DRAFT AGENDA - Ministry of Health NZ · 6.3 Healthy Food and Beverage Guidelines Update NOTE P Gush...

Wairarapa District Health Board APRIL 2016

DRAFT AGENDAHeld on Tuesday 19 April 2016Lecture Room, CSSB Building, Wairarapa DHB, MastertonCommencing at 11:00 am

BOARD PUBLIC SESSION

Board Members Only at 10:30am, Public Board Meeting to open at 11:00am

1. PROCEDURAL BUSINESS 20 11:00am

1.1 Karakia R Karaitiana

1.2 ApologiesDerek Milne ACCEPT L Southey

1.3 Continuous DisclosureInterest Register/Conflict of Interest

ACCEPT / CONFIRM L Southey

1.4 Minutes of previous meeting ADOPT L Southey

1.5 Matters Arising from Previous Meeting L Southey

1.6 Action Items Register L Southey2. REPORTS 11:20am

2.1 Chair Report NOTE 15

2.2 Inwards/Outwards Correspondence NOTE

2.3 C E Report NOTE A Isbister 15 11:35am

2.3.1 OIA Report April 2016

2.4 Finance Reporting March 2016 NOTE K Sheridan 15 11:50am

3. HEALTH & SAFETY 5 12:05pm

LUNCH – 30 minute break 12:10pm

4. DECISION PAPERS 12:40pm

4.1 Concerto Privacy Impact Assessment AGREE J ThorpeS Hunter

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5. DISCUSSION PAPERS 12:55pm

5.1 Pacific Health 6 Monthly Update NOTE T Sua’ole Gush 20

6. INFORMATION PAPERS 10 1:15pm

6.1 Dementia Monitoring NOTE S Williams

6.2 Nursing Workforce6.2.1 Appendix

NOTE H Pocknall

6.3 Healthy Food and Beverage Guidelines Update

NOTE P Gush

Wairarapa Board Public 19 April 16 - PROCEDURAL BUSINESS

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Wairarapa District Health Board APRIL 2016

7. MEETING REPORTS 1:25pm

7.1 CPHAC/DSAC Minutes Public NOTE

8. RESOLUTION TO EXCLUDE THE PUBLIC

Meeting to Close 1:30pm. Proceed to Public Excluded session


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WAIRARAPA DISTRICT HEALTH BOARD

Wairarapa Board INTEREST REGISTERLAST AMENDED: FEBRUARY 2016

Name InterestMr Derek MilneChair

∑ Chair, Wairarapa District Health Board∑ Deputy Chair, Capital & Coast District Health Board∑ Deputy Chair, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, Hutt Valley and CCDHB Finance Risk & Audit Committees∑ Ex Officio Member, WDHB Finance Risk & Audit Committee (30 March 2016)∑ Ex Officio Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Member, WDHB CPHAC/DSAC (30 March 2016)∑ Brother-in-law is on the Board of Healthcare Ltd

Mrs Leanne SoutheyDeputy Chair

∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee∑ Deputy Chair, Wairarapa District Health Board∑ Chair of Lands Trust Masterton (15 February 2016)∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees∑ Director, Southey Sayer Limited

∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina Sutherland Trust

∑ Trustee, Wairarapa Community Health Trust

∑ Sister-in-Law is employed by WDHB

∑ Shareholder of Mangan Graphics Ltd

∑ Member of UCOL Council

Ms Liz FalknerMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Retired General Practitioner with Masterton Medical Limited∑ Medical Advisor – Post Polio Support Society NZ Inc∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Dr Rob IrwinMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Trustee Wairarapa Community Health Trust∑ Member, South Masterton Rotary∑ Chair, Wairarapa Trails Trust (30 March 2016)

Ms Helen KjestrupMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Finance Risk and Audit Committee (30 March 2016)∑ Works for Central TAS as an Auditor∑ Shareholder, Property Investment Company – Kjestrup Properties∑ Assessor for Royal College of GPs for Cornerstones Programme

Mr Rick LongMember

∑ Member, Wairarapa District Health Board

∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee

∑ Chairman of Wairarapa Community Transport Services Inc

∑ Chairman of Tolley Educational Trust

∑ Trustee for Sport and Vintage Aviation Society

∑ Biomedical Services New Zealand Limited


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∑ Member of Masterton Lands Trust

∑ Director, Longs Properties Limited (1 February 2016)

Mr Alan ShirleyMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Surgeon at Wairarapa Hospital∑ Technical Advisory for Ministry of Health∑ Wairarapa Community Health Board Member∑ Technical Expert Advisor∑ Subregional Endoscopy Steering Group∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees (30 March 2016)

Ms Fiona SamuelMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Casual Nurse, at Wairarapa Hospital∑ Duty Nurse Manager, at Wairarapa Hospital∑ Contractor Auditor for TAS∑ Member of Clinical Board Wairarapa District Health Board

Ms Janine VollebregtMember

∑ Member, Wairarapa District Health Board∑ Chair, WDHB Hospital Advisory Committee (30 March 2016)∑ DHB Nurse Educator for the UCOL Undergraduate Maori Students. This 0.4 FTE position is

effective from 30 April 2008 to 30 June 2010.

∑ Community Health Clinic establishment∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Mr Ronald KaraitianaMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa Te Iwi Kainga Committee∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee∑ ACC Manager in Claims Management∑ Wife Kylie Smith is currently the DHB liaison from Child Youth & Family∑ Maori relationships with staff vary from a number of cousins working at DHB∑ Occasionally plays in a band (potential no risk to the board)∑ Trust Chairman Akura Lands Trust

Ms Jane HopkirkMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory Committees

& Disability Support Advisory Committees (30 March 2016)∑ Member, Wairarapa Te Iwi Kainga Committee∑ Kaiarahi, Takiri Mai Te Ata, Kokiri Hauora∑ Member, Occupational Therapy Board of New Zealand (23 February 2016)

Note: From 15 December 2015, additional items of interest will be dated accordingly as per Board request


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PUBLIC

Wairarapa District Health Board Page 1 Page | 1

Minutes: Anna Cardno, Board Secretary

Held on Tuesday 22 March 2016Lecture Room, CSSB Building, Wairarapa Hospital, Masterton

Commencing at 11am

BOARD PUBLIC SECTION

PRESENT

Derek Milne ChairLeanne Southey Deputy ChairJanine Vollebregt MemberRick Long MemberRob Irwin MemberFiona Samuel MemberJane Hopkirk MemberLiz Faulkner MemberRon Karaitiana MemberHelen Kjestrup Member

IN ATTENDANCEAdri Isbister Chief ExecutiveAnna Cardno Board SecretaryJustine Thorpe Programme Director, Tihei WairarapaJill Stringer Interim Director Wairarapa Health ServicesSandra Williams SIDUJason Kerehi Director, Maori Health ServicesNigel Fairley GM MHAID - 3DHBHelen Pocknall Executive Director Nursing & MidwiferyCatherine Sheridan Senior Finance Manager

APOLOGIESAlan Shirley Member

1.0 PROCEDURAL

INTRODUCTIONS

OPENINGA karakia was offered to open the meeting prior to the Workshop session preceding the meeting of the Board.

1.1 APOLOGIESAlan Shirley.


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PUBLIC


1.2 CONTINUOUS DISCLOSURE1.2.1 INTEREST REGISTER

Interest register to be altered to reflect the 2016 Board Committee membership.Anna Cardno to amend Membership.

The Board CONFIRMED that it was not aware of any other matters (including matters reported to/decisions made by the Board at this meeting) which would require disclosure.

1.4 MINUTES OF THE PREVIOUS MEETINGItem 4.3 Public Minutes 23/2/16: Edit required “Maori Directorate yet to confirm key priorities”

APPROVEDThe Board resolved to approve the minutes of the Members (Public) meeting held on 23 February 2016 as a true and accurate record of the meeting, pending the amendment described above.MOVED: Derek Milne SECONDED: Janine VollebregtCARRIED

1.5 MATTERS ARISINGRick Long reminded the Board Chair that a paper outlining the Nursing FTE was to be provided. Adri Isbister to follow up.

Intranet access still to be investigated for Board members. Access to the Intranet can be provided without the inclusion of WDHB email accounts. Rose Byl to action.

Theatre Utilisation Report – forward planning for theatres.Bring to April HAC meeting.

HAC business as usual reports to go to HAC only – no need for inclusion in CEs report to Board. Include information by exception only in the off-HAC month.Risk Register to be included in papers at every Board meeting.

1.6 ACTION ITEMS REGISTER

Concerto Privacy Impact Report has gone to the Clinical Group. Seeking consumer input.To come to the Board in April, after endorsement or otherwise by FRAC.

2.0 REPORTS

2.1 CHAIR REPORT - VERBALThe Chair gave a verbal report of all relevant appointments since the February Board meeting.

MIF: The Minister had questioned if IDFs were charged at full or part cost basis. There was some indication that negotiation of IDF rates may be undertaken. CE and SFO are keenly aware of IDF costs and


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PUBLIC


processes and will continue to closely monitor the IDF spend.

RGG Chairs Meeting: DHBs in slow/no growth populations (eg WDHB) are in a very different position than DHBs in faster growing regions. There are no retrospective payments, making the WDHB “share of the pie” much reduced. Challenges are high – and there is a potential opportunity to raise this issue with the government as a collective DHB voice.

The government’s Productivity Commissioners Report has strong primary focus on interagency collaboration and efficiencies.

Governing for Quality document - noted that it provides useful governance information that will be taken on board and assist the focus on improving the Board’s work within the DHB to achieve, and make a valuable difference.

Deficit: MoH focus remains on the deficit and living within our means.

The Chair was asked to provide a written report for the Board in future. This was agreed and will be actioned for the April meeting.

2.2 INWARDS / OUTWARDS CORRESPONDENCE

Noted correspondence as provided to the Board. Copies of any correspondence can be obtained from the Board Secretary.

INWARDS PUBLIC

23/2/16 Yvette Grace Letter to the Board1/3/16 MoH: Chai Chuah Delivery of better public service3/3/16 MoH: Dr Jonathon Coleman Quarter Two Health Targets5/3/16 Grayson Family Thank you for sympathy letter4/3/16 Dr Lindsay Tanne Thank you for retirement letterOUTWARDS PUBLIC

22/2/16 Grayson Family Sympathy letter4/3/16 Iwi Kainga Response to Yvette Grace letter 23 February 2016

HQS mail to come into Inwards Correspondence. Correspondence can be included in the Resource Centre in Boardbooks. No named correspondence relating to private/patient matters to be included in Public papers.

2.3 CHIEF EXECUTIVES REPORTPoints of specific note:

1. Workforce Development StrategyHow will we reshape our investment into workforce development? Noted the looming need to replace our ageing Nursing workforce, and likewise with GP’s demographic (retiring), while there is an abundant workforce in some skilled areas. WDHB workforce planning – management aim to have clinicians work at top of scope, and also to bring in Healthcare Assistants etc. Work towards WDHB being the Employer of Choice. Strategic Approach required:


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PUBLIC


What is our WDHB strategy? What are our predicted workforce requirements? Can we meet the demands of our community? People / Capability / Leadership : All being considered in a strategic approach. WDHB is an excellent training ground for graduate(particularly first year) doctors to get valuable hands-on experience that they do not get in larger hospitals..

2. Health and Safety AuditGood feedback post the review. Report not to hand yet. Favourable comments received.

3. CMOSkype Interviews with a wide team, involving clinical staff. Preferred candidate has been selected. SMO’s need to “buy in” and he will be coming to present to the SMOs for meet & greet session.

4. LaboratoryConfident that the Laboratory changeover is working well. No issues have been raised.

5. TrainingJanine Vollebregt queried the WDHB processes for Training. IDWHS to provide for April HAC.

2.3.2 IDWHS ReportColonoscopy Wait Times – visual graphic included – favourable statistics. Y Axis needs to be labelled “Compliance” to make sense.

Cardiac Monitoring SystemCMS is being installed. Five compatible monitors are being installed, which will be read in PACU. Staff being trained. Used in ED, HDU, MSW. Still does not provide enough monitors, so does require them to be strategically placed. Needs to be included as a risk on the Risk Register.

Winter Planning – ChristchurchMoH initiated planning workshops with like-sized DHBs. Very valuable cross pollination of initiatives from across the group and useful information sharing.

Child Development – Bannister StreetMove of the Child Development service to Bannister Street – has extra space that may be utilised for non-hospital focussed services eg: physio, continence clinics. The Board noted it is not ideal for all services to be scattered across the urban area.

Orthopaedic resourceIDWHS is confident of including a permanent resource in the long term, but continues to be filled by Locums in the meantime.

Theatre useA planning process to stabilise the case weights and volumes through theatre is underway to ensure that targets are met. Case weights are currently in excess. Key focus on looking at the General Surgeons’capacity, to increase IDFs inwards flow. Theatre use productivity is a priority area. Looking at robust production plans and quality improvement processes (eg, reducing duplication) to build a more productive theatre flow. Local Leadership is critical.Group of 7 staff is going to Whanganui DHB to look at reducing time to care. Interim Director Wairarapa Hospital Services (IDWHS) to report back to Board from Whanganui exercise.


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PUBLIC


Balanced ScorecardFaster cancer treatment: Does not show any increase indication in Maori clients. Currently no trends are identified in the breach information. Trend graphs are required. Increase in falls rates: Janine Vollebregt identified intense summer heat may be a contributing factor. IDFs to be included. ASH Presentations to be included. Data required on Acutes as well as Electives. Bed use data definitions required. Balanced Scorecard should be made available to all staff – better visibility and allows staff to take ownership of progress. Balanced scorecard will be amended as the Board requested and presented accordingly for HAC in April. IDWHS.

