Board – Community & Public Health Advisory Committee Agenda

Counties Manukau District Health Board Community & Public Health Advisory Committee Meeting Agenda Wednesday, 22 October 2014 at 1.30pm – 3.30pm, Manukau Boardroom, Lambie Drive Time Item Page No

1.30pm – 1.35pm 1.0 Welcome

1.35pm – 1.45pm 2.0 Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interest 2.3 Acronyms 2.4 Confirmation of Public Minutes (24 September 2014) 2.5 Action Items Register

2 3-5 6 7-13 14-15

1.45pm – 2.15pm

3.0 Presentation 3.1 SUDI and Pepi Pilot update – Carmel Ellis, Project Manager & Adrian Trenholme, Clinical Head, KidzFirst

-

2.15pm – 3.25pm

2.45pm – 2.55pm 2.55pm – 3.05pm 2.35pm – 2.45pm

3.05pm – 3.15pm

4.0 Director of Primary Health & Community Services Report – Mr Benedict Hefford

Glossary/Contents / Executive Summary 4.1 Actions from Previous CPHAC meeting/s 4.2 National Health Targets – Lisa Gestro 4.3 Primary Health – Lisa Gestro 4.4 Child Youth & Maternity – Carmel Ellis 4.5 Mental Health & Addictions 4.6 Adult Rehabilitation & Health of Older People 4.7 Intersectoral Initiatives 4.8 Progress with Systems Integration – Claire Garbett 4.9 Locality Reports 4.10 Financial Report

16-17 18 19-22 23-26 27-29 30-32 33-35 36-37 38-40 41-47 48

5.0 Resolution to Exclude the Public

49

3.25pm – 3.30pm

6.0 Confidential Items 6.1 Confirmation of Confidential Minutes (24 September 2014)

50-57

Next Meeting: Wednesday 26 November 2014, Lambie Drive

2

BOARD MEMBER ATTENDANCE SCHEDULE 2014 – CPHAC Name

Jan 26 Feb 26 Mar 16 Apr 21 May 18 June 16 July 20 Aug 24 Sept 22 Oct 26 Nov 17 Dec

Lee Mathias

No

Mee

ting

Colleen Brown

Sandra Alofivae (Chair)

X

David Collings

X *

George Ngatai

X

Dianne Glenn

Reece Autagavaia

X

Mr Sefita Hao’uli

X X

Ms Wendy Bremner

X

Mr Ezekiel Robson

X

* Attended part meeting only

3

BOARD MEMBERS’ DISCLOSURE OF INTERESTS

22 October 2014 Member Disclosure of Interest

Dr Lee Mathias, Chair • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Chair Health Promotion Agency • Deputy Chair Auckland District Health Board • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • Chairman, Unitec • External Advisor, National Health Committee • Director, Health Innovation Hub • Director, healthAlliance

Sandra Alofivae

• Chair of the Auckland South Community Response Forum (MSD appointment)

• Member, Fonua Ola Board • Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship • Board Member, Pacifica Futures

David Collings

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

Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland

Council • Life Member – Business and Professional Women

Franklin • President – National Council of Women

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

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

Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

4

Colleen Brown • Chair Parent and Family Resource Centre Board (Auckland Metropolitan Area)

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

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

Building and Housing • Chair, Early Childhood Education Taskforce for

COMET • Member, Manurewa Advisory Group • Member, Child Advocacy Group – Manukau • Deputy Chair, Auckland City Council Disability

Strategic Advisory Group • Chair ECE Implementation Team Auckland South • Chair IIMuch Trust • Director, Charlie Starling Production Ltd

George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

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

Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Board Member, United Otara Market

Sefita Hao’uli

• Trustee Te Papapa Pre-school Trust Board • Member Tonga Business Association & Tonga

Business Council Advisory roles: • Toko Suicide Prevention Project (Ministry of Health) • Tala Pasifika (NZ Heart Foundation Pacific Tobacco

Control) • Member Pacific Advisory Board, Auckland Council Consultant: • Government of Tonga: Manage RSE scheme in NZ • NZ Translation Centre: Translates government and

health provider documents.

Ezekiel Robson • Auckland Council Disability Strategic Advisory Group • Department of Internal Affairs Community

Organisation Grants Scheme Papakura/Franklin Local Distribution Committee

• Be.Institute/Be.Accessible ‘Be.Leadership 2011’ Alumni

Wendy Bremner • CEO Age Concern Counties Manukau Inc • Member of Auckland Social Policy Forum • Member of Health Promotion Advisory Group (7 Age

Concerns funded by MOH)

5

COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 22 October 2014 Director having interest Interest in Particulars of interest Disclosure date Board Action Mr George Ngatai

CMH Quit Bus Mr Ngatai is a Director of Transitioning Out Aotearoa who is a partner provider along with CMDHB and Waitemata PHO in the Quit Bus.

26th March 2014 That Mr Ngatai’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations or decisions.

Ms Kathy Maxwell

Community Pharmacy Owner Kathy the Chemist Ltd, which has a contract with CMDHB for Pharmacy Services.

26th March 2014 That Ms Maxwell’s specific interest is noted and the Committee agree that she may remain in the room and participate in any deliberations or decisions.

Mr Sefita Hao’uli

Rheumatic Fever national campaign

Mr Hao’uli is currently undertaking some work with the Ministry of Health on the Pacific campaign on Rheumatic Fever for next 2-3 weeks.

16th April 2014 That Mr Hao’uli’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations or decisions.

Mr Geraint Martin

Renewal of the Regional After Hours Agreement

Mr Martin’s wife is the Executive Director of Takanini Care Medical Services Limited Partnership. The company comprises 2 A&M clinics and 2 general practices at the same location.

21st May 2014 and 20th August 2014

That Mr Martin’s specific interest is noted and the Committee agree that he may participate in the deliberations of the Committee in relation to this matter because he is able to assist the Committee with relevant information, but is not permitted to participate in any decision making.

6

Glossary

ACC Accident Compensation Commission ADU Assessment and Diagnostic Unit ARDS Auckland Regional Dental Service BT Business Transformation CADS Community Alcohol, Drug and Addictions Service CAMHS Child, Adolescent Mental Health Service CNM Charge Nurse Manager CT Computerised Tomography CW&F Child, Women and Family service DNA Did not attend ESPI Elective Services Performance Indicators FSA First Specialist Assessment (outpatients) FTE Full Time Equivalent ICU Intensive Care Unit iFOBT Immuno Faecal Occult Blood Test MHSG Mental Health service group MoH Ministry of Health MTD Month To Date MOSS Medical Officer Special Scale OHBC Oral health business case ORL Otorhinolaryngology (ear, nose, and throat) PACU Post-operative Acute Care Unit PHO Primary Health Organisation PoC Point of Care SCBU Special care baby unit SMO Senior Medical Officer SSU Sterile Services Unit TLA Territorial Locality Areas WIES Weighted Inlier Equivalent Separations YTD Year To Date

7

Minutes of the meeting of the Counties Manukau District Health Board

Community & Public Health Advisory Committee Wednesday 24 September 2014

held at Counties Manukau Health Boardroom, 19 Lambie Drive, Manukau

commencing 1.30pm

COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Ms Sandra Alofivae (Committee Chair) Ms Colleen Brown Mr David Collings Mr George Ngatai Ms Dianne Glenn Mr Apulu Reece Autagavaia Mr Ezekiel Robson Mr Sefita Hao’uli

ALSO PRESENT:

Ms Margie Apa (Director, Strategic Development) Ms Karyn Sangster (Chief Nursing Adviser, Primary & Integrated Care) Mr Benedict Hefford (Director, Primary Health & Community Services Dr Campbell Brebner (Chief Medical Advisor, Primary Care) Ms Kathy Maxwell, Board member

APOLOGIES: Apologies were received and accepted from Ms Wendy Bremner and Mr Geraint Martin. WELCOME Apulu Reece Autagavaia opened the meeting with a short prayer. 2.2 DISCLOSURE OF INTERESTS The Committee noted Dr Lee Mathias is now a Director, Health Innovation Hub and Ms Colleen Brown is a Director, Charlie Starling Production Ltd. 2.2 SPECIFIC INTERESTS There were no specific interests to note with regard to the agenda for this meeting. 2.3 ACRONYMS The Acronym list was noted.

8

2.4 CONFIRMATION OF PREVIOUS MINUTES Confirmation of the public minutes of the Counties Manukau Community & Public Health Advisory Committee meeting held 20 August 2014. Resolution (Moved Ms Dianne Glenn/Seconded Apulu Reece Autagavaia) That the public minutes of the Counties Manukau Health Community & Public Health Advisory Committee meeting held on 20 August 2014 be approved. Carried 2.5 ACTION ITEMS REGISTER The Committee asked Mr Hefford to look into whether the Healthy Families Initiative presentation scheduled for November/December can be incorporated with the presentation on the Children’s Action Plan in October. Resolution (Moved Ms Sandra Alofivae/Seconded Dr Lee Mathias) That the Action Items Register of the Counties Manukau Health Community & Public Health Advisory Committee be received. Carried (Mr Ezekiel Robson arrived 1.40pm) 3. PRESENTATION 3.1 Health of Older People/InterRai Ms Dana Ralph-Smith, GM ARHoP and Ms Lynda Irvine, GM Manukau Locality took the Committee through the presentation. A copy of the presentation is available on the CMH website. Overview: • Health of Older People priorities

o InterRai to be mandated as primary assessment tool for all contracted Age Related Residential Care facilities in Counties Manukau from 1 July 2016

o Dementia Pathway implemented, particular community access o Needs Assessment services integrated into locality services alongside Home

Healthcare services • InterRai Programme

o Funding – CMH holds MoH contract to pay for a systems clinician and a lead practitioner to support the rollout of InterRai

o National reporting has commenced • Individualised Funding

o Payment mechanism for disability support in which people are empowered and enabled to live ordinary lives and have control and choice over that life.

o People with disabilities are able to directly employ their own support workers as long as the service they purchase are those assessed and allocated.

