Public Agenda - CCDHB · x Independent Physician, Auckland Medical Specialists x Fellow, Royal...

Capital & Coast District Health Board

CAPITAL & COAST DISTRICT HEALTH BOARD

Public Agenda11 NOVEMBER 2016

Level 11, Grace Neill Building, Wellington Regional Hospital, 11.30am

ITEM ACTION PRESENTER MIN TIME PG

1 PROCEDURAL BUSINESS 10 11.30am

1.1 Karakia

1.2 Apologies RECORD V Hope

1.3 Continuous disclosure

- Interest Register

- Conflicts of Interest

CONFIRM

ACCEPT

V Hope

V Hope

3

6

1.4 Confirmation of draft Minutes 14 October 2016 APPROVE V Hope 8

1.5 Matters arising NOTE D Chin

1.6 Action list NOTE D Chin 14

2 ADVISORY GROUP UPDATE

2.1 Sub Regional Disability Advisory Group update

NOTE M Faulkner 15 11.40am 16

3 FOR DECISION

3.1 Health and Safety Policy ENDORSE C Lowry 5 11.55am 22

4 FOR DISCUSSION

4.1 Chair’s report NOTE V Hope 5 12.00pm 23

4.2 Chief Executive’s report

4.2.1 Financial summary, September 2016

NOTE D Chin 10 12.05pm 24

28

4.3 CCDHB Health and Safety Report (for month of September)

NOTE C Lowry 5 12.15pm 42

5 FOR NOTING

5.1 Hospital Advisory Committee report back(Verbal)

NOTE V Hope 5 12.20pm

5.2 Final report on independent service review NOTE D Chin 10 12.25pm 71

OTHER

6 General Business NOTE V Hope 5 12.35pm

7 Resolution to Exclude the Public APPROVE V Hope 5 12.40pm 77

ADJOURN AND LUNCH 12.45pm

APPENDICES

2.1 Sub Regional Disability Advisory Group

∑ Disability responsiveness 78

11 November 2016 - CCDHB Board PUBLIC papers - AGENDA

1

Capital & Coast District Health Board of 2

∑ CCDHB Summary of milestone initiatives 84

3.1 CCDHB Health and Safety Policy 86

4.1 Chair’s report

∑ Letter to Director-General of Health – Disability responsiveness training for Primary Health Organisations

∑ Response from Director, Service Commissioning, Ministry of Health – Disability responsiveness training for Primary Health Organisations

∑ Letter from Director-General of Health approving Delegation Policy

99

101

102


∑ Financial summary, September 2016

∑ Approval from the Ministry of Health – System Level Measurements Improvement Plan 2016/17

∑ Accreditation Report – Royal Australian and New Zealand College of Ophthalmologists

103

104

5.2 Final report on independent service review

∑ Service review FY14/15 – revenue, cost and volume analysis 106

11 November 2016 - CCDHB Board PUBLIC papers - AGENDA

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Interest Register

11 NOVEMBER 2016

Name Interest

Dr Virginia HopeChairperson

∑ Chair, Hutt Valley District Health Board, member CPHAC/DSAC and FRAC and Chair HAC

∑ Chair, Capital & Coast District Health Board and member, statutory committees∑ Member, Regional Governance Board∑ Medical Director, Institute of Environmental Science & Research∑ Director & Shareholder, Jacaranda Limited∑ Fellow, Royal Australasian College of Medical Administrators and New Zealand

College of Public Health Medicine∑ Fellow and New Zealand Committee Member, Australasian Faculty of Public

Health Medicine∑ Member, Territorial Forces Employer Support Council∑ Member, Laboratory Round Table∑ Brother and sister work in health sector in the Wairarapa in disability support

and laboratoriesMr Derek MilneDeputy Chairperson

∑ Deputy Chair, Capital & Coast District Health Board∑ Chair, Wairarapa District Health Board∑ Member, Wairarapa FRAC committee∑ Member, 3 DHB FRAC committee∑ Central Region representative, HBL Transition Group∑ Brother-in-law is on the Board of Healthcare Ltd

Mr David ChoatMember

∑ Member, Capital & Coast District Health Board∑ Member, CCDHB Hospital Advisory Committee∑ Member, 3DHB CPHAC/DSAC committee∑ Partner employed as Solicitor, New Zealand Public Service Association∑ Chief Policy Analyst, Ministry of Education

Dr Judith AitkenMember

∑ Member, Capital & Coast District Health Board∑ Member, Finance Risk & Audit Committee, Capital & Coast District Health

Board∑ Member, CCDHB FRAC committee∑ Member, 3DHB FRAC committee∑ Member, HAC committee∑ Councillor, Greater Wellington Regional Council∑ Chair, Audit, Risk & Assurance Committee, Greater Wellington Regional Council∑ Member, Strategy and Policy Committee, Greater Wellington Regional Council∑ Trustee, Carter Observatory Trust∑ Board member, Citizenship Trust ∑ Board member, Holocaust Centre of New Zealand

Mr Peter DouglasMember

∑ Member, Capital & Coast District Health Board∑ Member, Hutt Valley District Health Board

11 November 2016 - CCDHB Board PUBLIC papers - Continuous Disclosure

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Name Interest

∑ Member, Capital & Coast DHB FRAC committee∑ Member, Hutt Valley DHB FRAC committee∑ Member, 3 DHB FRAC committee∑ Chair, Hato Paora College Board of Trustees∑ Deputy Chair, Hato Paora College Proprietors Trust Board∑ Chairman, Ruapuha Uekaha Hapu Trust∑ Member, Vulnerable Childrens Board

Ms Helene RitchieMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB CPHAC/DSAC committee∑ Councillor, Wellington City Council∑ Registered Psychologist, Private Practice∑ Founding member, Trust for Early Onset Dementia∑ Son is an emergency department doctor, Dunedin Hospital

Mr Darrin SykesMember

∑ Member, Capital & Coast District Health Board∑ Member, Capital & Coast District Health Board, FRAC committee∑ Member, 3 DHB FRAC committee∑ Trustee, Wellington Regional; Sports Education Trust (trading as Sports

Wellington)∑ Member, Sport and Recreation New Zealand (trading as Sport NZ)∑ Chief Executive, Crown Forestry Rental Trust

Mr Chris LaidlawMember

∑ Member, Capital & Coast District Health Board∑ Member, 3 DHB CPHAC/DSAC committee∑ Chair, Natural Resource Planning Committee, Greater Wellington Regional

Council∑ Trustee, ANEW Foundation∑ Trustee, Citizenship Education Trust∑ Advisory Board Member, Leadership New Zealand∑ Board Member, NZ Foundation for Progress and Wellbeing∑ Patron, Association of Blind Citizens of New Zealand∑ Vice Chairman, Oxfam∑ Chairman, Greater Wellington Regional Council∑ Deputy Chairman, Wellington Water Committee∑ Member, Wellington Regional Strategy Committee

Mr Nick LeggettMember

∑ Member, Capital & Coast District Health Board∑ Chair, 3DHB CPHAC/DSAC committee∑ Member, CCDHB FRAC committee∑ Member, 3DHB FRAC committee∑ Member, HAC committee∑ Board representative, Sub Regional Pacific Strategic Health Advisory Group∑ Mayor, Porirua City Council∑ Trustee, Spark Foundation∑ Chairperson, Wellington Regional Emergency Management Committee,

Greater Wellington Regional Council∑ Member, Wellington Regional Transport Committee, Greater Wellington

Regional Council∑ Member, Wellington Water Committee


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Name Interest

Ms Sue KedgleyMember

∑ Member, Capital & Coast District Health Board∑ Member, CCDHB HAC committee∑ Member, Greater Wellington Regional Council∑ Member, Consumer New Zealand Board

Mr Roger JarroldMember

∑ Member, Capital & Coast District Health Board∑ Chair, Capital & Coast DHB and Hutt Valley DHB FRAC committees∑ Chair, 3 DHB FRAC committee∑ Trustee, Auckland District Health Board Charitable Trust∑ Employee CFO, Downer New Zealand Ltd∑ Director, Downer New Zealand Ltd∑ Director, Works Infrastructure Cortex Resources JV Ltd∑ Director, Works Infrastructure Harker Underground Construction JV Ltd∑ Director, Works Finance (NZ) Ltd∑ Director, DGL Investments Ltd∑ Director, TSE Wall Arlidge Ltd∑ Director, Waste Solutions Ltd∑ Director, Underground Locators Ltd∑ Trustee, Works Superannuation Scheme∑ Member, Finance and Risk committee, Health Research Council∑ Past member, Ministry of Health Audit and Risk Committee (resigned 6

December 2013)∑ Director, Downer Utilities Alliance New Zealand Ltd∑ Director, Downer Utilities New Zealand Ltd∑ Assisting ADHB with a Cost of Service programme∑ Employer (Downer NZ) subcontracts to Spotless

Dr Margaret WilsherCrown Monitor

∑ Crown Monitor, Capital & Coast District Health Board∑ Chief Medical Officer, Auckland District Health Board∑ Clinical Associate Professor, University of Auckland∑ Member, Capital Investment Committee∑ Member, Hospital Redevelopment Partnership Group (Canterbury)∑ Director, New Zealand Health Innovation Hub∑ Independent Physician, Auckland Medical Specialists∑ Fellow, Royal Australasian College of Medical Administrators∑ Fellow, Royal Australasian College of Physicians∑ Member, ASMS∑ Member, Southern Partnership Group∑ Director, Northern Region Alliance Health Ltd


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Interest Register

EXECUTIVE LEADERSHIP TEAM11 NOVEMBER 2016

Debbie ChinChief Executive Officer

∑ Member, Rotary

∑ Member, HBL FPSC Procurement Steering Group (regional Chief Executive representative)

∑ Member, HBL Shared Services Council (regional Chief Executive representative)

∑ Trustee, Wellington Hospitals FoundationChris LowryChief Operating Officer

∑ Son works at HVDHB

Ms Sandra WilliamsActing Director, Service Integration & Development Unit, 3 DHB

∑ Director, Tupu Associates Limited

∑ Director, Kahu Wear Limited

Donna HickeyDirector, Human Resources, 3 DHB

∑ Sister is a nurse, working for Plunket

Tony HickmottActing Executive Director, Corporate Services, 3 DHB

∑ Wife is employed by CCDHB as a midwife

∑ Sister-in-law is medical director for Student Health Services at Victoria University

∑ Niece is employed by Deloitte Auckland as a senior marketing advisor

∑ Director, Allied Laundry (CCDHB representative)Roger PalairetActing Chief Legal Counsel

∑ Practices law as Palairet Law, specialising in public law

∑ Chair and Trustee of Carers NZ (non-profit organisation promoting the interests of family carers; funders include MoH, MSD and Waitemata DHB)

∑ Sister-in-law is a paediatric nurse at CCDHB

Nigel FairleyGeneral Manager, Mental Health Addictions & Intellectual Disability Service, 3 DHB

∑ Fellow, NZ College of Clinical Psychologists

∑ President, Australian and NZ Association of Psychiatry, Psychology and Law

∑ Trustee, Porirua Hospital Museum

Shayne HunterActing Chief Information OfficerTechnology, 3 DHB

∑ Currently in transition from a role at the Ministry of Health and assisting Rillstone Wells on the RHIP/CRISP review

Cheryl GoodyerCapability Manager, Māori Health Development Group

∑ Director, Otarere Māori Arts and Crafts

∑ Director, C A Goodyer Ltd

∑ Member, Goodyer family/whanau trust

∑ Various family members working across the DHB health sector –Hutt Valley/Auckland/Canterbury DHBs


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Taima FagaloaDirector, Pacific Health Directorate

∑ Cousin works as a community health worker for Ora Toa Health

∑ Director, TCF Consulting Limited

Mr John TaitChief Medical Officer

∑ Member Fertility Associates

∑ Member, National Maternity Monitoring Group

∑ Member, ACC taskforce neonatal encephalopathy

∑ Member, Waikato Womens’ service taskforce

∑ Board member, Wellington Hospitals Foundation

Catherine EppsExecutive Director of Allied Health, Technical & Scientific

∑ Expert Advisor (Leadership) to New Zealand Speech-Language Therapists Association

∑ Deputy Chair, National DHB Directors Allied Health

∑ Brother is an ENT surgeon with locum employment at CCDHB and HVDHB

Andrea McCanceDirector, Nursing & Midwifery

∑ Trustee, Mary Potter Hospice

Dr Pauline BoylesSenior Disability Advisor

∑ Past President/ Advisor to Board, Wellington Riding for the Disabled

∑ Managing Director, Dream Achievers Ltd

∑ Member on the Ministry of Health National Advisory Group for Review of Behaviour Support Services

Jannel FisherCommunications Manager

∑ Mother-in-law and sister-in-law are a Bureau nurse and Healthcare assistant respectively

∑ Another sister-in-law is a nurse at CCDHB


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CAPITAL AND COAST DISTRICT HEALTH BOARDDRAFT Minutes of the Board

Held on Friday 14 October 2016 at 11.38amKenepuru Education Centre, Kenepuru Community Hospital

Raiha Street, Porirua

PUBLIC SECTION

PRESENT: Dr V Hope (Chair)Mr D Milne (Deputy Chair) Ms H RitchieMr N LeggettMs S KedgleyDr J AitkenMr C LaidlawMr D ChoatMr R JarroldMr P Douglas (arrived 11.55am)Mr D Sykes

IN ATTENDANCE: Dr M Wilsher (Crown Monitor) – video conference callMs C Lowry (Acting Chief Executive and Chief Operating Officer)Mr T Hickmott (Chief Financial Officer/acting Executive Director 3DHB Corporate Services)Ms S Williams, (acting Director, Service Integration & Development Unit 3DHB)Mr N Fairley (General Manager, Mental Health, Addictions & Intellectual Disability 3DHB)Ms Andrea McCance (Director of Nursing and Midwifery)Mrs R Fitzgerald (Acting Board Secretary)

One member of the public (left 12.20pm).

Item 2.1 Mr J Rikihana (Chair, Māori Partnership Board) and Ms C Goodyer (Manager, Māori Health Development Group)

____________________________________________________________________________

1 PROCEDURAL BUSINESS

ITEM 1.1 PROCEDURAL

Mr D Sykes opened the meeting with a Karakia and Dr V Hope welcomed Board membersand management to the meeting.

ITEM 1.2 APOLOGIES

Ms D Chin, Chief Executive.

11 November 2016 - CCDHB Board PUBLIC papers - Confirmation of Minutes 14 October 2016

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ITEM 1.3 INTERESTS

1.3.1 REGISTER OF INTERESTS

No changes were advised.

1.3.2 CONFLICTS RELATED TO ITEMS ON THE AGENDA

Roger Jarrold informed the Board that he was currently assisting ADHB with a Cost of Service programme and that his employer, Downer NZ, subcontracts to Spotless – who are currently contracted to CCDHB.

No other conflicts were foreshadowed in respect of items on the current agenda but there would be an additional opportunity at the beginning of each item for members to declare conflicts of interest.

ITEM 1.4 MINUTES OF PREVIOUS MEETING 12 AUGUST 2016

RESOLVED THAT:

The minutes of the CCDHB Board meeting held on 12 August 2016, taken with the public present are confirmed as a true and correct record.

Moved: Darrin Sykes Seconded: Derek Milne CARRIED

ITEM 1.5 MATTERS ARISING UPDATE

Nil.

ITEM 1.6 ACTION LIST

Item 3.2 – Health and Safety (meeting 12 August 2016)Management were requested to consider the inclusion of the care of the aged as a health and safety risk. Information is not yet complete - an extension has been requested until November.

Item 3 – Discussion items (Chair’s Report) (meeting 8 April 2016)The Board requested management to investigate the level of H&S reporting of the subcontractors it engages with. Information is not yet complete - an extension has been requested until November.

Item 4.1 – CEO report (meeting 8 November 2013)The Board requested that Health Workforce New Zealand Chair should be encouraged to present to the Board and to provide a presentation on their long term strategic direction.

The reporting timeframes on the other open action items were NOTED.


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2 ADVISORY GROUP UPDATE

ITEM 2.1 MĀORI PARTNERSHIP BOARD UPDATE (J Rikihana, Chair MPB and Ms C Goodyer, Manager, Māori Health Development Group)

Mr J Rikihana, Chair MPB, was welcomed to the meeting. The Chair provided an update of the activities of the Board and confirmed the recent resignation of Dr Leo Buchanan from the Board.

NOTED and COMMENDED the Intervention Case Study examples (provided by Whānau Care Services) that were included in the Chair’s report. These case studies provide value insights and should be evaluated to identify if there is a need for system changes and what these may be.

Action:1. That the Intervention Case Study examples be referred to the Chief Executive CCDHB

for evaluation.2. That these Intervention Case Studies or similar be presented to the new Board.

3 DECISION ITEMS

ITEM 3.1 HEALTH AND SAFETY REPORT

The report was taken as read.

The Board NOTED :

(a) the Health and Safety Report for the month of July/August 2016(b) the current Health and Safety Risks as at August 2016 (c) the number of staff reported incidents for July/August 2016.

Moved: Judith Aitken Seconded: Derek Milne CARRIED

Action:1. Chair to write to the Chair of the newly elected Regional Council and Mayor of the

newly elected City Council to discuss the issue of emergency water supply for the local community and hospital.

2. Management to include KPIs for the next report.3. Management to benchmark against other DHBs and workforce.

4 DISCUSSION ITEMS

ITEM 4.1 CHAIR’S REPORT


The report was RECEIVED.


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The Board NOTED:

(a) that the Chair will respond to the Minister’s letter on the Health target results, quarter four 2015-16.

Action:1. Chair to respond to Minister’s letter on the Health target results, quarter four 2015-

16.2. Chair to contact Dr Andrew Simpson to express interest in being consulted on the

proposed operating model for the strategic prioritisation function of the Ministry of Health.

ITEM 4.2 CHIEF EXECUTIVE’S REPORT

The report was taken as read and the Board:

COMMENDED management for: joining the Global Green and Healthy Hospitals network; the Sustainable Awards nomination; Wellington region being the most popular destination for RMO training in New Zealand; the decline in rates of rheumatic fever across the three DHBs, and for participating in the Telestroke initiative that gives patients better access and faster treatment.


Action:1. Management to report back and confirm if CCDHB have a Transport Plan; who do we

link in with transport arrangements; how do we support other providers of transport, e.g. Cancer Society.

2. Management to provide timeline for System Level Measures Plan.3. Management to confirm who will undertake engagement with Kapiti stakeholders

and timeline for engagement4. Management to take report to Board workshop to discuss outcomes from

engagement with community5. Management to confirm Birthing Unit timeline and decisions needed

5 NOTING ITEMS

ITEM 5.1 HOSPITAL ADVISORY COMMITTEE (HAC) MEETING REPORT BACK

The Board was informed that during the recent National Civil Defence Emergency Exercise Tangaroa, in which CCDHB participated, Wellington Regional Emergency Management Offrice staff failed to alert any health agencies of the activation of their Emergency Coordination Centre; and obtaining up-to-date information from them on the development of the scenario was difficult.


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Action:1. Chair to write to the Wellington Regional Emergency Management Office to request

that the issue be addressed and remedied to ensure integrity of communication during a possible real event and any future exercises.

ITEM 5.2 CPHAC/DSAC REPORT BACK



ITEM 5.3 SUBCOMMITEE NOMINATION

The Board NOTED and RESOLVED to:

(a) ENDORSE the retrospective appointment of Kim Smith to the CPHAC/DSAC Committee up to and including December 2016.

(b) NOTE the appointment of new committee members to CPHAC/DSAC will be the responsibility of the new Board beyond December 2016.

Moved: Darrin Sykes Seconded: Nick Leggett CARRIED

6 GENERAL BUSINESS

There were no items of general business.

7 RESOLUTION TO EXCLUDE THE PUBLIC

ITEM 7.1 RECOMMENDATION

The Board NOTED and RESOLVED to:

(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 excluded papers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in respective public excluded papers

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

9(2)(i)(j)

Discretionary community investments

Allied Laundry AGM

Chair’s report

CEO’s report

Draft Annual Report 2015/16 Subject to Ministerial approval 9(2)(f)(v)


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Litigation Plan and Remediation Strategy Maintain legal professional privilege 9(2)(h)

Sub Committee report backs/draft minutes

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

9(2)(j)

Moved: Nick Leggett Seconded: Roger Jarrold CARRIED

The meeting closed at 1.18pm.

8 DATE OF NEXT MEETING

Friday 11 November 2016 at 11.30am, Boardroom 11, Grace Neill Block, Capital & Coast DHB.

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

DATED this ................................................day of...............................................2016

VIRGINIA HOPECCDHB BOARD CHAIR


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Meeting Type: BOARD PUBLIC

SCHEDULE OF ACTION POINTS – NOVEMBER 2016 PUBLIC MEETING

Board Meeting 14 October 20162.1 Māori Partnership

Board Update1. The Intervention Case Study examples be referred to the

Chief Executive CCDHB for evaluation2. The Intervention Case Studies be presented to new Board

COO

CEO

Refer to DNA team.

Schedule for Advisory Group updates 2017

November 2016

Early 2017

Completed

3.1 Health and Safety Report

1. Chair to write to the Chair of the newly elected Regional Council and Mayor of the newly elected City Council to discuss the issue of emergency water supply for the local community and hospital.

2. Management to include KPIs for the next report.3. Management to benchmark against other DHBs and

workforce.

Chair

COO Include in reporting

Include in reporting

November 2016

WIP

WIP4.1 Chair’s Report 1. Chair to respond to Minister’s letter on the Health target

results, quarter four 2015-16.2. Chair to contact Dr Andrew Simpson to express interest in

being consulted on the proposed operating model for the strategic prioritisation function of the Ministry of Health.

Chair November 2016

4.2 CEO’s Report 1. Management to report back and confirm if CCDHB have a Transport Plan

2. Management to provide timeline for System Level Measures Plan

3. Management to take report to Board workshop to discuss outcomes from engagement with community

4. Management to confirm Birthing Unit timeline and decisions needed.

COO

SIDU

SIDU

SIDU

Update in CE’s report November 2016

Early 2017

Early 2017

Early 2017

Completed

5.1 HAC meeting report back

1. Chair to write to the Wellington Regional Emergency Management Office to request that the issue be addressed and remedied to ensure integrity of communication during a possible real event and any future exercises.

Chair November 2016

AP No. Topic Action Responsible How Dealt with Delivery date Complete

11 November 2016 - CCDHB Board PUBLIC papers - Action list

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Board Meeting 12 August 20162.1 SRPSHAD update The Pacific Health unit director was requested to consider how

the pacific aspect can be incorporated into clinical training for all staff as the model of care and training opportunities are developed

Dir PHU Noted and ongoing WIP

2.4 Child Health Strategy update

The Board requested that the modelling work (for children to have access to the services they need in a coordinated way) undertaken be included in the LNI DHBs’ health systems plans for Board consideration

Dir SIDU Include in HSP Early 2017

3.2 Health and safety Management were requested to consider the inclusion of the care of the aged as a health and safety risk

COO Include in risk reportto FRAC

October 2016 Completed

Board Meeting 10 June 20163.1 CPHAC/DSAC

Recommendations1 Using the National indicators the Board will plan work on

specific indicators relevant to the Board

(g) That CPHAC/DSAC will be looking at an action plan medium term and look at recommendations for achieving progress in line with Board Strategy

CE Referred to CPHAC DSAC for action.

October 2016 Completed


Management were requested to report back on what options they recommend on birthing hubs

Dir SIDU Options paper being developed for Board

Early 2017

Board Meeting 8 April 20163 Discussion Items

(Chair Report)1. The Board requested management to incorporate

governance level reporting and KPIs into its health and safety updates and include these within the CE report

2. The Board requested management to investigate the level of H&S reporting of the subcontractors it engages with

CE

CE

Included in reporting going forward

Item 2 to be included in November 2016 report

November 2016

3DHB HAC meeting 15 May 2015H77 Operational Services

ReportFollowing the presentation to HAC, the committee requested that Dr Anne O’Donnell be invited to present/speak at a Board workshop.

Chair Update to HAC. Deferred until 2017

Board Meeting 8 November 20134.1 CEO report Schedule a presentation to the Board by HWFNZ. Chair CCDHB Chair to write to

HWNZ Chair and invite to Board meeting to present long term strategic direction.

TBC

11 November 2016 - CCDHB Board PUBLIC papers - Action list

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PUBLIC

Wairarapa, Hutt Valley and Capital & Coast District Health Board

BOARD DISCUSSION PAPER

Date: 18 November 2016

Author Dr Pauline Boyles, Senior Disability Advisor, Service Integration Development Unit

From Sandra Williams, Acting Director, Service Integration Development Unit

Endorsed by Adri Isbister, Chief Executive, Wairarapa DHB

Ashley Bloomfield, Chief Executive, Hutt Valley DHB

Debbie Chin, Chief Executive, Capital & Coast DHB

SubjectDisability Implementation Plan – six year milestones.

Update on Local area initiatives.

RECOMMENDATION

It is recommended that the Board:

NOTEa. Six year milestones for improving disability responsiveness in the sub regionb. The role of innovation and leadership at all levels that has achieved improved disability responsivenessc. The role of policy embedded in practice and plans for future localised policy at Hutt and Wairarapa DHBsd. Leadership on the health passport by Hutt Valley and Capital and Coast DHBs in 2011 was an important milestonee. Sub regional governance and system change contributed to progress since 2013f. The intentional use of co design for creation of enabling environment (based on World Health Organisation

Integrated Care model) 2013-16 g. Summary of sub regional progress 2015/16h. CCDHB Highlights

i. A quality improvement project to upgrade quality of original disability alerts is developedii. Emergency Department engages in training for improving disability responsivenessiii. Clinical training at CCDHB is stepped upiv. Disability Support Needs indicators are included in the SIDU Equity Report for the first time.

Sub Regional Disability Advisory Group updates:f. Chair of Sub Regional Disability Advisory Group Margaret Faulkner steps down in 2016 g. Members lead on an updated action plan 2016-21h. United Nations International Day of Persons with Disabilities December 3rd and plans for disability responsiveness

week in the sub regioni. Gratitude expressed to outgoing board members for long term commitment particularly CCDHB Dr Judith Aitken

for courageous leadership on disability for many years and to Dr Virginia Hope.