2.3.3 Allied Health, Scientific and Technical Child Development Service Update should be in HAC. Andy Harris is now reporting directly to the CE. The Chair noted Russell Simpson’s good work and key achievements, including the Professional Supervision SLA in place with HVDHB. The Board emphasised the need for these achievements to be continued. CE to draft a letter of recognition to Russell, on behalf of the Board.

2.3.6 Alcoholically impared people presentations and effects on EDA regular Police liaison meeting takes places and WDHB is well supported. Publicity was invoked by an Australian story that a local reporter picked up on. Health & Safety risk register should include alcoholically impared persons presentations and staff assault.

Board to acknowledge the Nurses & Midwives Day. Kaitiake Magazine – WDHB to look to include a Thank You to Our Nurses article.

The Board RECEIVED the reportMoved: Derek Milne Seconded: Ron Karaitiana

2.4 FINANCE REPORTINGThe Senior Finance Officer spoke to the Financial Reports. February is favourable for the third month, but any real trend will not be usefully assessed until next month. Forecast year end currently $3.5M deficit, down $100k on last month – moving in right direction.

IDFs hard to control or anticipate. Queried whether general public knows how IDFs affect the WDHB. Some of staff possibly unaware. IDWHS reported that an analysis of IDFs recently noted only 10-12 cases over the year that could have been managed in house. SMO awareness over IDF decision making has been emphasized. Education of staff and public is important – need to highlight the IDF issue. Noted that 4,500 people commute from Wairarapa to Wellington, and seek medical services in the city. No primary care to access after train arrives in Wairarapa destination. IDWHS to prepare an IDF report for the April HAC

SFO noted that there is no “fat in the system left to trim” in service delivery and savings identified are likely 18 mths to 2years to make an impact.

Mental Health bed nights queried concern that it may be an understaffed area – CE disagreed. Wairarapa has significant NGO support and there is sufficient funding.


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PUBLIC


Costs of pharmaceuticalsNeed to investigate the potential to increase the budget in light of the NZ dollar.

Maori Health Services Jane Hopkirk queried if savings have been identified in the Maori Health Services budget. SFO to investigate.

The Board RECEIVED the reportMoved: Derek Milne Seconded: Janine Vollebregt

3.0 PRESENTATIONS

3.1 PSYCHOSOCIAL SUPPORT FOR PEOPLE WITH CANCER IN WAIRARAPADr Philippa Croy, Regional Lead/Clinical Psychologist, 3DHBCatherine Epps, Director of Allied Health, Technical & Scientific, 3DHBTrish Chivers, Professional Lead for Social Work, WaiDHB/HVDHB

Cancer Support: Psychology & Social Work

(3DHB)Dr Philippa Croy, Regional Lead/Clinical Psychologist, 3DHB

Catherine Epps, Director of Allied Health, Technical & Scientific, 3DHBTrish Chivers, Professional Lead for Social Work, WaiDHB/HVDHB

4.0 INFORMATION PAPERS

4.1 ANNUAL LEAVE MANAGEMENT PLANNeed to introduce a statute of limitations on staff to use their Annual Leave. CE noted that the parameters of leave are embedded in the MECA. One week a year is able to be paid out to staff. Annual leave plans are very carefully monitored. Noted that Health and Safety is an issue if backfill is holding staff from taking leave.

5.0 MEETING REPORTS

5.1 HAC MINUTES & ACTION PLAN: PUBLICNoted.

5.2 CPHAC/DSAC MINUTES: PUBLICNoted.

5.3 HEALTH & SAFETY EMERGO REPORT


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PUBLIC


Noted.

6.0 RESOLUTION TO EXCLUDE THE PUBLICThe Board AGREED that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table. The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

1. Public Excluded MinutesBoard and Committees, Matters arising, Correspondence

For the reasons set out in the 16 June 20145 Board Agendas

2. Insurance Renewal2. H & S Strategic Risk Action Plan3. ALT Draft TOR 4. Potential Service Changes5. Savings Tracker6. Financial Appendix7. CE Report Excluded

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations

Section 9(2)(i)(j)

* Official Information Act 1982.

MOVED: Derek Milne SECONDED: Janine VollebregtCARRIED

MEETING ADJOURNED: 2:30pm

DATE OF NEXT MEETING: 19 April 2016

CONFIRMED that these minutes constitute a true and accurate record.Dated this day of 2016

DEREK MILNEChair, Wairarapa District Health Board


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WAIRARAPA DISTRICT HEALTH BOARD PUBLIC BOARD MEETING : ACTION ITEMS

Wairarapa District Health Board MARCH 2016 Page 1

MARCH 2016 – ALLOCATED TASKSPUBLIC MEETING

Chair To provide a written Chairs Report from April meeting forwardBoard Secretary Interest Register to amend to reflect new Committee Membership

Edit Minutes of meeting previous as per Draft Minutes CEO Letter of recognition to be sent to Russell Simpson, on behalf of the BoardAmber O’Callaghan Risk Register to be included in papers at every Board Meeting

Limited numbers of Monitors in the Cardiac Monitoring System – needs to be included as a risk in Risk RegisterRisk Register should include alcohol presentations and staff assault

Jill Stringer Y Axis of Colonoscopy wait times to be titles “Compliance” in BSCBSC to be amended as per 2.3.2 draft Minutes 22/3/16

Helen Pocknall Board to acknowledge Nurses and Midwives DayKai Tiake article has been arranged 4/4/16 (Helen Pocknall)

I T Rose Byl to action Intranet accounts for the Board

Red Text

Carried over BOARD HAC Quarterly Future Completed


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ACTION ITEMS

Action Responsible Meeting date

How Dealt with

Delivery date

Date Completed

PUBLIC BOARD MEETING

12/15.4 Health & Safety Risk actions

GM, H&S and CE to develop action plan to be implemented for/by the Board.

Amber O’Callaghan

15/12/15 Report 19/4/16 22 March 16

12/15.6 Suicide prevention

Report on current Wairarapa services for suicide prevention

Sandra Williams

17/11/15 Update 19/4/16 Defer until May 2016

2/16.1 Dementia Monitoring

Dementia Care in Wairarapa - who provides this, and how this is monitored by SIDU

Sandra Williams

23/2/16 Report 19/4/16

PUBLIC HAC MEETING

3/16.1 Theatre Utilisation

Theatre Utilisation paper to HAC 19 April 2016 Jill Stringer 22/3/16 Report 19/4/16

3/16.3 Nursing FTE Tracking Nursing FTE numbers Helen Pocknall

22/3/16 Report 19/4/16 Defer until May 2016

3/16.4 WDHB H & S Training

WDHB processes for Health and Safety Training requested by Janine Vollebregt

Di Mazey 22/3/16 Report 19/4/16

3/16.5 Whanganui DHB Reducing Time to Care

IDWHS to report back to Board from Whanganui DHB visit – information sharing: Reducing time to care

Jill Stringer 22/3/16 VerbalReport

19/4/16

3/16.6 IDF Report IDWHS to prepare an IDF Report for HAC Jill Stringer 22/3/16 Report 19/4/16

QUARTERLY REPORTS REQUIRED/

Pacific Community Health Report

Quarterly Report to the Board Tofa Suafole Gush

Report April

Nursing & Midwifery Report Quarterly Report to the Board Helen Pocknall

Report May


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Human Resources Quarterly Annual Leave Management Report including advice on any pay out period policies and management of staff well-being.

Donna Hickey / Gretchen Dean

Report May

FUTURE ACTIONS

12/15.7 Progress on HCSS tender

Any lessons from CC and Hutt DHBs from Home and Community Support Services joint tender process (1)

Sandra Williams

18/8/15 Report June

12/15.9 Concerto Privacy impact assessment

A substantive report on the Concerto Privacy Impact Assessment and patient informed/uninformed consent processes to be provided to the Board prior to implementation

Justine Thorpe

Report When it is to hand

12/15.10 Service Level Agreements

Service Level Agreements are required as standard arrangements, following best model approach

18/8/15 July

1The Procurement process is still open until a contract is signed. Report back on this in June. The Boards sign off on the provider at the April meetings. We get the contract

in place by early May/mid May. We will be able to consider the lessons learnt late May.


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Board Chair Correspondence of Note

BOARD CORRESPONDENCE REGISTER TO 15 April 2016

INWARDS PUBLIC

1/4/16 Hon Jonathan Coleman Value & High Performance of the Health System

OUTWARDS PUBLIC

12/4/16 Russell Simpson Acknowledging service to Wairarapa DHB

Wairarapa Board Public 19 April 16 - REPORTS

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BOARD DISCUSSION PAPER

Date: 12.04.16

Author Adri Isbister Chief Executive

Subject Chief Executive Report

RECOMMENDATION It is recommended that the Board:

NOTES The contents of this report

1. Executive Summary

Again a busy month for Wairarapa. I’ve attended many meetings including with Mayor Lynn Patterson; we are going to look at how best to lead an intersectoral initiative in Wairarapa.

We are again seeing a small profit a fourth month in a row to a deficit budget. WaiDHB is now “back on track” (to a deficit budget). We continue to communicate the need to prioritise the savings and initiatives strategy and the concept of identifying and committing to making savings and that everyone does their part in making an effort.

Thank you to Board members who took part in the flu jab campaign.

We have gone out to tender for cleaning, orderly and handyman services. This is now on the Government Electronic Website.

The preferred candidate for CMO Doctor Tom Gibson has agreed to come on board. Tom will be providing clinical services as well as CMO. He was able to make a presentation to the SMO meeting while he was in Masterton and this was very positive.

We have an update on the Healthy Food and Beverage strategy as an appendix from RPH. We will be going into phase three which focuses on food offered dominated by whole grains, vegetables and fruit with minimal fat, salt and sugar.

We also need to approve the CT scanner paper approved in principle in December which has better detail for the Board.

2. Financials

The month of March had a favourable variance to budget of $775k and year to date favourable variance of $291k. The bottom line result year to date was a deficit of ($1,480k) compared to a budget deficit of ($1,770k).

Pressures continue to be medical personnel, treatment related costs and IDF’s.


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3. Annual Plan 2016/17

Work continues on this activity. The first draft went to the MoH on 31st March. There have been a couple of questions regarding service change that I will be responding to.

4. Maori health

Focus has been on getting the first draft of the Māori Health Plan to Ministry of Health. DNA and Ante-natal projects are progressing well.

5. Allied Health

Please see enclosed report. Andy Harris the Director of Operations (2D) will be reporting to me directly with Russell’s exit.

6. Primary and Community

We continue to work closely with primary care. As you will see from the HAC report primary care was involved in the winter planning workshop

Palliative Care Update

The Wairarapa Palliative Care Network is near finalising the MOU that sets the protocols for how the network will function. Parties to the Network are Wairarapa DHB, Compass Health, Hospice Wairarapa, Wairarapa Cancer Society and Te Omanga Hospice. The group have agreed there is a need to look at respite care in the Wairarapa however has agreed to wait until the Lower North Island Palliative Care Clinical Network strategic direction which is due to be completed in May 2016. As part of ensuring Wairarapa consumer input into this direction a forum for people/family that have experience of receiving palliative care services in the Wairarapa was held on the 7th of April. Following the completion of the strategic direction the local Network will use it to guide the development of a terms of reference that will review respite services and investigate feasibility of solutions.

7. Laboratory

This appears to be going well. I am part of the lab governance group and have heard no real issues.

8. Hospital

We have had a number of audits provided by TAS, Colposcopy, Health and Safety and an information Security audit. No major issues being flagged.

Recommendation

That the Board RECEIVES the report.


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Board April Board Meeting Wairarapa OIAs to 8 April 2016 # Requestor Sent Request Due Referred to StatusOIA 16-08

A MarettLabour Researcher

28.01.16 • Copies of all correspondence (including emails) your district health board has sent to NZ Health Partnerships mentioning any issues with the National Infrastructure Platform since October 2015

• Copies of all correspondence (including emails) or advice that your district health board has sent to the Minister of Health or his office regarding the National Infrastructure Platform since June 2015

• Copies of all correspondence (including emails) that your district health board has sent to the Ministry of Health mentioning any issues with the National Infrastructure Platform since August 2015

26.02.16Extended

Shayne Hunter IT

In progress

OIA 16-10

Michelle NortonPharmacy Today

18.02.16 I am following up on what pharmacy service each DHB has funded through the $750,000 one-off pool for patient-centric services for the 2015/16 financial year, as part of the Community Pharmacy Services Agreement contract variation. 1. How much of the $750,000 pool has been allocated to your DHB?2. What specific pharmacy services has your DHB funded with this money and why did it choose those specific services?3. How has having this funding impacted on patient services in your DHB? (Any specific results would be useful)4. Is the DHB going to fund these services in the 2016/17 financial, if yes which services, if not, why not?Response:1. Wairarapa DHB (WDHB) has been allocated $8,377 of the $750,000 pool.2. These funds have not yet been allocated and are still under consideration. WDHB has sought and obtained feedback from pharmacy owners on a group of services that have been identified, and are considered to be patient-centric. WDHB also asked for further suggestions from pharmacy owners. Based on the initial feedback received, WDHB will be working with individual pharmacy owners to agree the services that will be funded and it will seek assistance from a small advisory group of pharmacists to inform the selection and development of those services. 3. Final decisions have not yet been made but WDHB expects commitments to be made on the services in 2015/16, although provision of some of the services may not all occur in 2015/16. 4. The $750,000 is a one-off funding pool that is only available for 2015/16.