9

The Chair thanked Ms Ralph-Smith and Ms Irvine for their presentation. 4. DIRECTOR’S REPORT Mr Hefford took the Committee through the Director’s report. 4.1 Executive Summary • Immunisation coverage increased to 93% total; 96% for Pacific babies and 89% for Maaori.

On track to achieve the revised national health target of 95% coverage by December 2014. Need to think about as people get older and their immunisations wear off or they have not ever been immunised, what are the implications for them (ie) whooping cough, measles, diphtheria, chicken pox. We may see a greater need in the future. The Committee asked Mr Hefford/Ms Apa to come back to them in November with a Resolution to go to the Board.

• ARI rolling out, breaking into the 50’s for practices now implementing the model of care with

over 300 patients with active care plans developed. All practices are expected to implement ARI over the next 9 months.

• Violence Intervention Programmed has been rolled out in the DHB with all staff in ED having

gone through training for Family Violence and Domestic Abuse. MoH is focussing on training with primary care but it is not a ‘required’ training at the moment but it is on the PHO radar.

4.2 Actions from Previous CPHAC Meetings • Access to dental clinics (pg 60) – it was confirmed that CMH does contract a ‘barrier-free’

auditor to audit the CMH facilities. • CMH website relaunch scheduled for end November.

4.3 National Health Targets • CVD & Smoking targets met by CMH but not met nationally. • Rotovirus - Rototec is not being counted as yet. MoH may include it when all DHBs get to

95%. We are working on the assumption that we want to ensure all babies have the opportunity to get vaccinated if consenting so we are making sure our systems and processes are in place to get these babies immunised.

• Stoptober campaign – national campaign to get smokers to quit for 31 days – borrowed programme form the NHS. Rationale is that if you are able to stop for 31 days you are more likely to stay quit or your next attempt is more likely to be successful.

4.4 Primary Health • Vulnerable Children Act – On 1 July 2014 the Vulnerable Children Act and other associated

legislation was passed into law under the Crimes Amendment Act. This Act wasn’t just targeting children, but rather it bundled up ‘children and vulnerable adults’ (ie) typically who we would consider people with disabilities - if they were for whatever reason more susceptible to abuse there was a duty put on professionals to act and to make them liable for not acting. Some attention to the ‘vulnerable adults’ should be taken into consideration.

3 years ago when the legislation changed Legal undertook some work right across the organisation with our clinicians on the implications of the Act. Where there were opportunities to align policies or processes that discussion also occurred particularly in areas where stroke/spinal or other disability services were provided. While that is not the full vulnerable adult spectrum it was the start place. There has been some conversation but

10

probably not as broad as it should be. We need to turn our minds actively to another whole pocket of vulnerability. The Committee asked Mr Hefford to have Legal look at the framework we are currently working under for vulnerable people with disabilities and to report back to the Committee.

4.5 Child Youth & Maternity Ms Carmel Ellis, Project Manager, took the Committee through this section of the Director’s Report. • First 2000 Days – The Committee asked that a copy of Ms Apa’s A3 document on this

programme be distributed to them. • Immunisation Coordination - Cold chain support (page 68) is a legal requirement about how

vaccines are stored. • B4 School Checks – weekend clinics reinstated at MSC. These will be closely monitored to

ensure we are maximising attendance. The Hearing & Vision team have started piloting their new service delivery model which includes working with localities alongside Plunket to coordinate visits to early childhood centres, primary schools, clinics and home visiting in the Mangere East locality.

• Mana Kidz – school teams continue to report better health of children with data reflecting this with fewer Strep+ throat and skin infections. Some school principals have also reported higher attendance rates for children at these schools.

4.6 Mental Health & Addictions • Long standing issue that our over 65’s access rate has been below target. New older adults

community support service will assist and should bring us up to target. • COPMIA (children of parents with mental illness and/or addictions) gone live. This

programme is about supporting young people using psycho-education, creative activities and peer support.

4.7 Adult Rehabilitation & Health of Older People Ms Dana Ralph-Smith, GM ARHoP took the Committee through this section of the Director’s Report. • NASC - People can either get referred or they can self-refer to NASC. Average delay from

being referred to actually getting a needs assessment done can be as quick as 12-24hrs, depends on the urgency. The Committee asked Mr Hefford to come back with the information on the number of Maaori & Pacific people assessing InterRai assessments.

4.8 Intersectoral Issues Ms Jude Woolston, Project Manager took the Committee through this section of the Director’s Report. • Warm Up Counties Manukau – currently targeting local factory employees.

11

4.9 Progress with System Integration • Community Health Integration – Transfer of NASC assessors into the 4 locality home health

teams has now been completed. Work is progressing on integration systems and processes between the 2 services to increase effectiveness and reduce duplication of effort. A longer term strategic direction and business case is being formulated for community health services.

4.10 Localities • E-shared care platform – software that integrates with practice management systems and

Concerto in the hospital to display a care plan and some care information. Although the platform is centred around the At Risk Individual, it is also used outside that programme. We now have 1500 patients who have an e-shared care plan. Includes patient portal.

4.11 Financials Taken as read. Resolution (Moved Ms Sandra Alofivae/Seconded Dr Lee Mathias) That the Community & Public Health Advisory Committee receive the report of the Director Primary Health & Community Services. Carried 5.0 RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Dr Lee Mathias /Seconded Mr George Ngatai) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

6.1 Asian Health Approaches

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

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

12

6.2 Minutes of the CPHAC Meeting with public excluded 20.8.2014


Confirmation of Minutes For the reasons given in the previous meeting.

6.3 Action Items Register - Confidential


Confirmation of Action Items Register For the reasons given in the previous meeting.

Carried 3.17pm Public excluded session. 3.33pm Open meeting resumed. 7.0 FOR INFORMATION 7.1 PHO Q4 2013-14 Health Target Results Taken as read. 7.2 CMH Maternity Quality & Safety Programme Annual Report 2013-14 Taken as read. The Committee asked Mr Hefford/Ms Ellis to look into whether we have our maternity data collection aligned with the national women’s data collection.

13

The Chair closed the meeting thanking everyone for their contributions to the meeting. The meeting concluded at 3.35pm. The minutes of the Counties Manukau Community & Public Health Advisory Committee meeting held 24 September 2014 be approved. (Moved /Seconded ) Chair Ms Sandra Alofivae Date

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

14

Community & Public Health Advisory Committee Meeting – Action Items Register – 22 October 2014 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

26.2.2014 4.0 Update from Auckland Regional Public Health Service

every 6 months on current issues. March 2015 Mr Hefford

16.4.2014 6.1 Presentation from Carers New Zealand

December Mr Hefford

21.5.2014 3.3 Presentation in relation to disability data once the Disability Survey results and the estimated resident population projections from Census 2013 are available – data to be aggregated by sex.

November Mr Hefford/Dr Winnard

18.6.2014 4.0 Director’s Report Fuller report on the SUDI pepi pilot. Presentation on the Children’s Action Plan.

October Oct/November

Mr Hefford Mr Hefford

16.7.2014 3.0 Director’s Report Immunisation - Ms Sangster & Ms Apa to come back to the committee with a proposal around extending the flu coverage next year to include vaccinating all children in our district for influenza.

November

Ms Apa/Ms Sangster

20.8.2014 3.1 St John New Zealand Follow-up presentation on the 111 Clinical Hub

November

Dr Brebner

20.8.2014 4.0 Director’s Report - Healthy Families Initiative presentation from the collective.

November Mr Hefford

20.8.2014 5.1 Community Engagement Further discussion on the inter-connected issues around community engagement (with the Children’s Action Plan)

Oct/November

Mr Hefford

24.9.2014 4.0 Director’s Report – Resolution on immunisation of older people. Primary Health – Legal to look at the framework we are currently working under for vulnerable people with disabilities. ARHoP – Information on the number of Maaori & Pacific people assessing InterRai assessments.

November November November

Mr Hefford/Ms Apa Mr Hefford Mr Hefford

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

15

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

24.9.14 7.2 CMH Maternity Quality & Safety Programme Annual Report 2013-14 – does our maternity data collection align with the national women’s data collection.