APPENDICES

1 Disability Responsiveness Programme Timeline ‘Road’ Map2 Summary of Milestone Initiatives

11 November 2016 - CCDHB Board PUBLIC papers - Advisory Group Update

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PUBLIC


1 PURPOSE

The main purpose of this Sub Regional Disability Advisory Group update is:∑ To present the main milestones of progress on disability responsiveness over six years of work;∑ To highlight the achievements, progress and leadership of CCDHB on innovation for Disability

Responsiveness; and∑ To honour the combined leadership and achievements of staff boards and community members.

2 DISABILITY RESPONSIVENESS PROGRAMME: THE ROAD SO FAR

The following commentary should be read alongside Appendix One.

2.1 Strategic Underpinnings There are two main documents that under pin the Disability Implementation Plan for the sub-regionthese are:∑ New Zealand Disability Strategy (NZDS)∑ United Nations Convention on the Rights of Persons with Disabilities (UNCRDP).

The NZDS is a vision for New Zealand society; to value lives and enable the full participation of disabled people. The strategy also provides a framework for government agencies and service providers. The mandate for the Strategy comes from the Health and Disability Act (2000)1. A key theme of the NZDS, relevant to health is the need for a person centred approach2.

The UNCRDP is the highest governing document - to which New Zealand is accountable to on disability issues3. Any policy or plans related to disability should adhere to the UNCRDP otherwise New Zealand will be in breach of the convention.

2.2 Innovation, Integration and Transformation Any system and service change to improve responsiveness involves a range of the following:

∑ Proactive initiatives led by both staff and community∑ Intentional integration using available tools to identify areas of need∑ Transformation over a longer period led by and with communities of interest alongside staff.

The above has been demonstrated over the last few years by a number of committed leaders. The original Senior Disability Advisor role was established in 2009 at CCDHB and the role became sub regional in 2013. The leadership demonstrated by Chief Executives over the years has ensured the work of the sub regional DHBs has national significance. Other District Health Boards are learning from the implementation of the plan that transformation occurs through innovative community driven, person centred initiatives and well planned integration within business as usual practices.

Changes across the sub region have been gradual but embraced by staff and community across all localities. The evidence of disability programme monitoring is that clinical services, attitudes and a level of commitment to improving systems is occurring in a number of different areas. While there is still a long way to go the momentum is occurring.

1 Office of Disability Issues (2016a), http://www.odi.govt.nz/nzds/2 Office of Disability Issues (2016b), http://www.odi.govt.nz/what-we-do/ministerial-committee-on-disability-issues/disability-action-plan/2015-actions-implementation/actions-for-implementation.html3 United Nations (2016), https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15&chapter=4&clang=_en


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PUBLIC


2.3 Policy and Practices for Disability Responsiveness are combined In 2011 the Disability Action Group (DAG) was established at CCDHB and attended by others from Hutt Valley DHB with a similar interest. DAG is a collection of committed senior and front line employees who, with the support of the Chief Medical Officer (CMO) CCDHB and the endorsement of Hutt Valley CMO have focused on meeting the goals of “quality, continuous improvement and patient safety for disabled people using DHB and Hospital services”4. DAG using a co design process wrote the Disability Responsiveness Policy. The key themes of the policy include:

1) The programme will Influence and improve health systems and practices to increase access and utilisation of primary, secondary and community services for disabled people.2) The programme will demonstrate responsive practices and provide evidence of improved performance.3) The programme will address service change in consultation with disabled people who have experience of health and hospital services5.

The policy was adopted in 2013/146 at CCDHB providing an opportunity for critical conversations about what is Disability Responsiveness? During 2016 it was agreed by Hutt and Wairarapa ELTs that an overarching disability policy would be shared sub regionally but with local variations to address the unique needs of each area. Progress is incremental but an example is the acceptance of mandatory training for staff in disability responsiveness, an area not well understood or supported in past years.

2.4 The Launch of the Health Passport 2011In 2011 HVDHB, CCDHB and Health and Disability Commission (HDC) partnered to become the pilot site for the newly developed Health Passport. The Health Passport was sponsored by HDC in response to the wishes of the family of a woman who died in 2009 in distressing circumstances7. The outcomes from the demonstration site while slow to be realised led to the request by Wairarapa DHB to lead a sub-regional re launch. The Health and Disability Commissioner has endorsed the leadership and investment made by CCDHB and subsequently the Wellington Sub Region. This is demonstrated by the request of the Commissioner for the three DHBs to collaborate with consumers and clinicians sub regionally to review and reproduce a document that is flexible and fit for purpose.

2.5 A Combined CPHAC/DSAC in 2012 Encourages Sub-Regional Leadership on Disability Leadership and collaboration has occurred sub regionally on disability for many years. In 2011/12 HuttValley and CCDHB combined DSAC committees and a first combined disability plan was endorsed by boards early in 20128.

Over 2013/14 a number of other critical changes occurred led by a combined CPHAC/DSAC and the establishment of SIDU with a new Director. Key milestones include:∑ SIDU established November 2012∑ CPHAC/DSAC committees were combined sub regionally9

∑ The first sub regional forum at Orongomai Marae led to a newly endorsed plan: “Valued Lives Full Participation”. The plan and the sub regional collaboration was overwhelmingly endorsed by localcommunities from Kapiti to Wairarapa

∑ The Sub Regional Disability Advisory Group (SRDAG) was established to ensure the new CPHAC DSAC had community leadership and input

∑ A further sub regional forum occurred at Silverstream in 2014 led by SRDAG and SIDU

4 DAG terms of reference, (November, 2015).5 Disability Responsiveness Policy, CapDocs, (November 2014), http://silentone/silentone/6 The Disability Acton Plan 16/177 Ms A. Ms A’s family believed with a passport, staff would have better understood and meet her support needs Health Passport Joint Pilot between CCDHB and HVDHB, Project Closure Report, September 2011 8 Valued Lives Full Participation Hutt Valley and CCDHB 2012-179 Six sub committees were combined across three DHBs with representatives from each board. Board members were allocated disability portfolios


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∑ The Disability icon was implemented at CCDHB in 2013 followed by Hutt Valley DHB 10

∑ The first Child to Adult transition (CAT) demonstration site was created.11

∑ Disability Initiatives Educators/Coordinators were employed or contracted in all three DHB providers.

2.6 Co Design is Used Intentionally “Creating Enabling Environments with People as Experts”Forums and workshops have played an important role in developing and monitoring the Implementation Plan and DR Programme. Each locality has hosted and led a community forum over2014-16.

In 2016 consumers and leaders from different sectors across Greater Wellington came together to commit to collaboration and creation of positive partnerships. The outcomes of this forum have created the basis for the new programme plan.

The local forums aim to connect industry leaders with the community. Community members from each locality take on organisational roles and assist with hosting duties at these local forums, ensuring the content and structure is suited for each locality. Using this model means that disabled people are in the driving seat, and have a direct way to connect with DHBs.

Workshop models have better engaged planning on Māori and Pacific disability communities led by appropriate community leaders. Co design of forums and action plans has occurred in successful well facilitated workshops over the last three years.

2.7 Progress 2015 and 2016Key successes in 2015 and 2016 include:∑ Leadership and educational initiatives are building sub regionally across all DHB providers∑ Reporting against disability clause in community contracts is mandated in 2015/16∑ Community engagement and co design processes (with service users) are gradually embedded

into planning processes. People with disability expertise are now proactively engaged in most co design and consumer leadership initiatives12

∑ Child to Adult Transition demonstration site Hutt Valley DHB to be developed across all areas in 2018

∑ Phase One New Zealand Sign Language in health research is completed∑ 2016 November new draft of Disability Plan is completed (2016-2021) to be presented to boards

January 2017.

3 CAPITAL & COAST DISTRICT HEALTH BOARD SEPTEMBER TO NOVEMBER 2016

3.1 Quality Improvement Project Since CCDHB was the first DHB to implement the disability icon it has been important to revisit and address the quality of information provided against Individual unique alerts.13 These were those previously added to the system in 2013 and 2014. During the process of updating, patients receive a letter from the DHB dedicated team and then a follow up phone call to discuss the process and the benefits of adding an alert to the system. This follow up, alongside increased education of both consumers and staff members will ultimately lead to quality alerts. This will not only improve the system indicators being developed but will more importantly, improve the patient journey.

10 The icon had been purchased in 2010 by both DHBs. The launch with the comprehensive quality programme of work has led to the ability to collate quantitative and qualitative data to inform planning and funding of services11 Newlands Johnsonville Tawa and Ngaio hosted a programme for 27 families from Child Development Services in transition to adulthood (14-16)12 Disability experience is included in consumer council models and the sub regional Mental health Consumer Leadership Group13 Without the specific documentation support needs (usually provided by the patient) are against each impairment category the alerts only provide a quantitative measure.


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3.2 Educational Partnerships for improvement of Emergency Department PracticesThe Disability Responsiveness (DR) educator has built a strong relationship with Emergency Department staff at CCDHB. This relationship will form the basis of disability responsiveness and disability literacy training programme as identified in a pending new updated Implementation plan. As ED is often the frontline for patients with complex communication needs, this has been a great opportunity to discuss the tools available and implement processes for communicating with people.The DR educator is developing a work plan with Emergency Department staff to meet their specific needs and time allowance. The launch of a video resource, e-Learning and other DR tools will further contribute to the education of administration and clinical staff within these essential 24/7 services.

3.3 Clinical Training The breadth and depth of disability input into clinical training at CCDHB continues to increase. Areas where the Disability Educator is currently providing training includes: RMOs, Pre-graduate and new nurses, ward handovers, service specific education, paramedic and HCAs. A new education plan is be made for 2017 to ensure all areas are covered in top of reactive education. To help embed disability education, a nurse educator module is being created.

4 SUB REGIONAL DISABILITY ADVISORY GROUP UPDATE

4. 1 Sub-Regional Disability Advisory Group LeadershipThe chair of SRDAG, Margret Falkner, will stand down as chair at the end of 2016. She has also agreed to stay on SRDAG to represent Porirua and Older Persons. The three Chief Executives will endorse a new chair, who will apply for membership of CPHAC DSAC 2017 – 2020.

4.2 Members Co Design an Updated Action PlanAs noted in 2.4 members of the group have actively engaged in a substantial re-write of the plan based on key themes of the 2016 intersectoral Sub-regional Disability Forum. Robust measures for the short medium and long term have been drafted based on feedback from the sector. A road show in early 2017 will take the updated plan to each new board for endorsement and the annual planning processes 2017/21 will provide the practical mechanisms for incremental change and investment.

4.3 United Nations International Day of Persons 2016 will end with Disability Responsiveness Week during the week 28th November – 2nd December. This week is a celebration to mark the United Nations International Day of Persons with Disabilities on December 3rd. The week will highlight the programme to all staff and be coordinated across the 3DHBs. Some events that will take place include: displays at each hospital, champions breakfast, Video Premiere, daily communications and a 3DHB wide department competition. The programme of work and events has been led by SRDAG members and Disability champions across the DHBs.

4.4 As boards of all DHBs change and enter a new term it is important to acknowledge the legacy some members have left. There are many members who have contributed time, energy, and courage over the last few years to ensure that the needs of 24% of the population receive improved services. There is now recognition that older members of the population who require better health access has brought disability issues into a different and more visible space.

The Management involved and the sub regional group wish to express their thanks to those members who have stepped up and by their leadership have ensured that disability remains a visible and important focus for health services and systems.

Particular recognition is offered to Dr Judith Aitken who always recognized the value to leadership on disability responsiveness in her robust leadership of DSAC over the years.


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Thanks also to:Margaret Faulkner who has believed in the work and remains committed in the future.Dr Virginia Hope who has supported and advocated leadership on disability issues, and Mr Bob Francis who is relentless in his pursuit of actions and outcomes.

The local communities and the leadership team involved sincerely thank you all.


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BOARD DECISION PAPER

DATE: 3 November 2016

Author Chris Lowry, Chief Operating Officer

Endorsement Debbie Chin, Chief Executive Officer

Subject Health and Safety Policy

RECOMMENDATION


a. Approve the revised Health and Safety Policy.

APPENDIX

1 Health And Safety Policy

1 INTRODUCTION

The DHB’s Health and Safety Policy has been reviewed to reflect the changes to the Health and Safety at Work Act. The policy has been reviewed by an external expert and feedback reflected in the attached –Appendix 1.

The policy has been through the DHB’s internal approval process and has been presented to FRAC for endorsement and a recommendation to the Board to approve.

11 November 2016 - CCDHB Board PUBLIC papers - FOR DECISION

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Author Virginia Hope, CCDHB Chair

Subject Chair’s report

RECOMMENDATIONS


a. Note this report.

APPENDIX1 Letter to Director-General of Health – Disability responsiveness training for Primary Health Organisations

2 Response from Director, Service Commissioning, Ministry of Health – Disability responsiveness training for Primary Health Organisations

3 Letter from Director-General of Health approving Delegation Policy

1 Disability responsiveness training for Primary Health Organisations

The Lower North Island DHBs (Wairarapa, Hutt Valley and Capital & Coast) have made a considerable investment in a programme of work to improve equity of access for people with disabilities of all ages.

At the 10 June Capital & Coast District Health Board meeting the Sub Regional Disability Advisory Group provided an update on the sub regional cross sectorial forum held on 3 June. An overwhelming mandate was given by participants to engage all responsible bodies in the improvement of disability literacy for health professionals.

The Capital & Coast District Health Board requested that a letter be sent to the Director-General of Health from the Board advocating and seeking support from the Ministry of Health for all PHOs to provide disability responsiveness training. Refer Appendix 1 and 2.

The Chair of SRDAG, Margaret Faulkner, welcomed the support from the Board and circulated a copy of the letter to SRDAG members. The Chair acknowledged the dedication of Pauline Boyles and the disability team,and praised their ability to transfer ideas into practical and workable solutions.

2 Approval of CCDHB’s Delegation Policy

Approval of CCDHB’s Delegation Policy has been given by the Director-General of Health. The finalised document will be released to the public. Refer Appendix 3.

11 November 2016 - CCDHB Board PUBLIC papers - FOR DISCUSSION

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Author Debbie Chin, Chief Executive Capital & Coast DHB

Subject Chief Executive’s report

RECOMMENDATION


a. Note the contents of this report.

APPENDICES

1. Financial summary, September 2016

2. Approval from the Ministry of Health - System Level Measurements Improvement Plan 2016/17

3. Accreditation Report – Royal Australian and New Zealand College of Ophthalmologists

1 FINANCIAL UPDATE

1.1 Financial overview

The DHB result is unfavourable to budget by ($384k) for September 2016 and unfavourable by ($333k) year to date (YTD). Refer Appendix 1.

The DHB has an actual deficit of ($1.6m) for the month and a year to date deficit of ($4.8m).

The main cost driver impacting the DHB YTD financial result is the adverse variance in mental health predominately relating to personnel costs associated with higher occupancy, sick leave and overtime, and corporate relating to legal and consulting costs associated with copper pipes and payroll.

Activity movement compared to last year


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2 OUR PEOPLE

2.1 Rangatahi Expert Nurses

Two more expert nurses have been added to the Mental Health, Addiction and Intellectual Disability Services 3DHB, including the first Pasifika nurse.

Expert level is the highest achievement for registered nurses who engage in post graduate level education – or the equivalent. The programme is approved by the Nursing Council.

The pair are based within the Regional Rangatahi Adolescent Inpatient Service (RRAIS), the central region’s acute adolescent inpatient unit based at Ratonga Rua o Porirua.

3 BUSINESS ACTIVITY

3.1 Tackling waste in CCDHB

A recent article on Stuff and in the Dominion Post reported on waste management at CCDHB. An audit of waste was undertaken to identify if there was room for improvement in the way CCDHB manages waste. CCDHB generates between 4000 and 5000 kilograms of waste every day. This includes biohazardous materials, recyclable materials and general waste. While some waste is subject to health and safety protocols other waste is being reviewed to see whether improvement in packaging and identification of what can be recycled. For example, CCDHB has been recycling plastic bags from intravenous treatments, such as saline, glucose and iron. They are trucked to Otaki and recycled into equipment used in children’s playgrounds. CCDHB goes through about 300,000 of these bags a year. About 500 kg of plastic has been diverted from landfill since this change was introduced.

4 OTHER MATTERS OF INTEREST

4.1 System Level Measures Improvement Plan for 2016/17

Approval by the Ministry of Health has been received for the 2016/17 System Level Measures Improvement Plan. As this is the first year of implementation the Ministry of Health has offered to assist DHBs in the development of their 2017/18 plans by providing feedback on the current plans. Refer Appendix 2.

4.2 Accreditation of the Ophthalmology Training Posts at Wellington Hospital

A recent inspection of the ophthalmology training posts at Wellington Hospital has resulted in four Wellington training posts be reaccredited for a further three years. Refer Appendix 3 – Draft report of inspection.

4.3 CCDHB Travel Plan Review and Transport Strategy

The Sustainability Steering Group and Sustainability Officer are developing a Transport Strategy for assessment and approval by the Executive Leadership Team. The Transport Strategy will include patient travel, fleet and internal goods transport (supply chain) as well as CCDHB’s strategic priorities for the next 10-15 years. Currently, and as a first step to this work programme the Sustainability Steering Group and Sustainability officer are reviewing the 2006 Staff Travel Plan.

Greater Wellington Regional Council (GW) has offered assistance and we are working on a Memorandum of Understanding to formalise the assistance. The likely outcome will be that GW will provide expert advice and review of the current staff travel data and some funding for a travel coordinator to assist with the plan development.

The review will be carried out in four steps:1. Gathering evidence via a travel survey. The survey is currently open for staff to fill in (November)2. Workshops with staff and managers/directors (December – February) to understand what are our staff

priorities are


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3. Developing an action plan including targets, funding and a reporting framework (March – April)4. Consultation and adoption of the plan (April – May).

4.4 Health Targets – Shorter Stays in ED

CCDHB performance against the SSIED for Quarter 1 was 85%. For the month of October performance against the target was 86.1%.

Although there has been a significant amount of work underway enhancing patient flow and ensuring patients receive timely, appropriate care, the on-going challenges given the size of the Emergency Department relative to the activity and the overall inpatient bed capacity relative to our population and demand continues to impact on compliance and difficulty maintaining the pace of change required to achieve a sustainable improvement in patient flow.

OccupancyOccupancy in the adult wards remains high. This is despite the increased bed capacity of 6 East. The impact of occupancy on patient flow is demonstrated in the graph below.

The hospital-wide focus on the patient journey continues with the establishment of a clinical leadership group with CMO leadership. The group have agreed a set of internal professional standards for all parts of the patient journey within CCDHB with a key focus on reducing delays and reducing wasted patient time, and underpinned by early senior review of all patients along all parts of the pathway.

Specific work activities over the past quarter include:∑ Review of all services stage two data and all major services are working to develop plans to improve

response times to ED∑ Weekend Discharges: Criteria led weekend discharge data has been collected for Wards 6N and 7N and

reviewed by the DONM and CMO. This found that 80% of the time patients with set criteria on Friday will be discharged on Saturday or Sunday. Similar data collection will be progressed in the medical wards over the next quarter.

∑ Transit Lounge: Work is underway with the Charge Nurse Managers to improve the utilisation of the transit lounge and to increase early morning discharges creating capacity to support patient flow

∑ Undifferentiated Abdominal pain pathway: Work is progressing with General Surgery, ED and Radiology consultants to establish a pathway for patients presenting with undifferentiated abdominal pain, who routinely stay in ED for more than 6 hours.

∑ A new process has been developed to monitor and intervene for long-stay vulnerable patients that have placement/accommodation needs. The review of 10+ day LOS patient’s is in place in the surgical services and is being re-instigated for Medical Services

∑ A new flow model commenced in the ED green zone in August 2016. One bed has been removed and replaced area with 6 chairs plus small table (created a waiting for review / results area) so we can place new patients into a bed for examination. Appears to be working well – this will be evaluated in September 2016.

∑ Approval of capex to establish a Mental Health assessment space in the Short stay unit. The project is underway with a completion date of December 2016

∑ More consistent use of flex beds into un-resourced beds as needed over winter months.


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∑ Use of Trendcare data by the 24 hour operations team to decide nursing resource allocation and when possible to resource flexing into resourced beds.

The DHB also has a significant work programme with primary care. There is on-going engagement and commitment to the work with primary care through the Alliance leadership group (ICC) and includes an acute demand work stream and the health care home programme of work

We have engaged the Frances Group to work with our teams over the next 10 weeks. This will provide additional resource and focus and accelerate the implementation of further improvements. Staff will be engaged in a ‘bottom up’ planning process that maps out the next 12 months programme of activity building on existing plans, identifying opportunities to enhance these as well as new opportunities.

4.5 Home Care Support Services Implementation Update Report

For the first time, the DHB has visibility of missed and late cares, complaints, and other critical information which no other DHB routinely receives information on to monitor against. We can monitor quality via the new quality framework developed, we are seeking regular feedback from consumers via the newly established Consumer Advisory groups and Access is incentivised to provide quality services via a newly established quality payment system.

Access has provided a weekly update since starting the contract with details of the complaints raised by clients during phone call (0.12% or 206). This is a small number compared with the 165,200 cares delivered in the first 8 weeks. Corrective actions have been put in place for all complaints.

Access provides reporting on phone response times and percentage of calls answered. The service agreement requires a minimum of 85% of calls answered during operational hours.

A review of outcomes for clients during the first eight weeks of service delivery under the new contract indicates there has been service disruption to a small percentage of the people receiving this support. An average of 0.2% of total visits rostered have not been delivered during the first eight weeks of service delivery (this represents about 3-4 visits out of an average of 3500 visits per day).

The percentage of late visits over the first eight weeks has averaged at 0.05%. Access does pre-empt these to let the clients know in many cases that their support workers will be late, and in most cases the clients are understanding of support workers’ unavoidable absence. While missed cares and late cares are concerning, the rate of these are low and well under the 2% KPI threshold that the DHB has instituted via its new Agreement with Access.

The service agreement quality reporting framework requires Access to report all complaints received, time frames for resolution and measurement of complaint severity as determined by the national Severity Assessment Code. This report is required quarterly. Further analysis of the rate and severity of complaints will be available by the end of November when the first quarterly reporting is due.


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CCDHB Financial Overview Page 1 September 2016

Capital & Coast DHB

Financial Overview

September 2016

Chief Executive OfficerDebbie Chin

Chief Financial OfficerTony Hickmott


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FINANCIAL PERFORMANCE RESULT AND OVERVIEW

The DHB result is unfavourable to budget by ($384k) for September 2016 and unfavourable by ($333k) year to date (YTD).

The DHB has an actual deficit of ($1.6m) for the month and a year to date deficit of ($4.8m).

The main cost driver impacting the DHB YTD financial result is the adverse variance in mental health predominately relating to personnel costs and corporate relating to legal and consulting costs associated with copper pipes and payroll.

Hospital Activity

The contributors by group to the September deficit of ($1.6m) and unfavourable variance of ($384k) are split below:

As reported in MoH MIF report Sep-16 Sep-15Variances Month

Months % change

YTD16/17

YTD 15/16

Variances YTD

YTD % change

Discharges 5,190 5,351 161 3.0% 15,976 16,484 508 3.1%Caseweights 5,608 5,802 194 3.3% 17,484 17,821 337 1.9%Bed Days (calculated from Hours) 12,761 13,024 263 2.0% 38,588 40,339 1751 4.3%Length of Stay (excluding day patients) 3.90 3.91 0.01 0.3% 3.85 3.93 0.08 2.0%ED Presentations 5,288 5,081 (207) -4.1% 16,014 16,056 42 0.3%ED Admissions 1,880 1,763 (117) -6.6% 5,664 5,536 (128) -2.3%Theatre Throughput (Hospital) 1,350 1,427 77 5.4% 4,291 4,265 (26) -0.6%

Groups

MonthActual ($000s)

MonthBudget ($000s)

MonthVariance

($000s)

Year to date

Actual ($000s)

Year to date

Budget ($000s)

Year to date

Variance ($000s)

Annual Budget

Provider HHS 2,948 2,957 (9) 11,284 11,280 4 25,553Mental Health 2,250 2,259 (9) 5,857 6,202 (345) 18,529SIDU - Funder/GFA (1,235) (1,041) (193) (5,086) (5,538) 452 (253)Corporate/Other (4,948) (4,736) (211) (15,101) (14,519) (583) (52,153)Exec (incl MoH Revenue) (607) (646) 39 (1,799) (1,937) 138 (7,636)Total DHB Variance (1,591) (1,207) (384) (4,845) (4,511) (333) (15,960)


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Provider Hospital Services – the HHS costs are on budget for the month and YTD. Favourable personnel costs and lower infrastructure costs offset the adverse variances in revenue and clinical supply costs.

Mental Health - the directorate is on budget for the month. Year to date variance is due to personnel costs associated with higher occupancy, sick leave and overtime in prior months.

SIDU – the funder has an adverse variance to budget of ($193k) for September. This is due to a revenue adjustment in the month. The funder is $452kfavourable to budget YTD due to higher than budgeted IDF revenue inflow received in the first three months.

Corporate – the corporate costs have an adverse variance of ($211k) for the month mainly due to unbudgeted legal and consulting costs related to copper pipes and the payroll review.