17.03.16 Keith FraserSIDU

Completed 15.03.16

OIA 16-11

Erin PennoResearcher Otago Uni

25.02.16 The last three for external consultancies and foe each consultancy please provide:a. The name of the organisation engaged to carry out the consultancyb. The date the consultancy was engaged and the durationc. The purpose of the consultancy and the expected outcomesd. The reason an external consultancy was sought rather than producing the work in housee. The process used to engage consultants (eg competitive tender, EOI via GETS, direct approach

to consultants etcf. The cost of the consultancy

SIDU On Hold re issued 04.04.16


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g. Details of what the consultants delivered. Please provide copies of all files supplied by consultants, for example final reports, preliminary reports or findings, slides and communications

h. Details of how the deliverables of the consultancy were used, including any improvements or changes that resulted.

Please provide all details of any processes in place to determine whether external consultancies provided value for money.

Please provide details of any consultancies planned in the future, including the purpose and expected outcomes, the reason an external; consultancy is being sought, and the expected duration and cost

OIA 16-12

Neil Shaw 29.02.16 1. How many recruits did your DHB hire at House Officer Position from 1 January 2015 to 17 February 2016 (this includes PGY1 and PGY2) whether on short-term or long-term contracts:2. During what months of the year were these recruits hired, how many recruits were hired on each instance and at what position;3. How these positions were advertised on each occasion;4. How many CVs did you screen for each position and;5. If you hired thru a recruitment agency, what agencies did you hire from?Please include information regarding the recruits who have been hired but may not have started their roles yet. In case you do not have this information because the hiring was thru an outside agency, I expect you to obtain this information.In regards to the information requested above, whether you hired these recruits directly thru a recruitment agency, I want to know:6. How many of those recruited did not have a New Zealand Residence Visa (NZRV) or Citizenship? To clarify this point, a Working Holiday Visa or Work Visa is not a Residence Visa:7. From what countries did these recruits without a NZRV graduate, and8. What is the citizenship of these recruits without a NZRV?Response was sent from 3DHB Donna Hickey. The Board can request a copy

29.03.16 Jenny Rutherford

Completed 22.03.16Emailed from 3DHB Donna Hickey

OIA 16-13

Mark Atkin 29.02.16 School Dental data for 5 year olds and 8 year olds: number of children with DMFT score per scoreResponse:Declined as would take 40 plus hours of reading each individual file, as this is not yet electronic

30.03.16 Andrea Rutene

Completed 15.03.16

OIA 16-14

Robert Steven Fairfax Media

01.03.16 1. How many doctors and how many nurses were employed full-time at Wairarapa Hospital in 2005 for at least nine months?2. How many doctors and how many nurses were employed full-time at Wairarapa Hospital hospital in 2010 for at least nine months?3. How many doctors and how many nurses were employed full-time at Wairarapa Hospital hospital in 2015 for at least nine months?4. How many patients can the Wairarapa Hospital inpatient ward hold? ie, how many beds?5. Did you close the Wairarapa Hospital inpatient ward at any point in 2013, 2014, or 2015, and if so, what were the primary reasons?

31.03.16 Gretchen / Jill

Completed 29.03.16


19

6. In 2015, did Wairarapa Hospital transfer some patients who presented acutely to the emergency department to Palmerston North hospital or Wellington hospital, and if yes to the above question, roughly how long does it take ambulances or ambulances to get to Palmerston North hospital or Wellington hospital?Response:Q 1, 2, 3

NCodeGroupWORKED 9+ Month in 2005

WORKED 9+ Month in 2010

WORKED 9+ Month in 2015

Medical 7 14 19Nursing 30 35 35Grand Total 37 49 54

4. Wairarapa hospital can accommodate up to 91 beds, but usually operates (resources) around 805. Several years ago, we planned to amalgamate the Assessment, Treatment and Rehabilitation ward

(capacity 14 beds) with the Medical/Surgical ward (capacity 38 beds) for three weeks over the Christmas period. While the occupancy figures from previous years indicated this was feasible, in the event we had a higher than anticipated number of admissions to MSW so reopened ATR after about ten days. Since then our overall population has increased, making it less likely that we would attempt this again, but we do offer staff the opportunity to take short-notice annual leave over this period if the workload allows.

6. Yes, Wairarapa hospital did transfer out patients who presented acutely to the emergency department in 2015. On average we transfer 12 patients a month from Acute Services (includes our High Dependency Unit) either by helicopter, fixed wing aircraft or road ambulance. Depending on the destination and environmental factors, it can take between 1.5 and 2 hours by road, considerably shorter by air. For an air transfer, the retrieval team has to arrive first, so it can usually take approximately about the same time from call to destination as by road. Most of these patients are transferred to Wellington, but some may go to Starship or Burwood spinal unit, which takes obviously longer.

OIA 16-15

Teressa ChoJustice Department

04.03.16 1. How many hospitals, schools, police stations, courthouses are on land where rent is being paid to an iwi or tribe?2. How much rent is paid to iwi/tribes annually for these properties? We understand that you may hold information about hospitals and I was hoping you could assist with this response.Response:Wairarapa DHB does not pay any rent to an Iwi or Tribe or operate on any land where rent is paid to an

05.04.16 Jennie M Kate S

Completed 10.03.16


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Iwi or Tribe.We do have some services operating on land rented from the Office of Treaty Settlements but to my knowledge none of this land has been passed back to an Iwi or Tribe at this stage.

OIA 16-16

Jackie BlueKaren JohansenHuman Rights Commission

09.03.16 As the funder of primary care services within your district we are seeking the following information from you:1. How many Maori /Iwi providers do you contract with?2. What are the names and contact details of each of these providers?3. Do you know how many clinical nurses (if any) are employed by each of these providers to deliver the contracted services?4. If yes, please provide details.5. Do your contracts with these providers have any specifications, requirements or specific contractual provisions regarding the rates of pay for clinical nursing staff employed by the provider?6. If yes, please provide details.7. If no, do you have any plans to introduce any contractual provisions of this nature?8. In relation to your primary health care service contracts with non-Maori/Iwi providers, do your contracts with these providers have any specifications, requirements or specific contractual provisions regarding the rates of pay for clinical nursing staff employed by the provider?9. If yes, please provide details.As a provider of health services in your district, can you please provide the following information regarding your own nursing workforce:1. How many clinical nurses do you employ?2. How many of these are Maori?3. What is the average pay rate for Maori and non-Maori nursing staff respectively?

08.04.16 SIDU In Progress

OIA 16-17

Phillip Wakefield NZ First

14.03.16 1. The total number of pharmacies investigated by the Wairarapa DHB for charging patients more than five dollars for medications fully subsidised by Pharmac, each financial year, since 2011, including year to date. 2. The total number of pharmacies found by Wairarapa DHB to be charging patients more than five dollars for medications fully subsidised by Pharmac, each financial year, since 2011, including year to date. 3. A breakdown of the actions taken by Wairarapa DHB against any pharmacy found to be charging patients more than five dollars for medications fully subsidised by Pharmac, each financial year, since 2011, including year to date.

14.04.16 SIDU In Progress

OIA 16-18

Gemma Hartley NZ Herald

14.03.16 • Number of times pest control has had to be called to the hospital, broken down into yearly figures for 2013;2014;2015;2016.• Details of the reasons why pest control were called to the hospital, broken down into yearly figures for 2013;2014;2015;2016.• What changes if any the hospital made following any/or all of the visits from pest control, broken down into yearly figures for 2013;2014;2015;2016.

14.04.16 Tina R Completed31.03.16


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• Cost of the call out and any work done by pest control upon attending the hospital, broken down into yearly figures from 2013;2014;2015;2016Response: Wairarapa DHB has a regular monthly on-site visit by the provider of pest control. These visits entail the checking and replacing of all bait stations and fly units. This service is provided to the Wairarapa DHB on a yearly contract basis by Canon Hygiene. The total cost of this service for Wairarapa DHB is $8,556 annually. There is an additional cost of $130.00 per hour for treatments outside of this contract. In the past year we have had to call the service once and that was due to flies in our Outpatient Department brought about by extremely hot weather. An automated fly spray dispenser was installed in the area to reduce/eliminate the number of flies. Prior to 2014, a different company provided the pest control service and unfortunately there are no available records that identify the number of times (if any) call-outs were made in addition to the contract.

OIA 16-19

A Marett Labour Researcher

16.03.16 Copies of all documents, advice, correspondence (including emails) received from the Ministry of Health and/or National Health Board and/or TAS that provides advice on the PBFF model on national pricing adjusters for the 2015/16 financial year and/or the 2016/17 financial year.

15.04.16 To be Transferred

Transferred to MoH

OIA 16-20


17.03.16 1. What is the total cost in dollars in terms of the increase for implementing the following MECAs for the 2015/16 year?- PSA Mental Health & Public Health Nursing MECA - PSA Allied Public Health and Technical MECA2. What is the total amount in dollars that you received in crown funding in 2015/16 to cover the costs from both these MECA agreements? What is your budgeted amount? Is there a funding gap, if so, how much in dollars?- PSA Mental Health & Public Health Nursing MECA - PSA Allied Public Health and Technical MECAPlease provide a breakdown for each MECA.

17.04.16 transfer to DHBSS

Transferred 29.03.16

OIA 16-21

A MarettLabour Researcher

22.03.16 1. In light of the recent Cochrane report (Native Tissue, Biological Grafts or Mesh for Transvaginal Pelvic Organ Prolapse Repair) and the reclassification by the FDA of surgical mesh used in Pelvic organ prolapse, what new guidelines or communications (please provide copies) have been implemented regarding the use of surgical mesh devices and of the surgical procedures that use synthetic mesh?2. What new policies or reports have been prepared regarding the use of surgical mesh for pelvic organ prolapse since October 2015?

21.04.16 Ian Denholm

In Progress

OIA 16-22


23.03.16 1. Is your district health board making efficiencies in managing personnel budgets/cost in 2015/16, if so, how much?2. As part of these efficiencies, is your district health board planning to make these savings in managing Individual Employment Agreement increases? If so, please provide a summary of the costings, number of planned IEA increases broken down all personnel categories (see question 3 below) 3. How many FTE staff were employed on collective contracts in each of the past five financial years

22.04.16 Donna H Gretchen

In Progress


22

broken down by personnel category: medical, nursing, allied health, support personnel, management/administration personnel?4. How many FTE staff were employed on individual contracts in each of the past five financial years broken down personnel category?5. What was the total remuneration paid to staff employed on collective contracts in each of the past five financial years broken down personnel category?6. What was the total remuneration paid to staff employed on individual contracts in each of the past five financial years broken down personnel category?

OIA 16-23

A Stewart The Press/Stuff

23.03.16 Act request to the Wairarapa District Health Board for information about the Child and Family mental health wait list, or its equivalent, since 2011.Please include:A breakdown, per month, of the average number of days each client spent waiting to be seen since 2011.A total per year of how many clients were seen by the CAF service since 2011, broken down by month. A total per year of how many clients were not seen in the 3-week ministry waiting time. An average amount of time a client waiting to be seen by the CAF would wait, prior to 2011.I would appreciate this information being provided in an Excel spreadsheet format.

22.04.16 withdrawn Withdrawn3.04.16

OIA 16-24

J Roden Radio NZ

29.03.16 Could the below questions please be answered for each of the last five years 2011-2015 and well as a total for the five years (also, not financial years). Could you please include the figures so far for 2016 if possible.1) The total cost incurred by the DHB for foreign patients each year?2) How much foreign patient debt has the DHB written off each year?3) How much of the foreign patient debt each year was emergency? How much was elective? (or any other category of medical care)4) How much, if any, additional funding over what was allocated in the budget did the DHB receive each year for foreign patients?Could the below questions please be answered as totals (ie not per year)1) What is the total amount of money owed to the DHB by foreign patients currently?2)What are the five largest amounts owed by foreign patients currently? (please include: What is it for? When did it occur? Was it an emergency? Where is the person from? Are they still in the country? Where is their repayment at? For example, are they making monthly repayments or have they been referred to a debt collection agency)Other1) Please provide any correspondence between the DHB and the Ministry/Minister of Health in regards to foreign patient debt over the last two years. 2) Please briefly outline the protocol the DHB has in place to recoup the cost of treatment from foreign patients.

27.04.16 Judith P In Progress

OIA A Marett 30.03.16 The CPAC threshold/commitment to treatment threshold (not the average CPAC score) for each of the 28.04.16 Sarah In Progress


23

16-25 Labour Researcher

following surgeries and please do not provide ranges:- Cataract surgery- Hip Joint replacement- Knee Joint replacementAt the end of the following months:- February 2013- February 2014- February 2015- February 2016

Boyes

OIA 16-26


31.03.16 Your DHB’s outpatient waiting list for a first attendance/appointment broken down by month for the past three calendar years for the following services:- Social Worker- Occupational therapist- Speech Language therapist- Dental therapist- physiotherapistPlease also break this down by facility.