November

Mr Hefford

16

Counties Manukau Health Director Primary Health & Community Services’ Report

Recommendation It is recommended that the Community & Public Health Advisory Committee receive the report of the Director Primary Health & Community Services. Prepared and submitted by: Benedict Hefford, Director Primary Health & Community Services Glossary of Terms Acronyms Description A&D / AOD Alcohol and Drug ACP Advanced Care Plan AH+ Alliance Health Plus ARDS Auckland Regional Dental Service ARI At Risk Individuals ARPHS Auckland Regional Public Health Service ARRC Aged Related Residential Care AT&R Assessment, Treatment and Rehabilitation AWHI Auckland Wide Healthy Housing Initiative B4SC Before School Checks BSMC Better, Sooner, More Convenient CCM Chronic Care Management CPET Clinical Pathway Enabler Tool COPD Chronic Obstructive Pulmonary Disease DHS Director Hospital Services DNA Did Not Attend EOI Expression of Interest GAS+ Group A Streptococcal Positive GP General Practitioner hA healthAlliance HBSS Home Based Support Services HHC Home Health Care4 HOP Health of Older People IDF Inter District Flows IFHC Integrated Family Health Centre IPIF Integrated Performance & Incentives Framework LTCF Long Term Conditions Facilities MOH Ministry of Health NGO Non-government organisation PHN Public Health Nurse POAC Primary Options to Acute Care PRIMHD Project for the integration of mental health data PSAAP Primary Services Agreement Amendment Protocol SUDI Sudden Unexplained Death of Infant VHIU Very High Intensive User VLCA Very Low Cost Access

17

Contents Executive Summary

1. Actions from Previous CPHAC Meetings 2. National Health Targets 3. Primary Health 4. Child, Youth and Maternity 5. Mental Health and Addictions 6. Adult Rehabilitation & Health of Older People 7. Intersectoral Initiatives 8. Progress with Systems Integration 9. Locality Reports 10. Financial Report

Executive Summary

• The latest phase of the national community pharmacy contract changes has been implemented

smoothly in Counties Manukau. Planning is now starting for the next phase, including evaluating the impact of the recent changes, surveying pharmacists to identify gaps and opportunities, and identifying potential ways of embedding medication management services into routine community pharmacy practices. It is likely that the current contract will be extended to 2016 while the next round of changes are being finalised.

• Initial first quarter results for both oral and child health show excellent progress, with increasing coverage, lower rates of arrears and higher activity across all the main performance areas.

• A new position of General Manager, Integrated Mental Health & Addictions has been created to better enable leadership of service integration across mental and physical health services. Tess Ahern was appointed to this position effective 1 October. Similar changes in roles and accountabilities in Child, Youth & Maternity Services have also been implemented to better enable integration of care in these areas.

• Immunisation coverage has increased to 94% total; 97% for Pacific babies and 91% for Maaori. We are

therefore on track to achieve the revised National Health Target of 95% coverage by December 2014. The increase in the Maaori immunisation rate, in particular, is very pleasing and reflects excellent work of the Child Health team to engage hard to reach whaanau. CVD and smoking targets remain on track.

• The implementation of the At Risk Individuals programme and other System Integration/Locality

initiatives is progressing well. CMH teams, NGOs and social service providers are becoming better aligned with GP clusters so that practices are supported through multidisciplinary teams and case conferences.

• The primary care nursing workforce is central to successful implementation of many of our integration

and enhanced community care initiatives. Key activities to support development of this workforce including; training, extended scope, specialised assessment and interactions and care coordination, have now reached critical mass with most nurses in the district now engaged in at least one of these developments in some way.

18

1. Actions from Previous CPHAC Meetings Action Description Maternity data collection alignment with National Women’s Health report.

The purpose of the Maternity Quality and Safety report is to report on the preceding years work plan. Clinical indicators have been set by the MoH and are uniformly reported by all DHBs. The dataset is provided by the MoH to DHBs for narrative and to verify the individual projects being implemented in alignment with the quality and safety programme. Reporting of clinical indicators is therefore consistent across all DHBs. In addition, Auckland DHB produces an annual Women’s Health report which is not currently produced by Counties Manukau Health.

19

4.2 National Health Targets OBJECTIVES

Target 14/15 Target

13/14 Q4

July 2014

August 2014

On Track

More Heart and Diabetes Checks 90% 91.3% 90.1% 90.3% Yes

Better Help for Smokers to Quit 90% 98.9% 86.3% 86.7% Yes

Immunisations 95% 92% 93% 94% Yes

PROGRESS

More Heart and Diabetes Checks Target (Cardiovascular Disease - CVD - Risk Assessment) The preliminary CMDHB result for August 2014 is 90.3% for CMH total population. The table below shows preliminary PHO performance for August:

PHO 2013/14 Q4 July PHO results August PHOs Results Procare 92.2% 90.7% 91.2% East Health 91.1% 90.5% 90.6% Alliance Health+ 90.6% 90.5% 90.4% NHC 89.8% 89.4% 89.1% Total Healthcare 89.7% 87% 87.4% CMDHB 91.3% 90.1% 90.3% National 85.1%

Note that there is a three month report lag due to national data assurance requirements:

These results are reported by the Ministry on a quarterly basis

20

Measures taken by the PHOs to maintain the 90% target for CVD risk assessments include: • Improving access for hard to reach people by providing transport and running after hours

and weekend clinics • Accessing Test Safe data to complete partially completed non face to face assessments • Outreach and after hours assessments • Nurse led clinics • Systems enhancement – with the use of Dr Info “one click” • Monthly Health Targets/IPIF meeting with the PHOs to share ideas and initiatives for

maintaining the target • Use of phlebotomy by practice nurses within practices to assist patients who would not

otherwise have travelled to a lab for tests • Clinical Medical and Clinical Nurse Education sessions • Increased training around phlebotomy and use of decision support tools • Weekly benchmarking of practices by PHOs to measure achievement • Practice support with practice advisors

Maaori, Pacific and other high-risk populations are actively targeted through the use of:

• Specific practice queries and recall systems, including queries on patients who are turning 35 within the next three months

• Appointment scanners (which can be used to identify patients who are booked in for a consultation with the GP or PN that day so a heart check can be offered opportunistically)

• Outreach services • CMH have a Maaori clinical champion who is able to assist practices where appropriate

A celebration with the PHOs and key stakeholders representatives was held during August to celebrate the significant success of the national health target achievements. Counties DHB was the second most successful individual DHB in the country across the target programme, and the northern region was the highest performing region, so this is a remarkable achievement. Better Help for Smokers to Quit The target is that 90% of patients seen in primary care who smoke receive brief advice about quitting. Preliminary PHO data for August indicates an unadjusted1 rate of 86.7%, an increase of 0.4% from July. The PHOs are using cessation support services such as Quit Line, face to face consultations and group cessation sessions. Practice facilitators and Smokefree Target Champions are continuing to spend time at low performing practices and encouraging these practices to implement quality processes that will ensure sustainable activity towards the 90% target. Practices are also using text to remind. A DHB smoking champion (Ken Bagnall) has been employed to assist the PHO smoking champions to attain the target. He will be working closely with the PHOs and the clinical champion to identify the low performing practices and offer assistance as required. Plans to increase support for PHOs with additional funding to increase the rates of cessation support (The “C” in ABC approach to quitting) have been approved.

1 The final result is adjusted to account for smokers who have not visited general practice in the previous 12 months. This increases the final results by approximately 15%.

21

PHO July PHO results Smoking brief advice and cessation support – Aug 2014 prelim. results

East Health 96.3% 93.4%

Total Healthcare 91.3% 91.6%

Alliance Health+ 83.7% 86.3%

NHC 81.6% 83.7%

Procare 81.5% 83%

CMDHB 86.3% 86.7%

Note that there is a three month report lag due to national data assurance requirements:

These results are reported by the Ministry on a quarterly basis Childhood Immunisation – 8 months The 8-month immunisation target for period ending December 2014, requires 95% of all eligible children eight months and two years of age to have completed their scheduled course of immunisation. Counties Manukau Health is currently reporting at 94% for total population, 97% for Pacific babies and 91% Maori coverage. The Child Health team are pleased to report that our targeted strategies have been effective resulting in a 5% increase for Maaori coverage. The strategies included the implementation of new outreach protocols and further follow-up of declined Maaori whaanau to further encourage and support immunisations.

22

70%75%80%85%90%95%

100%

Feb-

14

Mar

-14

Apr-

14

May

-14

Jun-

14

Jul-1

4

Aug-

14

Sep-

14

Cove

rage

Childhood Immunisation rates - 8 months by Ethnicity

All Maaori Pacific Target

23

4.3 Primary Health OBJECTIVE: To deliver comprehensive in and out of hours primary health care which is ‘Better, Sooner, and More Convenient’. PROGRESS Integrated Performance and Incentive Framework (IPIF) A monthly operational meeting focusing on quality improvement activities to meet the IPIF targets is occurring with participation from CMH and our PHO partners. Performance against the National Health Targets and other IPIF targets is reviewed at every meeting. PHOs have the opportunity to discuss gaps, risks and opportunities. Strategies to reach and engage patient populations to complete screening, immunisations and health improvement interventions are also shared amongst partners. The DHB provides a strong facilitation, project management and clinical support role. The focus is currently on maintaining performance against the National Health Targets and improvement activities for cervical screening coverage, particularly for Maaori, Pacific, Asian and other high needs groups. The group is also linked in with broader planning taking place through the Metro Auckland Cervical Screening Governance Group. Franklin Rural Service Level Alliance Team The Franklin Rural Service Level Alliance Team (SLAT) had its inaugural meeting in September. The SLAT has been established in response to the new policy direction for primary care rural service level alliancing in the PHO Services Agreement. Members of the SLAT include PHOs and practices receiving rural primary care funding, the Locality General Manager and the CMDHB Primary Care Portfolio Manager. The group is currently working on a three year plan for how the resource will be used to meet the objectives for rural funding which include:

• people in rural communities have equitable health outcomes, appropriate access to First Level Services and Urgent Care Services, and receive continuity of care

• rural primary health care services are sustainable • the rural primary health care workforce has safe workloads • rural general practice teams have access to appropriate clinical support and workforce

development opportunities • rural primary healthcare services are delivered by the right people, at the right time, and in

the right place

Mental Health Training for Primary Care Nurses A key objective of the CMH Mental Health and Addictions Strategic Action Plan 2013-18 is to increase and improve the delivery of mental health and addictions services in local primary care settings. PHOs, the DHB and the College of Mental Health Nursing have been discussing options for strengthening the primary care nursing workforce to deliver mental health and addictions interventions. The aim is to have more nurses undertaking screening, extended consultations, brief interventions, referral and care planning for patients with mental health and addiction issues and complex, long term conditions. The parties have agreed to a collaborative approach to designing an education package available to all PHOs. This is likely to include structured training, supported learning in practice, submission of a reflective case portfolio and the option of completing a post graduate paper at the University of Auckland or a Level Seven paper at MIT.