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CCDHB Operating Results at the end of September 2016

Capital & Coast DHBOperating Results - $000s

Actual Budget Last yearActual vs Budget

Actual vs Last year

YTD September 2016Actual Budget Last year

Actual vs Budget

Actual vs Last year

Year end forecast

Annual Budget Last year

Forecast vs Annual Budget

Forecast vs Last year

62,106 62,497 61,119 (391) 987 Devolved MoH Revenue 187,102 186,954 182,332 148 4,770 746,980 746,980 730,546 0 16,4343,589 3,790 3,307 (201) 282 Non-Devolved MoH Revenue 10,739 11,408 9,736 (669) 1,004 45,540 45,540 42,442 0 3,0982,743 2,846 2,390 (103) 353 Other Revenue 9,269 8,930 8,191 339 1,078 35,802 35,802 36,080 0 (278)

17,076 16,762 16,665 314 411 IDF Inflow 51,498 50,286 50,243 1,212 1,255 201,146 201,146 203,303 0 (2,157)547 618 781 (71) (234) Inter DHB Provider Revenue 1,737 1,770 2,458 (33) (721) 7,350 7,350 8,855 0 (1,505)

86,061 86,513 84,262 (452) 1,799 Total Revenue 260,346 259,349 252,960 997 7,386 1,036,819 1,036,819 1,021,226 0 15,592

Personnel11,334 12,316 11,625 982 291 Medical 35,199 36,394 35,246 1,194 47 148,658 148,658 141,923 0 (6,735)14,404 14,276 13,939 (128) (465) Nursing 43,802 43,692 41,533 (110) (2,269) 182,233 182,230 172,764 (3) (9,470)

4,427 4,354 4,855 (73) 428 Allied Health 13,328 12,906 14,618 (423) 1,290 53,019 53,022 53,988 3 969610 598 745 (12) 136 Support 1,805 1,796 2,212 (9) 407 7,212 7,212 8,035 0 823

4,879 5,092 5,080 213 201 Management & Administration 15,149 15,308 14,957 158 (192) 61,093 61,093 57,178 0 (3,915)35,654 36,636 36,244 982 590 Total Employee Cost 109,284 110,095 108,566 811 (717) 452,215 452,215 433,888 0 (18,327)

Outsourced Personnel458 284 313 (173) (144) Medical 1,181 863 915 (318) (266) 3,541 3,541 4,761 0 1,220

29 15 18 (14) (11) Nursing 54 45 35 (9) (19) 178 178 197 0 19134 98 132 (36) (2) Allied Health 451 293 246 (158) (206) 1,151 1,151 1,577 0 427185 163 158 (22) (27) Support 570 489 466 (81) (104) 1,959 1,959 1,932 (0) (27)197 39 54 (158) (143) Management & Administration 475 117 292 (359) (183) 456 456 2,263 (0) 1,807

1,002 599 674 (403) (327) Total Outsourced Personnel Cost 2,731 1,807 1,953 (925) (778) 7,285 7,285 10,731 (0) 3,446

9,452 9,116 9,436 (336) (16) Treatment related costs - Clinical Supp 27,918 27,336 28,418 (581) 500 105,893 105,893 108,725 (0) 2,8321,701 1,329 1,056 (372) (646) Treatment related costs - Outsourced 4,218 4,035 3,348 (183) (870) 16,821 16,821 24,561 0 7,7395,710 5,397 5,502 (314) (208) Non Treatment Related Costs 16,648 16,194 16,359 (454) (289) 56,967 56,967 60,588 0 3,6217,859 7,752 6,122 (107) (1,737) IDF Outflow 21,619 21,463 18,018 (156) (3,601) 91,229 91,229 81,507 0 (9,722)

21,606 22,252 22,200 645 593 Other External Provider Costs 68,877 69,008 67,650 131 (1,226) 266,661 266,661 257,763 (0) (8,898)4,667 4,641 4,822 (27) 155 Interest Depreciation & Capital Charge 13,896 13,922 14,600 26 704 55,707 55,707 55,383 0 (324)

50,996 50,485 49,138 (511) (1,858) Total Other Expenditure 153,175 151,958 148,394 (1,217) (4,782) 593,278 593,278 588,526 0 (4,752)87,652 87,720 86,056 68 (1,596) Total Expenditure 265,190 263,860 258,913 (1,330) (6,277) 1,052,779 1,052,779 1,033,145 0 (19,634)

(1,591) (1,207) (1,794) (384) 203 Net result (4,844) (4,511) (5,953) (333) 1,109 (15,960) (15,960) (11,919) 0 (4,041)

(406) (226) (115) (180) (290) Funder (2,780) (3,254) (36) 474 (2,744) 8,243 8,243 (339,270) 0 347,513(829) (815) (681) (14) (148) Governance (2,306) (2,284) (2,009) (22) (297) (8,496) (8,496) (8,046) 0 (450)(356) (166) (998) (191) 641 Provider 242 1,026 (3,908) (785) 4,150 (15,707) (15,707) 335,397 0 (351,104)

(1,591) (1,207) (1,794) (384) 203 Net result (4,845) (4,511) (5,953) (333) 1,108 (15,960) (15,960) (11,919) 0 (4,041)

VarianceAnnual

VarianceMonth - September 2016

VarianceYear to Date


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CCDHB material variances for year to date September 2016

Revenue – Additional Revenue Contributors The DHB revenue is favourable by $997k YTD. Additional MOH revenue was received for capitation programmes and IDF over-delivery in the first quarter.

Employee Costs and Outsourced Personnel CostsPersonnel costs are favourable by $982k for the month and $811k YTD.∑ Medical costs are favourable for the month by $982k and favourable to budget by $1,194k for YTD.

SMO direct costs are favourable to budget by $919k in the month and $2,217k YTD. Allowances and other costs are favourable $697k YTD, annual leave movement is $272k YTD favourable offset by the savings target of ($1,985k) YTD.RMO direct costs are favourable to budget by $92k in the month and $591k YTD. This offsets the adverse YTD variance of ($273k) in overtime and call-backs. Annual leave movement is adverse by ($274k) YTD. Allowances and indirect costs are unfavourable by ($51k) YTD mostly in course fees and conferences due to timing.

∑ Nursing costs are unfavourable for the month by ($128k) and ($110k) YTD.Nursing direct costs are favourable to budget by $444k YTD. Overtime, penals and allowances are adverse to budget by ($153k) YTD. This is mainly due to overtime in Surgery, Women and Mental Health. The annual leave movement was favourable by $778k YTD. These variances offset the YTD savings target of ($1,179k)

∑ Allied Health costs are adverse to budget by ($73k) for the month and ($423k) YTD.Allied direct costs are favourable in the month by $354k and $938k YTD. Overtime and allowances are unfavourable by ($70k) YTD. The annual leave movement is $75k favourable YTD. These variances offset the YTD savings target of ($1,366k) mainly in Mental Health and MCC.

∑ Support staff costs are ($12k) unfavourable for the month and ($9k) unfavourable YTD.∑ Management and administration costs are favourable to budget by $213k for the month and $158k YTD mainly due to vacancies.

Outsourced personnel costs have an unfavourable variance in the month of ($403k) and year to date variance of ($925k). Some of these costs offset vacancies in medical, allied and management/admin staff.∑ Medical (excluding A & M) outsourced costs are ($163k) unfavourable for the month and ($318k) YTD – SMO locums in Mental Health, Dermatology,

Cardiology and Immunology offsetting vacancies in personnel.∑ A & M Kenepuru outsourced medical cost is ($10k) unfavourable for the month and on budget YTD.∑ Allied Health costs are adverse to budget by ($36k) for the month and (158k) YTD - mainly related to anaesthetic tech cover in theatres. ∑ Management/Admin and support costs are ($180k) unfavourable in the month and ($440k) YTD – professional staff offsetting vacancies plus project

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Employee FTE Financial Reporting to Ministry of Health (MOH Accrued FTE)For financial accounting purposes MOH require an accrued FTE measure (as shown in the table below). This measure includes all hours on an accrual basis including leave accruals, overtime and casual hours. As an FTE measure this is highly volatile for a 24/7 facility due to the divisor being set based on the number of working days in the month. The Year to Date total is an average for the year. The average $ per FTE is impacted by MECA increases year on year.

Capital & Coast DHBMOH Accrued FTE


Actual vs Last year

YTD September 2016


Actual vs Last year

Year end forecast

Annual Budget Average FTE Last year



FTE856 842 831 (14) (25) Medical 861 849 847 (12) (14) 863 863 827 0 (36)

2,071 2,107 2,120 36 49 Nursing 2,133 2,155 2,105 22 (28) 2,257 2,257 2,099 0 (158)690 669 797 (21) 107 Allied Health 692 662 786 (30) 94 688 688 763 0 75136 140 184 4 48 Support 137 141 183 4 46 142 142 176 0 33839 861 871 22 32 Management & Administration 844 863 869 19 24 884 884 841 0 (43)

4,592 4,619 4,803 27 211 Total FTE 4,667 4,670 4,790 3 123 4,834 4,834 4,705 0 (128)Average $ per FTE

13,241 14,627 13,990 1,386 749 Medical 40,874 42,870 41,592 1,997 718 172,170 172,170 171,566 0 (603)6,955 6,776 6,574 (179) (381) Nursing 20,539 20,276 19,732 (263) (806) 80,758 80,756 82,309 (1) 1,5536,416 6,508 6,090 92 (326) Allied Health 19,265 19,505 18,592 240 (673) 77,095 77,099 70,765 5 (6,334)4,483 4,269 4,060 (214) (424) Support 13,185 12,706 12,093 (480) (1,092) 50,737 50,737 45,762 0 (4,976)5,816 5,914 5,834 99 18 Management & Administration 17,946 17,743 17,221 (203) (725) 69,127 69,127 68,004 0 (1,122)7,764 7,931 7,546 167 (218) Cost per FTE all Staff 23,418 23,577 22,666 159 (752) 93,556 93,556 92,209 0 (1,347)

AnnualVariance Variance Variance

Month - September 2016 Year to Date


33


CCDHB Employee Contracted Full Time Equivalent (FTE) MeasuresThe contracted FTE measure is the permanent hours each employee is contracted to work as set up in payroll (capped at 1 FTE per employee excluding staff on unpaid and parental leave). The table below is the measure of the contracted FTE numbers at the end of each month. These numbers are reported on a fortnightly FTE dashboard distributed to executive management. The contracted FTE over the last four months has been stable. The budget for 2016/17 includes FTE increases for the new beds known as 6 East which opened in August 2016.

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16Medical SMO 297 297 299 300 296 302 300 304 304 302 302 305 301 304 302Medical RMO 318 321 327 323 319 405 343 360 348 342 345 339 333 343 339Nursing 1,897 1,908 1,916 1,928 1,929 1,923 1,943 1,943 1,943 1,938 1,948 1,953 1,964 1,965 1,964Allied Health 649 649 660 656 656 668 677 673 677 674 680 682 680 688 684Non Health Support 126 129 129 134 134 129 127 126 125 124 123 123 123 125 129Managemt/Admin 829 836 838 833 828 833 818 818 821 821 832 831 823 829 828

Total Actual Contracted FTE 4,116 4,139 4,169 4,174 4,162 4,260 4,208 4,224 4,218 4,201 4,230 4,232 4,223 4,254 4,246* Personnel categories adjusted for 112 FTE in Labs for Jul-Oct 15 and 32 FTE Laundry starting from Jul 15 to Jan 16

Actu

al


34


Treatment related costs - Clinical Supplies and Outsourced Clinical ServicesTreatment related costs show an unfavourable YTD variance of ($764k). This is made up of an adverse variance for clinical supplies of ($581k) and of ($183k) for outsourced services.

The unfavourable year to date variance of ($581k) in clinical supplies is due to ($60k) additional volume and ($520k) price pressure.

Outsourced services are unfavourable YTD by ($183k) which is mainly due to higher costs for Genetics Labs and NZ blood service apheresis (donor) contracts.

The Clinical Supplies Work Programme is actively engaged both through Choosing Wisely and general programmes of work in a number of key savings strategies. The support of clinical staff continues to grow in these areas and supports the focus on all spend and particularly on identified priority areas

Capital & Coast DHBTreatment related Costs - $000s


Actual vs Last year


Actual vs Budget

Actual vs Last year

3,671 3,438 3,602 (233) (69) Treatment Disposables 10,667 10,336 10,578 (331) (88)403 452 478 50 75 Diagnostic and Other Clinical Supplies 1,242 1,366 2,240 124 998

1,022 926 1,077 (96) 55 Instruments and Equipment 2,863 2,767 3,072 (96) 208511 349 416 (162) (95) Patient Appliances 1,371 1,047 1,165 (324) (206)

1,363 1,645 1,634 282 270 Implants and Prostheses 4,537 5,018 4,806 482 2692,120 1,981 1,780 (139) (340) Pharmaceuticals 6,273 5,814 5,420 (459) (853)

362 325 450 (37) 87 Other Clinical and Client Costs 966 989 1,138 23 1721,701 1,329 1,056 (372) (646) Outsourced Clinical Services 4,218 4,035 3,348 (183) (870)

11,153 10,445 10,492 (709) (662) Total Clinical Supplies 32,136 31,372 31,766 (764) (370)

Month - September 2016 Year to DateVariance Variance


35


SIDU Funder – the main cost variances for external provider payments are:

The external provider payments variance year to date for September is ($25k) adverse to budget. The main drivers for these variances are:∑ Pharmaceuticals $141k favourable variance due to the release of a prior year accrual.∑ Capitation costs are ($45k) adverse mainly due to MOH unbudgeted programmes all of which are offset by MOH additional revenue.∑ Aged care rest home and hospital has a net favourable variance of $192k mainly due to lower volumes in the month.∑ HoP (Health of Older People) is ($183k) adverse due to NASC and respite service cost increases.∑ Mental Health expenses are ($67k) unfavourable due to savings targets still to be met.∑ Other expenses are $93k favourable, some of which relates to service changes.∑ IDF outflows ($156k) adverse due to additional electives and sleepover settlement paid to Hutt Valley DHB.

Capital & Coast DHB - FunderProvider Payments - $000s


Actual vs Last year


Actual vs Budget

Actual vs Last year

Year end forecast

Annual Budget Last year



External Provider Payments:5,737 5,876 5,625 139 (112) - Pharmaceuticals 17,821 17,962 16,852 141 (969) 68,895 68,895 66,819 0 (2,076)

69 28 98 (41) 29 - Laboratory Transition 74 84 277 10 203 587 587 983 0 3964,711 5,128 5,037 417 326 - Capitation 14,622 14,578 14,312 (45) (310) 58,447 58,447 57,370 0 (1,077)1,514 1,423 1,271 (91) (243) - ARC-Rest Home Level 4,413 4,364 4,199 (49) (214) 17,312 17,312 17,298 0 (14)3,447 3,634 3,444 187 (3) - ARC-Hospital Level 10,903 11,144 10,983 241 80 44,211 44,211 43,424 0 (787)1,439 1,501 2,173 62 734 - Other HoP 6,579 6,396 6,692 (183) 113 18,285 18,285 27,684 0 9,3991,761 1,830 1,876 69 116 - Mental Health 5,627 5,559 5,701 (67) 75 21,025 21,025 20,930 0 (95)

689 689 707 0 18 - Palliative Care/Fertility/Comm Rad 2,088 2,088 2,188 (0) 100 8,291 8,291 7,986 0 (305)2,239 2,142 1,969 (97) (270) - Other 6,750 6,833 6,447 83 (303) 28,717 28,717 24,898 0 (3,819)7,859 7,752 6,122 (107) (1,737) - IDF Outflows 21,619 21,463 18,018 (156) (3,601) 92,120 92,120 71,878 0 (20,242)

29,465 30,003 28,322 538 (1,142) Total Expenditure 90,495 90,470 85,668 (25) (4,826) 357,890 357,890 339,270 0 (18,620)

Variance Variance VarianceMonth - September 2016 Year to Date Annual


36


CCDHB Statement of Financial PositionCarital & Coast DHB

Balance Sheet

Actual Budget At Sep 2015Actual vs Budget

Actual vs Sep 2015 Notes YTD Sep 2016

94 93 84 1 10 1 Bank

5,635 4,820 10,554 815 (4,918) 1 Bank HBL

7,820 7,232 7,369 588 452 1 Trust funds

48,932 44,284 48,128 4,648 803 2 Accounts receivable

7,727 7,345 7,752 382 (25) Inventory/Stock

3,903 4,017 4,457 (114) (554) 2 Prepayments

74,112 67,790 78,344 6,322 (4,232) Total current assets

473,815 473,063 478,032 752 (4,216) Fixed assets

8,615 8,615 4,862 0 3,753 Work in Progress - CRISP

18,747 18,395 17,726 352 1,021 Work in progress

501,177 500,074 500,619 1,104 558 3 Total fixed assets

6,468 6,468 6,468 0 0 Investments in New Zealand Health Partnership

1,150 1,150 0 0 1,150 Investment in Al lied Laundry

7,618 7,618 6,468 0 1,150 Total investments

582,907 575,482 585,431 7,425 (2,524) Total Assets

0 0 0 0 0 1 Bank overdraft HBL

68,797 57,322 60,707 (11,475) (8,090) 4 Accounts payable, Accruals and provisions

62,244 62,326 34,244 81 (28,000) 5 Loans - Current portion

1,868 3,738 2,069 1,870 201 Capital Charge payable

67,786 69,314 65,592 1,528 (2,195) Current employee provisions

200,696 192,700 162,612 (7,996) (38,083) Total current liabilities

277,628 277,628 305,954 0 28,326 Crown loans

7,987 7,407 7,559 (580) (428) Restricted special funds

229 229 292 0 63 Insurance l iabi l ity

5,765 5,765 6,236 0 471 Long-term employee provisions

291,609 291,029 320,041 (580) 28,432 Total non-current liabilities

492,305 483,729 482,654 (8,575) (9,651) Total Liabilities

90,603 91,752 102,777 (1,149) (12,174) Net Assets

424,773 424,817 423,237 (44) 1,536 Crown Equity

0 0 0 0 0 Capital repaid

0 0 2,800 0 (2,800) Deficit support

23,498 24,271 23,599 (773) (101) Reserves

(357,668) (357,336) (346,859) (332) (10,809) Retained earnings

90,603 91,752 102,777 (1,149) (12,174) Total Equity

Month : Sep 16

Variance


37


Capital & Coast DHB

Statement of Cashflows


Actual vs Last year Notes YTD Sep 2016 Actual Budget Last year

Actual vs Budget

Actual vs Last year

Operating Activities

87,766 86,805 84,093 961 3,673 Receipts 265,040 260,416 253,285 4,624 11,755

Payments

35,728 35,728 38,091 0 2,363 Payments to employees 109,919 107,184 108,539 (2,735) (1,380)

49,064 48,847 47,225 (217) (1,839) Payments to suppliers 150,139 151,369 147,755 1,230 (2,384)0 0 0 0 0 Capital Charge paid 0 0 0 0 0

228 (1,387) 1,473 (1,615) 1,245 GST (net) 1,445 291 972 (1,154) (473)

85,020 83,188 86,789 (1,832) 1,769 Payments - total 261,503 258,844 257,266 (2,659) (4,237)2,746 3,617 (2,696) (871) 5,442 6 Net cash flow from operating Activities 3,537 1,572 (3,981) 1,965 7,518

Investing Activities

80 149 65 69 (15) Receipts - Interest 328 447 497 119 169

80 149 65 (69) 15 Receipts - total 328 447 497 (119) (169)

Payments

(119) 0 0 119 119 Investment in associates (829) 0 0 829 829

3,535 2,500 3,140 (1,035) (395) Purchase of fixed assets 8,658 7,500 5,475 (1,158) (3,183)3,416 2,500 3,140 (916) (276) Payments - total 7,829 7,500 5,475 (329) (2,354)

(3,336) (2,351) (3,075) (985) (261) 7 Net cash flow from investing Activities (7,501) (7,054) (4,978) (448) (2,523)

Financing Activities

0 0 2,800 0 (2,800) Equity - Capital 0 0 2,800 0 (2,800)

0 0 0 0 0 Other Equity Movement 0 0 0 0 00 0 (81) 0 (81) Other 0 0 (81) 0 (81)

0 0 2,719 0 (2,719) Receipts - total 0 0 2,719 0 (2,719)

Payments

2,586 2,473 2,473 (113) (113) Interest payments 2,586 2,473 2,473 (113) (113)2,586 2,473 2,473 (113) (113) Payments - total 2,586 2,473 2,473 (113) (113)

(2,586) (2,473) 246 (113) (2,832) 8 Net cash flow from financing Activities (2,586) (2,473) 246 (113) (2,832)

(3,176) (1,207) (5,525) (1,969) 2,349 Net inflow/(outflow) of CCDHB funds (6,550) (7,954) (8,714) 1,404 2,164

16,726 13,352 23,532 (3,374) 6,806 Opening cash 20,100 20,100 26,720 0 6,620

87,846 86,954 86,877 892 969 Net inflow funds 265,368 260,863 256,501 4,505 8,86791,022 88,161 92,402 (2,861) 1,380 Net (outflow) funds 271,918 268,817 265,215 (3,101) (6,703)

(3,176) (1,207) (5,525) (1,969) 2,349 Net inflow/(outflow) of CCDHB funds (6,550) (7,954) (8,714) 1,404 2,164

13,550 12,145 18,006 1,405 (4,456) Closing cash 13,550 12,145 18,006 1,405 (4,456)

Variance

Year to DateMonth : Sep 16

Variance


38


YTD Sep 2016

Notes Actual Budget Variance

$000 $000 $000

Net Cashflow from Operating 3,537 1,572 1,965

Non operating financial asset items (358) (443) 84

Non operating non financial asset items (860) - (860)

Non cash PPE movements

Depreciation & Impairment on PPE (7,775) (8,806) 1,031

Gain/Loss on sale of PPE - - -

Total Non cash PPE movements (7,775) (8,806) 1,031

Interest Expense (3,393) (3,341) (52)Working Capital Movement

Inventory (197) - (197)

Receipts and Prepayments (12,598) (9,994) (2,604)

Payables and Accruals 16,800 16,500 300

Total Working Capital movement 4,005 6,506 (2,501)

Operating balance (4,844) (4,511) (333)

Capital and Coast DHBRECONCILIATION OF CASH FLOW TO OPERATING BALANCE


39


Notes to the Balance Sheet and Cashflows

A) Notes to Balance Sheet:

1. The DHB’s cash balance at the end of September is slightly higher than budget. This is mainly due to timing differences of receipts and payments. All surplus funds are invested by New Zealand Health Partnerships in short term investments;

2. Accounts receivable is higher than budget due to timing differences. Some of the main customers include Ministry of Health $3.9m, Clinical Training agency $2.5m, Hutt Valley DHB $2.3m;

3. Total non-current assets are in line with the budget;

4. Accounts payable is higher than the budget mainly due to timing differences. Some of main suppliers include Spotless $5.1m, Healthcare Logistics $1.08m, Central Region Technical Advisory Services $0.7m;

5. Crown loans are in line with budget.

B) Notes to Cash flow statement:

6. The net cash flow from operating activities is less than budget. This is mainly due to timing differences;

7. The net cash flow from investment activities is higher than the budget. This is mainly due to timing differences;

8. The net cash flow from financing activities is in line with the budget.

C) Ratios

1. Current Ratio – This ratio determines the DHB’s ability to pay back its short term liabilities. DHB’s current ratio is 0.37 (2015/16: 0.45);

2. Debt to Equity Ratio - This ratio determines how the DHB has financed the asset base. DHB’s total liability to equity ratio is 84:16 (2015/16: 83:17).


40


Cash ForecastWe have projected our cash position based on the proposed capital budget and a forecast deficit of $15.96m for 2016/17. However any deterioration in these forecasts may put the facility limit at risk and we continue to monitor this closely. The projected cash position includes deficit support of $21.96m, which will be expected to be received in January 2017. The working capital facility limit is approximately $50m.


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Author Dave Lewis, Manager Health and Safety

Endorsed By Chris Lowry, Chief Operating OfficerDebbie Chin, Chief Executive

Subject CCDHB Health and Safety Report (for the month of September 2016)

RECOMMENDATION

It is recommended that the CCDHB Board:

a. Note the Health and Safety Report for the month of September 2016;

b. Note the reporting is evolving to reflect discussion at the Finance Risk and Audit Committee meeting relating to key indicators and benchmarking

c. Note the current Health and Safety Risks;

d. Note there were no Notifiable Events reported in the month of September 2016;

e. Note the number of staff and “Other” reported incidents.

APPENDICES

Appendix 1 – Health and Safety Risks Appendix 2 – Health and Safety Incident StatisticsAppendix 3 – Wellness and Injury ManagementAppendix 4 – Health and Safety Representative Survey Results

1 EXECUTIVE SUMMARY

1.1 Highlights∑ The external review of the two revised health and safety policies and risk management

policy has been completed and feedback received. The revised Health and Safety Policy has been circulated for consultation and will be submitted to FRAC in October for endorsement and approval by the Board. The other two policies are being updated based upon comments received.

∑ A survey of Health and Safety Representatives (HSRs) has been undertaken. The purpose of this was to assist in gaining feedback on how well they think they meet their responsibilities and what else we might do to support them in being more effective in their role. The results were very positive and are listed in Appendix 4. Occupational Health and Safety will use the information received in for the future development of HSRs and directorate meetings.

∑ On 20 September the DHB underwent an external audit for the ACC Partnership Program. We are pleased to advise that the audit went well with only a few minor recommendations which have been addressed. A report was forwarded to ACC and they have confirmed that we have maintained current Tertiary status.

1.2 Risks and ImpactThere are twelve health and safety risks identified on the risk register – Appendix 1.

The action plan from the gap analysis completed relating to the risk to staff from physical assault has been updated following review at the Health and Safety (H&S) committee


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meeting. This is currently being reviewed against other national activities in this area before being progressed.

2 INCIDENTS

H&S incident reporting is encouraged from all workers. Each incident reported is investigated by the relevant manager and appropriate actions are put in place to try and prevent a re-occurrence.

Higher reporting indicates a stronger health and safety culture and provides a more realistic picture of the exposure to hazards experienced by our workers. It is the actual harm (work injury claims – table 2 below) that accurately reflects harm that is occurring.

The various graphs in Appendix 2 show the distribution of incidents across the Directorates. Work is underway to be able to provide reports based upon the actual level of harm reported by the worker.

H&S will be implementing campaigns too target specific hazards and will aim to reduce the number of incidents occurring. These include needle-stick injuries, blood and body fluid incidents and workplace violence and aggression.

2.1 Statistics∑ There has been a rise in the number of Blood and Body Fluid Exposure incidents

reported for this month. Surgery Women's and Children's (SCW) Directorate displayed a rise in the number of incidents reported. H&S are in the process of developing a campaign to raise awareness of these types of incidents and preventative measures.

∑ There has also been an increase in the number of incidents involving verbal abuse/threat and violence (physical assault) – the majority of these occurred in the MHAIDS Directorate.

∑ Please refer to Appendix 2 for a summary of staff and others incidents. This now includes yearly statistics/trends as well as by incidents by type and Directorate.