28.04.16 Andy Harris and Sarah Boyes

In Progress

OIA 16-27

Laura HopkinsNZ First researcher

4.04.16 1. The total number of dental therapists employed by the Wairarapa DHB to provide dental care to pre-school children and school children each financial year since 2008 including the current number of dental therapists providing dental care to pre-school children and school children. 2. The total number of dental hygienists employed by the Wairarapa DHB to provide dental care to pre-school children and school children each financial year since 2008 including the current number of dental hygienists providing dental care to pre-school children and school children.

03.05.16 Carolyn B In Progress

OIA 16-11

Erin PennoOtago Uni

4.04.16 Re issue of request:1) Please provide the details of all external consultancies engaged over the last three years (from 2012/13 financial year to 1 April 2016) which cost in excess of $10,000. We would appreciate it if the following information could be provided:a) The year in which the consultancy was engaged; b) The name of the organisation engaged to carry out the consultancy;c) The purpose of the consultancy or the type of service provided;d) The cost of the consultancy;e) Whether or not tenders were invited. We would be very grateful if this information could be provided in an electronic spreadsheet if possible.2) What was the total amount spent on external consultants across all categories in each year?3) Do you have a current policy on the use of external consultants? If yes, please provide a copy of this.4) Do you have a current policy in place for determining whether external consultancies provide value for money? If yes, please provide a copy of this.

03.05.16 Finance In Progress


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25

Adri Isbister Catherine Sheridan

Chief Executive Senior Finance Manager

Wairarapa District Health Board

FINANCIAL REPORT(Summary)

MARCH 2016


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Wairarapa DHBOperating Report for the month of March 2016

Month $000s Year to Date AnnualActual Budget Variance Last Year Variance Actual Budget Variance Last Year Variance Budget Last Year

Revenue11,157 11,090 67 10,748 408 Devolved MoH Revenue 100,215 99,624 591 96,072 4,142 133,147 128,098

134 118 16 125 9 Non Devolved MoH Revenue 1,122 1,063 58 1,093 29 1,418 1,493140 178 (39) 100 39 ACC Revenue 1,743 1,604 139 1,331 412 2,138 1,944367 304 62 215 151 Other Revenue 2,898 2,739 159 2,897 1 3,776 3,808274 276 (3) 279 (5) IDF Inflow 2,472 2,486 (14) 2,523 (51) 3,315 3,34523 24 (2) 28 (5) Inter DHB Provider Revenue 251 219 31 264 (14) 293 371

12,094 11,992 102 11,497 597 Total Revenue 108,700 107,736 965 104,181 4,519 144,087 139,059

Expenditure

Employee Expenses874 871 (3) 838 (36) Medical Employees 7,965 7,455 (510) 7,048 (917) 9,916 9,599

1,446 1,605 159 1,409 (37) Nursing Employees 13,310 13,543 233 12,442 (868) 18,084 17,015455 489 35 430 (24) Allied Health Employees 3,778 4,170 392 3,783 4 5,555 5,10465 58 (7) 56 (9) Support Employees 588 497 (91) 486 (102) 661 688

520 516 (5) 382 (138) Management and Admin Employees 4,306 4,374 69 3,546 (760) 5,832 4,8763,360 3,539 179 3,116 (244) Total Employee Expenses 29,947 30,040 93 27,303 (2,644) 40,047 37,283

Outsourced Personnel Expenses189 172 (17) 215 27 Medical Personnel 1,798 1,547 (251) 2,012 214 2,063 2,69216 11 (5) 7 (9) Nursing Personnel 204 95 (109) 76 (129) 127 13229 2 (27) 4 (25) Allied Health Personnel 64 22 (42) 22 (42) 30 363 0 (3) 0 (3) Support Personnel 8 0 (8) 0 (8) 0 7

127 147 20 133 6 Management and Admin Personnel 1,150 1,320 170 1,084 (66) 1,760 1,459364 332 (32) 359 (4) Total Outsourced Personnel Expenses 3,225 2,985 (239) 3,193 (32) 3,980 4,326

242 340 98 363 121 Outsourced Other Expenses 3,059 3,045 (14) 3,250 191 4,065 4,428723 733 9 789 66 Treatment Related Costs 7,548 6,580 (969) 6,933 (616) 8,782 9,376725 721 (4) 717 (8) Non Treatment Related Costs 6,288 6,540 252 6,167 (121) 8,745 8,143

2,500 2,553 53 2,783 283 IDF Outflow 25,054 22,977 (2,077) 22,912 (2,143) 30,636 29,8193,633 3,974 341 3,693 60 Other External Provider Costs 32,771 34,962 2,191 34,252 1,481 46,553 45,571

243 272 29 303 60 Interest, Depreciation & Capital Charge 2,288 2,378 90 2,708 420 3,238 3,468

11,790 12,463 673 12,124 333 Total Expenditure 110,180 109,506 (674) 106,718 (3,462) 146,047 142,414

304 (472) 775 (627) 931 Net Result (1,480) (1,770) 291 (2,537) 1,057 (1,960) (3,355)

Result by Output Class647 206 441 (84) 731 Funder 2,977 2,448 529 266 2,711 3,642 1,08816 (5) 21 33 (17) Governance 148 (2) 149 386 (238) 1 354

(359) (673) 313 (577) 217 Provider (4,604) (4,216) (388) (3,189) (1,415) (5,602) (4,796)304 (472) 775 (627) 931 Net Result (1,480) (1,770) 291 (2,537) 1,057 (1,960) (3,355)

There may be rounding differences in this report


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STATEMENT OF FINANCIAL POSITION

Actual $000's

Budget $000's

June 15 $000's

Actual vs Budget

Actual vs Last year

Bank 0 0 0 0 0Accounts receivable & Prepayments 3,948 3,350 3,350 598 598Stock 871 797 797 74 74Total current assets 4,819 4,147 4,147 672 672Fixed assets 41,069 42,119 41,652 (1,050) (583)Work in progress 4,109 3,686 797 423 3,312Total fixed assets 45,178 45,805 42,449 (627) 2,729Investments in associates 644 643 3,349 1 (2,705)Trust funds invested 315 266 266 49 49Total Investments 959 909 3,615 50 (2,656)

Total Assets 50,956 50,861 50,211 95 745

Bank 1,758 73 1,499 (1,685) (259)Accounts payable and accruals 8,417 9,574 9,912 1,157 1,495Crown loans and other loans 5,069 5,069 5,069 0 0Capital charge payable 63 117 0 54 (63)Current employee provisions 6,102 7,370 5,702 1,268 (400)Total current liabilities 21,409 22,203 22,182 794 773Crown loans 20,750 20,750 20,750 0 0Other loans 325 325 376 0 51Long term employee provisions 562 563 562 1 0Trust funds 315 266 266 (49) (49)Total non-current liabilities 21,952 21,904 21,954 (48) 2Total Liabilities 43,361 44,107 44,136 746 775Net Assets 7,595 6,754 6,075 841 1,520Crown Equity 42,037 39,037 39,037 3,000 3,000Revaluation Reserve 5,558 5,558 5,558 0 0

Opening Retained earnings (38,520) (36,071) (35,165) (2,449) (3,355)Surplus/(deficit) (1,480) (1,770) (3,355) 290 1,875Total retained earnings (40,000) (37,841) (38,520) (2,159) (1,480)Total Equity 7,595 6,754 6,075 841 1,520

Variance

Wairarapa DHBStatement of Financial Position

Mar-2016


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3

2 CASHFLOW FORECASTThe cash flow forecast is based on cash flow expectations as at 11 April 2016 including the agreed $3m equity injection received in January 2016. The borrowing limit for Wairarapa DHB is $5.09 million.

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

$000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000

Operating Cash Flows

Operating receipts 13,359 13,770 13,791 13,674 13,564 13,484 14,034 13,784 26,179 4,544 13,819 13,524Operating payments -14,014 -13,360 -12,511 -13,704 -13,664 -13,910 -13,990 -13,250 -13,689 -16,900 -13,095 -14,610Capital charge paid 0 0 -228 0 0 0 0 0 -186 0 0 0

Total operating cash flows -655 410 1,051 -30 -100 -426 44 534 12,304 -12,356 724 -1,086

Investing Cash Flows

Interest Receipts 6 6 6 6 6 6 6 6 6 6 6 6

Sale of assets 0 0 0 0 0 0 0 0 0 0 0 0Purchase of Fixed Assets -175 -155 -150 -80 -80 -80 -127 -116 -81 -119 -119 -122Increase in Investments & Trust Funds 0 0 0 0 0 0 0 0 0 0 0 0CRISP investment 0 -615 -267 -79 -79 -79 -79 -79 -79 -79 -79 -79FPSC investment -20 -20 -20 -18 -18 -18 -18 -46 -92 -139 -139 -176

Total investing cash flows -189 -784 -431 -171 -171 -171 -218 -235 -246 -331 -331 -371

Financing Cash Flows

Capital Injections 0 0 0 0 0 0 0 0 0 3,000 0 0Equity repaid 0 0 0 0 0 0 0 0 0 0 0 0Loans drawn 0 0 0 0 0 0 0 0 0 0 0 0Debt repaid -6 -6 -6 -6 -6 -6 -6 -6 -6 -6 -6 -6Net interest expense (Loans) -245 0 -225 0 0 -44 -197 0 -225 0 0 -44

Total financing cash flows -251 -6 -231 -6 -6 -50 -203 -6 -231 2,994 -6 -50

Net Cash Flows -1,095 -381 390 -208 -278 -647 -377 292 11,826 -9,693 387 -1,507

Opening cash balance -1,765 -2,860 -3,241 -2,851 -3,059 -3,336 -3,984 -4,361 -4,068 7,758 -1,934 -1,547

Closing cash balance -2,860 -3,241 -2,851 -3,059 -3,336 -3,984 -4,361 -4,068 7,758 -1,934 -1,547 -3,054

Wairarapa District Health BoardForecast Statement of Cash Flows

For period April 2016 to March 2017


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PUBLIC

Wairarapa District Health Board – 3DHB ICT – Response to Concerto Privacy Impact Assessment – March 2016

WRDHB INFORMATION PAPER

Date: 11 April 2016

Endorsed by Adri Isbister – Chief Executive, Wairarapa DHB

Shayne Hunter – Chief Information Officer, 3DHB

Author Justine Thorpe – Programme Manager, Tihei Wairarapa

Subject Privacy Impact Assessment on Extending Access to Patient Hospital Electronic Health Record (Concerto)

RECOMMENDATION

It is recommended that the Wairarapa DHB Board:

Note this paper and the proposed way forward for extending access to Concerto within the Wairarapa context.

1 INTRODUCTION AND BACKGROUND

This paper has been developed to support the Patients First’s – Privacy Impact Assessment (Final v.16.3.8) dated 8 March 2016 for access to Concerto for the following areas:

∑ General Practice∑ Community Pharmacy and Ambulance Services

A PIA[1] is a systematic process for evaluating a proposal in terms of its impact upon privacy. It is designed to identify the potential effects that a proposal may have on an individual’s privacy, examine how any detrimental effects upon privacy might be overcome and ensure compliance with the health information privacy rules set out in the Health Information Privacy Code 1994.[2]

As part of the 3DHB Information Management Service Level Alliance work programme for 2014/15 Compass Health commissioned Patients First to undertake a PIA covering the 3DHBs on primary care access to concerto (includes GPs, Nurse, Wellington Free Ambulance and Community Pharmacy). This piece of work stalled due to a change in solution in CCDHB and delays in its development. Given this solution would not be available in the Wairarapa for some time it was decided to complete the original PIA to ensure something was in place for existing concerto access within the 3DHB region and further rollout in the Wairarapa to Wellington Free Ambulance and Community Pharmacy. This document covers all 3DHBs and is attached for your information.

As part of the process in finalising the PIA, Patients First met with the Office of the Privacy Commissioner (OPC). The purpose was to make OPC aware of the work and the main outcomes. OPC were provided a brief summary outlining the purpose of the project as sharing hospital and health information through to other care settings including general practice, community pharmacy and ambulance services.

Key themes were highlighted with particular focus on the information contained on hospital patient information forms (PIF) as the area needing the most focus. Patients First also highlighted that there were some more technical findings, but in the interest of pragmatism and moving the project forward

[1]Privacy Impact Assessment Handbook, Office of the Privacy Commissioner 2007: https://www.privacy.org.nz/news-and-publications/guidance-resources/privacy-impact-assessment-handbook/

[2] The Health Information privacy Code 1994 is a code of practice issued by the Privacy Commissioner under the Privacy Act 1993. See: https://www.privacy.org.nz/the-privacy-act-and-codes/codes-of-practice/health-information-privacy-code/

Wairarapa Board Public 19 April 16 - DECISION PAPERS

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these could be addressed in the future as IT solutions become available. Overall OPC were comfortable with the approach and appreciated being alerted to the work. OPC thought that the document should be a public document similar to the PIA for the primary care Shared Care Record.

2 CURRENT CONCERTO ACCESS ACROSS THE SUB-REGION

Access to concerto by third parties across the sub-region is not consistent. Below is a table outlining the current access for the third parties covered by the PIA.

Capital & Coast Hutt Valley WairarapaGeneral Practitioners/Nurse Practitioners Some Includes NPs

Community Pharmacy

Wellington Free Ambulance

General PracticeAll 3 DHBs provide some level of access to Concerto for general practice. CCDHB provides a limited number of GPs with access, however, further roll out will occur following the development of an improved IT solution. Hutt Valley GPs have had access for a number of years. Wairarapa GPs were offered access in 2015 and to date 80% of GPs have taken this up and the four nurse practitioners in primary care. The rationale for General Practice to have access to Concerto is straight forward.

