AGENDA - Hutt Valley District Health Board

Hutt Valley District Health Board MAY 2014

AGENDAHeld on Friday 2 May 2014 Boardroom, Pilmuir House, Hutt Hospital

Commencing at 9.00am

BOARD PUBLIC SESSION

Item Action Presenter Min Time Pg

1. PROCEDURAL 5 9.00 am

1.1 Karakia Peter Douglas

1.2 Apologies RECORD Virginia Hope

1.3 Continuous Disclosure- Interest Register- Conflict of Interest

CONFIRM Virginia Hope 2

1.4 Minutes of previous meeting ADOPT Virginia Hope 7

1.5 Matters arising from previous meetings ACCEPT Graham Dyer 15

2. PRESENTATION

2.1 Primary Care RECEIVE Bridget Allen 20 9:05 am 16

2.2 Regional Public Health RECEIVE Peter Gush 15 9:25 am 25

3. DISCUSSION PAPERS

3.1 Chair Verbal Report RECEIVE Virginia Hope 5 9:40 am -

3.2 Chief Executive Report NOTE Graham Dyer 15 9:45 am 29

4. COMMITTEE VERBAL REPORT BACKS

4.1 CPHAC NOTE Virginia Hope 5 10:00 am 40

5. OTHER

5.1 General 5 10:05 am

5.2 Resolutions to Exclude the Public APPROVE Virginia Hope 5 10:10 am 46

CLOSE 10:15 am

ADDENDUMS

2.1.1 PHO Funding Streams 47

2.1.2 PHO Performance 52

2.1.3 TeAHN Annual Report 54

2.1.4 TeAHN and DHB 6 month report 72

2.2.1 CvD Diabetes CPHAC Paper 151

2.2.2 RPH Presentation 158

3.2.1 Hutt Balanced Scorecard 166

3.2.2 Operating Report 167

3.2.3 3D Programme Update 179

3.2.4 Communications Update 181

3.2.5 OIAs 185

Hutt Valley PUBLIC 2 May 2014 - Agenda

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HUTT VALLEY DISTRICT HEALTH BOARD

Hutt Valley Board INTEREST REGISTER9 MARCH 2014

Name InterestDr Virginia HopeChair

∑ Chair, Hutt Valley District Health Board∑ Chair, Capital & Coast District Health Board∑ Chair, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Deputy Chair, Wairarapa, Hutt Valley and CCDHB Community Public Health Advisory

Committee and Disability Support Advisory Committees∑ Member, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Member, Hutt Valley, Finance Risk & Audit Committee∑ Member, Capital & Coast District Health Board, Finance Risk & Audit Committee∑ Health Programme Leader, Institute of Environmental Science & Research∑ Director & Shareholder, Jacaranda Limited∑ Fellow, Royal Australasian College of Medical Administration∑ Fellow and New Zealand Committee Member, Australasian Faculty of Public Health

Medicine∑ Fellow, New Zealand College of Public Health Medicine∑ Member, Territorial Forces Employer Support Council∑ Member, CRISP Governance Board∑ Member, Laboratory Round Table∑ Brother and Sister work in Health Sector in the Wairarapa Disability Support and

LaboratoriesWayne GuppyDeputy Chair

∑ Chair, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Chair, Hutt Valley District Health Board, Finance Risk & Audit Committee∑ Deputy Chair, Hutt Valley District Health Board∑ Member, Capital & Coast, Hutt Valley and Wairarapa DHBs Community Public Health Advisory

Committee and Disability Support Advisory Committee∑ Member, Capital & Coast District Health Board, Finance Risk & Audit Committee∑ Wife employed by various community pharmacies in the Hutt Valley∑ Trustee - Orongomai Marae∑ Upper Hutt City Council Mayor∑ Director MedicAlert

Katy AustinMember

∑ Member, Hutt Valley District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Fergusson Home (Upper Hutt) – Voluntary input

David BassettMember

∑ Deputy Chair, Hutt Valley District Health Board, Finance Risk & Audit Committee∑ Member, Hutt Valley District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Deputy Mayor Hutt City Council∑ Son owns Hutt City Auto Services, which has an automotive contract for the DHB∑ Director, Capacity Infrastructure Services Ltd

Peter DouglasMember

∑ Chair, Capital & Coast District Health Board, Finance Risk & Audit Committee∑ Chair, Hato Paora College Board of Trustees∑ Chair, Hato Paora College Proprietors Trust Board∑ Deputy Chair, Wairarapa, Hutt Valley & CCDHB Finance Risk & Audit Committee∑ Member, Hutt Valley District Health Board∑ Member, Capital & Coast District Health Board

Hutt Valley PUBLIC 2 May 2014 - Procedural Business

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∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, Capital & Coast District Health Board, Finance Risk & Audit Committee∑ Member, Hutt Valley, Finance Risk & Audit Committee∑ Member, Wairarapa, Hutt Valley and CCDHB Community Public Health Advisory Committee

and Disability Support Advisory Committees∑ Director, Te Ohu Kaimoana Custodian Limited∑ Director, Charisma Developments Limited∑ Chief Executive, Te Ohu Kaimoana, Māori Fisheries Trust∑ Member, Age Concern Board

Jaimes WoodMember

∑ Member, Hutt Valley District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Member, Hutt Valley District Health Board, Finance Risk & Audit Committee∑ Principal Advisor; Melbourne Business School-Mt Eliza∑ Strategic Advisor; Lightfoot Solutions (UK) Limited∑ Son-in-Law works for a supplier of HVDHB – and is the son of the principle shareholder