∑ All of the six staff lag indicators are within normal variation as at 30 September 2016 –Appendix 2.6.

Table 1 below identifies the number of Health and Safety Incidents reported monthly.

Table 1 - Number of Incidents Reported – by Month (Fiscal Year) – 2016/2017

91 98115

113

77

139

0

50

100

150

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16


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Table 2 below identifies the number of work related injury claims by month for the last twelve months. The trend line is showing a slight decrease.

Table 2 – Number of Work related Injury Claims – CCDHB Wide – 01/10/2016 – 30/09/2016

_____________ = Trend Line

Table 3 below shows the days lost by month across the DHB for the past year. This is also trending down.

Table 3 - Days Lost – CCDHB Wide - 01/10/2015 to 30/09/2016

_____________ = Trend Line

The team is focusing on the management of claims and reducing the days lost as a priority.

2.2 Notifiable Events (Previous term serious harm)Under the Health and Safety at Work Act 2015 WorkSafe NZ must be notified when certain work-related events occur. A notifiable event is when any of the following occurs as a result of work:∑ a death∑ notifiable illness or injury ∑ a notifiable incident

No notifiable events were reported for the month of September 2016

Table 4 – Notifiable Events (Fiscal year 2016-2017)

05

101520253035

2015

-10

2015

-11

2015

-12

2016

-01

2016

-02

2016

-03

2016

-04

2016

-05

2016

-06

2016

-07

2016

-08

2016

-09

0.050.0

100.0150.0200.0250.0300.0350.0400.0

2015

-10

2015

-11

2015

-12

2016

-01

2016

-02

2016

-03

2016

-04

2016

-05

2016

-06

2016

-07

2016

-08

2016

-09

012345



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Please see Appendix 2.8 for full descriptions and yearly statistics.

Serious Injury Reduction - The Government has set a target of reducing serious injuries and fatalities in the workplace by at least 25% by 2020.

As can be seen from Table 4, CCDHB has a very low incidence of Notifiable Events which are serious injuries and fatalities.

3 WELLNESS AND INJURY MANAGEMENT – Appendix 3

3.1 EAP – After a spike in costs relating to EAP the monthly expenditure has returned to its average level of expenditure. Information is now provided to show the number of sessions provided; reasons for work-related referral; means of referral and the age and gender of workers referring for EAP – Appendix 3.1.2–3.1.4

3.2 Workplace Injury Management – WellNZThere has been an increase in WellNZ costs over the last seven months as this was outsourced whilst the manager position was vacant. WellNZ have agreed to continue to manage any new claims on a month by month agreement and the outstanding four long-term claims. A proposal is being formulated to allow WellNZ to continue to undertake full case management, but under the terms of a new agreement. This will potentially allow for a significant reduction in costs, ∑ All workplace injury types are monitored and reviewed. Lumbar sprain injuries remain

the most frequent type of injury reported. ∑ Claims summary date is now shown by CCDHB and by Directorate.

4 EMPLOYEE PARTICIPATION AND ENGAGEMENT

4.1 Health & Safety Focus TopicsFor September information on Hazardous Substances and Safety Data Sheets, were distributed via HSRs to reinforce the safe management of hazardous substances and the availability of Safety Data Sheets to all workers.

4.2 Managers Health & Safety TrainingThe updated version of ‘Health and Safety Fundamentals for Managers’ eLearning module has been released to all managers. A communication has been sent to all people managers at all levels within the organisation to ensure their completion of the course. At the time of producing this report, 138 managers have completed this module and 224 have started and are currently in the process of completing it.

4.3 Health & Safety Representative (HSR) TrainingTraining for new HSRs commenced in July 2016. All Health and Safety Representatives who have not completed training have been contacted and requested to book upon a course. It is anticipated that the majority of HSRs will have completed the required training by the end of November 2016.

Work is underway to update the current list of HSRs held by H&S. This will allow them to identify all previously qualified HSRs and enable them to undertake a one day up skilling course in order to attain NZQA unit standard 29315 and to be able to exercise the new powers of a HSR as per the Health and Safety at Work Act 2015.

4.4 H&S Rep SurveyA survey of H&S Reps (HSRs) has been undertaken. The purpose of this was to assist in gaining feedback on how well they think they meet their responsibilities and what else we might do to support them in being more effective in their role. The results were very positive and H&S will use the information received for the future development of HSRs and


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directorate meetings. Please see Appendix 4 for a complete breakdown of all answers received.

5. OTHER BUSINESS

5.1 On-Line Hazard Identification & Risk Assessment System and RegisterWork is underway with the Quality Improvement and Patient Safety (QIPS) team to develop the SQUARE reporting system to support the reporting of hazards, perform risk assessments and to populate a risk register to ensure legal compliance.

5.2 Policy UpdatesTwo health and safety policies, and the CCDHB revised risk policy, were reviewed externally and feedback was received. The revised Health and Safety Policy has been circulated and is now awaiting final approval. The revised Contractors Policy (Control of Contractors) is due to be circulated for consultation in October. The Risk Management policy is being re-developed in association with QIPS, based upon comments received.

5.3 ACC Partnership Programme (ACCPP) Audit 2016ACC requires an independent annual audit against a set of standards (ACC440) and places employers in the programme at primary, secondary or tertiary (highest) status. The Audit has two parts: Workplace Safety Management Systems (Part A) and Injury Management Systems (Part B). Accredited employers at Tertiary status are permitted to undertake a partial audit on alternative years. CCDHB has been Tertiary in the ACCPP programme for a number of years and is entitled to partial audits alternative years. A partial (B) audit was conducted in September 2016. The audit was conducted by an independent ACC approved auditor provided by Price Waterhouse Coopers. The copy of the auditor’s report has beenreceived and submitted to ACC. With only two minor audit recommendations, the auditor has recommended to ACC that CCDHB maintain Tertiary status in the programme. ACC has reviewed the audit report and on 13 October they confirmed that they agreed with the audit findings and that CCDHB keeps its Tertiary status.

5.4 ACC Focus on HealthcareACC have visited CCDHB as part of their national focus on injury management and prevention. Healthcare has become one of the top five industries that they are now focusing on to try and reduce harm in that sector. They are particularly interested in reducing the numbers and severity of incidents involving moving, handling and workplace violence. H&S are currently working on a plan to redevelop the current manual handling training that it provides to ensure that it meets the requirements of the Health and Safety at Work Act 2015 and the ACC Moving and Handling People: The New Zealand Guidelines.Workplace violence is also being examined and a report is being produced which will make recommendations to the improvement of our current provision.

We hope to work with ACC to implement the recommendations and to assist with the resources required.


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APPENDIX 1 – ALL HEALTH & SAFETY RISKS AT AUGUST 2016

Risk Number

Risk DescriptionRisk

Owner

Pre Mitigation Likelihood

Pre Mitigation

Consequence

Risk Rating

Risk Category

MitigationPost

Mitigation Likelihood

Post Mitigation

Consequence

Post Mitigation Residual

Risk rating

Risk Profile Change in Reporting

Period

118 Asbestos ManagementThe presence of asbestos containing material (ACM) is known to be present in buildings constructed prior to 2000 and could result in exposure to asbestos fibres during activity where the product is friable or disturbed during maintenance or construction activity

Clinical Support

Unlikely High 2 H&S Removal of asbestos containing material (ACM) will only be undertaken as required.

Asbestos removal or investigation activities are currently occurring around campuses using certified asbestos management contractors. Register in place

Trades staff have been provided specific PPE and training when there is a need to manage asbestos

2 No change

PC0214 Changes to H&S LegislationProposed changes to Health and Safety legislation and regulations may mean that the DHBs will be significantly impacted or unable to comply

COO Unlikely Extreme 2 H&S New H&S manager in post.

eLearning module developed for all managers.

All people managers e-mailed and completion of module requested

DAA has undertaken a review of our health and safety systems The review was completed mid-April.

Report from DAA was presented at the May Board workshop and an action plan is to be developed

Policy review close to completion

Unlikely High 3 No change


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Risk Number Risk Description

Risk Owner


Pre Mitigation

Consequence

Risk Rating

Risk Category

MitigationPost


Post Mitigation

Consequence


Risk rating


Period

112 H&S Rep (HSR) TrainingAll HSRs are required to complete the 2 day health & safety representative training. At present of the 150 H&S Reps across CCDHB & HVDHB 110 have not completed this training and could lead to loss of ACC accredited employer status

COO Likely High 2 H&S External Contractor to run training approved and plan to ensure all HSRs reps are trained by the end of 2016 in place.

Highly Unlikely

High 3 Progressing

QIPS 15/15(CSS1228)

Overfilled Linen Bags Overfilled linen bags andincorrect placement in disposal rooms could lead to injury for support staff during manual handling.

DON&M Likely High 2 H&S Alliance has recommended four options to address reducing the size of the linen bags. The Laundry Contract Manager & Executive Director Clinical Support is negotiating currently with Alliance

Work has progressed and it is anticipated the risk will be closed by the end of November

Unlikely High 3 Progressing

SWC 0210

Inadequate Physical SpaceGenetic Services has had a significant service expansion this has now resulted in inadequate physical space and has the potential to adversely impact on future service expansion.

Delwyn Hunter

Likely High 2 H&S Occupational health reviewing workspace to ensure it meets minimum standards


130 Staff Risk of Exposure to Blood and Body Fluids Staff caring for patients are at risk of exposure to blood and body fluids that has the potential to cause them long term harm.

COO Likely High 2 H&S Staff training in required blood, body fluid safety process and action required if exposed. Regular monitoring of BBFE reportable events.



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Risk Owner


Pre Mitigation

Consequence

Risk Rating

Risk Category

MitigationPost


Post Mitigation

Consequence


Risk rating


Period

Hazard Register 7 South/Ward 2 has a residual hazard risk rating of a 2.

67 (QIPS19/15)

Physical Assaults on Staff On-going high rate of physical assaults on Emergency Department and MHAIDS DHB staff by patients.

COO

GM MHAIDS

Likely High 2 H&S A gap analysis has been completed looking at current practice and strategies against appropriate standards. The report and recommendations have been reviewed. A time framed action plan has been completed and was discussed at the Occupational Health Steering Group on the 14/06/2016.

Mitigations:1. Policy - Management of healthcare incidents – All events have a reportable event lodged for visibility.2. Policy – Security & presence of a security orderly 24/73. Meeting between Charge Nurse manager and Police Liaison to discuss individual cases/define process.4. Violence Intervention Programme training for ED staff5. Monitoring group is well established in MHAIDS

NB: Purehurehu/Tawhirimatea Hazard Register a residual risk of a 2. ED hazard register residual risk rating to be reduced as MCC



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Risk Owner


Pre Mitigation

Consequence

Risk Rating

Risk Category

MitigationPost


Post Mitigation

Consequence


Risk rating


Period

risk 68 closed.

129 Slips, Trips & FallsStaff through work duties at risk of slips, trips and falls which has the potential for harm.

COO Likely High 2 H&S Prompt reporting of contributing factors for repair, staff awareness and education, regular monitoring of reportable events.

Hazard Register KenepuruTheatres a residual hazard risk rating of a 2


139 Manual Handling – Patient & ObjectWhile moving patients’ and equipment staff at risk of a manual handling injury.

COO Likely High 2 H&S Manual handling training, regular monitoring of reportable events.

Hazard Register KenepuruTheatres a residual hazard risk rating of a 2

Unlikely High 3 128 & 127 risks combined

116 Temperature at Ward Block Kenepuru HospitalFluctuating environmental temperatures in clinical areas within the ward block throughout the year. The temperature variance is unpredictable as can change dependant on weather conditions. This impacts on delivery of patient care, staff and general business.

COO Likely High 2 H&S Monitoring the temperature routinely.When entering reportable event informing staff to record the actual temperature at the time. Encourage staff with regular hydration to prevent dehydration when temp exceeds acceptable levels.Portable Dyson fans in place combined with other portable fans.Portable air conditioning units in medication rooms Open windows within the limits of safety dependant on patients

Likely Moderate 3 No change


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Risk Owner


Pre Mitigation

Consequence

Risk Rating

Risk Category

MitigationPost


Post Mitigation

Consequence


Risk rating


Period

group

148 Increased Risk to Staff and Patients of Physical AssaultRisk of physical and psychological harm to staff and other patients as a result of long stay patient of Tawhirimatea Rehabilitation Unit with persistent assaultive behaviour associated with a chronic treatment resistive mental health condition.

MHAIDS Almost Certain

Very High 2 H&S Risk identified from hazard register as a residual hazard risk of a 2.

Staff control and restraint training Use of environmental restraint

Use of seclusion Personal alarms and duress devices Patient management/treatment plan

A moderate to long term plan has been formulated to transition the patient into a purpose build facility

Likely High 3 No change

TBC Management of Aged Residential Care ContractsThe management of contracts for aged residential care need to be aligned to the requirements of the Health and Safety at Work Act 2015 to ensure the DHBs obligations under the Act are met

SIDU Likely High 2 H&S Contractors policy (Control of Contractors) has been reviewed and is due to be disseminated for consultation.

All contractors will be auditedagainst the requirements of the policy.

An audit of all contractors will take place following the implementation of the policy to ensure they are compliant with the requirements outlined in their contracts.

Likely Moderate 3 New risk


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APPENDIX 2 – H&S INCIDENT STATISTICS

2.1 Breakdown of Incidents by Type and Directorate – September 2016

Specific Event Type Grand Total

CEO's OfficeClinical and

Support Services

COO’s OfficeCorporate Services -

3DHB

Medicine Cancer &

Community

MHAIDS 3DHB

Quality Improvement

& Patient Safety

Surgery Women's & Children's

Blood or Body Fluid Exposure (BBFE) 20 0 0 0 0 5 2 0 13Burn 1 0 0 0 0 0 1 0 0Exposure to Hazardous Substance 0 0 0 0 0 0 0 0 0Hit by or Ran Into Object 1 0 0 0 0 1 0 0 0Moving Object 4 0 1 0 0 2 1 0 0Moving Patient 7 0 0 0 0 4 0 0 3Motor Vehicle Accident 0 0 0 0 0 0 0 0 0Near Miss/Non-Injury 0 0 0 0 0 0 0 0 0Other 14 0 2 0 0 5 1 0 6Pain or Discomfort 3 0 0 0 0 0 0 0 3Potential for Harm 6 0 1 0 0 3 1 0 1Slip, Trip, Fall 8 0 0 0 0 1 2 0 5Verbal Abuse/Threat 32 0 0 0 0 5 25 0 2Violence (Injury as Result of Taking Part in Patient Restraint) 4 0 0 0 0 0 3 0 1

Violence (Physical Assault) 30 0 0 0 0 0 30 0 0Violence (Restraint) 0 0 0 0 0 0 0 0 0Violence - Physical Assault on Other 5 0 0 0 0 0 5 0 0Fire/Smoke 2 0 0 0 0 0 1 0 1Hazardous Materials 2 0 1 0 0 0 1 0 0

Grand Total 139 0 5 0 0 26 73 0 35

= Lag Injury Indicators


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2.2 Incident Reported by Directorate – September 2016

2.3 Number of Incidents Reported by Month (Fiscal year) – 2016/2017

2.4 Incidents by Directorate (Fiscal Year) 2016/2017

05

0 0

26

73

0

35

01020304050607080

9198

115113

77

139

020406080

100120140160


226

6 7

116

199

2

137

0

50

100

150

200

250


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2.5 Incidents Reported by Category (Fiscal Year) 2016/2017

Blood or Body Fluid Exposure (BBFE), 84

Burn, 6Exposure to Hazardous

Substance, 8

Hit by or Ran Into Object, 19

Manual Handling (Moving Object), 35

Manual Handling (Moving Patient), 50

Motor VehicleAccident, 4

Near Miss/Non Injury, 14Other , 82

Pain or Discomfort (Not Caused by Specific Incident), 15

Potential for Harm, 31Slip, Trip, Fall, 47

Verbal Abuse/Threat, 52

Violence (Injury as Result of Taking Part in Patient Restraint), 21

Violence (Physical Assault), 136

Violence (Restraint), 14

Violence - Physical Assault on Other, 26

Fire/Smoke, 5 Hazardous Materials, 2


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2.6 CCDHB Staff & Others Incident Lag Indicators as at 30 September 2016

30

17

40

10

20

30

40

inci

dent

s co

unt p

er m

onth

CCDHB wide: Blood or Body Fluid Exposure Reported Events

Data UCL CL (Mean) LCL18

9

00

5

10

15

20

inci

dent

s co

unt p

er m

onth

CCDHB wide: Slips , trips & falls Reported Events

Data UCL CL (Mean) LCL

52

34

17

0

20

40

60

80

inci

dent

s co

unt p

er m

onth

CCDHB wide : Violence (Physical Assault) Reported Events


4630

130

20

40

60

80

inci

dent

s co

unt p

er m

onth

MHAIDS : Violence (Physical Assault) Reported Events



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Note: All charts are within normal variation for the month of September

11

4

002468

1012

Jul-1

3Se

p-13

Nov

-…Ja

n-14

Mar

-…M

ay-…

Jul-1

4Se

p-14

Nov

-…Ja

n-15

Mar

-…M

ay-…

Jul-1

5Se

p-15

Nov

-…Ja

n'16

Mar

'…M

ay'…

July

'16

Sep'

16

inci

dent

s co

unt p

er m

onth

CCDHB wide excluding MHAIDS :Violence (Physical Assault) Reported Events


11

5

00

5

10

15

inci

dent

s co

unt p

er m

onth

CCDHB wide : Hit by or Ran Into Object Reported Events


11

5

00

5

10

15

Jul-1

3Se

p-13

Nov

-13

Jan-

14M

ar-1

4M

ay-…

Jul-1

4Se

p-14

Nov

-14

Jan-

15M

ar-1

5M

ay-…

Jul-1

5Se

p-15

Nov

-15

Jan'

16M

ar'1

6M

ay'1

6Ju

ly'1

6Se

p'16

inci

dent

s co

unt p

er m

onth

CCDHB wide: Manual Handling (Moving Object) Reported Events


15

7

00

5

10

15

20

Jul-1

3Se

p-13

Nov

-13

Jan-

14M

ar-…

May

-…Ju

l-14

Sep-

14N

ov-1

4Ja

n-15

Mar

-…M

ay-…

Jul-1

5Se

p-15

Nov

-15

Jan'

16M

ar'1

6M

ay'…

July

'16

Sep'

16

inci

dent

s co

unt p

er m

onth

CCDHB wide : Manual Handling (Moving Patient) Reported Events



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2.7 Incident Trends by Directorate (Fiscal Year) 2016/2017

0

1

2

3

4

5

April May June July Aug Sep

CEO's Office

012345678


Clinical and Support Services

0

1

2

3

4

5


COOs Office

0

1

2

3

4

5


Corporate Services - 3DHB


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0

5

10

15

20

25

30


Medicine Cancer and Community

0

10

20

30

40

50

60

70

80


MHAIDS 3DHB

0

1

2

3

4

5


Quality Improvement & Patient Safety

0

5

10

1520

25

30

35

40


Surgery Women's and Children's


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2.8 Notifiable Events (previously called Serious Harm)

Under the Health and Safety at Work Act 2015 WorkSafe NZ must be notified when certain work-related events occur. A notifiable event is when any of the following occurs as a result of work:

∑ a death ∑ notifiable illness or injury*∑ a notifiable incident*.

No Notifiable Events were reported in September 2016

The DHB reported the following Notifiable Events for the 2016/17 fiscal year:

No Date Event Injured Party Event Description1 13/06/2016 Fractured leg Visitor Patient’s visitor (sibling) came down a

sliding pole in the outside play area and landed awkwardly resulting in a fracture of their leg.

*Definitions

∑ Notifiable Injury - Any injury that requires (or would usually require) the person to be admitted to hospital for immediate treatment (see below for full details):

- Amputation- Serious Head Injury- Serious Burn- Spinal Injury- Loss of Bodily Functions- Serious Laceration- Skin Separation- Any injury that requires (or would usually require) the person to be admitted to hospital for immediate

treatment- An injury that requires (or would usually require) the person to receive medical treatment within 48 hours

of exposure to a substance

∑ Notifiable illness - If a person contracts an illness as a result of work and needs to be admitted to hospital for immediate treatment or needs medical treatment within 48 hours of exposure to a substance.

∑ Notifiable incident - People's health and safety are seriously threatened or endangered as a result of a work situation


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APPENDIX 3 – WELLNESS & INJURY MANAGEMENT

3.1 EAP SERVICES

3.1.1 Costs per month from October 2015 to August 2016*

*Septembers costs not available at time of report production

3.1.2 EAP Services usage statistics from October 2015 to September 2016

0

5000

10000

15000

20000

25000

Jul-15 Aug-15Sep-15 Oct-15 Nov-15

Dec-15 Jan-16 Feb-16 Mar-16

Apr-16 May-16

Jun-16 Jul-16 Aug-16

Monthly Spend Average

0

10

20

30

40

50

60

70

80

90

100

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Total number of Clients: New clients: Total number of Sessions:


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3.1.3 Categories of Reported Work-Related issues from October 2015 to September 2016

3.1.4 Referral Statistics - October 2015 to September 2016

Bullying, 43

Career, 35

Conditions, 32

Discipline, 11

Discrimination, 7

Environment, 54

Harassment, 7Performance, 23

Relationship with Co-Worker, 35

Relationship with Manager, 40

Restructuring, 8

Safety, 22

Trauma, 18Work Hours, 5

Workload, 29

Self90%

Manager Suggested

9%

Manager Formal

1% Male17%

Female83%

20 - 29 years19%

30 - 39 years28%40 - 49

years23%

50 & Over30%

Method of referral Gender

Age


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3.2 WELLNZ

3.2.1 Wellnz costs per month from October 2015 to September 2016

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Total

ACCPP Case & Claims Management

$6,684.00 $13,510.00 $14,822.00 $7,240 $12,002 $8,898 $9,814 $12,471 $17,095 $22,541 $24,386.90 $29,942.55 $17,9046.45

Medical Fees $16,070.45 $13,680.01 $11,2818.38 -$3,282.33 $30,837.66 $23,718.14 $17,124.34 $18,138.57 $22,050.86 $29,087.77 $14,381.36 $6,2962.2 $357,587.41

Total $22,754.45 $27,190.01 $12,7640.38 $3,957.67 $42,839.66 $32,616.14 $26,938.34 $30,609.57 $39,145.86 $51,628.77 $38,768.26 $92,904.75 $536,993.86

Notes:∑ Nov-15 - Included invoice for yearly Well-Web access of $6,500 and a late invoice for ACCPP Case & Claims Management of $6,580 for Sep-15∑ Dec-15 - Included a late invoice for claims management for Nov-15 of $7,582∑ Mar-16 - Inclided a late invoice for medical fees for Nov-15 of $11895.66∑ September 2016 has shown a spike in costs mainly due to $30,514.65 being paid out in surgery fees.

20,658.30 13,510.00

112,948.56

7,240.00

36,074.30 41,470.98

24,704.7228,250.25

36,285.85

47,879.31

38,768.26

92,904.75

-20,000.00

0.00

20,000.00

40,000.00

60,000.00

80,000.00

100,000.00

120,000.00

140,000.00

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

ACCPP Case & Claims Management Medical Fees


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3.2.2 Monthly Medical Fees by Directorate – September 2016

4.2.2 Yearly Medical Fees by Directorate – October 2015 - September 2016

$0.00

$7,932.04

$27.50 $35.48

$17,462.02

$29,318.96

$0.00 $570.97

$7,615.23

$0.00

$5,000.00

$10,000.00

$15,000.00

$20,000.00

$25,000.00

$30,000.00

3 DHB Services & SIDU, $18,988.01

Clinical & Support Services, $65,086.60

COOs Office, $186.06

Corporate Services, $395.99

Medicine & Cancer, $51,276.48Mental Health,

$159,182.37

People & Culture, $1,458.60

Support Units & Professional Heads,

$909.97

Surgery - Womens & Children,

$60,103.33


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3.2.3 Injury Claims by Injury Site (01/10/2015 to 30/09/2016)

3.2.4 Claims By Injury Type (01/10/2015 to 30/09/2016)

Abdomen/pelvis, 3Ankle, 10

Back/spine except Head Vertebrae, 32

Chest, 13

Ear, 5

Elbow, 18

Eye, 8

Face, 19

Finger/Thumb, 18

Foot, 6

Hand/Wrist, 28

Head (except face), 17Hip, upper leg, thigh,

13Internal organ, 1

Knee, 38

Lower back/spine, 63

Lower leg, 7

Neck, Back of Head, Vertebrae, 20

Nose, 1

Shoulder, 40

Toes, 2Unobtainable, 4

Upper and lower arm, 7

Upper back/spine, 1

Contusion15.24%

Fracture2.41%

Gradual Process3.74%

Laceration6.15%

Misc8.29%Sprain

60.43%

Not Stated3.74%


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3.2.5 Wellnz Claims Summary by Accident Date - 01/10/2015 to 30/09/2016

*The figures in these columns show the costs paid for injuries by the month the injury occurred

3.2.6 - Number of Claims – CCDHB Wide - 01/10/2015 to 30/09/2016

3.2.8 - Days Lost – CCDHB Wide - 01/10/2015 to 30/09/2016

_____________ = Trend Line

3.2.9 Claims Summary by Directorate - 01/10/2015 to 30/09/2016

0

5

10

15

20

25

30

35

2015

-10

2015

-11

2015

-12

2016

-01

2016

-02

2016

-03

2016

-04

2016

-05

2016

-06

2016

-07

2016

-08

2016

-09

0.050.0

100.0150.0200.0250.0300.0350.0400.0

2015

-10

2015

-11

2015

-12

2016

-01

2016

-02

2016

-03

2016

-04

2016

-05

2016

-06

2016

-07

2016

-08

2016

-09

Month No of Claims Avg Cost of Claims* Days Lost Avg Days Lost

per ClaimOct – 15 24 $518.75 44.2 1.84Nov – 15 30 $1,273.48 56.5 1.88Dec – 15 22 $2,227.00 185.1 8.41Jan – 16 21 $1,029.89 97.0 4.62Feb – 16 18 $2,051.04 134.4 7.47Mar – 16 19 $2,805.00 306.2 16.11Apr – 16 22 $458.80 47.0 2.14May – 16 30 $1,032.26 161.9 5.40Jun – 16 23 $185.37 41.0 1.86Jul – 16 31 $574.92 138.2 4.61Aug - 16 24 $44.65 18.2 1.14Sep - 16 15 $66.15 17.0 1.13

Grand Total 279 $1,133.24 1,358.2 4.87


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3.2.10 - Number of Claims by Directorate - 01/10/2015 to 30/09/2016

3.2.11 - Days Lost by Directorate - 01/10/2015 to 30/09/2016

6

4350

60

1 4

5851

6

010203040506070

3 D

HB

Serv

ices

& S

IDU

Clin

ical

& S

uppo

rtSe

rvic

es

Med

icin

e &

Can

cer

Men

tal H

ealth

Peop

le &

Cul

ture

Supp

ort U

nits

&Pr

ofes

sion

al H

eads

Surg

ery

- Wom

ens

&Ch

ildre

n

Unk

now

n

Tran

sfer

9.0

268.3 235.3

476.7

0.0 18.0

273.5

77.7

0.0

100.0

200.0

300.0

400.0

500.0

600.0

3 D

HB

Serv

ices

& S

IDU

Clin

ical

& S

uppo

rtSe

rvic

es

Med

icin

e &

Can

cer

Men

tal H

ealth

Peop

le &

Cul

ture

Supp

ort U

nits

&Pr

ofes

sion

al H

eads

Surg

ery

- Wom

ens &

Child

ren

Unk

now

n

Cost Centre No of Claims Avg Cost of Claims Days Lost

Avg Days Lost per

Claim3 DHB Services & SIDU 6 $18.50 9.0 1.50

Clinical & Support Services 43 $1,235.08 268.3 6.24

Medicine & Cancer 50 $1,132.02 235.3 4.71

Mental Health 60 $1,844.73 476.7 7.94

People & Culture 1 $33.80 0.0 0.00

Support Units & Professional Heads 4 $393.16 18.0 4.50

Surgery - Womens & Children 58 $1,401.46 273.5 4.72

Transfered Back to ACC 6 $12.08 0.0 0.00

Unknown 51 $249.12 77.7 1.52

Grand Total 279 $1,133.24 1,358.2 4.87


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APPENDIX 4 – HEALTH & SAFETY REPS SURVEY RESULTS

46 Responses Were Received


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Q 8 – Please feel free to make any additional comments about your role as an H&S Rep.