Community PharmacyHutt Valley Community Pharmacists have had access to Concerto for approximately 7 years. Many other DHBs also have access including Counties Manukau, Canterbury, South Canterbury, Taranaki, and Hawkes Bay. The experience of Hutt Valley community pharmacies is that access to Concerto has significant benefits in patient safety and reducing patients’ waiting time. It also has significant time savings for community pharmacists. Pharmacists report that they would not be without it.

A number of community pharmacies also have access to patients’ primary care record through general practitioners, and like Concerto access will allow the multi-disciplinary team to function and to contribute to a Shared Care Patient Plan.

Community pharmacists are Registered Health Professionals and are usually the first health professional contact a patient will have after a hospital discharge. There are often prescriptions issues that require a resolution that access to Concerto supports. It makes the system safer for the patient and saves time for both the patient and pharmacist. It lets the pharmacist spend more time counselling patients on their medications rather than on tracking down hospital staff to check the accuracy of the discharge script and changes to the patient’s medication regime.

Wellington Free AmbulanceAccess to concerto for Wellington Free Ambulance (WFA) has been rolled out in the CCDHB and Hutt Valley districts. Through this access WFA also have access to the primary care shared care record via the concerto interface. WFA have a clinical desk that is responsible for providing clinical advice to ambulance crew, providing access to better information on patients to the WFA clinical desk greatly improves clinical decision making and the quality of services to patients.

3 A PROPOSED WAY FORWARD

Providing access to Concerto is consistent with both the Government’s strategic goals of system integration and the smart system envisioned in the refreshed NZ Health Strategy. A large section of this strategy is dedicated to the importance of access to information technology for patients and the whole


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multidisciplinary team. Access to Electronic Health records for all health providers will allow all professionals involved in looking after the patient the ability to share information with others to ensure timely and consistent care and to make better decisions.

It is proposed that access to Concerto be extended. The PIA is complete and the OPC have expressed that they are comfortable with the document. The PIA finds that the existing controls are sufficient for extending access but make a number of recommendations to further strengthen its these controls. Appendix 1 summarises the key recommendations of the PIA which cover strengthening information governances, making changes to the patient information forms, increasing staff and patient awareness of information sharing and enhancing auditing.

The DHB will begin extending access in partnership with Compass Wairarapa. It will also review the recommendations and report back on its implementation.


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APPENDIX 1

The table summarises the recommendation and proposed Wairarapa District Health Board follow up of the recommendations.

Theme Report Reference

Recommendation Action Proposed

Patient Information Forms

1 WDHB should model the information content of the Patient Information forms on the CCDHB form (including the improvements to the latter form)

Review Patient Information Form and decide to either adopt CCDHB form or adapt current Wairarapa form as per the recommendations.

2 If WDHB does not adopt the CCDHB form it should be modified to contain the following statements:

∑ Indicating to patients that they have the right to access their information or have it corrected

∑ Indicating the purpose of the information collection

∑ Outlining the intended recipients of the information collected

∑ That the supply of information is voluntary and

∑ Remove reference to information “on this form” from the PIF when referencing the purpose of collection

∑ That patients have the right to access and correct their information or

∑ A reference to further information including that outlined above that sets out what happens to patient health information collected by the DHB and the rights patients have with regard to that information

Modify patient information form as per recommendations as it is out dated within the context of the current health environment.

4 All patient information for DHBs should include a statement covering:

∑ Health information will be collected from the patient during and about their hospital services

∑ Hospital health information may be shared with authorised health providers external to the hospital that provide health care to the patient

∑ External providers should seek consent to view hospital health information about a patient

∑ Discharge information will be shared with the patient’s enrolled or usual general practice

Include health information statement in patient information as per the recommendations.

7 Recommend that all three DHBs collaborate to share common patient information statements to begin to provide sub-regional consistency to such statements. This is

DHBs to decide if they will share a common patient information statement to provide consistency. This will


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particularly relevant where patients are transferred between facilities from one DHB to another.

be recommended.

9 There appears to be no documented mechanism to easily identify patients who wish to withhold the sharing of their hospital health information. Until such time a reliable mechanism can be established, we recommend that statements suggesting information can be withheld should not be included in Patient Information forms.

Adopt this recommendation and not include statements that suggest information can be withheld in the patient information form. This is consistent with current practice and we do not create a privacy issue that we will have if we offer it and don’t implement a solution.

10 Recommend that all references to “Family Doctor” be replaced with more appropriate terminology. Recommend using the phase “health services involved in your care” to convey briefly but accurately the concept that hospital health information may be shared amongst a number of health services.

If not wanting to provide such a broad and succinct statement, recommend that patient information forms list “enrolled or usual general practice”, “ambulance services”, “community pharmacy”, and “accident and medical and after hours services” to convey clearly the settings in which their hospital health information may be accessed. Such statements should be kept up to date as access to hospital health information is changed.

Adopt this recommendation to use the phase ‘health services involved in your care’ as the general statement to avoid the form becoming quickly out of date as information sharing increases.

11 Recommend that hospitals maintain a list of agencies who will hold health information, including laboratory and radiology service providers. Because such a list may be significant it may not be included on the Patient Information Form, but should be available in some ancillary document and refined on the PIF. Such a list should be updated for time to time to ensure it is current and accurate.

Develop an ancillary document to the patient information form that keeps a list of agencies that have access to and hold health information. This list should be maintained as changes occur and reviewed annually for accuracy.

12 Recommend that the Patient Information Form includes a short statement outlining the general consequences of not supplying or sharing health information. While a statement indicating that patients have the right to withhold the sharing of such information they may only make an informed decision about doing this if they understand the nature of such consequences. A patient who may wish to withhold information may be reluctant to have a conversation about this with a staff member.

Adopt this recommendation and build into the changes required to be made to the patient information form.

15 Recommend that the Patient Information Form includes a statement indicating that the supply of information is optional and that this is placed near the beginning of the form. This should also include a general statement on the consequences of not supplying information.

Adopt this recommendation and build into the changes required to be made to the patient information form.

Awareness 5 All three DHBs should establish an education campaign to ensure external providers seek patient consent to access hospital health information. This is particularly import while patients are not able to opt-out of having their information shared at the hospital level.

∑ General practice patient information forms should state that GPs and practice nurses may access their hospital health information

Compass Health in collaboration with DHB ICT will develop an education campaign to ensure that patient consent is requested prior to an external provider accessing the hospital health information. This education will also include privacy training.


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∑ Ambulance service patient information forms should state that the ambulance service may access their hospital health information for the purposed of care, care co-ordination and statistical reporting

∑ Community pharmacies should display patient information signs advising that pharmacists may access their hospital health information

None of the steps above should preclude the providers seeking consent (verbal/written) from patients to access their hospital health information prior to doing so where practical.

In addition, and as part of this campaign Compass Health will support external providers listed to make appropriate changes to patient information forms and resources that can be displayed in waiting areas.

Guidelines 6 The project should develop material to use in each care setting which outlines appropriate guidelines around the access and use of hospital health information. Items that should be considered for each care setting include but are not limited to:

General Practice∑ Access should be made by clinical staff (GPs and Practice Nurses) only

Community Pharmacy∑ Access should be made by pharmacists only

∑ Access should be restricted to computers in private clinical areas (e.g. dispensary)

∑ Any conversations regarding patient clinical information, especially that obtained from hospital health information or shared records should be done in a private area of the pharmacy

Ambulance Services∑ Access should be made by the clinical desk or authorised users only

∑ Information should be relayed to ambulance crews only over a private channel (e.g. mobile phone).

There may already be material/protocols established for the project, or sub-regions of the project already using some shared access arrangements. These should be consolidated, distributed and promoted even if they currently exist.

As part of the education campaign these guidelines will be developed and distributed to each care setting.

Governance 8 A clear governance structure should be established or an existing structure identified which is responsible for setting rules/policies around access to hospital information. Such as governance should include representation from all stakeholder groups including consumers, hospital services, general practice services, community pharmacy services and ambulance services

An approach will be made to the 3DHB Information Management Service Level Alliance to become the governance structure responsible. This group currently have these responsibilities for Manage My Health.

Patient Amendments

13 Recommend that there is a documented and agreed process whereby disputed patient information is attached to a patient record in a way that this is clear to external health providers who access the system. In the current system this has implications in making such information available and obvious. In the future this has an implication ensuring that

This recommendation will be considered and discussed by the governance group once this accountability has been confirmed.


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information is not filtered from the external provider view.

Password Policy

14 Recommend that the 3DHBs review their identity verification procedures particularly for the purpose of resetting passwords for authenticating to the external authentication device proposed in the unintegrated, integrated and future state models. One way of ensuring this is to maintain a list of practice call-back numbers, and ensuring call-backs to physical practice locations are made prior to password resets.

3DHB ICT team will undertake a review of identity verification procedures to ensure robust authentication is enabled.

Third Party Management

16 Recommend that all DHBs share a common memorandum of understanding form to be agreed to by all third party organisations providing their staff access to shared information systems. The form may be modelled on the CCDHB memorandum of understanding form supplied. It should include the CCDHB Remote Access Policy Compliance document or similar.

Review the Wairarapa MoU that is in place with General Practices against CCDHB and make changes as required ensuring consistency across the sub-region, prior to rolling out access to community pharmacy and WFA. Ensure the Wairarapa MoU includes a sub-regional remote access policy compliance document or similar.

17 Recommend that the CCDHB memorandum of understanding includes a clause which compels any third party organisation accessing hospital systems to disclose to the hospital any breach or suspect breach of privacy involving access to their system or information.

Ensure that this clause is also incorporated into the Wairarapa MoU with third party providers.

20 Add to the CCDHB Remote Access Policy Compliance document a statement that a consequence of not following the policy may also lead to notification to the person’s employer, Office of the Privacy Commissioner, Office of the Health and Disability Commissioner or applicants Registration body. If DHBs use and alternative policy document it should contain a statement similar to this also.

As this policy compliance document will become sub-regional this will also be an addition in the WDHB.

Auditing 18 Recommend that CCDHB, WDHB, and HVDHB should put in place at the first opportunity a proactive analytics based system for the detection of suspicious record access that does not rely on random audits of records or initial human review.

This recommendation is to be reviewed once system capacity and capability is available.

Controls at the Pharmacy

19 Recommend that community pharmacies, identify a way in which to have private conversations with patients attending the pharmacy when discussing matters related to their hospital health information. This may be through the creation and used of “private discussion spaces” or consultation rooms.

Majority of community pharmacies have a consultation room as part of the LTC programme that they run, which provides a “private discussion space”. This recommendation will be part of the education campaign.


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Hutt Valley and Wairarapa DHBs APRIL 2016

BOARD DISCUSSION PAPER

Date: 19 April 2016

Author Tofa Suafole Gush, Director Pacific Health

Endorsed By Adri Isbister, Chief Executive Officer, Wairarapa DHB

Dr Ashley Bloomfield, Chief Executive Officer, Hutt Valley DHB

Subject Pacific Health Directorate Update –Wairarapa & Hutt Valley

RECOMMENDATION

It is recommended that the Boards:

a) NOTE the progress made on the strategic direction for Pacific as described in the Pacific Action Plan 2015 – 2018

b) NOTE sustained improvement in Pacific attendance at outpatients clinics

c) NOTE the Sub-regional Pacific Strategic Health Group work update to February 2016

d) NOTE primary care activities to improve Pacific Health.

ADDENDUM

1. Summary of primary care activities to improve Pacific health.

1. PURPOSE

The purpose of this paper is to provide the Boards with an update of activities, progress and issues on the radar for the Pacific People’s Health Directorate for Wairarapa and Hutt Valley DHBs.

This paper reports our strategic direction for Pacific as described in the Pacific Action Plan. Additionally, Ala Mo’ui National Indicators and Equity Indicators are reported here under headings reflecting the key strategies of the Pacific Action Plan (PAP) – Pāolo mo tagata ole Moana.

2. PACIFIC ACTION PLAN (PĀOLO MO TAGATA OLE MOANA, 2015-2018) PROGRESS UPDATE

A number of initiatives are underway to address the priorities in the PAP and our agreed actions. Table one on page two demonstrates how the PAP priorities align to most if not all of the national Pacific priorities and the Equity Indicators. Note also the indicators that are significant contributors to the wellbeing of Pacific people in Wairarapa and Hutt Valley DHBs.

While some priorities are not covered by the Ala Mo’ui and Equity Indicators, they are included as this is what the community signalled to the team during the consultation phase of the PAP. An example of this is taking health education programmes to churches; ‘develop parish nursing approach as an outreach model working with churches’.

Our focus is working across the services to ensure the actions and the measures are achieved during the term of the Plan.

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Table one: Pacific Action Plan priorities 2015 – 2018Priority 1:Improved Child Health;

Priority 2:Improving community action on health literacy & education programmes;

Priority 3:Improved access to care;

Priority 4:Improved capacity to deliver quality services to Pacific;

*~- increase WCTO core checks;

*~- immunisation at 8 months to meet target;

*~- oral health checks annually;

- develop healthy lifestyle program;

- develop parenting program about healthier families;

Key: * Ala Mo’ui~ Equity indicators

- facilitate health education sessions based in community;

- develop parish nursing approach as an outreach model working with churches;

*- raise awareness of health messages improving health literacy amongst the community;

*~- achieve better access to care through a combination of reducing barriers to primary care;*- investigate Pacific barriers to accessing primary care;- investigate options to fund solutions;

- undertake a stocktake of current Pacific workforce across both districts, to include primary, community providers and DHBs;

*- grow and strengthen Pacific workforce by supporting their professional development;-equip and support DHB and PHO staff to be responsive to the needs of Pacific patients;

*- invest in Pacific youth development by offering scholarships to pursue health related studies.