24

Primary Care Nursing Update Over the past month the CMDHB Primary Care Nursing team has been actively involved in supporting implementation of priority health initiatives and public health planning. A summary of key activity is provided below:

• Northern Regional Diabetes Nurse Workforce forum is finalising a nurse-led clinic tool kit as

part of capacity and capability building in the sector. Diabetes nurse prescribing is a Health Workforce NZ priority this year. In September, eight CMH nurses were funded for the MIT diabetes paper.

• Introduction of the Rota teq vaccination to the immunisation schedule requires a different way of working with midwives and primary care practices. Babies need to complete the first dose of the vaccination by 14 weeks and six days. Work has been carried out with PHOs to support improved systems for tracking and vaccinating babies on time. An initial planning meeting was held in September with key stakeholders.

• Education providers have indicated they will no longer provide assessment of practice nurses to complete authorised vaccinations. CMDHB Primary Health Nursing Service has been accepted as an assessor until a more sustainable answer is found. PHOs will nominate their own assessors to ensure timely completion of the process.

• All caregivers of ‘declined’ immunisations for Maaori babies are being phoned to assess any patterns for decliners. A proportion of these have agreed to have immunisations and have been referred to outreach.

• The Board have indicated that they will look favourably on a business case to immunise children in 2015. Paediatric clinicians initiated this proposal.

• Both clinical nurse specialists are supporting the Safety in Practice initiative in localities and practices.

• School nurse youth specialists are supporting roll out of Rheumatic Fever in secondary funded schools in collaboration with National Hauora Coalition Mana Kidz programme.

• Very Low Cost Access practice new graduates have now been allocated to PHOs. Four positions will be filled with one position for the Counties Manukau district and the other three for practices in other DHBs.

• Care coordinator training is occurring bi-monthly and to date 186 nurses have attended. • The Primary Care Nursing Director attended a Ministry of Health workshop on barriers to

primary care innovation looking at Nurse Practitioners enabled through legislation. This will take a further 12 months then Registered Nurse prescribing will be a priority.

• A research paper was completed for spirometry on the Quitbus. Other current activities related to the primary care nursing workforce in Counties Manukau are highlighted below:

• There were 37 post graduate applications received for semester one 2015 funding for nurses working in primary care, district nursing, hospice, Plunket and aged care settings.

• Two nurses are working towards Nurse Practitioner prescribing this year. One school nurse is aiming to do a prescribing practicum next year and funding and supervision needs to be sourced to support this goal. One A&M nurse is also requesting prescribing practicum funding.

• We are exploring options for MIT to commence level 7 papers for primary health care nursing to link with the diabetes course to provide a complete qualification.

• All locality nurse lead positions have now been filled. • There have been no more measles cases in Auckland since July which means a return to

business as usual.

25

Regional Clinical pathways programme 50 clinical pathways now on the Healthpoint site covering common adult and paediatric conditions which have been regionally agreed as priorities. This provides best practice evidence based care on disease specific conditions and aligns with priorities and areas of focus across the metro Auckland DHBs. After Hours The business case was approved for five year sustainable funding at the September board, and has similarly been accepted by Waitemata and Auckland DHB boards so a procurement process is now being developed regionally. Community Pharmacy Community Pharmacy Services Agreement Stage 4 has been implemented smoothly. Planning is starting for the Phase 2 road shows on “Payments and Reporting” which will take place in November. Community Pharmacy Services Agreement 2015 Work is progressing on the strategic development of the next pharmacy contract, as the current contract expires 30 June 2015. Following the discussion at the DHBs “CPSA strategic planning” workshop there was general agreement that DHBs want to ensure community pharmacy services remain focused on delivering patient-centric medication management services. There was also agreement that it is likely that there is not enough time to implement a new contract by 1 July 2015, especially in a ‘change weary’ sector. The Pharmacy Programme has developed recommendations for proposing an extension of the current contract for a period of 12 months, whilst supporting DHBs to develop and implement the next Community Pharmacy Services Agreement. Guild Roadshows It is understood that the Pharmacy Guild is planning to undertake road shows seeking members input into what they would like to see in the next CPSA; the planned date for the road shows is October and November. Drug Margins The Community Pharmacy Services Programme is contracting an independent third party to undertake an ‘environmental scan’ including international benchmarking, and identification of the issues and pressure points currently facing the supply-chain. This would feed into a discussion document which would be issued by the CPS Programme in late November which would include a number of possible options to address the issues identified. Pharmacy sector feedback would be sought on the discussion document. Following receipt of the feedback, a detailed proposal would be developed and the sector would be consulted on this in March/April 2015, for proposed implementation from 1 July 2015; in line with the proposed contract extension. Contract (CPSA 12) Evaluation An evaluation of the current CPSA is being planned. The Ministry of Health has agreed to co-fund it, and funding is sought from DHBs as well. Pending the DHB agreement, the evaluation would be undertaken by an independent third party and would seek to answer the questions ‘are we on the right track’ and ‘what could be done to improve /

26

enhance community pharmacy service delivery’. It would focus on the impact of the CPSA on patients, pharmacists as health professionals and the pharmacy business infrastructure.

DHBs will seek pharmacy sector input into the Evaluation scope and plan via the Community Pharmacy Services Operations Group in October of this year. It is proposed an Expression of Interest would be issued later this year, followed by a Request for Proposals early next year. It is proposed the evaluation would commence around the middle of 2015. This would inform the development of the next contract from July 2016. Localities The first Locality Pharmacy Clinical Network meeting for pharmacists in the Manukau locality was held on the 4th of September. Lynda Irvine presented an overview of the Manukau Locality and Dr Tim Hou, Clinical Director of the Mangere Locality and GP Mangere Health Centre presented on the “At Risk Individual” Programme. Community Pharmacists were invited to complete a questionnaire to identify current communication processes, gaps in service delivery, opportunities for innovative service and professional development. Community pharmacists were challenged to visit practices commencing on ARI and then provide a proposal regarding what could be done better in the future. The third Locality Pharmacy Clinical Network meeting for Mangere / Otara pharmacists was held on the 16th of September. Sarah Marshall, GM for the Locality, described the ARI service to the pharmacists. Various examples of Clinical Pharmacist Services available in other parts of New Zealand were discussed. A discussion followed and the pharmacists were asked to consider what they were able to offer to assist GP practice encourages integration. The Medicines Adherence Support Service (MASS) delivered in CCMS over the Shared Care Network has been seen as a key enabler to integration of GP practice and Pharmacy in the delivery of the ARI programme. Roll out of this tool was touted for mid-September but has been delayed by HSAGlobal until late November. There is a possibility that we could launch earlier but without the functionality to bulk enrol patients. This may lead to significantly time spent by pharmacist to enrol patients before they can start working with the tool. Community Pharmacy Anticoagulant Management Service (CPAMS) We have seen further improvement in GP Practice referral into CPAMS and we are tracking at 55.8% of capacity. Average tests per is currently at 1.7 tests per patient per month which is marginally above the breakeven point of 1.67 tests per patient per month, representing great value for the DHB. In light of the fact that referrals by East Tamaki Health Care practices into the service has been poor to date, the service was presented to group of their doctors at a Continuing Education event with the support of Richard Hulme. There were encouraging signs from all present to support referral into the service. When capacity utilisation improves there is the opportunity to award more contracts for pharmacies to provide the service. In CMDHB we have on pharmacy who have had their cap of patients increased from 50 to 60 patients and we have another pharmacy with the potential to have their cap increased to 100 once we sufficient reporting establish quality delivery of the service.

27

4.4 Child, Youth and Maternity Services OBJECTIVE(S) To integrate maternal and child health services; reduce perinatal mortality; improve care in the First 2,000 Days of life; intervene early to support vulnerable children; reduce Rheumatic Fever by two-thirds to 1.4 cases per 100,000; and improve youth services. PROGRESS First 2,000 Days Maternity Care We have started a planning exercise to identify, develop and analyse options for the potential configuration and location of primary birthing facilities across Counties Manukau, and the model of care/services provided within them. Options will consider the impact of changing population demography and clinical need on service sustainability; capacity required for future needs; and balance cost effectiveness with convenience for the population and LMCs, as well as aligning with broader strategic objectives including how options improve maternity care experiences and increase deliveries in primary birthing facilities.