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INFORMATION

Date: 17 October 2016

Author Stuart McCaw, Programme Manager

Endorsed by Debbie Chin, Chief Executive Officer; Tony Hickmott, Acting Chief Financial Officer

Subject Final report on independent service review – discovery phase

RECOMMENDATION


a. Note the report from Price Waterhouse Coopers.

b. Note that many hospital services do not breakeven and this information provides a starting point for future detailed service reviews.

c. Note that CCDHB’s hospital labour costs for WIES produced were the third lowest across four comparator DHBs and if CCDHB labour cost per WIES was the same as Auckland then CCDHB labour costs would have been $8M higher than it was for the period.

d. Note that PWC recommends that CCDHB work with other DHBs to review national pricing and cost-to-serve, in order to establish best practice and review the adequacy of current funding.

e. Note that CCDHB will report back to FRAC on 25 November 2016 on a plan for detailed service reviews.

f. Note that the Ministry of Health is interested in the results of the initial review and has been prepared to accept a variation to the Annual Plan should the report identify opportunities for significant savings achievable within the 2016/17 year.

a. At this stage, the high level report does not identify immediate areas for savings but the individual service reviews may identify opportunities for better practice.

APPENDIX

1 Service review FY14/15 – revenue, cost and volume analysis

1 PURPOSE

Price Waterhouse Coopers (PWC) has submitted its final report on the first phase of a hospital-wideservice review. This paper provides context for the report and an overview of its findings. The full report can be found in the Appendix 1.

2 BACKGROUND

At its meeting of 8 April 2016, the Board delegated to the Chair & Chair FRAC the finalisation of terms of reference for a timely independent external review of opportunities to improve performance to allow the delivery of the 2016/17 Annual Plan.

The terms of reference were for a project to identify the relative financial positions of individual services, involving:

∑ analysis and validation of revenue and costing data at service level

∑ a review of service mix.

It included benchmarking against tertiary DHBs.

11 November 2016 - CCDHB Board PUBLIC papers - FOR NOTING

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Na onal�rate:�414�Average�rate:�402.8�

PWC was commissioned to complete this review. Staff at CCDHB have been kept informed of the PWC report through various channels of communication including monthly Medical Reference Group meetings (SMOs), clinical leaders and staff forum.

3 CONTEXT

3.1 Demand, cost and funding pressures

Capital and Coast DHB faces a challenging set of demand, cost and funding pressures, as shown in these two tables.

3.2 Sector performance

Within this context, the DHB can be proud of its performance against key health and disability sector indicators. The Ministry of Health recently published four measures on the performance of the sector overall and CCDHB is a good performer in all of them, nationally and within the central region. These measures are:

∑ standardised acute bed days per 1000 population by DHB of domicile

∑ ambulatory sensitive hospitalisation (ASH) rates for children aged 0-4 years

∑ amenable mortality

∑ satisfaction with DHB provided services.

Acute bed daysThis is a measure of efficient use of resources. The DHB is not only the second-best overall performer, it has also made the second-greatest gains over the last three years (next to Hawkes Bay DHB). The DHB also has one of the lowest average lengths of stay in Australasia as reported by the Health Round Table. It also has one of the lowest readmission rates across tertiary hospitals in New Zealand. Taken together, these three measures indicate that CCDHB is both an effective and an efficient provider of non-mental health hospital services. Areas identified for improvement are in the length of stay for older patients and in avoiding admissions in the first place, especially for acute episodes of chronic conditions and particularly in Maori and Pacific communities.


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ASH rates (0-4 years)This is a measure of how well the DHB isintervening to stop children from being hospitalised due to conditions that can be avoided or managed within community settings. CCDHB performs well against the national average although it can improvethe ASH rates for Pacific children. This is why CCDHB invests in, for example, the Porirua Social Sector Trial and the Healthcare Homes initiatives.

Amenable mortality ratesCCDHB’s amenable mortality rates (death rates that can be influenced by health sector activity) are well below the national average.

Patient experienceCCDHB performs at the sector average (in a high 80%-85% band) across the four patient experience indicators.

3.3 Financial performance

CCDHB has also been a solid performer in terms of its financial performance, as measured by the improvements to its deficit performance over recent years. However, as the graph shows, financial sustainability is once again an issue for the DHB (forecast deficit of $14.9M for this financial year).


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CCDHB management has developed a sustainability plan to address the underlying issues behind the worsening position. The plan looks at both costs and revenue, both in the immediate term and out as far as 2030. One aspect of the plan is to conduct reviews of hospital services in order to understand where, if any, improvements can be made to ensure both clinical and financial sustainability. The first stage of this work was to conduct a high-level analysis to identify the possible order of in-depth reviews.

The Ministry of Health is interested in the results of the initial review and has been prepared to accept a variation to the Annual Plan should the report identify opportunities for significant savings achievable within the 2016/17 year.

Price Waterhouse Coopers (PWC) was commissioned to complete this stage and their final report was received on 14 October.

4 PWC REPORT: SCOPE AND CAVEATS

4.1 Scope

The analysis was restricted to non-mental health services provided by the DHB through the regional hospital. It excludes diagnostics and is limited to the 2014/15 financial year as that was the most recent year for which full financial data was available (including for benchmarking purposes). More detail on the scope can be found in the report.

4.2 Caveats

PWC completed its terms of reference, except that the outpatient data has not been fully validated. This is not a constraint to accepting the report because:

∑ outpatient costs represents less than 10% of total hospital costs and ∑ the report provides sufficient guidance to prioritise the order of detailed service reviews.

Nevertheless, findings that reference outpatient information should be considered estimates.

During the analysis, cost allocation issues were uncovered with emergency medicine and allied health. These can be clearly seen within the report. These issues are being addressed with the current implementation of the new costing system.

While CCDHB data has been validated, the costs sourced from the Ministry of Health on the benchmark DHBs have not. Therefore, the reported results for those DHBs should be treated with caution and as indicative of relative differences.

5 FINDINGS

∑ All of the benchmark DHBs struggle to deliver the top five ‘deficit’ services1 at a cost per discharge (WIES) that is less than or equal to the national price. PWC recommends that CCDHB “work with other DHBs to review national pricing and cost-to-serve, in order to establish best practice and review adequacy of current funding”.

∑ CCDHB’s labour cost structure is lower than Canterbury and Auckland DHBs. CCDHB is not an outlier and it has a cheaper cost per WIES for some services.

1 Note that two of these services, emergency medicine and orthopaedic surgery, are ‘profitable services’ when their non-DRG costs and revenues are accounted for (assuming the outpatient estimates are reasonable). Note also, that the review exposed issues related to the cost allocations to emergency medicine in the 2014/15 year that have subsequently been rectified. A similar coding issue has been uncovered in the outpatient Allied Health costing data, which is why it appears as a significant outlier in the information. This issue is being addressed.


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∑ There are individual service areas where the cost of provision is higher than the national price paid and the extent of their ‘deficits’ can be used to assist with prioritising individual service reviews. The total estimated value of the deficit is $28.5M, which is close to the reported provider arm deficit of 2014/15.

6 DISCUSSION

The report assists CCDHB management understand whether or not it is inefficient relative to other tertiary DHBs, especially in relation to labour costs by service. There appears to be some room for closer examination, but not as much as might have been initially considered when the Board commissioned the review.

The labour cost comparisons with benchmark DHBs indicate possible differences in skill mix and associated models of care. However, as the report focuses on cost, we do not know whether there are enough differences in quality, patient complexity, patient flow and/or volumes to indicate that we should be altering the way we deliver any particular service to reduce the cost. These aspects will also form part of detailed reviews.

The report is valuable in prioritising the order of the in-depth service reviews, indicating that allied health, oncology/haematology, genetics and cardiology could be looked at first.

The Ministry of Health had made provision for CCDHB to submit an update to its 2016/17 Annual Plan based on an expectation that this report would identify opportunities for additional and immediate savings. The report does not identify any services where this is obviously the case.

Some of the issues experienced in completing the review demonstrate that data validation will be an important step in the detailed reviews.

PWC pose a number of questions that could be answered in the detailed reviews. These questions indicate that there are a range of reasons for service ‘deficits’ and ‘surpluses’, including:

∑ incorrect revenue and cost allocations

∑ possible issues with the national pricing methodology

∑ diseconomies of scale

∑ possible over- and under-servicing

∑ subsidising the care of other district populations

∑ a mixture of all of the above.

For example, one of the top five inpatient deficit services is orthopaedics. This service was examined closely in 2007, which showed that the service was efficient across a range of benchmarks when compared to other tertiary DHBs but was financially unsustainable at the national price. This is a


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diseconomies issue. The in-depth service review will help us understand the extent to which this is the case for any of the reviewed services and what actions are appropriate to close the gap.

7 NEXT STEPS

DHB management support using the PWC report to determine whether or not there should be any changes in service mix and/or delivery. The next steps are to:

∑ settle on an order for the detailed service reviews with clinical and professional leaders and finalise the detailed scope of these reviews (to include matters of clinical as well as financial sustainability)

∑ agree the plan with the Board

∑ engage an independent provider to manage the review process, through a competitive tender process

∑ initiate the reviews.

The PWC report will also be discussed with the Ministry of Health and regional DHB Chief Executives.

A plan with the agreed order and scope of in-depth reviews will be reported to FRAC at its 25 November 2016 meeting.

PWC recommended that CCDHB engage with other tertiary DHBs to look at whether there are opportunities to share good practice and reduce cost-to-serve and also to establish whether there is a rationale to review the national price. CCDHB will seek to engage with the benchmark DHBs as part of the detailed service reviews. The DHB has also commissioned a report on funding from Sapere, a draft of which is currently being considered.


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BOARD DECISION PAPER

Date: November 2016

Author Virginia Hope, Capital & Coast District Health Board Chair

Subject Resolution to Exclude the Public

RECOMMENDATION

It is recommended that the Board

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 excluded papers

Public Excluded Matters Arising from previous Public Excluded meeting

For the reasons set out in respective public excluded papers

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

9(2)(f)(i)(j)

Chair’s report

CEO’s report

Copper pipes update Maintain legal professional privilege 9(2)(h)

Sub Committee report backs/draft minutes

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

9(2)(j)

* Official Information Act 1982.

11 November 2016 - CCDHB Board PUBLIC papers - OTHER

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DisabilityResponsiveness

The road so far 2010-2016

11 November 2016 - CCDHB Board PUBLIC papers - APPENDICES

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Unequal citizenship, participation and access to services

Complete citizenship for all

2007: UNCRDP2001: NZ Disability Strategy

2011: DAG established

2012: DR goes 3DHB

2013:CPHAC DSACcombined

2013:SRDAG Established

2010:Senior Disability Advisor role created

2013: 2013-18 Disability Implementation Plan

launched

2016: Intersectoral Sub Regional Forum

2013: Sub Regional Forum

2014: Sub Regional Forum

2015: Child to Adult Transition

becomes first non disease pathway

2015: NZSL in Health Review. CCDHB leads the country at

responsiveness to Deaf

2015: eLearning is mandatory at CCDHB

1 in 4 people have a Disability

(StatsNZ, 2013)

2011: Health Passport Launched

2013: 3DHB Champions network

2013: DR policy endorsed

2011: DR Policy created CCDHB

2013: Disability Alert

2013: CCDHB Child –Adult Transition

demonstration site2013: Educator

Hired

2014-16: Locality Forums

Disability Equity fully embedded in 3DHB Annual Plans


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Endorsements of theProgramme

Paul Gibson, Disability Rights Commissioner: “The work being undertaken in the Wellington sub region to improve health services andhealth outcomes for people with disabilities, is not only of significance nationally but alsoof international significance”

3DHBs are leading the way at a national level

CCDHB, HVDHB and WAIDHB have all endorsed the directions and significance of the Disability Responsiveness Programme


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Champions Network

• The champions networks is a group of individuals across the 3DHBs who are committed to enabling staff and service users.

• They are available to help navigate the systems and services, plus hold information so Disability Responsiveness is integrated into current services and systems.


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Sub Regional Disability AdvisoryGroup

• The Sub Regional Advisory Group (SRDAG) is was created in 2013 to provide feedback and help monitor the disability implementation plan.

• SRDAG exemplifies co design and partnership for service and systems transformation principals.

• SRDAG is one of the main mechanisms for transparent community engagement


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Areas of Opportunity• Integration of disability support needs in all future ICT• Improved measurement around health impacts and equity for

disabled people accessing health• To achieve evidence to influence funders and funding

formulas• Work collaboratively with MOH while redesigning community

and NASC services. • Co design whole of life services for all age groups requiring

disability support• Build on relationship with Otago to embed disability literacy

within all key clinical disciplines


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Appendix Two

The Launch of the 5 year Implementation Plan

There was wide spread community consultation on the Implementation Plan before it was launched at the first Sub Regional Forum in 2013 at Orongomai Marae, hosted by the newly established SRDAG. Due to the depth of the implementation plan, it was received extremely well and referred to as the first of its kind in the country.

The Sub Regional Disability Advisory Group (SRDAG) was established as part of the 2013-2018 Implementation Plan. It is part of the DHB plan to stay connected with disability communities. SRDAG has grown to become important to the Disability Responsiveness programme; making sure every project or initiative has been planned or consulted on – utilizing a process of co-design. The model employed by the DR team and SRDAG has become highly regarded throughout the sector.

Other examples of sub regional innovation are:

1 Disability Responsiveness EducationKey education achievements include: ∑ Video Tool Kit∑ Health Passport and Alert Tool Kit∑ Ward Training ∑ Clinical staff training ∑ eLearning ∑ Generic Orientation∑ Admin Training

2 Community EngagementCommunity engagement as a quality check happens at many levels. These levels include: ∑ Disability Support Needs Form∑ Disability Alert follow up∑ Champions ∑ 0800 numbers ∑ Health Passport follow up∑ Health Passport Survey∑ Pop up events∑ Help Desks

3 Child to Adult TransitionBuilding on the success of the 2013 Child to Adult Transition site, an electronic Health Pathway to help general practice through the transition process has been drafted. It is the first non-disease pathway in Australasia. To complement the pathway a consumer lead tool kit is being created to empower families and young people throughout the process. Once these are completed in 2017, a 3DHB policy will be created.

4 NZSL in Health ProjectThe NZSL in health research is a pioneering project lead by Joanne Witko and Dr Pauline Boyles. The research will provide a basis for action as to how the 3DHBs can improve access


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to health and health outcomes for NZSL users. In keeping with the Disability Responsiveness ethos this project has been lead by a steering group made up of mainly NZSL users. NZSL use in health is currently a topic of national interest.

5 Launch of the Disability IconThe launch of the Disability Icon in 2013 was an important step forward in improving access to health services and reducing inequity. The Disability serves two purposes: At a strategic level it is a measurement tool used to monitor several key data sets. At an operational level, the alert is the patient’s voice in the hospital system. Through the use of the Disability Support Needs form, patients can add their expertise on their own support needs into the alert system on Concerto.

6 CAT projectA demonstration site, showing how improve child to adult transition also took place in 2013. The project involved 27 families and took place in Newlands, Ngaio, Johnsonville and Tawa.The initial project was led by practice staff and resulted in many positive outcomes for families and learning for staff. These outcomes have laid the foundations for the current Child to Adult Transition work stream.


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Health and Safety Policy

Document author: Manager – Health & Safety

Authorised by [Designation/Committee]

Issue date: Review date: Date first issued: Document ID [to be developed]: Page 1 of 13

CONTROLLED DOCUMENT – The electronic version is the most up to date version. The DHB accepts no responsibility for the consequences that may arise from using out of date printed copies of this document.

Contents

1. Purpose ...........................................................................................................................................22. Scope...............................................................................................................................................23. Policy Statement .............................................................................................................................24. Principles.........................................................................................................................................35. Definitions.......................................................................................................................................46. Responsibilities ...............................................................................................................................5

6.1 PCBU........................................................................................................................................56.2 Board.......................................................................................................................................56.3 Chief Executive........................................................................................................................56.4 General Manager Corporate Services.....................................................................................66.5 Executive Leadership Team (ELT)............................................................................................66.6 Finance Risk and Audit Committee (FRAC) .............................................................................56.7 CCDHB Health and Safety Steering Committee ......................................................................66.8 Chief Medical Officer, Executive Director of Nursing & Midwifery and Executive Director Allied Health, Scientific and Technical ................................................................................................76.9 Directorate Leads and Senior Managers.................................................................................76.10 Managers (roles with workers reporting to them) .................................................................76.11 Workers...................................................................................................................................86.12 Contractors .............................................................................................................................96.13 Health and Safety Representatives.........................................................................................96.14 Health and Safety..................................................................................................................10

7. Arrangements for Health and Safety ............................................................................................107.1 Safe Systems of Work ...........................................................................................................107.2 Hazard Identification and Risk Assessment ..........................................................................107.3 Incident Reporting, Recording and Investigation .................................................................117.4 Induction and Training..........................................................................................................117.5 Injury Management and Rehabilitation................................................................................117.6 Worker Participation, Engagement and Representation......................................................127.7 Emergency Planning and Management ................................................................................127.8 Contractor Management ......................................................................................................127.9 Review, Evaluation and Continuous Improvement ..............................................................13

8. References ....................................................................................................................................13

Health and Safety

Type: Policy

Issued by: [Approving Committee] Version: Final

Applicable to: All CCDHB workers Contact Person: Manager – Health & Safety


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1. Purpose

This Health and Safety Policy and statement outlines the organisation and arrangements that Capital and Coast District Health Board (CCDHB) will implement to ensure the minimisation of the risk of harm to workers (employees, students, volunteers, contractors) and others within its workplaces by providing a safe and healthy work environment for all.

The overall aim of this Policy is to promote a continual positive health and safety culture and to encourage ownership at every level as well as the development and sustainability of high quality Health and Safety support services and systems. It will also demonstrate compliance with the Health and Safety at Work Act 2015; Regulations made under that Act, and the supporting Approved Codes of Practice.

2. Scope

This policy applies to all CCDHB workers (see definitions for further explanation) as well as patients and visitors in some circumstances.

3. Policy Statement

The Board of Capital and Coast District Health Board (CCDHB) are committed to ensuring a safe environment for its workers, patients, families and other people at work.

The Board recognises that it is has a critical role to play in the implementation of health and safety and the health and safety culture of the organisation.

The Board will fulfil its role by ensuring that appropriate policies and procedures are adopted and implemented and by reviewing and monitoring the identification, reporting, culture and management of health and safety hazards and risks.

All directors will familiarise themselves with their obligations under the relevant legislation (including any amendments) and their obligations as directors and ensure the appropriate policies and processes are in place to meet those obligations.

The Board will ensure the above by:

Policy and Planning Ensuring the DHB: ∑ Has effective health and safety polices ∑ Has an annual Health and Safety plan ∑ Holds the Chief Executive Officer (CEO) accountable for the implementation and management of

the plan and polices by specifying expectations and feedback requirements ∑ Tracks the DHBs health and safety performance via timely reports.


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Delivery∑ Laying down clear expectations that the DHB will have a fit for purpose health and safety

management system ∑ Exercising due diligence by ensuring that this system is effectively implemented, regularly

reviewed and continuously improved ∑ Being sufficiently familiar with best practice health and safety systems to know whether the DHB

systems are fit for purpose ∑ Monitor the implementation of the health and safety program ∑ Seeking independent expert advice if needed

Monitoring and Review ∑ Ensuring internal and external health and safety system audit reports are submitted to the Board

in a timely manner and that any recommendations from these reports are acted on and the Board is notified when they are remedied

∑ Ensure progress reports on the DHBs Annual Health and Safety Plan are included in the Quarterly Health and Safety report to the Board

4. Principles

Capital and Coast District Health Board, through its Chief Executive, so far as is reasonably practicable, will: ∑ promote a culture of health and safety with all workers∑ maintain and continually improve its Health, Safety and Environmental Management systems.∑ set targets for improvement and measure, appraise and report on performance∑ consult and actively promote participation with employees and contractors to ensure they have

the training and skills, knowledge and resources to maintain a safe and healthy workplace∑ ensure all officers and managers have an understanding of their due diligence obligations in

relation to health and safety and are reviewed against their designated duties∑ provide a safe and healthy workplace, fixtures, fittings, plant, products, substances and materials∑ ensure the commitment of senior managers to workplace health and safety is maintained,

ensuring the management of workplace health and safety is given at least equal importance asall other management functions

∑ ensure the effective control of contractors who may come onto CCDHB premises, ensuring such contractors are competent and aware of their health and safety responsibilities as per the CCDHB Control of Contractors Policy

∑ require our contractors to demonstrate the same commitment to achieving excellence in health and safety performance

∑ consult and work with other PCBU’s who provide services and/or products/equipment, to ensure that the plant, substances, and structures designed, manufactured, imported or supplied (as relevant) are without health and safety risks when they are used for their intended purpose in a workplace

∑ consult, co-operate and co-ordinate activities with other PCBUs who have overlapping duties, so that they can all meet their joint responsibilities

∑ comply with relevant legislation, regulations, codes of practice and safe operating procedures.


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∑ support the rehabilitation, early and safe return to work of injured employees∑ work in partnership with unions to support a healthy and safe working environment

5. Definitions

PCBU This is a ‘person conducting a business or undertaking’. A PCBU may be an individual person or an organisation. CCDHB is a PCBU.

OfficerThis is a person who occupies a specified position or who occupies a position that allows them to exercise significant influence over the management of the business or undertaking. This includes, but may not be limited to, company directors and chief executives.

WorkerThis is an individual who carries out work in any capacity for a PCBU. A worker may be an employee, a contractor or sub-contractor, an employee of a contractor or sub-contractor, an employee of a labour hire company, an outworker (including a homeworker), an apprentice or a trainee, a person gaining work experience or on a work trial, or a volunteer worker. Workers can be at any level (e.g. managers are workers too). This definition for CCDHB also includes those with Special Staff Status.

Workplace ∑ means a place where work is being carried out, or is customarily carried out, for a business or undertaking; and

∑ includes any place where a worker goes, or is likely to be, while at work.Other Person at Work

∑ This includes workplace visitors and casual volunteers at workplaces.∑ Other persons have their own health and safety duty to take reasonable care

to keep themselves and others safe at a workplace.

Contractor A person who is engaged to carry out work in any capacity for a PCBU (otherwise than as an employee/worker) for gain or reward.

Subcontractor A person who is engaged to carry out work in any capacity for a PCBU (otherwise than as an employee/worker) for gain or reward, including work as an employee of a contractor or subcontractor

So Far as is Reasonably Practicable

Something is reasonably practicable if it is reasonably able to be done to ensure health and safety, having weighed up and considered all relevant matters, including:• How likely are any hazards or risks to occur?• How severe could the harm that might result from the hazard or risk be?• What a person knows or ought to reasonably know about the risk and the ways

of eliminating or minimising it (e.g. by removing the source of the risk or using control measures such as isolation or physical controls to minimise it).

• What measures exist to eliminate or minimise the risk (control measures)?• How available and suitable is the control measure(s)?

Lastly weigh up the cost:• What is the cost of eliminating or minimising the risk?• Is the cost grossly disproportionate to the risk?

For other duties such as worker engagement and participation duties, the above definition does not apply.


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6. Responsibilities

6.1 PCBU

A PCBU must ensure, as far as is reasonably practicable, the health and safety of:• Workers who work for the PCBU, while the workers are at work in the business or undertaking• Workers whose activities in carrying out work are influenced or directed by the PCBU, while the

workers are carrying out the work

It must also ensure:• Other persons are not put at risk from work carried out as part of the conduct of the business or

undertaking • The provision and maintenance of a safe work environment, safe plant and structures and safe

systems of work are provided and maintained• The safe use, handling, and storage of plant, substances, and structures• The provision of adequate facilities for the welfare at work or workers• The provision of any information, training, instruction, or supervision that is necessary to

protect all persons from risks to their health and safety arising from work carried out as part of the conduct of the business or undertaking

• The health of workers and the conditions at the workplace are monitored for the purpose of preventing injury or illness of workers arising from the conduct of the business or undertaking

Health and safety is the responsibility of everyone working within CCDHB. Although health and safety strategies are integrated into all aspects of the workplace, specific responsibilities are outlined below.