To monitor progress against the PAP, we will use a combination of data reported routinely via Ala Mo’ui and the DHBs’ Equity Indicators (both reported six-monthly) alongside internally collected information. When new data becomes available this will be reported with a narrative summary including achievements, areas needing improvement and challenges to address.

Attached also is a summary of data and activities that the Hutt Valley District Health Board PHO (Te Awakairangi Health Network (TeAHN)) is delivering to improve the health of its Pacific population.

Many of these improvements are noted under the four priorities of the PAP. Compass Health Network PHO activities (for Wairarapa) are also noted under the priorities.

2.1 Priority 1 update: Improved Child Health

This entails working across both PHOs (TeAHN & Compass Health) in supporting families to attend GPs appointments for vaccinations and follow up, and working with oral health service to follow up itsPacific ‘did not attend’ (DNA) list and ensure the method of connecting and engaging with our families are working.

In Wairarapa, key focus areas for Compass Health for this priority are eight-month old immunisation and the healthy lifestyle programme. Pacific immunisation as at 31 March 2016 is at 100 percent. A weekly lifestyle programme has been established by one of the local churches with support from thePHO and the Pacific Unit. It is proving popular with all family members who are involved. The group has requested support with the ‘biggest loser’ programme and between Compass Health, Masterton Medical Centre, Whaiora, Regional Public Health and the Pacific Unit we will attend once per month to deliver health education and advice.


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2.2 Priority 2 update; Improving community action on health literacy and health education

Delivery of health information to the community is business as usual and we continue to utilise the Pacific radio stations for getting information out. We recently had a Public Health Medicine Registrar talk about Zika virus and the affect it has on communities and health information for people travelling to and from the Pacific countries.

In the Wairarapa support for the Pacific lifestyle group will ensure key health messages are getting to the community. In addition, the relationships now established with community leaders support us to get key messages when the need arises. A recent example of this was the first ever Pacific health focus group which included 12 people that had had recent experience of mental distress. This was part of an Otago School of Medicine research project. Key leaders were involved in contacting the participants for the workshop.

2.3 Priority 3 update: Improved Access to care

There is work yet to be done in this area, which requires community feedback as to the barriers of accessing health services and solutions to the problem.

2.4 Priority 4 update: Improved capacity to deliver quality services to Pacific

Figure 1: Hutt Valley DHB Pacific workforce stocktake

Hutt Valley DHB SMO RMO NursingAllied

Health SupportManagement

& AdminDHB

TotalHVDHB

popn

‘Number of employees who have identified as Pacific 2 6 48 21 38 7 122 9,939

Total number of employees 197 174 1,069 576 138 386 2,540 138,378 Percentage of employees identfying as Pacific 1.0% 3.4% 4.5% 3.6% 27.5% 1.8% 4.8% 7.2%Target (7% or more of employees are Pacific) 14 12 75 40 10 27 178

Key

less than 4%

4 - 6.9%

7% or more

The workforce data demonstrates the low numbers of Pacific staff in Medical, Allied, and Management and Administration positions compared with the large numbers in support roles (which include orderlies and domestic services staff). Increasing the number of Pacific staff in other occupational groups is clearly a goal.

For Wairarapa DHB, the Pacific workforce is small and highly skilled, with one pharmacist, three senior MRTs (radiology), two registered nurses and one social worker as at March 2016.

Both DHBs have an emphasis on growing the Pacific Nursing workforce. One out of six graduates in the first cohort of the NETP Programme in Wairarapa and one in nine in the Hutt Valley is Pacific.

A significant achievement is that our very first recipient of our Pacific Oral Health scholarship started her first semester of studies at Otago University. We will report to the Ministry of Health on herprogress in May 2016. Attached is a snapshot of the workforce data for Hutt Valley DHB and we will look to address the areas where we are not doing well when we do the stocktake later this year.


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3. ATTENDANCE AT OUTPATIENT CLINICS - HVDHB

3.1 Background

In February 2014, as part of the “99 percent attendance” initiative, the Pacific Unit commenced work in improving attendance to Hutt Valley DHB outpatients clinics by working with nine priority clinics (Audiology, ENT, Paediatrics, Fractures, Cardiology, Colposcopy, Gynaecology, and Rheumatology) with community radio messaging regarding the importance of attending hospital appointments. Later in 2014, the Unit’s work moved to include all outpatients’ appointments for all children under 15 years of age (now including a large number of appointments with Fracture clinic and Plastics). Additionally, the work now includes Pacific people with appointments at Wairarapa DHB clinics.

The work is performed by the Pacific nurses who use their knowledge and relationships in the community to contact patients and/or their families using Pacific languages to encourage them to attend, linking them with other agencies such as the Pacific Health Service based in Naenae as needed.

Patient story: Patient Masina “didn’t believe that DHB understands her struggle in getting her 4 year old to many appointments with no transport, she also cares for her blind mother and live in Porirua. A visit by one of our Pacific nurse reveals the struggle, their living conditions and why they often do not attend appointments. This was discussed with the clinic and appointments are now once a month.”

3.2 Progress to February 2016

The following graph demonstrates the overall Pacific DNA rate for appointments at Hutt Valley DHB over the 2012 – 2015 time period. Due to the smaller population, month-by-month variation is greater for the Pacific population; however, compared with the 2012/13 baseline DNA rate (shown as the dotted line), Pacific DNA is now most often at or below the line demonstrating a clear reduction in non-attendance sustained over more than 12 months.

Specifically, this data demonstrates a drop in overall Pacific DNA rate from 16 percent in 2012/13 to 13 percent in 2014/15. This equates to 350 more appointments were attended by Pacific people over a 12 month period than prior to the initiative. Importantly, 100 of these 350 appointments were in children under the age of 15 years.


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4. ATTENDANCE AT OUTPATIENT CLINICS – WAIRARAPA DHB

In the Wairarapa, data collection varies and it can not be directly compared to Hutt Valley DHB data. As in the Hutt Valley, Pacific nurses contact people prior to their appointments and encourage them to attend. There are between 40 and 50 appointments each month for Pacific people at Wairarapa DHB with seven or fewer DNAs per month; the Pacific nurses aim to keep this number as low as possible by addressing barriers to attendance. This has been in place since February 2015 and is slowly improving as we continue to remind the community during community health education session on Saturdays of the importance of attending hospital appointments.

4.1 Future directions

This work demonstrates that high rates of Pacific DNA are not necessary. A method of engaging with Pacific people by phone and connecting them with appropriate services is a proven method for improving access to specialist appointments.

4.2 Wairarapa Activities

We are in the third month of our very first healthy lifestyle program with all the four local Pacific churches. The support of the churches for the Saturday sessions has been positive with many families now joining these every Saturday. The health education sessions are delivered every third Saturday by a local nurse/doctor from either the PHO, hospital or Regional Public Health. We hope to evaluate this programme in June 2016 and get feedback from the community of its value to their well being.


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5. SUB REGIONAL WORK

The Pacific Sub-regional Strategy Health Group to the 3DHB Boards had its first meeting for this year in February 2016. A presentation made by the Chief Executive of TeAHN was well received. The group acknowledged the work of the PHO in engaging and the important links that have been made in working with the Pacific community in the Hutt Valley and the role that Pacific Unit has in encouraging the connection to community Leaders.

A similar presentation was made by the Chief Executive of Compass Health Network to the group last November meeting updating on their work with the Wairarapa Pacific community.

The group also endorsed the Pacific priorities in the draft annual plans for 2016/17 and is looking for progress reports during the year.

The Chair and the Chief Executive of Central Pacific Collective met with the group to update and share their work plan for the year. There is a number of initiatives they will pursue unrelated to health, but the group will support them where we can in working across to our small Pacific providers in the Hutt.


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BOARD INFORMATION PAPER

Date: 15 March 2016

Author Joanne Edwards, Senior Manager

Endorsed By Sandra Williams, Interim Director, SIDU

Subject Provision of Dementia Care in Wairarapa

RECOMMENDATION

It is recommended that the Boards

a. Note the response to their query from their meeting 22 February 2016

ADDENDUMS

1. PURPOSEThe purpose of this paper is to provide a response to the Wairarapa DHB regarding provision and monitoring of dementia care services in Wairarapa ARC facilities. Back ground is given relating to support of people with dementia and their families in order to put the ARC related response into context.

2. BACKGROUND

2.1 Dementia care Pathway

In accordance with Ministry direction, the Wairarapa DHB has implemented the dementia care pathway over the past few years. This pathway is based on the national Dementia Framework and has been incorporated into the sub-regional Cognitive Impairment health Pathway. Implementation of the Dementia care pathway continues to be a ministry requirement for the DHB Annual Plan and is reported on quarterly to the Ministry.

The pathway implementation sits with Tihei Wairarapa. Programme Mangement is provided by Compass Health.

Dedicated staffing has been resourced to:∑ Increase awareness of GPs and Practice Nurses of the Cognitive Impairment Pathway and its

appropriate use (e.g. timely diagnosis and guidance for referrals)∑ Promote the value of the pathway through case study approach with individual GP practices∑ Identify usage and any barriers to using the pathway. Monitor any increase in usage.∑ Report clinical problems encountered in using the pathway to the Health Pathway clinical editor (with

suggestions where appropriate)∑ Report technical/administrative problems encountered to the Health Pathways Coordinator (with

suggestions where appropriate)

2.2 Training

Implementaton of the dementia pathway includes training and education of health professionals and support workers. Wairarapa piloted “Walking in Another’s Shoes” dementia training up to late 2015. This was provided mainly to residential facilities. Progress on this was reported from the trainer to the portfolio manager monthly.

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On-line courses are available for health professionals and support staff caring for people with dementia and a number of RNs in Wairarapa have registered for the on-line course run by the University of Tasmania.

The Aged residential Care (ARC) contract for secure dementia care units details the training requirements for staff working in a dementia unit. This is monitored via the National HealthCert process with portfolio managers responsible for monitoring any corrective actions required. The DHB encourages all other residential care facilities to have their staff attend recognised dementia training and all of them have a number of staff trained in dementia care.

2.3 Specialist services

Specialist assessment, advice and education is provided by a psycho-geriatrician who visits the Wairarapa for approximately 20 hours per month which is generally set within a weekday clinic to enable multi-disciplinary team (MDT) liaison, and a Saturday clinic. Both clinics are hospital and community based (ARC and home visits). Additional psycho-geriatric support is given to physicians and GPs in Wairarapa through telephone consultations.

Regular MDT meetings are held regarding coordinated management of services for more complex people with dementia and their families.

The DHB Psychogeriatric Specialist Nurse works with and supports the Psycho-geriatrician, especially within the context of local management of more complex people with dementia.

The Nurse Practitioner (NP), Psycho-Geriatric Service, started her role early 2016. She adds to the specialist service provided. This role is a shared one between CCDHB (80%) and Wairarapa DHB (20%). This NP role is funded from the combined dementia pathway money for all 3 DHBs. The Nurse Practitioner sends monthly reports to the portfolio managers.

2.4 Support services

A range of support services are provided to support people with dementia and their families. These include home and community support services and a range of services to support family carers such as respite care, day activity support in the community and carer support in the home. Access to these services is through FOCUS. Assessment of support needs and reviews focus on the needs of carers of people with dementia, recognizing the need for their support and the various dynamics which may inhibit such support being optimized. In addition to providing a day activity support service for people with early dementia, Alzheimer’s Wairarapa also provides education and support to families and carers of people with dementia through their field officer.

4. DEMENTIA CARE IN ARCDementia occurs on a gradual continuum, from early signs of dementia to cognitive impairment that impairs safety of the person and/or others (e.g. wandering). It is people in this latter stage who may be deemed appropriate for secure care following specialist clinical assessment. However, anecdotally, ARC providers report that most of their residents have dementia to some degree and efforts are made to ensure appropriate and safe care in their familiar environment, without resorting to secure care.

Caring for people with dementia who are in residential care is therefore not just restricted to secure facilities. For a number of reasons (e.g. level of physical care they need), a person may have quite advanced dementia and not be in a secure facility. It can therefore be misleading to judge the quality of dementia care as that relating only to the secure facilities.

Provision of secure dementia care is certified by the Ministry as “Rest Home Care” and it does not have its own certification category.


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However, the national Aged Residential Care Contract does have additional stipulations for dementia care, which includes training requirements of staff.

Three facilities in Wairarapa are contracted by Wairarapa DHB to provide long term residential dementia care in a secure setting. They also provide short term care and day activity services for people with dementia.

Facilities with dementia level beds number of bedsKandahar Court (Masterton) 25Roseneath (Carterton) 13Lyndale (Masterton) 20Total 58

At any one time, there are about three Wairarapa people who need a higher level of secure care (psycho-geriatric residential care) and these people need to move out of the area. Advice for the need for such a highly specialized service in Wairarapa has been sought from the Psycho-geriatrician who strongly suggests that the small number of people needing that very specialized level of care would not be feasible for Wairarapa. However, he does note that because of this situation, one facility in particular in Wairarapa has developed advanced skill sets to safely meet the needs of their more challenging residents in order to keep them resident in Wairarapa. In comparison, newer dementia units are in an earlier phase of building their expertise, but all must meet certification standards.