Infant Nutrition Project The overarching aim of the infant nutrition project is to improve nutrition and promote healthy feeding of infant and toddlers (aged 0-2 years old) through community based initiatives that engage with wider whaanau/family environments using a public health approach. The Infant Nutrition project is currently in RFP phase and are working towards the following timeframes:

Event Scheduled Date RFP Release to respondents 15 September 2014 RFP Workshop/Briefing 25 September 2014 Last day for clarification questions from respondents

7 October 2014

Closing date for submission of responses 10.00am on 13 October 2014 CMDHB to acknowledge responses 13 October 2014 Clarification, reference checks and evaluation

13 October to 7 November 2014

Presentation (if required) 20 October to 6 November 2014 Successful and unsuccessful respondents advised

7 November 2014

Successful respondent negotiations completed

28 November 2014

Contract signed By 19 December 2014 Contract implemented 1 January 2015

28

Before School Checks (B4SC) We are on track with quarter one results show tracking at 25% for total population and 19% for our high deprivation population. Weekend clinics at the Super Clinic continue along with a new service delivery model pilot should see improved access and service provision for our high deprivation whaanau. Well Child/Tamariki ora The Ministry have introduced a new funding model within the Well Child/Tamariki ora schedule. The new model has been welcomed by our providers as it allows for compensation of additional follow-up for whaanau not actively engaging with the service and other local strategies. Discussions are being held with providers to negotiate additional Well Child contacts to provide support for safe sleep, nutrition (breastfeeding) immunisations and GP enrolments. Mana Kidz - Rheumatic Fever (RF) Prevention Programme The four areas under the Mana Kidz programme are; school based services, drop-in clinics, a Community Engagement Strategy and the Auckland Wide Housing Initiative (AWHI). School teams continue to report better health of children with the data reflecting this with fewer positive strep results and skin infections. Antibiotic adherence trails are underway. The four arms of the study are as follows;

Preliminary results will be available in December with the trial due for completion in February 2015. Oral Health Services

School Dental Service The school dental service has met the arrears targets of reducing the number and % of children more than 30 days overdue for the recall appointment and have achieved 3.8% versus a target of 7%. The achievement is due to increased dental therapists and assistants filling vacancies. As arrears have decreased and new staff are fully trained, examinations, preventative treatments, and treatments have increased. Adolescent Oral Health Services Update for the first quarter is due in October however providers report increased patients. Target for 2014 is 85%, 2013 achieved 77%. A further two secondary schools (Howick College and Botany College) with large roll, mix of high risk ethnicities and current utilisation of only 55% of the school roll going to a dentist have agreed to have on-site mobile dental services for the 2015 year. Adult and Family Community Dental The Oral Health pilot for women with Diabetes In Pregnancy continues to progress well with 327 women under treatment and 73 on a waiting list out of the proposed cohort of 400 patients to be completed.

29

Due to the women’s oral health status we have had a higher level of clinical need and volume of treatments required. Initial evaluation indicates a high incidence of dental and periodontal pain and infection and discomfort, affecting all aspects of life including social behaviour and nutrition, eg 58% of the women have severe periodontal pocketing versus 5% of the population (reference NZ Oral Health Survey 2009). This is concerning as there is an established bidirectional relationship between diabetes and periodontal disease; diabetes is a risk factor for periodontal disease, and, severity of periodontal disease influences glycaemic control. The pilot has been granted an additional year of service and funding so will continue to maintain the women’s oral health through 2015.

30

4.5 Mental Health and Addictions VISION: That the communities of Counties Manukau will support mental health and wellbeing and be able to get support when they need it, quickly and easily, in their local community. PROGRESS Service Access Rates and Waiting Times Total access rates to Mental Health services for all ethnicities and ages are being met or exceeded except for Older Adults. CSW support for older adults has went live is July with all FTEs now in place – access rates for this age group will continue to be monitored. There are no wait times for these services indicating that demand for clinical services is being met. Note that there is a 3 month report lag due to national data assurance requirements:

Figure 1: Graph showing access rates for mental health services from July to June 2014 (NGO & DHB services).

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14

% S

een

12 months period ending

Maori and Non-Maori clients seen by DHB of domicile, Ethnicity - Total

0-19 Yrs 20-64 Yrs 65+ Yrs

Target 0-19 Yrs Target 20-64 Yrs Target 65+ Yrs

31

Figure 2: Graph showing waiting times for NGO AOD services from Mar 13 to Feb 14. Access to the right support in a timely manner is evidenced as being critical within the addictions sector. This is an on-going priority area for our providers, as indicated, with the continued improvement shown with regards to the wait times for NGO AOD – all ages. General Manager, Integrated Mental Health and Addictions A new position of General Manager, Integrated Mental Health and Addictions has been created to replace the existing GM and Senior Portfolio Manager roles. This is to better enable ‘whole of system’ leadership. The new role reports jointly to the Director of Hospital Services in relation to inpatient and acute services and to the Director of Primary & Community Services in relation to community based services delivered and/or funded by CMH. Following a selection process last week, Tess Ahern has been appointed to this position effective from 1 October 2014. In partnership with the Clinical Director of Mental Health, this position will work in collaboration with clinicians, NGOs, PHOs, locality and consumer groups to lead integration of mental health and addiction services with primary and community care. Richmond New Zealand Trust Limited Richmond NZ has a regional Contract Agreement for Mental Health Residential Support – Youth which is managed by ADHB. Significant issues have been reported to ADHB and have been followed up by the Clinical Directors for ADHB and CMH. A serious incident review is underway and the director for Mental Health at MoH has been updated. There is a question regarding future use of this service that will be dependent on the outcome of the investigation which may lead to a need for alternative solutions being sourced in the interim. The clinical teams are providing advice and support. Navigate Update Navigate, the Northern Regions collection of Mental Health NGOs, attended the September Regional Mental Health Planning and Funding meeting. They are continuing to lobby on various agenda items including extending contract terms from three years to five, issues with current audit processes and the fair funding campaign.

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

100%

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

2013 2014

Counties Manukau DHB - NGO AOD, all ages

> 8 weeks - % of total clients

>3 and <=8 weeks - % oftotal clients

< 3 weeks - % of total clients

No wait - % of total clients

< 3 weeks - DHB target

>3 and <=8 weeks - DHBtarget

32

The Navigate Executive stated that the campaign has achieved significant political traction and that key areas of concerns include, application of CCP, the national variance in pricing and burden of bureaucracy and excessive reporting and auditing. Mental Health First Aid Mental Health First Aid is an education course developed to enable individuals to recognise when someone developing a Mental Health problem or in a Mental Health Crisis and to give support until appropriate professional treatment is received or until the crisis resolves. Any interested adult living in the Counties Manukau DHB area can attend. The roll out plan for the Mental Health First Aid Programme is complete and the first training sessions have commenced. Access to training is coordinated via Ko Awatea. Your Smile Matters Recovery Solutions, Mental Health and Addiction Services have launched the ‘Your Smile Matters’ oral health campaign in September. The goal is to enable access to support for the improvement of oral health to clients accessing their service. This includes providing free oral health products, advice and information to clients whilst promoting the importance of good oral health. Reporting Rationalisation Project The NGO sector has for some time identified excessive and divergent reporting requirements as a significant burden. Navigate has more recently identified this as an issue as part of their ‘Fair Funding’ Campaign. Representatives from the Regional Funders and Planners group have agreed to look at rationalising reporting and potentially reporting systems across the Northern DHBs. A small working group is currently being set up to include representation from key stakeholders to progress this project. Prior to Sonya’s departure a paper was commissioned to look at reporting rationalisation with CMH.

33

4.6 Adult Rehabilitation and Health of Older People OBJECTIVE: To support older people in their homes and communities with integrated, locality based services that maximise independence through rehabilitation and quality care. PROGRESS Home Health Care - Community District Nurses and Allied Health Teams The Home Health service is available to people in their own home or at a clinic facility at four sites aligned to the four localities. The Home Health teams consist of allied health, district nursing, care assistants and other locality based staff with professional, clinical and cultural skills. Home Health Care received 1,070 referrals; discharged 1,113 clients and completed. Contacts across all bases for the month of September were 9,225.

Community Allied Health - (delivered from Home Health Care) Waitlists for Occupational Therapy and Physiotherapy in both Manukau and Orakau sites have increased slightly due to staff vacancies. Arrangements are underway to utilise available Allied Health Staff from the acute service during the refurbishment of Ward 23.

Previous month Total Orakau Manukau Pukekohe Howick

Waiting list Dietetics 10 5 0 0 2 3

Contacts Dietetics 74 97 33 25 14 25

Waiting list Occ Therapy 122 Not available 32 Not available 22

Contacts Occ Therapy 363 287 83 66 34 104

Waiting list Physiotherapy 30 101 43 10 18 30

Contacts Physiotherapy 340 259 60 102 47 50

Waitlist - Acute Allied Health Outpatients Waitlist Activity Women’s Health waitlist numbers have continued to decline with additional resource in the service. The waitlist target remains at 100, which will enable patients to be seen within clinical timeframe targets. The musculoskeletal outpatient’s waitlist has begun to stabilise with re-establishment of full

1000

2000

3000

4000

5000

April

May

June

July

Augu

stSe

ptem

ber

Oct

ober

Nove

mbe

rDe

cem

ber

Janu

ary

Febr

uary

Mar

chAp

rilM

ayJu

neJu

lyAu

gust

Sept

embe

rO

ctob

erNo

vem

ber

Dece

mbe

rJa

nuar

yFe

brua

ryM

arch

April

May

June

July

Augu

stSe

ptem

ber

2012 2013 2014

HHC Contacts

Botany

Orakau

Papakura

Pukekohe

34

staffing resources nearing completion. In the short term the team are investigating initiatives to reduce the waitlist.

Assessment and Coordination of Care for Older People – (Reported Quarterly in arrears) At 14 August 2014 100% of facilities were either training or booked for training:

• 30 (71%) facilities are trained or actively involved in training • 14 (29%) facilities are engaged and awaiting training.