6.2 Board

The Board of CCDHB has overall accountability for the activities of the organisation. It providesgovernance for health and safety within the District Health Board (DHB) and will ensure that appropriate assurances can be provided with respect of compliance with the Health and Safety at Work Act 2015 and supporting legislation. The Board is also responsible for periodically reviewing the effectiveness of the policy and personnel under its control to whom responsibilities have been assigned.

6.3 Finance Risk and Audit Committee (FRAC)

The Committee will have responsibility for overseeing health and safety matters together with the Board of CCDHB. The Committee’s duties in respect to health and safety include:∑ Reviewing, monitoring and making recommendations to the Board on the organisation’s health

and safety risk management framework and policies to ensure that the organisation has clearlyand effectively set out its commitments to manage health and safety matters

∑ Reviewing and making recommendations for Board approval on strategies for achieving health and safety objectives

∑ Reviewing and recommending for Board approval targets for health and safety performance and assess performance against those targets

∑ Monitoring the organisation’s compliance with health and safety policies and relevant applicable legislation


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∑ Ensuring that the systems used to identify and manage health and safety risks are fit forpurpose, being effectively implemented, regularly reviewed and continuously improved. This includes ensuring that the Board is properly and regularly informed and updated on matters relating to health and safety risks

∑ Seeking assurance that the organisation is effectively structured to manage health and safety risks, including having competent workers, adequate communication procedures and proper documentation

∑ Reviewing health and safety related incidents and consider appropriate actions to minimise the risk of recurrence

∑ Making recommendations to the Board regarding the appropriateness of resources available for operating the health and safety management systems and programmes

∑ Approving health and safety policies∑ Undertaking any other duties and responsibilities which have been assigned to it from time to

time by the Board

6.3 Chief Executive

The responsibility for the organisation of health and safety arrangements within CCDHB rests with the Chief Executive (CEO). The CEO is responsible for ensuring that compliance with current health and safety legislation is met and that structures and programmes are in place to maintain and improve health and safety within CCDHB.

6.4 General Manager Corporate Services

In addition to their duties as a manager and a worker:∑ Reports directly to the CEO and has delegated authority from the CEO to oversee process and

procedures are in place to ensure an effective health and safety structure is in place within CCDHB

6.5 Executive Leadership Team (ELT)

The ELT is accountable to the Chief Executive for ensuring the health, safety and welfare of workersor others who may be affected by its acts or omissions and shall, as far as is reasonably practicable, ensure compliance with statutory legislation and corresponding Approved Codes of Practice.

In addition to their duties as a manager and a worker, will ensure that:∑ The prevention of ill health and injury to workers and others is given a high priority in the overall

management of CCDHB∑ Management structures and responsibilities are identified and functioning for the effective

management of Health and Safety across their areas of responsibility∑ Adequate equipment, resources and suitable and sufficient training is made available to enable

compliance with statutory requirements∑ Ensuring all workers within their management responsibility fully implement the CCDHB Health

and Safety Policy

6.7 CCDHB Health and Safety Steering Committee

The Health and Safety Steering Committee functions include:∑ Supporting the on-going improvement of health and safety across the whole workforce


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∑ Assisting in developing standards, rules, and policies or procedures to improve workplace health and safety outcomes

∑ Assisting with implementation of strategies∑ Reviewing health and safety compliance, performance and as necessary individual hazards or

service issues and advising on options for improvement

6.8 Chief Medical Officer, Executive Director of Nursing & Midwifery and Executive Director Allied Health, Scientific and Technical

In addition to their duties as a manager and a worker, ensures that:∑ Clinical policies, procedures and guidelines meet health and safety requirements

6.9 Directorate Leads and Senior Managers

In addition to their duties as a manager and a worker, they will:∑ Facilitate effective communication and partnership working with workers and health and safety

representatives (HSRs) in respect of health and safety management∑ Provide assurance to CCDHB that effective health and safety management arrangements are in

place and functioning across their areas of responsibility∑ Escalate any significant health and safety issues identified, that cannot be dealt with within their

areas to the ELT for discussion prior to elevation to FRAC∑ Ensure there are adequate resources available to meet health and safety statutory requirements∑ Ensure all managers are competent to discharge their health and safety responsibilities in line

with health and safety legislation∑ Ensure directorate health and safety systems are effective and comply with relevant legislation,

regulations, codes of practice, safe operating procedures and CCDHB policy requirements∑ Ensure health and safety performance is incorporated within Governance meetings∑ Ensure regular meetings with Directorate health and safety representatives (HSRs) are held and

these are attended by senior management members. Minutes from meetings are documented and any outstanding health and safety issues reported to CCDHB’s Health and Safety Steering Committee

6.10 Managers (roles with workers reporting to them)

In addition to their duties as a worker, will ensure that:∑ CCDHB health, safety and wellbeing systems, policies and practices are integrated into their

work areas inclusive of workers and all others∑ All hazards identified in their area(s) are risk assessed and appropriate measures are

implemented to either eliminate or adequately control the hazard (see section 7.2). These control measures must be communicated to all relevant workers. Any hazards which they cannot control are escalated to other departments/services and or senior management. All risk assessments will be reviewed on a periodical basis in line with the timescales set by the individual assessment

∑ Health and safety considerations are incorporated when planning new or refurbished facilities and/or the purchase of new equipment

∑ All workers have undergone pre-employment screening and have received occupational health clearance to work as set out in the Pre-Employment Health Assessment Policy

∑ All workers have a health and safety induction specific to their work area and they receive appropriate training to minimise the risk of harm related to workplace hazards


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∑ They support health and safety representatives (HSRs) through resource allocation by providing non-duty time to complete health and safety tasks and attend HSR training and forums

∑ They facilitate election of HSRs for their area of responsibility when required∑ Planned Workplace Inspections/Checklists of work areas under their control are completed at

least every six months∑ Appropriate personal protective equipment is provided, ensuring it is used and in working order

and employees are trained in correct use∑ All contactors doing work within their area of responsibility have a safety plan prior to

commencing work and comply with safe work practices∑ No fixtures, fittings, plant or processes present a risk to the health and safety of any person, and

are not introduced to the area before all health and safety compliance requirements are in place∑ Ensure the effective identification, control and management of hazardous substances in areas

under their control ∑ They attend all relevant health and safety training required of them∑ Ensure that all staff have receive appropriate training for any tasks they are required to

undertake∑ Undertake a suitable and sufficient investigation of all incidents reported in their workplace and

document the findings ∑ Contractor Engagement and Management - CCDHB managers who are responsible for the

engagement, supervision and management of contracts:- are responsible for ensuring that the terms of the Control of Contractors Policy are fully

complied with- need to be fully cognisant of the relevant legal requirements, so that compliance is assured

e.g. necessary technical competence, registration/certification- must ensure all health and safety documentation pertaining to a contract is held by the

PCBU stored in the contract file. This includes, where necessary, signed Confidentiality Agreements

- are responsible for ensuring induction of contractors and their workers receive a formal Health and Safety orientation occurs within their area of responsibility

- if works include interfering with the fabric of the building, structure and infrastructure, authorisation must be sought from Facilities Management prior to any work commencing

- also see section 7.8 Contractor Management

6.11 Workers

Whilst at work all workers have a duty to:∑ Take reasonable care of their own health and safety at work, and of other persons who may be

affected by their acts or omissions∑ Co-operate with their managers in meeting any requirements of the law∑ Adhere to all policies, procedures, guidelines, safe systems of work and instructions∑ Not interfere with or misuse any equipment provided, to protect their health, safety and welfare

in compliance with law∑ Participate in health and safety training and ensure knowledge and skills are regularly updated in

line with legislation and CCDHB requirements∑ Use equipment in the way they have been trained∑ Report any defects or hazards in the workplace∑ Complete an incident report for any injury, illness or near miss


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∑ Follow general safety rules:- all workers shall immediately report any unsafe practice or condition to their line manager- any workers under the influence of alcohol or any other intoxicating drug, which might

impair motor skills or judgement, whether prescribed or otherwise, shall not be allowed onto work

- horseplay, practical joking or any acts, which might jeopardise the health and safety of any other person, are strictly forbidden

- workers shall not adjust, move or otherwise tamper with any electrical equipment, machinery, air or water lines in a manner not within the scope of their duties

- no workers should undertake a job until they have received adequate safety instruction, been deemed competent and have been authorised to carry out the task

- all waste materials must be disposed of carefully and in such a way that they do not constitute a hazard to others

- no workers should undertake a job that appears unsafe- all injuries and near misses must be reported to the appropriate manager- workers should take care to ensure that all protective guards and other safety devices are

properly fitted and in good working order and shall immediately report any deficiencies to their manager

- work shall be well planned and supervised to avoid injuries in the handling of heavy materials and while lifting equipment

- no workers shall use chemicals/hazardous substances without the knowledge required for working with those chemicals safely/hazardous substance

- suitable clothing and footwear will be worn at all times. Personal protective equipment shall be worn wherever provided

- workers must ensure that while using a DHB vehicle or their own vehicles for DHB driving on official business, they adhere to all road safety regulations. Mobile phones must not be used when driving

- windows and doors must be checked and locked by workers prior to leaving departments- unless specified otherwise in the departmental policy, identification cards must be worn at

all times

6.12 Contractors

Will:∑ Comply with all aspects of CCDHB Control of Contractors policy∑ Ensure that, by their acts or omissions, will not cause harm to workers or others at CCDHB ∑ If providing a service on behalf of CCDHB ensure that, as a PCBU, they by their acts or omissions

cause no harm to CCDHB workers or others

6.13 Health and Safety Representatives

In addition to their duties as a worker, will:∑ Actively participate in the health and safety systems and encourage fellow employees to comply

with all health and safety requirements∑ Complete the Workplace Inspections/Checklists ∑ Report-back to their manager and colleagues regarding activity and items discussed at the health

and safety training and other communication from the Health and Safety Service(H&S)∑ Review and update contents of their department’s health and safety manual and notice board

regularly


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∑ In conjunction with the area manager, provide local health and safety induction training for new workers

6.14 Health and Safety

Will:∑ Advise managers with regard to all practicable steps to keep workers safe at work∑ Keep up to date with legislative requirements and evidence based best practice in health and

safety∑ Develop, implement, maintain, review and continuously improve health and safety systems and

policies with a focus on injury prevention∑ Provide subject matter expertise and advice to the CCDHB management in matters of

occupational health and health and safety∑ Provide reports to management on the activity and effectiveness of health and safety systems∑ Identify staff occupational illness and injury trends and develop practical and effective controls

to manage the risk of hazards identified∑ Provide pre-employment screening, health monitoring, vaccinations and contact tracing∑ Provide return to work assistance∑ Assist managers to investigate workplace incidents∑ Provide appropriate training to managers and HSRs∑ Administer the ACC Partnership Programme∑ Undertake statutory reporting requirements

7. Arrangements for Health and Safety

The following systems will be developed, maintained and reviewed to provide a framework for the management of health and safety:

7.1 Safe Systems of Work

Each Directorate/Service/Department is required to have health and safety arrangements and procedures specific to that area.

The Directorate/Service/Department Manager is responsible for ensuring that Policies/Safe Systems of Work/Standard Operating Procedures are operational for all procedures undertaken within the Department. These must be strictly observed.

All Policies/Safe Systems of Work must be monitored and regularly reviewed for their effectiveness with a maximum review period of three years.

Following the assessment of risks, the Directorate Managers/Heads of Department are responsible for devising, documenting and implementing any safe systems of work/Safe Operating Procedures necessary in areas under their control, to eliminate hazards or minimise any risk to the health and safety of workers and others.

7.2 Hazard Identification and Risk Assessment

Hazard identification and risk assessment is an essential part of any risk management system. Risk assessment methods are used to decide on priorities and to set objectives for eliminating hazards


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(where possible) and reducing risks. Wherever possible risks are eliminated; if they cannot be eliminated then the hierarchy of controls must be implemented to minimise the risk.

A risk is deemed acceptable when there are adequate control mechanisms in place and the risk hasbeen managed as far as is considered to be reasonably practicable. The potential benefits should outweigh the potential harm.

Procedures and systems are in place for the identification and reporting of hazards and for managers to assess and take suitable precautions to eliminate or minimise risks.

7.3 Incident Reporting, Recording and Investigation

To ensure that there is a culture in which incidents are investigated appropriately and to make certain that lessons can be learnt from incidents and near misses it is a requirement that all incidents, whether they result in actual harm or not, are reported on CCDHB’s incident reporting system Square. The term ‘incident’ must be interpreted in its widest context to include concerns, accidents and near misses.

The information produced by effective reporting and investigation will enable CCDHB to identify, track and monitor trends of incidents and accidents and to implement measures to try and prevent reoccurrences. Effective monitoring of these events depends on the willingness of workers to report organisational process failures as well as their own errors and thus every effort must be made to avoid cover-ups of adverse incidents, mistakes or near misses.

The overall approach within CCDHB will be one of help and support to each other, rather than recrimination and blame and to this end, workers should be encouraged to report all incidents. Every incident that is reported presents a chance to learn in order to improve the services in the future.

7.4 Induction and Training

The following training will be provided:∑ All new workers will receive local induction in the health and safety management in their area of

work∑ All new employees will attend an orientation, which includes a session on Occupational Health

and Health & Safety∑ On-going training in specific areas including Fire Safety, Emergency Preparedness, Manual

Handling, Personal Safety etc. will be made available to all relevant workers as required∑ All managers will be provided with training in their role and responsibilities for the management

of health and safety in their area of responsibility∑ All officers will receive training on their due diligence obligation in relation to health and safety

7.5 Injury Management and Rehabilitation

Prevention of injury/illness is the primary objective of the workplace health and safety programmes however the CCDHB recognises that injury or illness may still occur during the course of employment.


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Workplace rehabilitation promotes an early, safe and sustainable return to work following injury orillness in order to maximise recovery and independent functioning and minimise the impact of injury on the employee and to the workplace.

Wherever possible, employees will be assisted to remain at work in some capacity even if they are unable to carry out their normal duties. Restricted, modified or alternative duties will be provided if appropriate (with medical clearance).

All employee injuries or illnesses (work or non-work related) will be managed under the principles outlined in the Workplace Rehabilitation Policy.

CCDHB is an Accredited Employer in the ACC Partnership Programme. Workplace injury and rehabilitation procedures are audited yearly by ACC to ensure Partnership Programme performance indicators are met.

7.6 Worker Participation, Engagement and Representation

Worker involvement is fundamental to good health and safety performance and good business practice, and is written into the legislation.

CCDHB supports employee consultation and participation in all activities related to health andsafety. This includes consultation with the trade unions representing the employees.

There are procedures and processes in place for the active participation, engagement and representation of its workers. This includes elected and trained Health and Safety Representatives, Directorate/Service Health and Safety meetings and a CCDHB Health and Safety Committee.

7.7 Emergency Planning and Management

Emergencies are any unplanned events that can have a significant effect on CCDHB workers, services and/or others. They may involve physical or environmental damage, or injury, harm or death to workers or other persons at work. They may also involve events that disrupt business operations. Specific procedures and plans have been developed to help to protect workers, customers, visitors, premises and the environment.

7.8 Contractor Management

CCDHB will ensure that systems are in place so contractors, subcontractors and their workers do not cause harm to DHB workers, patients and/or visitors while undertaking the work required by the contract, and that the contractors and sub-contractors are kept safe from harm in the course of performing work for CCDHB.

Contractors also have duties under the Health & Safety at Work Act 2015. These duties mean that they must take all reasonably practicable steps to ensure they prevent harm to their own employees, any subcontractors they engage, and all other people within the vicinity of the workplace including but not limited to CCDHB employees, patients, visitors and other contractors.Before contracts are finalised, the competence of contractors will be assessed in relation to health and safety as detailed in the CCDHB’s Management of Contractors Policy.


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On occasions where contractors are required to work within areas that are unfamiliar to them, they must be provided with any relevant information or rules applicable to the area. They should also be provided with any instruction and supervision necessary to ensure their safety, and the safety of any other persons who may be affected by their acts or omissions. All hazards on CCDHB sites that could affect contractor personnel should be clearly defined and controlled. The interests of workers, patients and visitors must be protected before and during contracted work.

7.9 Review, Evaluation and Continuous Improvement

CCDHB will strive to ensure continuous improvement in its management of health and safety at all levels and within all areas of the organisation. Annual objectives will be developed along with health and safety key performance indicators which will be regularly reviewed and monitored.

8. References∑ Health and Safety at Work Act 2015∑ Health and Safety at Work (General Risk and Workplace Management) Regulations 2016∑ Health and Safety at Work (Worker Engagement Participation and Representation) Regulations

2016∑ Capital & Coast District Health Board Health & Safety Charter∑ Workplace Rehabilitation Policy∑ Management of Reportable Events Policy∑ Control of Contractors Policy


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Capital & Coast DHB | Private Bag 7902, Wellington South

Wellington Hospital, Riddiford Street, Newtown, Wellington 6021

Phone: 04 385 5999 | Fax: 04 385 5856

20 October 2016

Chai Chuah

Director-General of Health

Ministry of Health

PO Box 5013

WELLINGTON 6140

[email protected]

Dear Chai

Disability responsiveness training for Primary Health Organisations

Following a sub-regional cross sectorial forum on 3 June an overwhelming mandate was given by

participants to engage all responsible bodies in the improvement of disability literacy for health

professionals.

Capital and Coast District Health Board, at their meeting on 10 June, subsequently requested that a letter be sent to you on their behalf “to advocate and seek support from the Ministry of Health for all PHOs to provide disability responsiveness training”. The new Health Strategy has included disability throughout the document and a request has been

made to the Minister for inclusion of people with learning disabilities as a priority group. Access to

health services for people across disability groups and consequent health disparities has been noted

in the last two United Nations Convention on the Rights of People with Disabilities (UNCRPD)

monitoring reports, and we have been advised some progress is being made led by Ministers in a

cross-Government working group on a national Disability Action Plan.

The Lower North Island (LNI) DHBs (Wairarapa, Hutt Valley and Capital & Coast) have made a

considerable investment in a programme of work to improve equity of access for people with

disabilities of all ages. The World Health Organisation Integrated Care model provides a mainstream

theoretical framework for our Disability Plan which includes longer term goals for “whole of system

integration”. The first three (2013-16) years have given our teams the opportunity to lay a strong

foundation for change achieved within the everyday business of health. A diagram of the plan is

appended to this letter.

A “whole of system approach” requires participation and collaboration with primary and community

health services. Initial steps have been taken to support our primary providers. However the 3 June

forum outcome’s message from staff and consumers of services is that basic disability literacy

training is still required in the critical area of primary health care.


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Canterbury, Waitemata, Lakes, and Hawkes Bay DHBs, among others, have been in contact with the

Disability Directorate to discuss similar issues.

We would welcome any ideas and opportunities for engagement and proactive support for our joint

interests as requested by the LNI Boards.

Yours sincerely

Dr Virginia Hope

Board Chair


Encl. cc: Chairs, Wairarapa and Hutt Valley DHB Boards cc: Mrs M Faulkner, Chair, Sub Regional Disability Advisory Group (SRDAG) cc: Mr B Francis, Co-Chair, SRDAG


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16-0347 eFile: EA3.3 CCDHB Delegations Policy


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No.1 The Terrace PO Box 5013 Wellington 6145 New Zealand T+64 4 496 2000

31 October 2016

Debbie Chin Chief Executive Capital & Coast DHB Private Bag 7902 Wellington 6242 Dear Debbie

System Level Measures Improvement Plan for 2016/17 Thank you for submitting the improvement plan on behalf of your district alliance. We appreciate the time and effort invested by your alliance in the development of this plan. Your plan has met the following approval requirements:

1. a milestone to either maintain or improve performance for the four System Level Measures

2. contributory measures that show clear line of sight to the achievement of your improvement milestones

3. district alliance stakeholder agreement of the plan – signatures of all parties to the plan. Accordingly your improvement plan has been approved and the DHB Quarterly Reporting database reflects this status. This approval releases 50% of capacity and capability fund to PHOs that are partners to the plan. This payment will be made through the DHB on 04 December who will pay the PHOs by 15 December 2016. Chief Executives of your PHOs have been sent a copy of this letter for their information. As this is the first year of implementation for the System Level Measures and development of the improvement plans, along with the limited guidance provided, the format and content of the improvement plans has been variable. To assist with development of your 2017/18 improvement plan we plan to provide further feedback by 15 December 2016. This feedback is outside the approval process and does not in any way affect the approval status or the 50% PHO payment. If you have any questions around the System Level Measures Programme, please do not hesitate to contact me. Yours sincerely

Kanchan Sharma National Programme Manager DDI: 04 816 3415 Email: [email protected] cc Mr Martin Hefford, Compass Health – Capital and Coast cc Ms Lyn Allen, Cosine Primary Care Network Trust cc Mr Matiu Rei, Ora Toa PHO Limited cc Ms Sharon Cavanagh, Well Health Trust


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mailto:[email protected]

ACCREDITATION REPORT INSPECTION OF TRAINING POSTS NEW ZEALAND NETWORK

Wellington Regional Hospital

Thursday 13 October 2016

Trainee positions: 4 Training post numbers: 9201, 9202, 9203, 9204 Fellowship posts: 2 Senior Staff: 14 Catchment population: 445,720 Outpatients seen per annum: 27,405 Surgical cases per annum: 2,156 INSPECTION TEAM Dr Peter O’Connor, Chief Inspector of Posts Dr David Kaufman, Inspector of Posts Ms Penny Gormly, General Manager Education & Training RANZCO Discussions were held with; Ms Christine Lowry, Acting Chief Executive Dr John Tait, Chief Medical Officer Dr Neil Aburn, Head of Department The inspection team is most grateful for their time. INSPECTION The Wellington Regional Hospital eye department is now in a new physical area. There is also extra space available for expansion, should it become necessary. The eye department offers a very good learning experience. Facilities and Equipment There are at least 9 consulting rooms, with the trainee’s room within easy access to all consultants. Other rooms are occupied by adequate clerical staff and by all the ancillary equipment necessary for good ophthalmic care delivery. There are 4 accredited training posts, 2 unaccredited registrar posts and 2 fellows’ posts, both of which are not filled at present but will be within a short period. There are 13 consultants, 1 of whom does not have a FRANZCO. There is a dedicated eye theatre with dedicated eye staff. A number of clinics involving both outpatient department and surgical events are carried out at Hutt Hospital and also the Kenepura Hospital. These also involve the trainees. Mostly Cataracts and a little Oculoplastics are done at these institutions. Vitrectomies are not carried out at Kenepuru or Hutt except in the context of complicated cataract surgery or secondary IOL implantation. Trainee workload This department has a very good teaching culture, and all the trainees are very appreciative of the time and effort put in by the consultants. There is a 1 in 5 on-call after hours on the weekend with 1 night on-call during the week. The workload on the weekend is not onerous and the trainee infrequently attends the hospital after 10:00pm.


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Teaching The eye department has a dedicated Friday PM teaching session for all the trainees. At present this is a trainee led exercise and up until recently was a little haphazard. There is a weekly consultant meeting on Friday lunch time prior to the Eye School presentation and all trainees participate in this meeting. In the 2 hours protected teaching session the consultants are asked to present on their sub-speciality interest ensuring active participation for the trainee. To widen the scope of this session it has been suggested that there be an invitation to other medical disciplines associated with ophthalmology to expand the scope of interest. COMMENTS: As on the previous inspection the projected teaching time is not utilised to its maximum extent. The inspection team would like to see it more consultant led with participation by the senior trainee to maximise the benefit. RECOMMENDATIONS: 1. That the four Wellington training posts be reaccredited for a further three years. 2. That the 2 hours protected teaching time be better maximised and consultant led, incorporating

consultation with the senior registrar to maximise its effectiveness.

3. That the College be notified of the structured teaching programme by end of June 2017.


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Capital and Coast District Health Board

Service review FY14/15 –revenue, cost and volume analysis

October 2016

www.pwc.co.nz


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PwC

Private & Confidential

Dr Virginia Hope Mr Roger JarroldChair Chair, Finance Audit and Risk CommitteeCapital and Coast District Health BoardWellington HospitalRiddiford Street, NewtownWellington 6021

14 October 2016

Dear Virginia and Roger

In accordance with our engagement letter dated 29 April 2016, we are pleased to provide our service line review for Capital and Coast District Health Board (CCDHB).

The scope of our work on this engagement was to provide a high level overview on the activities of the provider arm. It was intended to facilitate discussion and strategic decision making about where to focus effort, potentially reconfigure the services provided, and change the current model of care.

This report has been prepared in accordance with the terms and conditions set out in our engagement letter dated 29 April 2016 and should be read in conjunction with the key terms of business and restrictions and disclaimers included in that document, as well as the disclaimers and assumptions noted on page 3 of this report.

If you require any clarification or further information, please do not hesitate to contact us.

Yours sincerely

Neil Haines Hadley Slade-Jones Partner [email protected] [email protected]

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Disclaimers

This report has been prepared for Capital and Coast District Health Board (CCDHB) and solely for the purposes stated herein and should not be relied upon for any other purpose. We accept no liability to any party should it be used for any purpose other than that for which it was prepared. This report is strictly confidential and (save to the extent required by applicable law and/or regulation) must not be released to any third party without our express written consent which is at our sole discretion.

To the fullest extent permitted by law, PwC accepts no duty of care to any third party in connection with the provision of this report and/or any related information or explanation (together, the “Information”). Accordingly, regardless of the form of action, whether in contract, tort (including without limitation, negligence) or otherwise, and to the extent permitted by applicable law, PwC accepts no liability of any kind to any third party and disclaims all responsibility for the consequences of any third party acting or refraining to act in reliance on the Information.

The content of this report is based on information provided to us by CCDHB. We have not independently verified the accuracy of information provided to us, and have not conducted any form of audit. Accordingly, we express no opinion on the reliability, accuracy, or completeness of the information provided to us and upon which we have relied.

