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GENERAL MANAGER’S REPORT

AGM

25 October 2011

Neil Heslop

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C O N T E N T S

Introduction............................................................................................................. 3

Funding .................................................................................................................... 3

Our Patients............................................................................................................. 3 Recipient Numbers ................................................................................................ 4 Waiting Lists ......................................................................................................... 4

Facilities ................................................................................................................... 4

Staffing..................................................................................................................... 4

Suppliers .................................................................................................................. 5 Cochlear Limited................................................................................................... 5 MED-EL Limited ................................................................................................... 5

Significant Events 2010-11 ...................................................................................... 5 February 22 Canterbury Earthquake ..................................................................... 5 Appointment of General Manager.......................................................................... 5 Van Asch Deaf Education Centre........................................................................... 6 Loud Shirt Day ...................................................................................................... 6 Habilitation Review ............................................................................................... 6 Cochlear Limited CI500 Implant Recall................................................................. 6

Looking Forward 2011-12....................................................................................... 7 Securing Roll-Over of Ministry of Health Contract ................................................ 7 Re-Fit of Milford Chambers Facilities ................................................................... 7 Waiting Lists – Adult Candidates........................................................................... 7 Outreach Planning ................................................................................................ 7 Management of Private Programme ...................................................................... 8

Summary ................................................................................................................. 8

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Introduction This report covers the key operations of the Southern Cochlear Implant Programme (SCIP) for the period 1 July 2010 until 19 October 2011. The report does not include financial information; a detailed financial report is available from the Financial Officer of the Southern Hearing Charitable Trust (SHCT). The SHCT is funded by the Ministry of Health to operate publicly-funded cochlear implant services in the Southern region of New Zealand. It does this through its provider arm, the SCIP. The region covered by the SCIP includes all of the South Island and the lower North Island from Gisborne on the east coast to New Plymouth on the west coast. The programme also provides cochlear implant services to a small number of other patients funded through a variety of other sources such as ACC, War Pensions, and patients funding themselves. Funding

The SHCT is contracted to provide 15 new implants for pediatric candidates per year and 10 new implants for adult candidates per year. Additionally the Ministry of Health also provides funding for 8 new implant systems to cater for children identified by the Universal Newborn Hearing Screening (UNHS) programme. Any UNHS systems unused are then made available to other candidates, usually adults. The Ministry of Health provides funding for most ancillary services associated with cochlear implants including: equipment, surgery, Audiology, and Rehabilitation. For children, the Ministry of Health also provides funding for the provision of spare parts, repairs, and batteries to children under 18 years. The Ministry of Education separately funds Habilitation services for children though under the same contract. The Ministry of Health provides assistance with travel and accommodation for all candidates and recipients through a separate National Travel Assistance fund.

Our Patients The programme provides support and services to 463 existing recipients. Of these 166 are children and 297 are adults. In addition there are 134 adults waiting for surgery, surgical funding, or assessment. In the reporting period the programme met or exceeded all of its Ministry of Health contracted service volumes. As in previous years the demand for cochlear implants for adults significantly exceeds available funding. As a result there are significant waiting times for both assessments and surgery.

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A breakdown of patient numbers is as follows: Recipient Numbers

Adults 2010-2011 All Years

Public 15 258 Private 3 31 ACC 1 7 War Pensions 0 1 19 297 Children 2010-2011 All Years

Public 25 166

Totals 44 463

Waiting Lists

Adults Number Waiting Time

Funded, Waiting Surgery 12 4-6 weeks Waiting Funding 40 5-6 years In Assessment or Waiting Assessment

82 2-3 years

Children

No waiting list

Facilities The SCIP clinic is based at the Milford Chambers site on the St. George’s Hospital campus. All surgeries are also carried out at St. George’s Hospital. The SHCT had, until 1 July 2011, contracted van Asch Deaf Education Centre (VADEC) to provide paediatric services on its Sumner site. A combination of the Canterbury earthquake of February 22 and a desire to consolidate both programmes on one site has meant that all clinical services are now based out of the Milford Chambers rooms. Staffing The programme employs 9 staff out of its Milford Chambers rooms:

• General Manager • Receptionist (job-shared between 2 staff) • Programme Administrator • 4 Audiologists • 1 Rehabilitationist

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The SHCT also funds VADEC to employ 2 paediatric Habilitation staff and while they remain VADEC employees they are also based at the Milford Chambers rooms and their day-to-day wok is managed by the General Manager. Wages make up a significant component of the programme’s costs and are in the order of $1.06 million for all staff in 2012. The programme has in place arrangements with 3 surgeons to provide its surgical services. All surgeries are carried out at the St. George’s Hospital theatre suites. Suppliers The programme has budgeted approximately $1.87 million dollars in cochlear implant devices and equipment for 2011-12 in order to meet its Ministry of Health obligations. The programme offers more than one manufacturer’s device as a means of providing recipients choice. This is consistent with programmes internationally. Cochlear Limited

Until 2006 the SCIP and what was then the NZ CI programme offered Cochlear Limited devices exclusively. Of the 463 recipients in the programme approximately 90% have a Cochlear Limited device. MED-EL Limited

The programme has offered the MED-EL products since 2006. The programme initially offered these to adult candidates and began offering them to paediatric candidates since early 2010. Significant Events 2010-11 February 22 Canterbury Earthquake

The February 22 earthquake has had a significant impact on operation of the programme. The paediatric programme based at VADEC in Sumner was forced to immediately re-locate to the Milford Chambers site because of significant damage to roading, services, and buildings in the Sumner area. The programme operated a skeleton service for 1 week following the February 22 earthquake but had resumed all services by the beginning of March 2011. Appointment of General Manager

In recent years the programme has grown considerably to the point where the Trustees, in a purely voluntary capacity, no longer have the time to effectively oversee the operation of their programme. Also, with amalgamation of the adult and children’s programmes on one site the Trustees made the decision to appoint a General Manager from 1 July 2011.

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The General Manager reports directly to the Trustees and assumes responsibility for the day-to-day operation of all programme services. The role also involves implementation of the goals identified through the Strategic Plan. Van Asch Deaf Education Centre

The SHCT had a service agreement with VADEC to provide its paediatric CI services for the period March 2003 until 30 June 2010. The SHCT made a decision in early 2010 to consolidate both programmes on its St. George’s site. This consolidation was accelerated following the February 22 earthquake. At the direction of the Ministry of Education the SHCT has a Memorandum of Understanding with VADEC to employ Habilitation staff for the paediatric programme. Otherwise, all paediatric services previously contracted to VADEC (repairs, spare parts, Audiology, administration) are now provided directly by the programme out of Milford Chambers. Loud Shirt Day

The SCIP participates in the annual September fundraiser for children with cochlear implants organized by the equivalent children’s programme in the Northern region, The Hearing House.

As a result of the Canterbury earthquakes in 2010 and 2011 there has been a drop in funds from Loud Shirt day activities. In previous years the SCIP benefited from Loud Shirt Day donations to the tune of approximately $20,000 per annum. Projected funds this year will probably be in the order of $16,000. Habilitation Review

The Ministry of Education concluded the review of Habilitation services originally started in 2008. As a result of the review an additional 2 FTE Habilitation positions will be funded in both the Northern and Southern regions. We expect these positions to be advertised late 2011 for a start date of early 2012. Staff will be employed by VADEC under the terms of the Memorandum of Understanding but will be managed day-to-day by the General Manager at Milford Chambers. Cochlear Limited CI500 Implant Recall

Cochlear Limited announced in early September a voluntary recall of all their non-implanted CI500 series of cochlear implants due to a known manufacturing fault. The SCIP has not to date had any failures with this device. Based on the rate of failure we might expect to see no more than 1 or 2 failures. Recipients with the CI512 device were notified and kept up to date with developments. The company has available an alternative implant model that is comparable to the withdrawn device and there are no plans to stop using Cochlear Limited devices.