This is an increase of 8% trained or actively involved in training. Early Supportive Discharge – Supporting Life after Stroke The Early Supportive Discharge service is actively supporting 16 patients at the moment. The service is now stable and is completing minor changes now to finalise processes to complete the ESD project. The service presented a poster at APAC conference in Melbourne at the start of the month and the team was nominated in the allied health awards for team of the year. The team is now working towards putting together a business case to propose the continuation of the service. National and Regional Spinal Strategy The National Spinal Action Plan first National Governance Committee meeting was held this month. The majority of work in September from Counties Manukau Health (CMH) has been on implementing and communicating the acute referral guidelines across the Auckland Northern Regional area. Community Geriatric Services (CGS) An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential the CGS team continue to provide support to five GP practices during the month of September. Target <80 Emergency Care presentations from residential facilities per month

• September 2014 saw 106 Aged Related Residential Care (ARRC) Clients present to Emergency Care. Of these, 16 presentations were falls related; a decrease from 17 for the

Acute Allied Health Outpatients

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

May 14

Jun 14

Jul 14

Aug 14

Sept 14

MSOP 231 208 259 249 243 225 298 296 304 314 346 380 407 Obstetrics/ Gynae

231 200 254 301 288 317 297

Gynae 253 214 196 168 127 128 Obstetrics 35 50 37 29 27 25 MORRSA [rheumatology]

54 71 49 59 61 59 67 55 64 56 56 53 30

Physio Hyperventilation Service

64 70 78 96 97 97 106 112 103 94 106 107 112

Cardiac Rehabilitation

12 14 25 21 22 17 7 10 17 28 29 24 22

Pulmonary Rehabilitation

147 150 134 89 152 124 64 80 56 49 33 94 99

OT Rheumatology

29 16 12 8 4 26 29 18 15 25 22 18 42

Total AAH waitlists

768 729 811 823 867 865 868 859 817 767 788 830 865

35

month of August, and 14 were potentially avoidable admissions, an increase from 12 for the month of August.

Memory Team 20,000 Days Collaborative – An out-reach model of the dementia pathway is under development to enable the service to be accessible for all Counties Manukau residents. This model has Primary Care as the lead with support from the specialist Memory Team service. Integration of teleconferencing to enable virtual multidisciplinary team reviews is being investigated. To 30 September 2014, the Memory Service had received 383 referrals, of which 62% were referred by Primary Care. The decline rate for the months of September was 3% a reduction from 14% for the month of August. Long Term Support Chronic Health Conditions (LTS CHC) Update on service mix provided – (Reported Quarterly) Counties Manukau Health LTS-CHC utilisation as at March 2014 (Note: date of reporting is unchanged but data has been updated as at 01 August 2014) There are 160 clients receiving long term chronic care funding and who are receiving the following services:

Service Number of clients Community Residential Services Dementia 5 Hospital and Specialised Continuing Care 24 Rest Home 18 Respite 3 Rehab and Community Carer support - Household Management 63 Personal Care 82 Individualised Funding 12 CMDHB's payment for DHB-IF has increased in current qtr, in

line with increase in number of clients from 10 in Dec-13 to 12 LTS-CHC clients in Mar-14. 4 LTS-CHC clients' payments (~$36k) processed incorrectly against the HoP contract in 2013 Q3 have been adjusted and reversal payments actioned by Sector Services now captured. Hence further increase in YTD and 12-Month Running is observed.

Dementia Day Care 1 Total 160

36

4.7 Intersectoral Initiatives OBJECTIVE Target populations/communities with high health, housing, social, employment and education needs to improve the health status and reduce health inequalities. PROGRESS

Warm Up – Counties Manukau (Retrofitting Home Insulation Project) Warm Up Counties Manukau is a free home insulation programme that retrofits insulation into the homes of low income families with high health needs. This programme is funded and delivered through a working partnership between the Energy Efficiency Conservation Authority (EECA), Autex Industries Limited, The Insulation Company, Right House Limited, Auckland Council -The Southern Initiative, Counties Manukau Health and the Middlemore Foundation. We insulate the homes of low-income families with health issues that may be related to housing, creating ‘healthier homes’ which are more energy efficient, thus ensuring that the home contributes to the health of the family. In addition, we offer a comprehensive health and social assessment for participating families to ensure that they are accessing appropriate health and social services. This approach ensures that we can address both housing and health issues. Referral Generation Counties Manukau Health is responsible for referral generation. Families/households can self- refer or may have the programme suggested to them by their health professional. We target the programme through information accompanying outpatient clinic appointments and by working in partnership with health professionals, government agencies, the non-government sector and the local community. Project Outcomes for the Warm up – Counties Manukau Project (1 July 2014 to 30 June 2015)

Month

Total Number of Referrals

Total Number of Homes Insulated

Total Number of Home Visits completed post install

July 2014 313 98 48 August 2014 251 107 47 September 2014 169 83 48 Total number of referrals generated

733 288 143

Please note: There is a time delay between referrals being received and the completion of the insulation install. The PATHS (Providing Access to Health Solutions) Programme PATHS is an intersectoral programme resulting from a partnership between Counties Manukau Health, and the Ministry of Social Development (MSD) that was established in 2004 in an effort to help tackle the growing problem of long-term benefit dependency. The aim of the PATHS programme is to assist people in receipt of certain benefits to return to work (the programme is voluntary), using an intensive individualised case management model aimed at reducing health barriers to employment. The key objective of the PATHS programme is to reduce health barriers to employment by providing an appropriate health intervention, which enables participants to return to employment.

37

Total Number of Voluntary Participant Enrolled onto the PATHS Programme

Month Total Number of Participants enrolled

July 2014 15 August 2014 20

September 2014 13 Total Number 35

38

4.8 Progress with Systems Integration OBJECTIVES

• Improved health and equity for all populations • Improved quality, safety and equity of care • Best value for public health system resources

PROGRESS At Risk Individuals (ARI) Programme The first tranche of practices have gone live with the programme, with 48 practices now utilising the ARI model of care. There are now 552 patients enrolled in the programme and patient feedback is positive. Training in the use of the CCMS care planning IT tool has been provided to 14 services within CMDHB and two NGOs to ensure that a patient’s care plan can be shared between care team members across primary, secondary and community. An ARI pathway has been developed and is available on the HealthPoint site, a total of 458 page views have been achieved since its go live in September. A practice learning session was held on 16 September and was attended by 32 general practice staff, representing most of the practices working within the ARI model at the time. Excellent feedback was provided by practice staff which will be used to improve the programme roll out plan. Key themes were:

• High level of support for the principles of the programme and a recognition that previous approaches were not maximising the support to complex patients

• Positive feedback on the use of the Partners in Health assessment tool, enabling general practice staff to engage with their patients in a much more meaningful way

• Recognition from general practice that this programme is exposing a level of previously unmet need, and this does require a large change in the way they work with complex patients

• The requirements of the programme are time consuming, and managing the pace of change is challenging for general practice

• Frustrations with the IT tool, particularly the lack of integration between the CCMS care planning tool and MedTech (practice management system)

• Acknowledgement of the low levels of health literacy and general literacy among this patient group The DHB are developing an action plan to address the concerns raised by the practices, and to provide them with additional support in implementing the programme. Issues relating to the usability of the IT tool remain unresolved, and this has been escalated to the regional Care Connect governance group, and a meeting held at an executive with the vendor to agree a service improvement plan. The following practices have transitioned to the ARI model:

39

• Millhouse Medical Centre • Highland Park Medical Centre • Clendon Medical Centre • Fellbrook Medical Centre • Hillpark Family Medical Centre • Manurewa Healthcare Medical Group • MCAM Medical Limited • Papakura Family Health Centre • The Wood Street Doctors • Greenstone Family Clinic • Botany Town Medical Practice • Clendon Family Health Centre • Conifer Grove Medical Centre • Drury Surgery Ltd • Dr Upsdell Surgery • Howick Medical Practice • Johns Lane Surgery • Leabank Health Centre • Mangere Bridge Surgery • Manukau Medical Associates • Manurewa Medical • Manurewa Peoples Centre • Drs Holmes & MacKay (Papakura East Medical Clinic) • Papatoetoe Family Doctors • Papatoetoe Medical Centre • Papatoetoe South Medical Centre • Pukekohe Family Health Centre • Papakura Christian Medical Centre • Takanini Family Health Care • Tuakau Health Centre • Turuki Health Centre • Your Health Centre (Peter Cameron) • Manurewa Family Doctors Ltd • Hunters Corner Medical Centre (26 Hoteo) • Hunters Corner Medical Centre (28 Hoteo) • Howick Health & Medical Centre • Tiakina Te Ora • Dr Kala Magan • Waiuku Medical Centre • Bader Drive Health Centre • Southseas

Safety in Practice This month the Safety in Practice Clinical Lead, Dr Beven Telfer, has been visiting practices and getting an oversight of the project from each practice’s perspective. He has been able to assist with audit and trigger tool queries and has been able to offer his support and guidance where needed. The meetings held have been encouraging in regard to the quality of practice self-assessment/reflection while informative in regard to adapting the Scottish audit tools to the New

40

Zealand context. They have also provided an opportunity to reflect on the collaborative organisation during the second year of this pilot. The two project improvement advisors have been working closely with PHO Facilitators and practices providing coaching around ‘Plan Do Study & Act (PDSAs)’, process mapping and the audit tools, in addition to providing coaching at the monthly Facilitator sessions. Dr Neil Houston, National Clinical Lead for the Patient Safety in Primary Care Programme in Scotland will be joining the Safety in Practice project team for two weeks in November to attend the Collaborative Learning Session in addition to individual and group practice and PHO visits. During Neil’s time here he will also coach the PHO Quality Facilitators and the Safety in Practice project teams. Neil will also be joining with the Safety in Practice Steering Group at their November meeting. Preparation for the Safety in Practice Learning Session in early November is well underway and with good uptake and interest indicated from practices. The practices have been sent a storyboard template to complete and this will allow the bundle groups to confer and share learning and ideas around improvements within their practices at the Learning Session. Three of the groups will also be presenting to illustrate learning around the three bundles in addition to one practice sharing their experience using the trigger tool to drive improvement within their organisation. The monthly PHO Facilitator Training Sessions have previously focused on familiarisation and issues around the three bundles, and the trigger tool. The group are now moving to using the meeting as a platform to share progress, common barriers and solutions. Monthly reports are now being generated from each practice indicating progress, including data where available.