We reserve the right, but will be under no obligation to review or amend our report as a result of this review, or if any additional information, which was in existence on the date of this report, was not brought to our attention or subsequently comes to light.

Key assumptions made in this review include the following:

• We assume the provider arm is receiving funding for all the services they provide. This assumption is present in our revenue calculations; we have calculated revenue for DRG activity using WIES values, and we assume that CCDHB have received funding for all the WIES they have served.

• We assume the provider arm receives the national price for the services they provide.

• We assume that data provided to us by CCDHB is accurate, we have not conducted any form of audit or independent verification of this data.

The statements and opinions expressed herein have been made in good faith, and on the basis that all information relied upon is true and accurate in all material respects, and not misleading by reason of omission or otherwise. The statements and opinions expressed in this report are based on information available as at the date of the report.

This report is not to be copied or released to any other party, or referred to in any public forum, without our prior written consent for each party/purpose requesting its release.

This report is issued in accordance with our letter of engagement with Capital and Coast District Health Board dated 29 April 2016.

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Contents

4

Executive summary 5

Next steps 7

1. Our methodology 8

2. Overview of services 12

3. Service analysis 14

4. Cost benchmarking analysis 24

5. Conclusion 27

6. Appendix 29

Data sources 30

Cost benchmarking 32

Top 100 DRGs 35


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Introduction

Capital and Coast District Health Board (CCDHB) need to operate as a financially sustainable health system. To do this, it is important that the DHB have a solid understanding of the cost of service provision, and any opportunities to improve. This needs to be done in a politically acceptable and clinically sustainable manner and must give consideration to national, regional, and local contexts, taking into account the funding path.

The purpose of this review is to provide a transparent view of cost efficiency on service provision, identifying where CCDHB is “winning and losing” in the services they provide. Areas of analysis include:

• The financial result for FY14/15 for services split by DRG and non-DRG activity (i.e. where are we winning or losing?)

• The cost of service provision at CCDHB, benchmarked against other comparable DHBs

• The cost components for each service, benchmarked against other DHBs

• Labour costs (e.g. medical, nursing), benchmarked against other DHBs

• The financial result by patient group (e.g. top 100 DRGs in deficit)

• The cost components by patient group (e.g. top 5 DRGs in deficit)

Scope and approach

We used a service line approach to build and articulate a burning case for change. This approach had two steps:

1. Creating service lines, testing data availability and quality. Deliverables from Step 1 included a map of CCDHBservices based on agreed service lines, and a view of how to best use the data for analysis to identify improvement opportunities.

2. Assessing service line profitability, clinical sustainability and performance.Step 2 involved an analysis of service cost data, and a deeper dive into the service mix.

Note: Analysis of service cost data for outpatients was done at a high level and is indicative only. Therefore outpatient information contained in this report should be treated as an estimate.

Executive summary

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Summary of findings

• Overall estimated deficit is $28.5m, made up of $27.4m for inpatient activity and $1.1m for outpatient activity, for the services covered in this review.

• Looking at inpatient and outpatient combined, 37 of the 48 specialties are operating at a deficit, and four of the specialty areas account for 38% of the total deficit.

• Seven of the specialities make a loss in both inpatient and outpatient services (Anaesthesiology, Endocrinology, General Medicine, Immunology, Infectious Diseases, Respiratory Medicine and Specialist Paediatric Surgery [Others]).

• Benchmarking against other DHBs showed that, for most specialties, CCDHB is broadly in line with comparable providers in terms of cost-to-serve.

• Labour costs for WIES produced was the third lowest across the group of four comparator DHBs. If CCDHB Labour cost per WIES was the same as Auckland then CCDHB labour costs would have been about $8 million higher than it was for the period.

Next Steps

Following on from this Phase 1 review, we recommend that CCDHB look to:

1. Undertake a deep dive in areas highlighted through this review.

2. Work with other DHBs to review national pricing and cost-to-serve, in order to establish best practice and review the adequacy of current funding.

3. Update its reporting frameworks to provide better understanding of costs, drive efficiencies, and simplify processes.

Executive summary

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Recommendation 1. Deep dive investigation

We recommend the following questions are included in the deep-dive analysis:

• Which cost drivers are influenceable?

• Are we providing tertiary services to others at the cost of servicing our own population?

• Are we over-delivering in some areas and under-delivering in others?

• Which services are suffering from diseconomies of scale?

This investigation should be undertaken into targeted areas, to better understand the drivers of costs and revenues. For example, CCDHB may wish to do a “deep dive” on:

• Services that are in deficit.

• Services where there are questions over the accuracy or reliability of the data, for example out-patients and performance against the price-volume schedule

• Top performing services, to understand good practice approaches

Recommendation 2. National cost and price review

There is also an opportunity undertake further analysis across DHBs to understand cost-to-serve and performance against national price. This will help DHBs to understand:

• Opportunities for good practice learning to help reduce costs.

• If there is rationale to review the national price in areas where all comparator DHBs struggle to provide services within the funding envelope.

Recommendation 3. Updated reporting framework

We understand that CCDHB are working towards implementing a ward-to-board report framework.

Analysis of data at the level presented in this review should be considered for inclusion as a part of CCDHB’s performance reporting processes, to help:

• Enable accurate understanding of the provider arm’s cost-to-serve

• Drive business efficiencies

• Simplify internal and external reporting processes.

This could be further extended, for example measuring costs at a surgeon level, to enable adoption of best practice approaches and encourage efficiencies in operations by reducing variation.

Next steps

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Our methodology


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Scope of review

This analysis (Phase 1) provides a high level overview on the activities of the provider arm. It is intended to facilitate discussion and strategic decision making about where to focus effort, potentially reconfigure the services provided, and change the current model of care.

In our review, we worked with CCDHB to determine what would be included and excluded. These items are detailed below.

Timeframe set to FY14/15 only

Our review only relates to the financial year 2014/2015. We have reviewed CCDHB’s activities from 1 July 2014 to 30 June 2015 only.

MCC and SWC directorates only

We have reviewed provider arm services only, with a particular focus on Medicine, cancer and community (MCC) and Surgery, women’s and children’s (SWC).We have excluded all other directorates: Chief Operating Office, Directorate of Mental Health Services, Clinical and Support Services, Corporate Services and the Executive Office.

Detailed analysis of DRG activity and high level analysis of non-DRG activity

We have completed a detailed analysis of costs and cost breakdowns for DRG activities, specifically Ministry of Health-funded activities. We have excluded ACC, private patient and overseas patient activities.

We have completed a high level analysis for non-DRG activities, noting that there was insufficient time for the parties to fully understand the data in detail and so the information provided in the report on

outpatients is indicative only.

Benchmarking for specialties across three DHBs, and costs using CS2

We have provided benchmarking for specialties and costs across three other DHBs (Auckland, Canterbury and Waikato).

Cost benchmarking and breakdowns have been done using the Ministry of Health’s CS2 cost schedule. We have excluded analysis of the CS7 costs.

Other exclusions

We have excluded FTE-specific analysis (i.e. number of FTEs, etc). We have excluded services such as radiology and labs, as these fall under the out of scope directorates outlined previously.

Two other services, A&M (Accident and Medical, MCC) and Patient Services Coordination Unit (SWC) have been excluded, because the costing engine has captured no costing data for these services.

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Directorate/business unitTotal cost from

costing data

Medicine, cancer and community $225,367,250

Surgery, women’s and children’s $272,287,600

Directorate of mental health services $4,175,846

Directorate of clinical and support services

$199,990

Corporate services NA

Executive office (Maori Health Unit) NA

Chief operating office NA

$502,030,686

Reconciling provider arm expenditure to costing data for FY14/15The tables below illustrate the reconciliation between the submitted provider arm expenditure and the figures in this report. The left hand column shows the costs submitted to MoH for the services covered by this review, the right hand column represents the value of the costs captured in the costing data supplied to us for this review.

10

DescriptionTotal cost from MoH

NCCP Submission

Provider arm expense $663,863,247

Plus: Governance $10,458,747

Total expenditure for provider arm and governance

$674,321,994

Less: Non-core costs $13,928,339

Less: Non-provider arm costs $8,660,278

Less: MSG cost recoveries $40,605,782

Less: Uncounted services $18,453,088

Less: Net work in progress $3,801,198

Less: Mental health (estimated) $86,839,768

Total $502,033,541


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Terminology

Throughout this document, we use terminology that is defined as follows.

Cost is all the cost (both directly and indirectly attributable to patients) captured by the CCDHB costing engine, that relates to a patient discharge or episode of care.

Revenue is funding that CCDHB receives. Some revenue is specifically WIES-related revenue.

A service is a specialty defined by CCDHB, such as Cardiothoracic, Gynaecology and Genetics.

A specialty is as defined by the Ministry of Health (MOH), such as Cardiology or Specialist paediatric cardiology. A table of these specialties (and their three character codes) is available on the Ministry’s website.

WIES stands for Weighted Inlier Equivalent Separation, and is MOH’s methodology for weighting patient events for funding purposes.

WIES value is the “quantity” of WIES allocated to a given event (or specialty, etc).

WIES revenue is the amount of funding associated with a given event (or specialty, etc). We assume that the WIES revenue for an event (or specialty, etc) is calculated as WIES value national price.

DRG activity refers to inpatient services provided. These services have diagnosis-related groups (DRGs) and WIES associated with them.

Non-DRG activity refers to outpatient services provided. These services do not necessarily have DRGs or WIES associated with them.

Tertiary adjuster is additional funding received by CCDHB for being a tertiary service provider (i.e. providing specialised services beyond that of a secondary service provider).

Non-core costs includes interest, general rents, accommodation rentals, gains on sales of fixed assets, training course fees (non-Crown agencies), professional and consultancy fees, research grants, drug trial revenue and other income.

Non-provider arm costs includes governance expenses for non-provider arm and net overhead adjustments between provider arm and funder arm.

MSG cost recoveries includes patient co-payments (dental and other), other patient related recoveries, PCT drug recovery, clinical training agency recoveries, other DHBs recoveries, training fees and subsidies, NZ Blood Service recoveries, and other Government recoveries.

Uncounted services include:• disability support - purchase unit code "Disability D71 and D72"• patient transport - purchase unit code "TR0201"• haemophilia blood - purchase unit code "NHMG Blood"• A&M Kenepuru - purchase unit code COGP0020• other health services - purchase unit codes “Primary P60” and

“Primary P70”

Net work in progress includes:• Prior year intermediate product costs in current year purchased

events• Current year intermediate product costs incurred in events not

discharged at end of year

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Overview of services


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Revenue split for funder and provider arms (estimated)

13

The diagram on the left shows the best available estimate of the funding flows through the DHB for 2014/15.

This diagram was populated by CCDHB, recognising that while it does not completely capture all funding, it is directionally correct.

We would recommend that this is updated for accuracy in the future.

Available funding$905m

Capital and Coast District Health Board – Outline of funding for 2014/15

Available funding$911m

Health services provided by NGOs in the district and by other DHBs

$339m

Health services provided by Capital and Coast DHB

$566m

Services for the Capital and Coast

population$678

Services for other

populations$227m

Ministry of Health$37m

Other Government$2m

Funding envelope revenue$872m

PBFF (incl $101m for mental health)

$645m

Tertiary Adjuster$25m

IDFs$177m

Community/NGOs$245m

Community Laboratory $21m Pharmaceuticals $69mPHOs & Primary Care $68m Mental Health $13m

Health of Older People $74m

In other DHBs for CCDHB$50m

Laboratory & Pharmaceuticals $3mPHOs & Primary Care $13m Mental Health $4m

Health of Older People $2m Hospital Services $28m

Medicine, cancer and community$157m

Surgery, women’s and children’s$171m

Mental health $52m

Community/NGOs for other populations$44m

Pharmaceuticals $4m PHOs & Primary Care $19m Mental Health $9m Health of Older People $12m

Non funding envelope revenue

$39m

National Services / Topslice$25m

Medicine, cancer and community$63m

Surgery, women’s and children’s$90m

Mental health$30m

Primary Care $3m


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Service analysis overview

Note that for slides 15 – 17, the following assumptions have been made in relation to revenue:

• All activity is being funded

• All funding is provided at the National Price

The impact of those two assumptions is that the financial results set out on these slides may be more favourable than what is achieved in reality. This is because it is likely that the Provider receives revenue from the Funder that is lower than the National Price, and it is possible that more activities have been provided than agreed (and funded) in the Price-Volume Schedule.


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-6

-5

-4

-3

-2

-1

-

1

2

Mill

ions

FY14/15 financial result for all servicesInpatient and outpatient activity – total estimated deficit $28.5m

As shown on the chart below, 37 of the 48 services are operating at a deficit. The surplus/deficit estimate has been calculated as (WIES revenue + tertiary adjuster + outpatient revenue) – total cost.

15

$


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-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

Mill

ions

The surplus/deficit estimate has been calculated as (WIES revenue + tertiary adjuster) – total DRG-related cost.

FY14/15 financial result for all servicesInpatient activity only – total estimated deficit $27.4m

16

$


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-6

-5

-4

-3

-2

-1

-

1

2

3

4

Mill

ions

FY14/15 financial result for all servicesOutpatient activity only – total estimated deficit $1.1m

The surplus/deficit estimate has been calculated as (outpatient revenue volume) – total non-DRG-related cost.

17

$


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FY14/15 total cost per WIES comparison for top 5 services in deficit Inpatient activity onlyThe chart below shows the cost per WIES comparison for the CCDHB services in the greatest deficit, compared against Auckland, Canterbury and Waikato DHBs. The cost per WIES is calculated as total cost / total WIES for each service. The orange line indicates the FY14/15 national WIES price of $4,681.97.

As shown, CCDHB and the comparator DHBs struggle to provide these services at the WIES price. In most cases, CCDHB’s cost-to-serve is in line with the other DHBs, with the exception of emergency medicine. CCDHB has done a separate analysis to understand the costs within this service line, and they believe this is a function of the way that staff activity is attributed to the emergency department. This is discussed further on the following slides.

18

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Cardiology Emergency Medicine Orthopaedic Surgery Oncology NICU (Level III)

Cost per

WIE

S (

$)

Capital and Coast Auckland Canterbury Waikato National price

FY14/15 WIES Price


123

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FY14/15 clinical labour cost comparisonInpatient activity only

19

0

200

400

600

800

1000

1200

Nursing labour perWIES

SMO labour per WIES RMO labour per WIES

Cost per

WIE

S ($)

Cardiology

Capital and Coast Auckland Canterbury Waikato

For these services with the greatest deficit, clinical labour costs have been examined in further detail on the following slides. This is due to the costs of staffing representing a high proportion of the total operational cost of a service. In addition, staff costs can be highly influencable through the use of skill-mix and models of care. For example, achieving an appropriate balance of nurses, junior doctors and senior doctors is important to the delivery of a high quality, financially sustainable service.

As noted above, CCDHB is broadly in line with peers, in terms of staffing costs across these services. However this does not mean that there is not still an opportunity for all DHBs to deliver improvements in staff costs and mixes. One indicator of this is that it is very difficult to for these DHBs to deliver services at the WIES price, as noted above.

For emergency medicine, CCDHB appear to be significantly higher than comparator DHBs. CCDHB have advised that this appears to be the result of a series of cost allocation errors that are in the process of being rectified with the implementation of the new costing system.*

0

500

1000

1500

2000



Cost per

WIE

S ($)

Emergency Medicine


*There were approximately 57,000 presentations to ED, of which approximately 30,500 became inpatient events. There appears to have been insufficient costs from the ED cost centre attached to the inpatient events as a result of volume activity not being created in the costing system for these events. Understating the volumes that should have been allocated to inpatient specialties pushes up their unit costs, and this also appears to have been magnified by the activity that was created, going against Emergency Medicine inpatient discharges. This resulted in 61% of ED cost centre charges allocated to Emergency Medicine discharges. The result appears to be a material increase in the average costs per event for Emergency Medicine. This does mean that there is an underestimation of costs associated with those patient specialties, but the impact is likely to be immaterial as they are spread across a number of cost centres and across a much larger number of patients.


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FY14/15 clinical labour cost comparisonInpatient activity only

20

0

500

1000

1500

2000

2500

3000

3500



Cost per

WIE

S ($)

NICU [Level III]


0

500

1000

1500

2000


SMO labour perWIES

RMO labour perWIES

Cost per

WIE

S ($)

Oncology


0

200

400

600

800

1000

1200

1400

1600



Cost per

WIE

S ($)

Orthopaedic Surgery



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FY14/15 nursing, SMO, RMO labour cost per WIESInpatient activity only

As noted above, staff costs are a major driver of cost-to-serve for the hospital services. This analysis seeks to highlight differences and similarities across DHBs in staffing models and use of skill-mix to achieve efficient service delivery.

The graph bars show the proportion of total clinical labour cost that is allocated to each labour type. Total clinical labour cost has been calculated as the sum of nursing labour cost, SMO labour cost, RMO labour cost and Allied Health labour cost. The yellow dot shows the total labour cost per WIES, read from the right-hand axis.

For the majority of services, CCDHB and the comparator health boards use similar staffing models, and achieve similar staff costs per WIES. As noted above, CCDHB has a significantly higher cost for emergency management, however, as shown on the graph below, CCDHB have a similar staffing mix as other DHBs, and in fact use a higher proportion of lower cost labour in this area. This supports the view put forward by CCDHB that the staff costs captured here are providing outputs for other service areas, leading to an over-stated cost per output for emergency medicine.

21

-

500

1,000

1,500

2,000

2,500

0%

20%

40%

60%

80%

100%

Capital andCoast

Auckland Canterbury Waikato

Tota

l clin

ical l

abour

cost per

WIE

S

Pro

port

ion o

f to

tal clin

ical l

abour

cost

Cardiology

Nursing labour per WIES SMO labour per WIES

RMO labour per WIES AH labour per WIES

Total labour cost per WIES

-

1,000

2,000

3,000

4,000

5,000

0%

20%

40%

60%

80%

100%

Capital andCoast


Tota

l clin

ical l

abour

cost per

WIE

S

Pro

port

ion o

f to

tal clin

ical l

abour

cost

Emergency Medicine





126

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FY14/15 nursing, SMO, RMO labour cost per WIESInpatient activity only

22

-

1,000

2,000

3,000

4,000

5,000

0%

20%

40%

60%

80%

100%

Capital andCoast


Tota

l clin

ical l

abour

cost per

WIE

S

Pro

port

ion o

f to

tal clin

ical l

abour

cost

NICU [Level III]




-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

0%

20%

40%

60%

80%

100%

Capital andCoast


Tota

l clin

ical l

abour

cost per

WIE

S

Pro

port

ion o

f to

tal clin

ical l

abour

cost

Oncology




-

500

1,000

1,500

2,000

2,500

3,000

0%

20%

40%

60%

80%

100%

Capital andCoast


Tota

l clin

ical l

abour

cost per

WIE

S

Pro

port

ion o

f to

tal clin

ical l

abour

cost

Orthopaedic Surgery





127

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CS2 cost breakdown for the 10 largest deficit DRGsRepresenting 24% of the total DRG activity deficit .

Rank DRG

CCDHB cost per

WIES

Other DHBs’

cost per WIES

Nursing labour

per WIES

SMO labour

per WIES

RMO labour

per WIES

Mgmtand

admin labour

per WIES

Non clinical labour

per WIES

AH labour

per WIES

Other clinical costs per

WIES

Implants per WIES

Outsourced clinical

services per WIES

Pharmaceuticals

per WIES

Infrastructure

per WIES

Central sterile

per WIES

Overhead costs per

WIES

1P67D - Neonate, AdmWt >2499 g W/O Significant OR Procedure W/O Problem

6,573 5,149 $990 -$28 $148 -$152 -$80 -$106 $54 $0 $0 -$74 -$84 $31 $724

2 A07Z - Allogeneic Bone Marrow Transplant 8,356 7,449 -$178 $159 $93 -$39 -$37 $164 $1,419 -$2 -$225 $832 $129 $8 -$1,416

3 F74Z - Chest Pain 6,503 4,855 $267 $198 $348 -$60 -$13 -$67 $154 -$1 $6 -$96 -$77 $0 $989

4G02A - Major Small and Large Bowel Procedures W Catastrophic CC

6,340 5,417 -$77 $371 $210 -$35 -$41 $75 $376 -$59 $7 $258 -$15 $22 -$169

5 P61Z - Neonate, AdmWt <750 g 6,236 6,446 -$511 $68 $235 -$44 -$12 -$20 $290 -$2 $2 -$60 -$23 $10 -$142

6F12B - Implantation or Replacement of Pacemaker, Total System W/O Catastrophic CC

6,048 5,458 -$163 $175 $70 -$21 $2 $10 $145 $290 -$23 -$51 -$64 -$2 $221

7O60B - Vaginal Delivery W/O Catastrophic or Severe CC

5,460 6,586 $33 -$584 -$168 -$194 -$81 -$92 -$203 $0 $10 -$93 -$118 $31 $334

8F76B - Arrhythmia, Cardiac Arrest and Conduction Disorders W/O Cat or Sev CC

6,672 5,251 $156 $154 $299 -$3 -$19 -$130 $76 -$25 $31 -$62 -$100 $22 $1,021

9 D63Z - Otitis Media and URI 6,518 5,724 $215 $61 $177 -$135 -$38 -$51 $232 -$6 -$9 $168 -$33 $21 $194

10 G66Z - Abdominal Pain or Mesenteric Adenitis 5,653 4,782 $336 $213 $265 -$112 -$28 -$54 $122 -$6 -$6 -$1 -$73 $2 $213

23

The table below shows the difference between CCDHB’s cost per WIES and the average of Auckland, Waikato and Canterbury’s costs per WIES, for the DRG cost groups with the greatest deficit. This:

1. Shows that a specialty may be delivering within its budget but still have opportunities to improve2. Provides a focus on specific improvement opportunities that are more targeted than looking to improve and entire specialty3. Highlights areas where there may be improvements not at a specialty level, but across the organisation, for example RMO labour


128

Cost benchmarking analysis


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Cost benchmarking with other DHBs

In this cost benchmarking analysis, we compare the costs of CCDHB’s service provision with that of other similar DHBs (Auckland, Canterbury and Waikato). The analysis is based on data from the Ministry of Health’s cost cube (as requested by CCDHB). The data has not been adjusted or modified in any way.

We examine costs broken down into the following categories:

• Nursing labour

• SMO labour

• RMO labour

• Mgmt and admin labour

• Non clinical labour

• AH labour

• Other clinical costs

• Implants

• Outsourced clinical services

• Pharmaceuticals

• Infrastructure

• Central sterile

• Overhead costs

(See the appendix for definitions of these categories.)

In addition, the analysis considers costs for the following specialties (that have been drawn from the Ministry of Health’s health specialty table):

25

Anaesthesia services and pain management

Neurosurgery

Cardiology Oncology

Cardiothoracic surgery Ophthalmology

Dental surgery Orthopaedic surgery

Emergency medicine Otorhinolaryngology (ENT)

Endocrinology Paediatric medicine

Gastroenterological surgeryPaediatric neonatal special/intensive care [Level III]

Gastroenterology Renal medicine

General medicine Respiratory medicine

General surgery Specialist intensive care

Gynaecology Specialist paediatric oncology

Immunology Specialist paediatric surgery [Others]

Infectious diseases Thoracic surgery

Maternity services Urology

Neurology Vascular surgery


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Cost benchmarking with other DHBsAll services (DRG only)

26

Note that some specialties have been excluded from this benchmarking analysis, such as specialist paediatric endocrinology, as it is not provided by Auckland, Canterbury or Waikato DHBs. Several other specialties are not provided by Capital and Coast DHB; these specialties have also been excluded.

25%

25%

27%

24%

16%

18%

16%

12%

9%

8%

7%

6%

0% 20% 40% 60% 80% 100%

Capital and Coast

Auckland

Canterbury

Waikato

Nursing labour SMO labour RMO labour

Mgmt and admin labour Non clinical labour AH labour

Other clinical costs Implants Outsourced clinical services

Pharmaceuticals Infrastructure Central sterile

Overhead costs

The graph below illustrates how the DHBs incur similar labour costs for providing services. However, CCDHBs labour cost per WIES is approximately $200 per discharge cheaper than Canterbury and Waikato.

DHB Total labour cost WIESLabour Cost

per WIES

Waikato $199,307,743 82,646 $2,412

Canterbury $266,161,254 87,430 $3,044

Auckland $400,803,942 133,191 $3,009

Capital and Coast $188,794,305 65,470 $2,884


131

Conclusion


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Conclusion

There is opportunity to undertake further analysis in this area, and to use the results to date to identify and work on improvement areas.

CCDHB and the comparator DHBs may also wish to consider working together to review cost-to-serve. This would help identify any opportunities for good practice learning, and highlight if there are areas in which the national price does not sufficiently cover costs of delivery.

An over-arching opportunity area is for CCDHB to make improvements in its reporting frameworks. We understand that the DHB is already working to implement “Ward to Board” reporting (as illustrated in the diagram on the right), to drive efficiencies in the business and demonstrate good practice to The Ministry.

The type of analysis set out in this report, and other related comparisons such as doctor to doctor benchmarking, could be a part of that new performance reporting.

28

Department

level

Directorate level

Provider-funder split

Whole of entity view Board

Provider

Medicine, cancer and community

General MedicineEmergency Medicine

Surgery, women’s and

children’s

Paediatric etc

Funder

“Ward to Board” reporting

Ward / individual clinician view

Aggregated

Dis-aggregated

As highlighted through this review, there has been difficulty in building a full financial picture of the services, due to incomplete information regarding costs, revenues and allocation methodologies. This review should therefore be considered as a “start”, and we acknowledge that CCDHB is working to improve the situation, for example by purchasing a new costing engine.

The information set out in this report, while not necessarily a complete picture, does provide a useful understanding of the broader financial situation for each of the services, and has enabled us to undertake some high-level benchmarking against comparator DHBs. This benchmarking has shown that CCDHB is performing broadly in line with its peers, and has similar cost-to-serve and labour cost mixes.


133

Appendix


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Data sources, preparation and calculation

Data sources

The analysis presented in these slides is based on the following data sources:

• Event level data (version 3, received on 1 June 2016); the event level data provides a detailed view of CCDHB’s activities for the financial year 2014/2015.