3. QUALITY ASSURANCE AND IMPROVEMENT

3.1 Certification

All Aged Residential Care (ARC) facilities must meet the Health and Disability Services Standards NZS 8134:2008, and be certified to operate by the Ministry of Health (HealthCERT). The Health and Disability Services Standards 2008 came into effect on 1 June 2009. They replaced the Health and Disability Standards 2001. These are the same standards that must be met by public hospitals. These standards are on the ministry web site and can be accessed at:http://www.health.govt.nz/our-work/regulation-health-and-disability-system/certification-health-care-services/health-and-disability-services-standards

The Ministry of Health arranges both regular and ‘spot’ audits of all rest homes to ensure they are continuing to meet both the Standards, and the District Health Board contract requirements. The District Health Board and the Ministry of Health will carry out additional inspections if needed.

As for public hospitals, all ARC facilities are audited by a Designated Auditing Authority (DAA) for certification. The full audit reports for all residential homes are publically available on the Ministry’s web site.

3.2 Certification Cycle

Certification can be between one and four year period. A new provider may only be granted a one-year period of certification and a four year certification period requires the facility to have none or very few low risk corrective actions and to have been commended for quality and care initiatives. Facilities have a surveillance audit within three months either side of half way between their certification periods. This is an unannounced audit. Therefore if a facility has a three year certification they are audited approximately every 18 months. For two year certification, they are audited annually. As audits are expensive, it is also in the provider’s interest to meet the standards and ensure high quality care.

More corrective actions and higher risk levels will result in shorter certification periods and more frequent monitoring and auditing.


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The three dementia facilities audit cycles are:

Facilities with dementia level beds

Certification audit

Outstanding Corrective

Actions as at 15 March 2016

Period of certification

Next audit due

Kandahar Court (Masterton) Nov 2014

none 24 months Feb 2016‘Spot’

surveillance audit

Roseneath (Carterton) June 2015

none 24 months August 2016‘Spot’

surveillance audit (3 months either side of this date)

Lyndale (Masterton)

Oct 2015 *Provisional

audit

none 12 months October 2016Full Certification

auditTotal

3.3 Addressing Corrective Actions

DHB staff work with the facilities once an audit has been undertaken to agree a plan to address any corrective actions they need to undertake and monitor compliance with the plan. This process is documented on the HealthCERT Provider Regulation and Monitoring System (PRMS) website. This approach works well and enables the DHBs to:

∑ identify those facilities that could gain the most benefit from additional quality improvement inputs such as Nurse Practitioner (or other) led education sessions.

∑ monitor the progress against the corrective actions and share examples of good practice∑ maintain and strengthen relationship between the facility and the DHB

Most providers (including public hospitals) will have some corrective actions following an audit against the H&D Standards, but there are a few ARC providers who have none. It needs to be noted that these providers may well have a history of a number of corrective actions (which they have addressed), and may have some again in the future with the dynamic of changes in ARC ownership or management.

Wairarapa has no ARC providers with any high risk corrective actions to be addressed. For dementia care, there are no outstanding corrective actions.

4. DHB Contract

All Residential care providers must also meet the requirements set in their contract with the District Health Board. This is a nationally agreed contract and includes specified expectations for long term residential care. Performance against contract is audited alongside the certification audit.

As for other facilities, requirements for secure dementia units includes quality and safety obligations.In addition, there are specific requirements for secure dementia facilities (Section E of the ARC contract). It states:

The objective of Specialist Dementia Services is to provide for the safe and therapeutic care of Subsidised residents affected by dementia in an environment that enhances those Subsidised residents’ quality of life and minimizes the risks associated wit their “confused” states.”


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The contract requirements include accommodation, facilities and equipment, assessment, care planning, support and care intervention and human resources.

4.1 Feedback and Quality Improvement

Informal Monitoring

The DHBs have a number of staff who frequent ARC sites for a variety of reasons. Portfolio Managers visit to clarify any queries, resolve issues, monitor progress on corrective actions and maintain relationships. In addition, DHB specialist staff (nurses and allied health) are also often on site with regard to their role of specialist assessment advice and education relating to the needs of specific residents. Feedback from other health professionals such as GPs and palliative care services also contributes to the DHB knowledge about a provider.

Formal Monitoring

In addition to reporting adverse events to the Ministry, all ARC facilities are required through their contract to report quarterly on the number and categories of beds and residents at the facility. This is achieved through a Ministry electronic survey. Additional electronic monitoring is also undertaken (e.g. meeting interRAI assessment and care planning requirements for residents).

ComplaintsIn addition to information required to be given by an ARC facility to its residents and families, the Ministry of Health website clearly explains how to make a complaint. Other websites also give advice about how to complain regarding residential care and who to contact if the complaint is not resolved. For example, the Age Concern website contains the information and web site links to other agencies able to help. Senior Line is a free NZ help line (0800 725 463) which is also being given increasing publicity by DHBs for their role in providing a wide range of information and assistance for older people and their families.

There are therefore a number of portals for information about how to complain with regard to residential care, what process needs to be followed and how to escalate the complaint if it is not resolved.

If a major complaint about residential care is referred to a DHB, HealthCERT or HDC, there is an agreed inter-agency process whereby one of these agencies will take the lead in resolving the issue and report progress to the other two.

The DHB has received no complaints related to care of dementia residents in the past year. One facility has been investigated by the HDC following a complaint to the Commissioner, but the decision was made to take no further action on this complaint. This investigation and outcome will be notified to the auditors for their next certification audit.

5. CONCLUSION

Over the past few years there has been a continual emphasis on improving quality assurance in residential care, but all agencies recognise that there will always be room for improvement. Robust monitoring, auditing and complaints systems are pivotal to assuring safe and appropriate residential care for people with dementia.


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Date: April 2016

Author Helen Pocknall, Executive Director of Nursing and Midwifery

Endorsed By Adri Isbister , Chief Executive

Subject Nursing Workforce

RECOMMENDATION

It is recommended that the Board

a. Note the increase in nursing staff numbers from 2013 to current day.

b. Note the comparison between Wairarapa, Tairawhiti and South Canterbury DHBs.

c. Note the mean age of the Wairarapa workforce as being 50 years old.

d. Note that TrendCare is used by Wairarapa Hospital to monitor daily staffing levels, utilisation and productivity.

ADDENDA

APPENDIX 1: NURSING HEADCOUNT, FTE AND SEX

APPENDIX 2: MEAN LENGHTH OF STAY AND AGE

APPENDIX 3: ETHNICITY

1.0 Executive Summary

Nursing numbers have been increasing over the past three years to ensure the supply of staff meets demandfor patient care. The increases over budgeted FTE have been approved following sound business cases being put forward to the executive team. Data from TrendCare was used and patient safety issues analysed to assist in providing information and evidence which showed where and when additional staff was required.

2.0 Nursing Numbers

The information provided covers the period of 2013 through until the current day. The graph in appendix one illustrates the increases over the three year period acknowledging that there have been quarters when the numbers have decreased, generally towards the end of the calendar year when workload is traditionally not as high as in winter.

Appendix 2 provides mean length of stay and age. It is concerning to see that the mean age of the Wairarapa workforce now sits at 50 years of age.

Appendix 3 illustrates that there is still a lot more work required to grow our Maori and Pacific workforce.


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3.1 TrendCare

TrendCare is a workforce planning and workload management system that provides dynamic data for clinicians, department managers, hospital executives and high level healthcare planners. TrendCare was introduced at Wairarapa for nursing in 2001. The then surgical ward was one of a few pilot sites around the country at the time. Over the years more and more services have adopted Trendcare as the system has been upgraded and updated. It is also one of the Human Resource Management Systems that we use, mainly for nursing and midwifery and some allied health staff.

Trendcare is used on a daily basis to assess the acuity of patients and what hours of nursing and midwifery care are required to meet the needs of those patients. We are currently providing refreshers to the Charge Nurse Managers who have worked with it for a long time and teaching those who are unfamiliar with what it can offer.

3.2 Reports

TrendCare reports are used extensively from the floor through to the executive team. It provides us with patient turnover data, which is referred to as ‘churn’ or utilisation. The data can show that there have been three patients in one bed over one eight hour shift and, whilst we may have 38 beds on our medical surgical ward (MSW) for example, in actual fact 50 patients have been in those beds in the last 24 hours. TrendCare also provides the variance in hours in terms of our supply of staff versus the demand for care on a shift by shift basis.

Productivity is also collected in TrendCare. Productivity is defined as hours required for inpatient care and the hours worked to provide inpatient care. The benchmark internationally is 90-105%. During winter 2015 the data illustrates that MSW had high productivity whilst it has been lower in recent summer months overall(Appendix 4).

Productivity percentages provide another marker as to the intensity of nursing work. When considering productivity, as with utilisation, the skill mix, use of casuals, sick leave and increase in event reporting is useful. It is not desirable to have productivity over 100% for long periods of time as this means that staff are unable to take their required breaks and, on occasion, will have worked over time.

Hours per patient day calculates the required hours of care needed based on acuity of patients vs the number of nursing hours available. Whilst it may seem appropriate to have these numbers matching a buffer is necessary as this measure does not take into account the environment that staff work in and the skill mix of staff caring for the patients. There is no specific buffer set by Trendcare, however, monthly productivity must be looked at with daily shift variance to get the most accurate picture.


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Appendix 2: Mean Length of Stay and Age

Female Male Total

DHB RegionMean age

Mean LoS

Mean age

Mean LoS

Mean age

Mean LoS

30/06/2013 48.6 9.4 49.8 8.7 48.8 9.3Tairawhiti Midland 48.8 9.7 48.9 8.3 48.8 9.4Wairarapa Central 48.8 8.5 50.2 7.4 49.0 8.3South Canterbury Southern 48.1 10.2 50.4 10.3 48.5 10.231/12/2013 48.5 9.3 49.8 8.6 48.7 9.2Tairawhiti Midland 47.8 8.9 47.2 7.2 47.7 8.6Wairarapa Central 49.4 8.7 50.7 7.4 49.6 8.5South Canterbury Southern 48.2 10.4 51.5 11.0 48.7 10.530/06/2014 48.3 9.3 50.7 8.3 48.7 9.1Tairawhiti Midland 47.7 9.1 48.6 7.4 47.9 8.8Wairarapa Central 49.2 8.6 53.1 7.7 49.7 8.5South Canterbury Southern 47.9 10.0 50.3 9.8 48.4 10.031/12/2014 48.8 9.9 49.3 8.4 48.9 9.6Tairawhiti Midland 48.7 9.5 48.8 7.3 48.7 9.1Wairarapa CentralSouth Canterbury Southern 48.9 10.2 49.8 9.5 49.0 10.130/06/2015 48.9 9.4 49.8 8.1 49.1 9.2Tairawhiti Midland 48.6 9.4 48.9 7.6 48.6 9.0Wairarapa Central 49.3 8.7 50.5 6.8 49.5 8.4South Canterbury Southern 48.9 10.2 49.9 10.0 49.1 10.231/12/2015 49.0 9.5 50.0 7.9 49.2 9.2Tairawhiti Midland 48.3 9.4 49.2 7.4 48.5 9.0Wairarapa Central 49.7 8.7 51.7 6.9 50.0 8.4South Canterbury Southern 49.0 10.3 49.1 9.5 49.0 10.1


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Appendix 3: Ethnicity

DHB Region Other Maori Asian Pacific Unknown30/06/2013 682 79 12 3 73Tairawhiti Midland 217 68 9 ** 2Wairarapa Central 183 11 3 3 44South Canterbury Southern 282 ** ** 0 2731/12/2013 664 74 17 2 69Tairawhiti Midland 218 65 13 ** 2Wairarapa Central 174 9 4 2 42South Canterbury Southern 272 ** ** 0 2530/06/2014 602 85 28 0 121Tairawhiti Midland 212 66 12 ** **Wairarapa Central 134 8 4 0 97South Canterbury Southern 256 11 12 ** 2431/12/2014 459 77 29 0 20Tairawhiti Midland 206 68 12 ** **Wairarapa CentralSouth Canterbury Southern 253 9 17 ** 2030/06/2015 666 99 33 1 57Tairawhiti Midland 209 76 11 ** **Wairarapa Central 207 12 7 1 37South Canterbury Southern 250 11 15 ** 2031/12/2015 606 90 36 7 130Tairawhiti Midland 216 74 12 6 **Wairarapa Central 138 7 6 1 107South Canterbury Southern 252 9 18 ** 23


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Appendix 1: Headcount, FTE and Sex

Female Male Total

DHB Region Headcount FTE Mean FTE Headcount FTE Mean FTE Headcount FTE Mean FTE%

Female

30/06/2013 798 587.7 0.73 60.0 52.8 0.9 858.0 640.5 0.75 93%Tairawhiti Midland 282 214.1 0.76 18 15.0 0.83 300 229.1 0.76 94%Wairarapa Central 224 148.8 0.66 19 16.5 0.87 243 165.3 0.68 92%South Canterbury Southern 292 224.8 0.77 23 21.3 0.92 315 246.1 0.78 93%



31/12/2014 545 421.0 0.77 46.0 40.6 0.9 591.0 461.5 0.78 92%Tairawhiti Midland 271 206.9 0.76 20 16.5 0.82 291 223.4 0.77 93%Wairarapa CentralSouth Canterbury Southern 274 214.1 0.78 26 24.1 0.93 300 238.1 0.79 91%

30/06/2015 801 597.7 0.74 61.0 53.5 0.9 862.0 651.3 0.76 93%Tairawhiti Midland 282 215.7 0.76 19 14.9 0.78 301 230.6 0.77 94%Wairarapa Central 245 169 0.69 19 16.5 0.87 264 185.5 0.70 93%South Canterbury Southern 274 213 0.78 23 22.1 0.96 297 235.2 0.79 92%



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Date: 4 April 2016

Author Peter Gush

Endorsed By Adri Isbister, CE

Subject3DHB Healthy Food and Beverage Environments Guideline (the Guideline) Implementation

RECOMMENDATION

It is recommended that the Board:

a. NOTES this update report

1. PURPOSE

This paper is provided to update the Wairarapa District Health Board on the implementation of the Healthy Food & Beverage Guidelines.