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Looking Forward 2011-12 Securing Roll-Over of Ministry of Health Contract

The SHCT is currently negotiating service agreements and funding levels with the Ministry of Health. We expect these negotiations to be concluded by the end of 2011 for new contracts beginning 1 July 2012. The goal is to secure a 5-year contract for services, with annual review of funding levels. Re-Fit of Milford Chambers Facilities

As the programme has grown in recent years pressure has been placed on clinic space. The SHCT has secured additional clinic space adjacent to the current rooms. This will increase existing working space by approximately 50%.

The additional clinic space available from 2012 should meet the needs of the service as patient numbers grow. It also provides an opportunity to re-fit existing spaces to maximize available clinical facilities. Re-fit is scheduled to be completed early 2012. We expect minimal disruption to clinical services.

Waiting Lists – Adult Candidates

There are considerable waiting times for adults requiring both assessment and surgery. Waiting times for surgery are subject to funding from the Ministry of Health. Typical waiting times for an adult assessed and approved as a cochlear implant candidate are in the order of 5 years for non-urgent cases. The goal in 2012 is to continue to negotiate with the Ministry of Health for further funds to address these waiting times. Waiting times for assessment in non-urgent cases is 2-3 years. At present there are 82 adults waiting for cochlear implant assessment. The goal is to reduce waiting times to no longer than 6 months. This goal is eminently achievable and should be achieved by the second quarter of 2012. Outreach Planning

The programme provides services to children, adults and their families over a geographically wide area. In order for the service to be viable, the Ministry of Health provides travel and accommodation funding for candidates and recipients visiting the clinic in Christchurch. Nevertheless approximately two-thirds of recipients live outside of Christchurch. Subject to funding and resources, some services located closer to children and adults in the regions outside Christchurch may result in a better and more effective service. The provision of services in the regions might be achieved in a number of different ways:

• Remote technology to allow MAPping of recipients close to their home centre • Skype and/or other videoconference technology to allow Habilitation closer to a

recipient’s home centre

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• Set-up of one or more regional centres separate to the Christchurch clinic All of these options will be considered and developed further in 2011-12. No timeframe for implementation of any of these options has been confirmed. All of these possible solutions are subject to funding. The St. George’s Hospital / Milford Chambers site will remain the “Centre of Excellence” for the SCIP and there are no plans to set up a second completely “autonomous” Southern programme outside of Christchurch. Management of Private Programme

The programme provides services to a small number of adults who fund their own device, as well as a small number of children whose families fund a second device. The numbers of adult patients who fund their own treatment is expected to increase as the number of people likely to benefit from a cochlear implant exceeds government funding levels. To date privately funded patients have been managed as time and resources have allowed at the Milford Chambers clinic. Numbers are now at the point where privately funded children and adults may need to be managed separately.

Summary

The 2010-11 year resulted in significant changes for the SCIP. The Canterbury earthquake of February 22 forced the relocation of the peadiatric service to the Milford Chambers site, and this move has now been made permanent. This has placed some pressure on clinic space. The SHCT undertook a strategic planning exercise in July 2010 and as a result now employs a General Manager to oversee its operations. Cochlear Limited announced a recall of one of their products. This has not impinged on patients significantly to date but may do so in 2012. The 2011-12 year poses a number of challenges. The SHCT is currently negotiating with the Ministry of Health to secure an ongoing 5-year contract. It is hoped that these negotiations will be concluded by the end of 2011. On a positive note the Ministry of Education confirmed funding of an additional 2 FTE Habilitation positions. We hope to fill these by early 2012 in conjunction with van Asch Deaf Education Centre. The Milford Chambers site will be re-fitted to provide for more clinic space, required as a result of the re-location of the children’s programme but also due to increasing patient

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numbers. This will provide more clinic space but will result in some minor disruption in early 2012. The waiting time for adult candidates is a priority for 2012 and the goal will be to reduce assessment waiting times to a more acceptable 6 months. As greater numbers of recipients live outside of Christchurch consideration and planning for outreach services will be needed. Management of an increasing number of privately-funded recipients is also in need of review as these patients threaten to impact on public resources.