41

4.9 Locality Reports

Eastern Locality Projects At Risk Individual (ARI) programme The At Risk Individual Programme is progressing with a further 10 Eastern Locality practices starting on 1 October 2014. Falls Prevention Programme and osteoarthritis The early intervention for osteoarthritis, physiotherapist-led, group sessions are continuing and the results for strength and balance will be available mid-October when the programme is completed. There are already a number of referrals for a second programme. COPD A comparison of annual admissions with COPD and a primary or a secondary diagnosis for July 2012 to June 2013 compared to June 2013 to May 2014 is 173 versus 76 respectively. This relates to 123

Eastern Locality Dashboard - August 2014

1. Acute Demand

Indicator Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14

CMDHB Avg Last 12 mths

1.1 Unplanned readmission rate (28 days) 6.1% 5.3% 5.7% 5.3% 5.2% 6.1% 6.4%1.2 ASH rate per 1,000 enrolled patients 1.4 1.3 1.1 1.4 1.6 1.4 2.11.3 Average bed day usage in last 6 months of l ife~~~ 10.8 10.2 14.8 9.3 13.5 16.1 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2. Aged Res identia l

Care Bed Days in Pukehoke and Frankl in Memoria l Hospi ta ls are included in the figures for 1.3 - this wi l l primari ly a ffect Frankl in as ARC faci l i ties are

independently located in a l l other loca l i ties .

2. Quality



2.1 Children fully immunised at 8 months (Target = 90%) 94.4% 93.8% 94.2% 94.4% 94.6% 95.1% 90.1%2.2 Children fully immunised at 24 months (Target = 95%) 93.1% 93.6% 94.1% 94.5% 95.0% 95.2% 93.2%2.3 Middlemore Radiology < 6 week wait time for GP referrals 82.1% 90.6% 90.2% 89.8% 88.2% 97.0% 94.0%2.4 CCM+++ CVD patients on triple therapy 86.4% 80.4% 83.5% 84.1% 77.2% 80.6% 85.2%2.5 DAR and CCM+++ Diabetes patients with HBA1c <= 64 mmol/mol 80.6% 74.6% 78.4% 77.5% 74.0% 70.3% 61.9%+++ We are us ing CCM data pending ava i labi l i ty of robust whole of population data

3. Shared Accountability Services

Item Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14Last 12

MthsLast 12

Mths Plan% Act vs.

Plan3.1 ED presentations not admitted 230 235 222 221 203 222 2,701 2,685 101%3.2 Acute medical bed days 1243 1209 1118 1231 1519 1643 14,983 14,787 101%3.3 Acute casemix-funded non-medical bed days 931 871 640 790 941 778 9,997 11,625 86%3.4 Medical outpatient attendances 2128 1878 2077 1872 1989 1808 22,915 20,561 111%Note : Al l SAS volumes for previous months may change as IDF updates are received and coding i s modi fied

4. Other



4.1 Percentage e-Referrals 14.1% 14.4% 16.7% 14.4% 14.0% 12.6% 10.5%4.2 Medical Outpatient DNA rate 1.8% 2.5% 3.0% 1.7% 3.9% 3.7% 8.5%Note : Numbers for previous months may change as coding i s modi fied for 4.2 , and additional referra ls are included for 4.1

42

patients versus 61 patients respectively. We need two more years’ worth of admission data to check if this is a sustainable trend or was due to a mild winter. Health Care and NASC integration On 1 October 2014 the NASC Eastern pod of 5.5 staff are being relocated to the Eastern Locality, Spectrum House, to join with the eastern Locality Home Health care Team. There are four; 2-hour Team Building and Redesign workshops planned for the 8th, 15th, 22nd and 29th October, led by Martin Chadwick and Mark Young. Clinical Advisory Pharmacist For July to September 2014 there have been 59 medication reviews, including 48 polypharmacy reviews, and provided three medicines information bulletins. The clinical advisory pharmacist is undertaking a weekly session in a general practice and attends the Locality multidisciplinary team meeting for patients identified as high risk. Clinical care bundle audits, including appropriate prescribing, for heart failure and for cardiovascular disease for all practices are almost compete.

Mangere-Otara Locality Dashboard - August 2014

1. Acute Demand



1.1 Unplanned readmissions (28 days) 6.6% 6.3% 7.5% 6.7% 7.7% 8.0% 6.4%1.2 ASH rate (per 1,000 enrolled patients) 2.5 2.5 2.5 2.5 2.8 2.9 2.11.3 Average bed day usage in last 6 months of l ife 8.8 8.4 12.8 8.8 14.9 17.0 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2. Aged Res identia l



2. Quality



2.1 Children fully immunised at 8 months (Target = 90%) 90.5% 90.8% 91.2% 91.1% 91.5% 91.6% 90.1%2.2 Children fully immunised at 24 months (Target = 95%) 94.3% 94.8% 94.3% 94.3% 94.3% 94.5% 93.2%2.3 Middlemore Radiology < 6 week wait time for GP referrals 94.4% 91.6% 96.3% 96.5% 91.9% 93.5% 94.0%2.4 CCM+++ CVD patients on triple therapy 87.3% 88.3% 86.1% 88.6% 87.6% 89.0% 85.2%2.5 DAR and CCM+++ Diabetes patients with HBA1c <= 64 mmol/mol 54.4% 52.8% 51.9% 51.7% 56.1% 57.9% 61.9%+++ We are using CCM data pending availabil ity of robust whole of population data



MthsLast 12

Mths Plan% Act vs.

Plan3.1 ED presentations not admitted 633 619 605 642 598 617 7,314 6,960 105%3.2 Acute medical bed days 1,681 1,863 2,168 2,120 2,154 2,301 23,868 23,000 104%3.3 Acute casemix-funded non-medical bed days 1,581 1,460 1,624 1,406 1,293 1,136 16,630 20,588 81%3.4 Medical outpatients 2,869 2,616 2,927 2,731 2,800 2,765 31,163 29,454 106%Note : Al l SAS volumes for previous months may change as IDF updates are received and coding i s modi fied

4. Other



4.1 E-referrals as % of all referrals 7.9% 7.4% 8.0% 6.8% 9.5% 9.6% 10.5%4.2 Medical Outpatient DNA rate 14.2% 14.5% 10.7% 14.0% 13.7% 14.6% 8.5%Note : Numbers for previous months may change as coding i s modi fied for 4.2 , and additional referra ls are included for 4.1

43

Otara/Mangere Locality Projects At-Risk individuals Programme – General practices are focused on implementing the ARI Programme. We are in the final design stages of the multidisciplinary approach which will supply a team of professionals allocated to general practices clusters, to work as one team supporting At Risk Individuals by sharing assessment information, forming care plans together and collectively monitoring the impact of their interventions. The co-design of a better integrated way of working for the Orakau Road Home Health Care Team is complete. There are seven domains of improvement which have informed an action plan. Staff are agreeing ways of working together to develop the ideas into “deliverables”. We continue to work on property solutions for Better, Sooner, More Convenient Health care in Otara and Mangere. The Otara-Mangere Leadership Groups will meet together for the first combined leadership group meeting in the last week of October.

Manukau Locality Dashboard - August 2014

1. Acute Demand



1.1 Unplanned readmission rate (28 days) 7.0% 5.8% 5.5% 6.3% 7.7% 7.8% 6.4%1.2 ASH rate (per 1,000 enrolled patients) 2.2 2.1 2.1 2.1 2.7 2.5 2.11.3 Average bed day usage in last 6 months of l ife~~~ 12.3 8.1 10.6 8.3 15.4 8.0 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2. Aged Res identia l



2. Quality



2.1 Children fully immunised at 8 months (Target = 90%) 89.3% 89.2% 89.4% 89.7% 89.8% 90.4% 90.1%2.2 Children fully immunised at 24 months (Target = 95%) 92.4% 92.6% 92.8% 93.2% 93.3% 93.5% 93.2%2.3 Middlemore Radiology < 6 week wait time for GP Referrals 95.2% 96.1% 97.7% 95.8% 94.2% 92.5% 94.0%2.4 CCM+++ CVD patients on triple therapy 81.0% 81.2% 84.6% 83.8% 85.1% 83.7% 85.2%2.5 DAR and CCM+++ Diabetes patients with HBA1c <= 64 mmol/mol 67.6% 63.5% 62.5% 63.8% 65.0% 66.0% 61.9%+++ We are using CCM data pending availabil ity of robust whole of population data



MthsLast 12

Mths Plan% Act vs.