2. BACKGROUND

In March last year each of the three District Health Boards in the greater Wellington sub-region supported the Guideline and a 3DHB Implementation Group was formed. That group has been working over the last 12 months to implement the Guideline across all three DHB sites, which in particular has required a significant amount of work with the food and beverage retailers and their suppliers.

3. SUMMARY

The first two phases have been successfully implemented:

Phase 1 – 1 October 2015: saw the removal of all sugar sweetened beverages.

Phase 2 – 18 January 2016: Packaged snack foods containing less than 800 kilojoules per packet, with limited confectionary and fried snack foods (all points of sale including vending machines).

The remaining four phases are:

Phase 3 – 1 June 2016This phase sees changes so that the food and beverages available are:

∑ dominated by whole grains, vegetables and fruit, ∑ options are prepared with minimal fat, salt and sugar, and ∑ beverage choice always includes water


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Phase 4 – 6 July 2016This phase sees the complete removal of deep fried foods (where they continue at present) and the removal of artificially sweetened drinks.

Phase 5 – proposed implementation September 2016Portion sizes of baked snack food (muffins, cakes, scones, biscuits, pastry based food, slices) are small (details to be agreed).

Phase 6 – proposed implementation December 2016Resources and communications will be provided to engage staff in all three DHBs regarding fundraising, gifts offered to guest speakers on behalf of the DHBs, and sponsorship of DHB programmes and services that meet the guidelines.

Since the Guidelines were approved by the DHB Executive Teams and supported by the Boards the Ministry has brought together a National DHB Food and Beverage Environments Network with membership from each of the DHBs. The Network’s purpose is to support DHBs in creating sustainable healthy food and beverage environments and to advocate for national change and consistency across food and beverage environments. The Network has developed healthy food and beverage principles (our Guideline is consistent with these) and is working towards a national policy which is to be made available by July 2016.


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Wairarapa, Hutt Valley and Capital & Coast District Health BoardsDRAFT March 2016

WAIRARAPA, HUTT VALLEY AND CAPITAL & COAST DISTRICT HEALTH BOARDSCOMMUNITY PUBLIC HEALTH ADVISORY AND DISABILITY SUPPORT ADVISORY COMMITTEES DRAFT

MINUTES

9.00am Friday, 18 March 2016Board Room, Pilmuir House, Hutt Valley District Health Board

PRESENT: IN ATTENDANCE:

Committee Management & Externals

Nick Leggett (Chair)Derek Milne (Member)Virginia Hope (Deputy Chair)Katy Austin (Member)Wayne Guppy (Member)Dr Tristram Ingham (Member)Tino Pereira (Member)Leanne Southey (Member)Helene Ritchie (Member) – Phoned in @ 9.25amChris Laidlaw (Member)Sandra Greig (Member)Margaret Faulkner (Member)Jane Hopkirk (Member)

Debbie Chin (CEO, CCDHB)Dr Ashley Bloomfield (CEO, HVDHB)Adri Isbister (CEO, WRDHB) Sandra Williams (Acting-Director, SIDU)Dr Pauline Boyles (Senior Disability Advisor, SIDU)Alison Mitchell (Well Health PHO)Alison Hannah (SIDU)Andrea Bright (Minute Secretary)

Board Members Presenters

Taima Fagaloa

APOLOGIES:Wayne Guppy for lateness

Committee Management

1.0 PROCEDURAL BUSINESS

Committee member opened the meeting up with a karakia.

1.1 Apologies

Sharon Cavanagh, Alan Shirley

Moved: Nick Leggett Seconded: Derek Milne CARRIED

1.2 Conflicts of Interest:

Two Committee Members requested their conflicts of interest be updated (Tristram Ingham and Tino Pereira.

Action: Minute Secretary to update both Tristram Ingham and Tino Pereira’s conflicts of interest.

1.3 Confirmation of Minutes

Wairarapa Board Public 19 April 16 - MEETING REPORTS

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Committee member raised issues from the previous minutes which he would like clarification on:

1. Equity Review: It was requested that the Equity Indicator report include actions being undertaken to improve the equity indicator results.

The Committees noted the minutes as read.

Moved: Derek Milne Seconded: Virginia Hope CARRIED

1.4 Schedule of Action Points:

Director SIDU provided an update on the following action points:

CEAGUpdate on the work programme for May 2016.

Smoking Cessation Programme UpdateThe Ministry of Health is retendering the smoking cessation contracts. Any iwi based programme will be incorporated into the Tobacco Control Plan when it is refreshed..

Work Force Training for the Home Care SectorThis action was reported on in the Directors SIDU report.

Pacific HealthMonitoring the actions around Pacific Health was covered in the agenda item Pacific Action Plan.

The action transferred from HAC H85Director SIDU advised that this is scheduled in the work programme for November 2016.

EquityBoth Maori and Pacific are scheduled in work programme.

NZ Health StrategyDirector SIDU advised that invitations to the sessions run by the Ministry of Health had been sent out to Board members.

Annual Plan

The action of workshops had been picked up by CEO’s. These were held in February and March.

DISCUSSION PAPERS

2.1 Director, SIDU Report

The Committee noted the proposed work programme:

MARCH ∑ Disability Plan Implementation Update∑ Refugee Health∑ Obesity Prevention∑ Service Integration – PHOs invited to discuss integration sections of

Annual PlanMAY ∑ Disability Plan Implementation Update

∑ Equity & Maori Health Indicators Quarter Report/Equity Indicators Review

∑ PHO Updates including targets and IPIF∑ Health System Plan (HSP) Update∑ Population Health Update

JULY ∑ Disability Plan Implementation Update


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∑ Palliative Care Update∑ Mental Health & Addiction Update including Suicide Prevention Plan

UpdateSEPTEMBER ∑ Disability Plan Implementation Update

∑ Child Health & Youth Health (including Rheumatic Fever)∑ HSP Update∑ Alliance Leadership Team Update (Integration Achievements)∑ Equity & Maori Health and Pacific Health Indicator End of Year Report

NOVEMBER ∑ Disability Plan Implementation Update∑ Annual Planning Process for 2017/18∑ Equity and Maori Health Indicators Quarter Report∑ Population Health Programmes∑ Health of Older Persons∑ Draft HSP Report

Patient information and electronic records

A number of questions were raised by Committee Members about access to patient information including what patients understood about the information in their records, what was available to those accessing that information, how the patient’s permission was sought and what communication was being done to patients.

The PHO (Well Health) representative advised the committee about their process. She noted that it was a systematic roll out and that smart phones were one way people were accessing the information. Some members noted that smart phones are beyond many peoples income although there was high usage of these with younger people and also many in other age groups.

Questions asked around what information can be assessed on line as there were concerns raised by Committee Member about the risk of Elder Abuse and families accessing information.

Acute Demand

Committee members noted that the communications sent out had an impact. Noting that there has been a increase though in ED (triage 3). It is important to maintain the message “what you go to your GP for” and “what you go to ED for”.

A Wairarapa Committee member mentioned that there are not a lot of After Hours centers in the Wairarapa area, the GPs close at 5pm so therefore there is not a lot of choice but to attend ED.

The Committee NOTED the contents of this report.

Action: More information on patient information and electronic records will be made available at the May 2-16 meeting.

Moved: Nick Leggett Seconded: Katy Austin CARRIED

1.1 Update on Sub Regional Disability Implementation Plan

Dr Pauline Boyles updated the Committee. Handouts were distributed (these will be made available in the Resource Centre).

The Biennial Sub regional Disability Forum 3 June 2016 was noted.

Committee members noted the development of the Needs Assessment Service Coordination (NASC) guide which had generated interest form the Ministry of Health as a possible base for a national guide.


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Child and Adult Transition. There is work being done with families in the sub region and the draft of an electronic health pathway is ready for review. Once the review process is completed there will be a roll out programme to support its use across the sub region.

Action: CPHAC DSAC committee asked to see the guide once the consultation on the NASC guide is completed.

Action: Circulate the date of the sub regional Disability Forum to all CPHAC/DSAC members.

The Committee NOTED the contents of this report:

1. Progress against the five year plan;2. Sub Regional Forum June 3 is to be opened by Associate Minister of Health and Disability Issues;3. A draft of the first ever electronic health pathway for children with chronic health and disability in

transition has been completed and is attracting national interest;4. RNZCGP has agreed to work in an improving clinical effectiveness module with Primary Care

(Improving Health Outcomes Working Group);5. NZ Health Strategy: submissions by SRDAG and the MOH working Group to ensure the health of

people with disabilities is addressed; and6. NZ Disability Strategy is also under review.

Moved: Nick Leggett Seconded: Katy Austin CARRIED

2.3 Pacific Action Plan

The Director, Pacific Health CCDHB presented the Plan to the Committee.

Committee members commended the efforts put into the plan.

The Committee NOTED the report and the Draft Capital & Coast District Health Board Pacific Plan 2017- 2020.

Moved: Tino Pereira Seconded: Tristram Ingham CARRIED

2.4 Obesity Stocktake

Director SIDU updated Committee. It was noted that there is an interest in working with Councils and other bodies to move this piece of work forward.

A lot of things happening in the community in this area eg Kokiri Marae Health Promotion are pushing healthy eating, drinking and being active in sports and are looking for a partnership.

Committee Member asked if the data was robust and what the quality of the data was. The CE, Hutt Valley DHB advised the committee that he was confident that the data presented was accurate.

The CE, Hutt Valley DHB noted that he had joined the Steering Group for Healthy Families Lower Hutt and expected to see more progress in the next few months and will report on progress at the next CPHAC DSAC meeting.

ACTION: CE, Hutt Valley DHB to report back on progress made by Health Families Lower Hutt at the next meeting.

Committee Members identified other initiative such as Wilford School which has a programme in the school which is working well and how we might leverage these types of initiatives and especially how Regional Public Health could work with schools and councils.

A Committee Member noted the celebration of 10,000 homes being insulated and heated. An thought that a similar strategy could be used with child obesity.


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It was identified that the three key groups to work on obesity together were Schools, Health and Local councils(including the Regional Council).

It was identified that Regional Public Health has a very significant role in prevention, education, and co-ordination across the sub region.

The Committee:

∑ Noted the report;∑ Noted that reducing childhood obesity is being a priority area;∑ Noted the six key recommendations of the ECHO report to reverse the rising trend of childhood obesity:

∑ promote intake of healthy foods;∑ promote physical activity;∑ preconception and pregnancy care;∑ early childhood diet and physical activity;∑ health, nutrition and physical activity for school-age children; and∑ weight management.

∑ Noted the three key focus areas in the New Zealand Childhood Obesity Plan ∑ targeted interventions for those who are obese;∑ increased support for those at risk of becoming obese; and∑ broad approaches to make healthier choices easier for all New Zealanders.

∑ Noted the new health target will be implemented from 1 July 2016: ‘By December 2017, 95% of obese children identified in the Before School Check (B4SC) programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions’; and

∑ Noted that management will work towards aligning Health Promotion funding and annual planning across the sub-region in order to reduce duplication and support the recommendations of this document.

The Committee was silent on the following recommendations:∑ Consider the continued expansion of Project Energize, across the 3DHBs as resources become available ∑ Consider the procurement of referral options to support the B4SC Health Target such as;

∑ Active Families Preschool programme;∑ Maternal Green Prescription programme;∑ Referral options for nutritional support; and

∑ Consider further the implementation of the no cost/low cost recommendations (Table three).

Moved: Helen Ritchie Seconded: Margaret Faulkner CARRIED

4.0 RESOLUTION TO EXCLUDE THE PUBLIC

It is recommended that the Community & Public Health and Disability Advisory Services Committees:

(a) Agree that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:

Subject Reason Reference*

Public Excluded Minutes For the reasons set out in the respective public excludedpapers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in respective public excluded papers

Refresh of the Greater Wellington Sub-regional Rheumatic Fever Prevention Plan

Papers contain information and advice that is likely toprejudice or disadvantage commercial activities and/ordisadvantage negotiations

9(2)(i)(j)

* Official Information Act 1982.


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Moved: Nick Leggett Seconded: Derek Milne CARRIED

The meeting concluded at 11.20am

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.

DATED this day of 2015

Nick LeggettCHAIR


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Wairarapa District Health Board April 2016

BOARD DECISION PAPER

Date: April 2016

Author Derek Milne, Wairarapa District Health Board Chair

Subject Resolution to Exclude the Public

RECOMMENDATION

IT IS RECOMMENDED that the Board AGREE that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table.The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the 16 June 2015 Board Agendas

Financial matters; Strategic Action plans; Risk planning

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations

Section 9(2)(i)(j)

Wairarapa Board Public 19 April 16 - RESOLUTION TO EXCLUDE THE PUBLIC

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