• CS2 cost data (received on 26 May 2016); the CS2 cost data provides a breakdown of costs according to the Ministry of Health’s CS2 cost schedule. The CS2 cost data also includes a unique identifier which was used to match CS2 data to event level data.

• Tertiary adjuster data (received on 24 June 2016); the tertiary adjuster data provides a list of specialties and the tertiary adjuster for local and IDF activities in each specialty. The total tertiary adjuster for the financial year 2014/2015 was $17.6m

• DHB benchmarking data (received on 19 May 2016); the DHB benchmarking data provides detail on the costs of CCDHB and threeother DHBs (Auckland, Waikato and Canterbury). This data contains multiple components: CS2 and CS7 cost breakdowns, and casemix and non-casemix data. This data has been used to benchmark CCDHB’s costs.

Data preparation

The process below outlines the data preparation process for the event level data.

1. Excluding event data as recommended.Some of the event data was marked for exclusion by CCDHB. Data with a blank or null WIESExclusionCode was included, as was data with a WIESExclusionCode of “Bariatric”, “Neo”, “OBS”, or “PH”; all other WIESExclusionCode values were excluded.

2. Adding the tertiary adjuster.The tertiary adjuster was added to the event data as follows:

a. Calculate the total adjuster for each specialty.The data provided contained a local and an IDF adjuster for each specialty; the total specialty has been calculated as the sum of these.

b. Calculate the total WIES value for each specialty.The total WIES value has been calculated by summing the WIESValue field from the event data.

c. Divide total adjuster by total WIES for each specialty.The tertiary adjuster per WIES has been calculated by dividing total adjuster by total WIES (for each specialty).

30


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Data sources, preparation and calculation

3. Adding the tertiary adjuster (continued).

d. Add a proportional tertiary adjuster to each event.An additional field was added to the event data for a proportional tertiary adjuster. Each event was allocated a tertiary adjuster as follows: tertiary adjuster per WIES × event WIES value. The proportional tertiary adjuster was added to events from the NMDS (National Minimum Dataset), that occurred in Wellington Hospital, and had a valid DRG code (i.e. a non-null DRG code).

4. Joining event data and CS2 data.The event data and the CS2 data contain a shared unique identifier (3091EventCostByCS21415ID) that was used to match events with their associated CS2 cost breakdown.

5. Aggregate data for analysis.The data was then aggregated for analysis. Several raw fields were extracted (LastSpecialty, ServiceLine, DRGCode, etc) in their original state, while others were extracted as a sum (e.g. WIES $$, WIESValue, TotalCost) or a count (e.g. number of events).

No preparation or modification was made to the DHB benchmarking data.

Identifying DRG and non-DRG activity

We distinguished between DRG and non-DRG activity using the UnitOfMeasure field in the event level data; DRG activity included all records where the UnitOfMeasure field was “Cost Weighted

Discharge”, while non-DRG activity included all records where the UnitOfMeasure field was anything else.

Calculating non-DRG revenue

Non-DRG revenue has been calculated using an outpatient price list provided by CCDHB, and purchase unit codes in the event level data. An outpatient price is assigned to each event based on the event’s purchase unit code. Revenue is then calculated as the event volume figure (from the event level data) multiplied by outpatient price.

In addition, an adjustment of $406 for PCT has been considered on CCDHB’s guidance. The adjustment has not been included. It is unclear whether this adjustment has been included in CCDHB’s data submission to the Ministry of Health. Consequently, it is also unclear whether the DHB benchmarking data from the Ministry of Health’s cost cube includes this adjustment.

We have not made any PCT adjustment to the DHB benchmarking data – we cannot discern where these adjustments would need to be made.

31


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Cost benchmarking

The benchmarking presented in section 4 is based on health specialties as defined by the Ministry of Health in their Health Specialty code table.

The following specialties have been excluded because there is no data on CCDHB’s activities in these specialties (with the exception of Specialist paediatric endocrinology, CCDHB is the only DHB with data for this specialty):

The cost benchmarking is based only on CS2 casemix data from the Ministry of Health’s cost cube (requested and provided by CCDHB).

32

S65 Burns surgery

M15 Dermatology

M96 Diabetology

P42 Paediatric neonatal special/intensive care [Level II]

P41 Paediatric neonatal special care [Level I]

M80 Palliative and terminal care

S60 Plastic surgery

M90 Radiotherapy

M70 Rheumatology

M54 Specialist paediatric oncology

M97 Specialist paediatric endocrinology

M24 Specialist paediatric endocrinology and diabetology

M34 Specialist paediatric haematology

M59 Specialist paediatric intensive care

M49 Specialist paediatric neurology

M84 Specialist paediatric palliative care

S58 Specialist paediatric surgery [neonates]

M79 Specialist paediatric venereology


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Cost benchmarkingCS2 cost buckets

The cost buckets used in this analysis are taken from the CS2 cost schedule published by the Ministry of Health. (The CS2 cost schedule can be found in the Common Costing Standards available on the Nationwide Service Framework Library (NSFL, https://nsfl.health.govt.nz/)). Two CS2 cost buckets have been excluded from this analysis (DA, DL) as they are from an outdated cost schedule.

These CS2 cost buckets are as follows:

33

CS2 code Description

DQ Administrative labour

DO Allied Health technician labour

DN Allied Health therapist labour

DM Building deprn, leases and rents

DK Central sterile costs

DG Implants

DI Infrastructure and non clinical supplies

DD Labour non clinical

DP Management and professional labour

DS Medical labour RMO

DR Medical labour SMO

DB Nursing labour

DH Other clinical costs

DJ Outsourced clinical services

DF Pharmaceuticals

O* (all overhead codes) All overhead codes starting with O


138

https://nsfl.health.govt.nz/

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Cost benchmarkingCS2 cost buckets

These CS2 cost buckets have been simplified further, as shown below:

34

CS2 code Description Updated CS2 cost bucket

DQ Administrative labour Mgmt and admin labour

DO Allied Health technician labour AH labour

DN Allied Health therapist labour AH labour

DM Building deprn, leases and rents Infrastructure

DK Central sterile costs Central sterile

DG Implants Implants

DI Infrastructure and non clinical supplies Infrastructure

DD Labour non clinical Non clinical labour

DP Management and professional labour Mgmt and admin labour

DS Medical labour RMO RMO labour

DR Medical labour SMO SMO labour

DB Nursing labour Nursing labour

DH Other clinical costs Other clinical costs

DJ Outsourced clinical services Outsourced clinical services

DF Pharmaceuticals Pharmaceuticals

O* (all overhead codes) All overhead codes starting with O Overhead costs


139

“Top” 100 DRGs


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Top 100 DRGsDRG activity only

36

The table below lists the top 100 DRGs (these are the top 100 DRGs taken from a list of DRGs sorted in descending order on surplus or deficit). The top 10 DRGs account for 24% of the deficit. The top 100 DRGs account for 90% of the deficit.

Rank DRG Home specialtyNumber of

events

Total

WIESWIES revenue Total cost

Cost per

WIES

Revenue

gap

Revenue gap

per event

% Total

deficitCumulative loss

Cumulative %

total deficit

1 P67D - Neonate, AdmWt >2499 g W/O Significant OR Procedure W/O Problem Obstetrics 2874 777.6 3,640,551 5,102,851 6,563 1,397,244- 486- 5% 1,397,244- 5%

2 A07Z - Allogeneic Bone Marrow Transplant Haematology 15 243.7 1,140,864 2,030,051 8,331 776,952- 51,797- 3% 2,174,195- 8%

3 F74Z - Chest Pain General Medicine 1607 457.6 2,142,291 2,968,377 6,487 734,630- 457- 3% 2,908,825- 11%

4 G02A - Major Small and Large Bowel Procedures W Catastrophic CC General Surgery 102 524.8 2,457,145 3,325,749 6,337 686,715- 6,733- 3% 3,595,540- 13%

5 P61Z - Neonate, AdmWt <750 g Neonatal 22 565.7 2,648,468 3,528,032 6,237 628,163- 28,553- 2% 4,223,704- 16%

6 F12B - Implantation or Replacement of Pacemaker, Total System W/O Catastrophic CC Cardiology 208 429.7 2,011,701 2,598,602 6,048 565,555- 2,719- 2% 4,789,258- 18%

7 O60B - Vaginal Delivery W/O Catastrophic or Severe CC Obstetrics 1460 662.3 3,101,057 3,618,858 5,464 517,610- 355- 2% 5,306,868- 20%

8 F76B - Arrhythmia, Cardiac Arrest and Conduction Disorders W/O Cat or Sev CC Cardiology 670 254.5 1,191,517 1,701,228 6,685 467,107- 697- 2% 5,773,975- 21%

9 D63Z - Otitis Media and URI Emergency 821 292.5 1,369,524 1,897,342 6,486 418,993- 510- 2% 6,192,968- 23%

10 G66Z - Abdominal Pain or Mesenteric Adenitis Emergency 1632 547.1 2,561,462 3,095,020 5,657 388,582- 238- 1% 6,581,550- 24%

11 G67B - Oesophagitis and Gastroenteritis W/O Cat/Sev CC Emergency 904 303.3 1,420,208 1,895,601 6,249 380,051- 420- 1% 6,961,601- 26%

12 X62B - Poisoning/Toxic Effects of Drugs and Other Substances W/O Cat or Sev CC General Medicine 732 249.6 1,168,717 1,633,084 6,542 368,259- 503- 1% 7,329,860- 27%

13 A06A - Tracheostomy W Ventilation >95 hours W Catastrophic CC Neurosurgery 41 1030.1 4,822,909 5,501,862 5,341 365,421- 8,913- 1% 7,695,282- 29%

14 G70B - Other Digestive System Diagnoses W/O Catastrophic or Severe CC General Surgery 1168 444.9 2,083,099 2,576,852 5,792 345,519- 296- 1% 8,040,801- 30%

15 E01B - Major Chest Procedures W/O Catastrophic CC Cardiothoracic 113 393.0 1,840,003 2,241,076 5,703 343,618- 3,041- 1% 8,384,419- 31%

16 O01A - Caesarean Delivery W Catastrophic or Severe CC Obstetrics 119 295.2 1,381,997 1,724,314 5,842 341,025- 2,866- 1% 8,725,444- 32%

17 Q60C - Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC W/O Malignancy Respiratory 289 181.5 849,746 1,208,461 6,658 327,540- 1,133- 1% 9,052,985- 34%

18 J64B - Cellulitis W/O Catastrophic or Severe CC General Medicine 717 412.8 1,932,610 2,395,531 5,803 327,501- 457- 1% 9,380,486- 35%

19 H01A - Pancreas, Liver and Shunt Procedures W Catastrophic CC General Surgery 26 154.1 721,528 1,095,731 7,110 324,632- 12,486- 1% 9,705,118- 36%

20 D40Z - Dental Extractions and Restorations Dental 707 358.6 1,679,069 2,008,768 5,601 303,511- 429- 1% 10,008,630- 37%

21 O01C - Caesarean Delivery W/O Catastrophic or Severe CC Obstetrics 742 968.1 4,532,849 4,832,357 4,991 299,508- 404- 1% 10,308,137- 38%

22 F62A - Heart Failure and Shock W Catastrophic CC General Medicine 118 179.9 842,147 1,183,313 6,579 290,715- 2,464- 1% 10,598,853- 39%

23 X60B - Injuries W/O Catastrophic or Severe CC Emergency 645 190.7 892,718 1,217,399 6,385 284,467- 441- 1% 10,883,320- 40%

24 L03A - Kidney, Ureter and Major Bladder Procedures for Neoplasm W Catastrophic CC Urology 21 126.7 593,172 907,575 7,164 282,545- 13,455- 1% 11,165,864- 41%

25 G01A - Rectal Resection W Catastrophic CC General Surgery 43 248.3 1,162,464 1,520,476 6,124 274,564- 6,385- 1% 11,440,429- 42%

26 N07Z - Other Uterine and Adnexa Procedures for Non-Malignancy Gynaecology 422 350.0 1,638,913 2,004,029 5,725 271,289- 643- 1% 11,711,718- 44%

27 P67C - Neonate, AdmWt >2499 g W/O Significant OR Procedure W Other Problem Neonatal 221 200.8 940,250 1,297,324 6,460 268,098- 1,213- 1% 11,979,816- 44%

28 F42C - Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc, Sameday Cardiology 520 515.8 2,415,038 2,704,739 5,244 265,094- 510- 1% 12,244,910- 45%

29 G70A - Other Digestive System Diagnoses W Catastrophic or Severe CC Oncology 251 248.4 1,163,198 1,550,224 6,240 260,002- 1,036- 1% 12,504,912- 46%

30 B71B - Cranial and Peripheral Nerve Disorders W/O CC Neurology 284 196.7 921,174 1,219,668 6,199 258,012- 908- 1% 12,762,923- 47%

31 B80Z - Other Head Injury General Medicine 571 183.5 859,004 1,156,366 6,303 250,945- 439- 1% 13,013,869- 48%

32 I75B - Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle W/O CC Emergency 372 133.6 625,506 884,645 6,622 233,201- 627- 1% 13,247,070- 49%

33 V60B - Alcohol Intoxication and Withdrawal W/O CC General Medicine 333 81.2 380,344 635,659 7,825 232,058- 697- 1% 13,479,128- 50%

34 G03A - Stomach, Oesophageal and Duodenal Procedure W Malignancy or W Catastrophic CC General Surgery 29 239.4 1,120,660 1,433,809 5,990 229,775- 7,923- 1% 13,708,904- 51%

35 I68C - Non-surgical Spinal Disorders, Sameday Emergency 399 79.8 373,621 610,509 7,650 228,773- 573- 1% 13,937,677- 52%


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37


events

Total


Cost per

WIES

Revenue

gap

Revenue gap

per event

% Total


Cumulative %

total deficit

36 I71B - Other Musculotendinous Disorders W/O Catastrophic or Severe CC Emergency 344 111.4 521,589 777,196 6,976 226,335- 658- 1% 14,164,012- 53%

37 B77Z - Headache General Medicine 765 226.4 1,060,119 1,360,871 6,010 226,138- 296- 1% 14,390,150- 53%

38 F41B - Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W/O Cat or Sev CC Cardiology 173 239.0 1,118,774 1,353,886 5,666 223,713- 1,293- 1% 14,613,862- 54%

39 I74Z - Injury to Forearm, Wrist, Hand or Foot Emergency 343 112.4 526,075 764,394 6,803 219,346- 639- 1% 14,833,209- 55%

40 C10Z - Strabismus Procedures Ophthalmology 125 87.5 409,567 633,478 7,242 216,331- 1,731- 1% 15,049,540- 56%

41 O60A - Vaginal Delivery W Catastrophic or Severe CC Obstetrics 284 264.3 1,237,563 1,452,199 5,494 214,432- 755- 1% 15,263,972- 57%

42 I15Z - Cranio-Facial Surgery Neurosurgery 26 82.6 386,922 638,415 7,725 213,915- 8,227- 1% 15,477,887- 57%

43 E01A - Major Chest Procedures W Catastrophic CC Cardiothoracic 90 455.6 2,132,947 2,437,232 5,350 208,285- 2,314- 1% 15,686,172- 58%

44 T01A - OR Procedures for Infectious and Parasitic Diseases W Catastrophic CC General Surgery 52 254.0 1,189,316 1,472,362 5,796 205,466- 3,951- 1% 15,891,638- 59%

45 L04A - Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W Catastrophic CC Urology 31 117.9 552,012 809,692 6,868 204,969- 6,612- 1% 16,096,607- 60%

46 P67B - Neonate, AdmWt >2499 g W/O Significant OR Procedure W Major Problem Neonatal 169 220.6 1,032,726 1,335,010 6,052 202,736- 1,200- 1% 16,299,343- 61%

47 F65B - Peripheral Vascular Disorders W/O Catastrophic or Severe CC Vascular Surgery 143 81.6 382,020 606,828 7,437 198,727- 1,390- 1% 16,498,070- 61%

48 O01B - Caesarean Delivery W/O Catastrophic or Severe CC Obstetrics 216 385.0 1,802,396 1,998,606 5,192 193,968- 898- 1% 16,692,038- 62%

49 E65B - Chronic Obstructive Airways Disease W/O Catastrophic CC General Medicine 446 305.2 1,429,149 1,736,194 5,688 193,059- 433- 1% 16,885,097- 63%

50 C03Z - Retinal Procedures Ophthalmology 297 257.7 1,206,327 1,422,653 5,522 192,086- 647- 1% 17,077,183- 63%

51 E60A - Cystic Fibrosis W Catastrophic or Severe CC Respiratory 13 40.7 190,786 386,322 9,481 184,393- 14,184- 1% 17,261,575- 64%

52 A08B - Autologous Bone Marrow Transplant W/O Catastrophic CC Haematology 12 10.7 49,886 238,755 22,408 183,961- 15,330- 1% 17,445,536- 65%

53 O66A - Antenatal & Other Obstetric Admission Obstetrics 565 260.9 1,221,315 1,433,186 5,494 180,689- 320- 1% 17,626,225- 65%

54 F73B - Syncope and Collapse W/O Catastrophic or Severe CC General Medicine 577 193.5 906,080 1,134,800 5,864 178,540- 309- 1% 17,804,765- 66%

55 T63Z - Viral Illness Emergency 556 186.6 873,564 1,123,064 6,019 176,637- 318- 1% 17,981,402- 67%

56 I10B - Other Back and Neck Procedures W/O Catastrophic or Severe CC Neurosurgery 88 230.6 1,079,753 1,295,665 5,618 171,425- 1,948- 1% 18,152,828- 67%

57 J64A - Cellulitis W Catastrophic or Severe CC General Medicine 159 196.0 917,838 1,164,526 5,940 167,594- 1,054- 1% 18,320,422- 68%

58 R61A - Lymphoma and Non-Acute Leukaemia W Catastrophic CC Haematology 28 108.1 506,203 723,020 6,687 166,627- 5,951- 1% 18,487,049- 69%

59 L64Z - Urinary Stones and Obstruction General Medicine 499 189.6 887,802 1,106,850 5,837 165,636- 332- 1% 18,652,685- 69%

60 N08Z - Endoscopic and Laparoscopic Procedures for Female Reproductive System Gynaecology 182 142.9 668,939 867,789 6,074 163,592- 899- 1% 18,816,277- 70%

61 L63B - Kidney and Urinary Tract Infections W/O Catastrophic or Severe CC General Medicine 588 257.2 1,204,087 1,462,450 5,687 162,515- 276- 1% 18,978,792- 70%

62 O64A - False Labour Before 37 Weeks or W Catastrophic CC Obstetrics 114 38.2 178,673 338,806 8,878 159,900- 1,403- 1% 19,138,692- 71%

63 K60B - Diabetes W/O Catastrophic or Severe CC General Medicine 213 131.0 613,540 820,122 6,258 153,819- 722- 1% 19,292,511- 72%

64 M04Z - Testes Procedures Paediatric Surgical 219 152.8 715,218 901,758 5,903 153,733- 702- 1% 19,446,244- 72%

65 I04B - Knee Replacement W/O Catastrophic or Severe CC Orthopaedics 149 505.4 2,366,042 2,558,555 5,063 152,033- 1,020- 1% 19,598,278- 73%

66 J65B - Trauma to the Skin, Subcutaneous Tissue and Breast W/O Cat or Sev CC Emergency 303 88.6 414,711 585,379 6,609 150,472- 497- 1% 19,748,750- 73%

67 Z60A - Rehabilitation W Catastrophic CC General Medicine 30 78.3 366,539 516,683 6,600 150,144- 5,005- 1% 19,898,894- 74%

68 N04B - Hysterectomy for Non-Malignancy W/O Catastrophic or Severe CC Gynaecology 123 217.0 1,016,087 1,238,532 5,707 148,359- 1,206- 1% 20,047,252- 74%

69 H43B - ERCP Procedures W/O Catastrophic or Severe CC General Surgery 68 87.2 408,301 586,971 6,731 143,890- 2,116- 1% 20,191,143- 75%

70 L65B - Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic or Severe CC Emergency 282 103.6 485,267 663,320 6,400 143,133- 508- 1% 20,334,276- 76%


142

PwC


38


events

Total


Cost per

WIES

Revenue

gap

Revenue gap

per event

% Total


Cumulative %

total deficit

71 F03A - Cardiac Valve Proc W CPB Pump W Invasive Cardiac Investigation W Cat CC Cardiothoracic 18 220.1 1,030,620 1,198,113 5,443 139,817- 7,768- 1% 20,474,093- 76%

72 Z60B - Rehabilitation W/O Catastrophic CC General Medicine 50 96.6 452,346 591,670 6,124 139,108- 2,782- 1% 20,613,201- 77%

73 E71B - Respiratory Neoplasms W/O Catastrophic CC Oncology 131 94.7 443,395 624,758 6,597 137,577- 1,050- 1% 20,750,778- 77%

74 N06B - Female Reproductive System Reconstructive Procs W/O Catastrophic or Severe CC Gynaecology 95 99.5 465,692 634,051 6,375 137,256- 1,445- 1% 20,888,034- 78%

75 Z63B - Other Surgical Follow Up and Medical Care W/O Catastrophic CC Orthopaedics 89 59.1 276,839 426,450 7,212 137,066- 1,540- 1% 21,025,100- 78%

76 F43Z - Circulatory System Diagnosis W Non-Invasive Ventilation Cardiology, General Medicine 14 38.0 177,887 323,258 8,508 136,609- 9,758- 1% 21,161,709- 79%

77 K60A - Diabetes W Catastrophic or Severe CC General Medicine 32 36.9 172,532 325,248 8,826 136,001- 4,250- 1% 21,297,710- 79%

78 E75B - Other Respiratory System Diagnosis W Severe or Moderate CC General Medicine 143 104.2 487,715 681,884 6,546 135,910- 950- 1% 21,433,620- 80%

79 P66C - Neonate, AdmWt 2000-2499 g W/O Significant OR Procedure W Other Problem Neonatal 38 92.5 432,987 609,294 6,588 135,206- 3,558- 1% 21,568,826- 80%

80 F62B - Heart Failure and Shock W/O Catastrophic CC General Medicine 345 269.7 1,262,857 1,483,151 5,499 133,253- 386- 0% 21,702,079- 81%

81 C15A - Glaucoma and Complex Cataract Procedures Ophthalmology 46 42.2 197,461 334,602 7,934 133,114- 2,894- 0% 21,835,193- 81%

82 N12A - Uterine and Adnexa Procedures for Malignancy W Catastrophic CC Gynaecology 29 95.3 446,391 621,213 6,516 132,175- 4,558- 0% 21,967,368- 82%

83 B70A - Stroke and Other Cerebrovascular Disorders W Catastrophic CC Neurology 70 123.0 575,961 758,712 6,168 131,565- 1,879- 0% 22,098,933- 82%

84 B71A - Cranial and Peripheral Nerve Disorders W CC General Medicine 39 34.8 163,035 306,555 8,804 130,955- 3,358- 0% 22,229,888- 83%

85 X06A - Other Procedures for Other Injuries W Catastrophic or Severe CC Orthopaedics 50 105.6 494,412 655,515 6,208 130,762- 2,615- 0% 22,360,650- 83%

86 F17B - Insertion or Replacement of Pacemaker Generator W/O Catastrophic or Severe CC Cardiology 87 120.1 562,486 698,622 5,815 130,405- 1,499- 0% 22,491,055- 84%

87 B76B - Seizure W/O Catastrophic or Severe CC General Medicine 467 200.4 938,264 1,141,526 5,696 128,802- 276- 0% 22,619,857- 84%

88 L03C - Kidney, Ureter and Major Bladder Procedures for Neoplasm W/O Cat or Sev CC Urology 25 75.3 352,494 497,483 6,608 127,615- 5,105- 0% 22,747,472- 84%

89 B72B - Nervous System Infection Except Viral Meningitis W/O Cat or Sev CC Neurology 46 36.3 170,146 307,806 8,470 124,153- 2,699- 0% 22,871,625- 85%

90 P06A - Neonate, AdmWt >2499 g W Significant OR Procedure W Multi Major Problems Neonatal 22 225.9 1,057,884 1,281,554 5,672 123,252- 5,602- 0% 22,994,877- 85%

91 F11A - Amputation for Circ System Except Upper Limb and Toe W Catastrophic CC Vascular Surgery 14 68.5 320,653 466,527 6,812 122,318- 8,737- 0% 23,117,195- 86%

92 L60A - Renal Failure W Catastrophic CC General Medicine 45 101.3 474,137 656,875 6,486 119,670- 2,659- 0% 23,236,865- 86%

93 F75B - Other Circulatory System Diagnoses W Severe or Moderate CC Cardiology, General Medicine 96 75.9 355,241 501,218 6,606 116,697- 1,216- 0% 23,353,563- 87%

94 D10Z - Nasal Procedures ENT 129 103.8 485,931 627,522 6,046 114,730- 889- 0% 23,468,292- 87%

95 B82C - Chronic and Unspecified Paraplegia/Quadriplegia W or W/O OR Pr W/O Cat/Sev CC General Medicine 34 29.5 138,326 261,228 8,842 114,194- 3,359- 0% 23,582,486- 88%

96 I66B - Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC General Medicine 69 37.5 175,695 300,987 8,021 113,628- 1,647- 0% 23,696,114- 88%

97 F75C - Other Circulatory System Diagnoses W/O CC Cardiology 126 86.4 404,552 547,844 6,340 113,387- 900- 0% 23,809,501- 88%

98 G65A - GI Obstruction W Catastrophic or Severe CC Oncology 66 79.1 370,469 521,071 6,585 113,303- 1,717- 0% 23,922,804- 89%

99 B03B - Spinal Procedures W/O Catastrophic or Severe CC Neurosurgery 36 131.0 613,428 748,361 5,712 111,373- 3,094- 0% 24,034,177- 89%

100 I20Z - Other Foot Procedures Orthopaedics 90 115.1 538,706 673,331 5,852 111,016- 1,234- 0% 24,145,193- 90%

Total 30,011 21,940.0 102,722,201 132,057,479 6,019 24,145,193- 805- 90% 1,594,856,917-

The home specialty for a DRG has been calculated as the specialty with the maximum number of events for that DRG (when a DRG has two home specialties, the two specialties have the same maximum number of events for that DRG).

There are 667 unique DRGs in the benchmarking data used for this analysis.


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