Plan3.1 ED presentations not admitted 628 657 649 627 691 665 7,962 7,771 102%3.2 Acute medical bed days 2,585 2,265 2,238 2,566 2,701 2,937 30,741 31,454 98%3.3 Acute casemix-funded non-medical bed days 1,929 2,432 1,905 1,854 1,996 1,595 23,362 25,882 90%3.4 Medical outpatient attendances 3,666 3,635 4,048 3,695 4,120 3,761 43,745 41,510 105%Note : Al l SAS volumes for previous months may change as IDF updates are received and coding i s modi fied

4. Other



4.1 Percentage e-referrals 11.0% 10.6% 12.0% 12.3% 14.4% 13.6% 10.5%4.2 Medical outpatient DNA rate 7.4% 7.7% 7.2% 7.4% 7.8% 7.3% 8.5%Note : Numbers for previous months may change as coding i s modi fied for 4.2 , and additional referra ls are included for 4.1

44

Manukau Locality Projects The Home Health redesign project team have had a significant morale boost from winning the team of the year award at the recent Allied Health awards. The team continue to trial the changed intake process and will commence their first trial of clinic visits for allied health in October. The team have also been assigned to primary care teams in the Manukau locality clusters and will start working with the clinical leads and the GM to introduce themselves as primary points of contract for primary care teams. The At Risk Individuals program continues to roll out. The major technical issues that faced the Procare practices are mostly resolved, however, some of the practices will now require additional training and support to move forward with patient enrolments and achieve the desired uptake rates that will allow them to become confident with the program and further develop assessment and care planning skills. NHC indicate a later start than October for their practices. Community engagement process continues with presentations given by the General Manager on the locality model of care given to Papakura Community Network Group and we are awaiting formal permission to engage with them as a consultation group. The locality has also completed presentations for the international day for older people and has participated in the Manurewa Health Expo which was highly successful. Following on from the first pharmacy network meeting we have met with the newly appointed integration pharmacist and developed a steering group to identify ways in which we can support Community Pharmacists to engage with and support ARI implementation. The nurse lead role for the locality has been appointed and is currently working her way through the orientation process.

45

Franklin Locality Dashboard - August 2014

1. Acute Demand



1.1 Unplanned readmissions (28 days) 5.4% 4.8% 6.6% 6.8% 6.1% 6.5% 6.4%1.2 ASH rate (per 1,000 enrolled patients) 1.9 2.2 1.8 2.1 2.2 2.6 2.11.3 Average bed day usage in last 6 months of l ife~~~ 10.0 11.3 18.6 16.0 14.2 24.4 12.3Notes : Numbers for previous months may change as additional morta l i ty data i s received for 1.3 and as coding i s modi fied for 1.1 and 1.2. Aged Res identia l



2. Quality



2.1 Children fully immunised at 8 months (Target = 90%) 87.4% 86.9% 86.1% 86.1% 86.7% 86.9% 90.1%2.2 Children fully immunised at 24 months (Target = 95%) 90.9% 91.6% 91.7% 92.0% 91.9% 91.6% 93.2%2.3 Middlemore Radiology < 6 week wait time for GP Referrals 92.3% 81.8% 92.6% 100.0% 90.5% 91.9% 94.0%2.4 CCM+++ CVD patients on triple therapy 85.0% 81.1% 79.3% 84.0% 77.1% 82.0% 85.2%2.5 DAR and CCM+++ Diabetes patients with HBA1c <= 64 mmol/mol 68.2% 73.8% 70.9% 64.9% 71.6% 75.2% 61.9%+++ We are using CCM data pending availabil ity of robust whole of population data



MthsLast 12

Mths Plan% Act vs.

Plan3.1 ED presentations not admitted 113 113 110 116 95 106 1,305 1,248 105%3.2 Acute medical bed days 633 726 599 768 830 1,137 9,836 8,686 113%3.3 Acute casemix-funded non-medical bed days 591 555 550 625 735 521 7,080 7,858 90%3.4 Medical outpatient attendances 1,118 1,026 1,084 1,039 1,168 1,099 12,216 11,081 110%Note : Al l SAS volumes for previous months may change as IDF updates are received and coding i s modi fied

4. Other



4.1 E-referrals as % of all referrals 13.8% 13.8% 12.7% 14.1% 13.9% 15.8% 10.5%4.2 Medical Outpatient DNA rate 6.4% 7.7% 6.6% 6.8% 5.9% 4.2% 8.5%Note : Numbers for previous months may change as coding i s modi fied for 4.2 , and additional referra ls are included for 4.1

46

Franklin Locality Projects

Two Year Anniversary The Franklin Locality celebrated its two year anniversary with a roadshow for staff and interested groups both at Pukekohe Hospital and Franklin Memorial Hospital detailing our achievements and direction for the future. Self-Management Campaign A successful launch of the Self-Management Campaign at Ko Awatea was attended by several members from the Health Forum in Franklin. A follow up meeting will be arranged to pool ideas and to shape up a collaborative to contribute towards achieving self-management support programmes for 50,000 people with long term conditions by December 2016. Franklin Locality is well positioned to support this campaign within its already established Communities of Interest and Health Forum. Locality Strategic Opportunities Following a strategic planning session for the Locality Leadership Group (LLG) a draft two-three year locality plan is being developed for approval at the next LLG meeting. Franklin Rural SLAT (Service Level Alliance Team) Nationally the Rural Ranking Score (RRS) has been used as the mechanism for determining rural primary care funding over the recent past. The model has been problematic and has not taken into account all the issues local rural communities are facing. The National Rural Advisory Group recommended to the Government that that RRS should be replaced by local rural alliancing, and in October 2013 the government announced its support for allocating rural funding through an alliancing approach between each District Health Board, PHOs and the relevant GP practices.

Within CMH only two GP practices are classified as rural and qualify for MoH monies as part of the Rural Ranking Score. These are Waiuku Health Centre and Tuakau Health Centre. Both of these practices sit within the Franklin Locality. Under the new alliancing framework and PHO Services Agreement 14-15 the rural funding received by these two GP Practices can now be used as a flexible resource once the alliance is established. There is a national requirement for 75% of those receiving the funds as at 30 June 2014, to be involved in the SLAT and to agree how the funds will be utilised. The Franklin Rural SLAT comprises of the relevant PHO’s, the two GP Practices and CMDHB representatives. It met for the first time in September 2014 and the following main actions were agreed: • Waiuku Health Centre and Tuakau Health Centre to prepare annual plans (2014-15) outlining

how the funds will be utilised / allocated. • A three year plan for the Franklin Rural SLAT be developed for approval by the District Service

Alliance. Marae-based Health Services Work continues on developing a Franklin model of care for the Whare Oranga clinics in conjunction with the National Haurora Coalition as part of their Integrated Service Agreement work programme. Members of Franklin LLG met with representatives of a large number of marae in Franklin at Huakina Development Trust recently to hear their views on the Whare Oranga clinics.

47

Progress with Annual Workplan – First Quarter progress The Franklin Annual Workplan has reported on the first quarter achievements. Locality initiatives have been mostly achieved, with the exceptions of Palliative Care and the implementation of the community model initiative. DHB wide initiatives are on track except for dementia services (Memory Team Pathway). Work is about to begin to adapt the Memory Team pathway for the rural environment in Franklin. PHO initiatives are progressing, and at this stage concern is over the locality immunisation rates.

48

4.10 Finance Report This report highlights net exceptions from agreed budget with a focus on full year variances.

CPHAC Financial Report Mth Mth Mth YTD YTD YTD

As at August 2014 Actual Budget Var. Actual Budget Var.

$000 $000 $000 $000 $000 $000 Total Revenue 32,001 33,004 (1,003) 64,531 66,008 (1,477)

Expenditure

Pharmaceuticals 8,321 8,337 16 16,658 16,675 17 PHO/GMS/Rural Retention 6,811 6,902 90 13,620 13,803 183 Primary Care NGOs 891 914 23 1,902 1,829 (73)

Chronic Health Conditions Programme (CCM) 765 923 158 1,693 1,846 154 After Hours Regional Service 636 566 (70) 1,242 1,133 (109) Maori & Pacific Health NGOs 519 527 7 1,078 1,053 (25) Child, Youth & Mortality 635 588 (47) 1,199 1,176 (23) Oral Health 463 464 1 927 928 1 Localities/20k initiatives 251 445 194 494 891 397

LTS - Chronic Health Conditions 325 347 21 576 693 118 Immunisations 243 246 3 491 491 1

Primary Options for Acute Care (POAC) 159 181 23 340 363 23

> 65 Home Based Support Services 94 60 (34) 189 121 (68) > 65 Aged Residential Care 2,027 1,920 (107) 3,992 3,841 (151) > 65 Other 6,069 6,178 109 12,203 12,356 153 Mental Health NGOs 3,603 4,194 592 7,685 8,389 704 Other 125 88 (37) 30 175 146 Total Expenditure 31,938 32,882 943 64,317 65,763 1,446

Net contribution 63 122 (59) 214 245 (31)

A number of variances net off between costs and revenue. The net favourable year to date variance of $29k is made up of the following highlights:

Localities & 20k days Initiatives (FY $397k favourable, 44.6%) New initiatives have phased implementation. Expected to come in on Budget for the full year. After Hours Regional Service (FY$109 unfavourable, 9.6%) Most of the unfavourable variance is matched by a favourable revenue variance the small net unfavourable residue variance is as the result of the consortium agreement post budget finalisation. Other (FY$146 favourable) Offset by reduced revenue YTD August.

49

Counties Manukau District Health Board Community & Public Health Advisory Committee Meeting – (22nd October 2014)

5.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

6.1 Minutes of the CPHAC Meeting with public excluded 24.9.2014


Confirmation of Minutes For the reasons given in the previous meeting.

Counties Manukau District Health Board Community ......2014/10/22 · (Mr Ezekiel Robson arrived...

Documents

Transcript of Counties Manukau District Health Board Community ......2014/10/22 · (Mr Ezekiel Robson arrived...