WM Bamford & Co Limited∑ Part time member – Local Government Commission

Ron MarkMember

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

and Disability Support Advisory Committees∑ Member, Wairarapa Iwi Kainga Committee∑ Mayor for Carterton District Council∑ Patron, Te Awa Ora a Maori Mental Health Service Provider in Christchurch∑ Trustee & Lead Negotiator, Ngati Kanhungunu ki Wairarapa Tamaki Nui A Rua (Treaty

Settlement) TrustKen LabanMember

∑ Member, Hutt Valley District Health Board∑ Member, Hutt Valley District Health Board, Finance Risk & Audit Committee∑ Member, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Trustee, Hutt Mana Charitable Trust∑ Member, Ulalei Wellington∑ Member, Hutt City Sports Awards Committee∑ Member, Greater Wellington Regional Council∑ Commentator, Sky Television∑ Broadcaster, Numerous Radio Stations∑ Member, Christmas in the Hutt Committee∑ Member, Hurricanes Rugby Board∑ Member, Wellington Rugby Football Union∑ Trustee, Tana Umaga Foundation

David OgdenMember

∑ Member, Hutt Valley District Health Board∑ Member, Hutt Valley District Health Board, Finance Risk & Audit Committee∑ Member, Wairarapa, Hutt Valley and CCDHB Finance Risk & Audit Committee∑ Principal, Oak Chartered Accountants Limited∑ Accountant, affiliated, with Simple Accounting Services Limited, and indirectly its

subsidiary, Five Plus Accounting Limited. Both companies have various clients involved in the Health Sector

∑ Presiding Member – Lotteries Commission Wellington and Wairarapa Communities Committee. The Funding Committee shares some applicants with regional health board providers

∑ My daughter is an Intern Psychologist with a Health Board outside this regionJohn TerrisMember

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

Sandra GreigMember

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

and Disability Support Advisory Committees∑ President Woburn Probus∑ Member Greater Wellington Regional Council∑ Cousin is a midwife in Napier


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Updated April 2014

Wairarapa and Hutt Valley DHB Executive Leadership Team

Interest register April 2014

Name Interest

Graham DyerChief ExecutiveWairarapa and Hutt Valley DHBs

∑ Trustee, Bossley Dyer Family Trust∑ Wife is a Director of i-Management which does consulting and

audit work in the Health Sector∑ Member, Crisp Interim Governance Board∑ Member, Health Workforce New Zealand

Bridget AllanChief Executive, Te Awakairaongi Health Network (PHO)

∑ Chief Executive, Te Awakairangi Health Network (PHO)∑ Board member of Vibe

Ashley BloomfieldDirector Service Integration and Development

∑ Trustee, AR and EL Bloomfield Trusts ∑ Fellow, NZ College of Public Health Medicine ∑ Board Member, Action on Smoking and Health (ASH) NZ ∑ Member NZ College of Public Health Medicine Finance and Risk

Committee∑ Sister is a nurse at Hutt DHB∑ Wife was employed at Hutt Family Planning Association clinic

during 2009-10Pete ChandlerChief Operating Officer

∑ Chair – Central Region Chief Operating Officers Group∑ Chair – National Laboratory Engagement Group

Carolyn CooperExecutive Director, people and Culture

∑ Sister in law is an independent member of the Community Labs Group

Judith ParkinsonFinance Manager

No interests declared.

Helen PocknallExecutive Director Nursing and Midwifery

∑ Board Member, Health Workforce New Zealand

Nadine MackintoshBoard Secretary

No interests declared.


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Updated April 2014

Richard SchmidtExecutive Officer

∑ Member of the Hutt Foundation

Russell SimpsonExecutive Director Allied Health, Scientific and Technical

∑ Chair, Central Region Directors of Allied Health∑ Member, Regional Leadership Committee

Jill StringerCommunications Manager

∑ Trustee, Wairarapa Regional All Weather Track Trust∑ Husband works for Rigg Zschokke Ltd

Iwona StolarekChief Medical Officer

∑ Member, ASMS JCC∑ Husband Andrew Simpson:

- Executive Director for Medicine Cancer & Community CCDHB

- Executive Member of the Cancer Society Wellington Division

- National Clinical Director Cancer Programme – Ministry of Health

Justine Thorpe ∑ Tihei Wairarapa Programme Director, employed by Compass Health

∑ A member of the Wairarapa Campaign Committee for the NZ Labour Party

Cate TyrerGeneral Manager Quality and Risk

∑ Shareholder and Director of Framework For Compliance Ltd (FFC)

∑ Husband is an employee of Hutt Valley DHB

Stephanie TurnerDirector Maori Health

∑ Represent Rangitane Iwi on the Wairarapa Cultural Trust (Aratoi)

∑ Establishing member of Pasifika Wairarapa Trust∑ Director Waingawa Ltd∑ Director Aroha Ki Te Whanau Trust∑ Member Cameron Community House Governance Group

Tofa Suafole GushDirector Pacific Peoples Health

∑ Member of the Te Awakairangi Health Board∑ Husband is an employee of Hutt Valley DHB

Kuini PuketapuManager Maori Health Advisor

∑ Chair of Board of Trustees, Pukeatua Te Kohanga Reo∑ Board Member, Te Runanganui o Taranaki Whanui ki te Upoko

o te Ika a Maui who has contracts with Hutt Valley DHB to provide health services in the Hutt Valley area and is an approved Whanau Ora provider

∑ Member, Wainuiomata Community Governance Group∑ Chair, Waiwhetu Medical Group which is a limited liability

company affiliated to Te Awakairangi Health PHO

John Ryan3DHB Executive Director, Corporate Services

∑ Son works for Spotless Services.∑ Cousin works as Orthopaedic Nurse at Capital and Coast DHB


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Hutt Valley District Health Board MARCH 2014 Page 1

MINUTES Held on Friday 21 March 2014 Board Room, Pilmuir House, Hutt Hospital, Lower Hutt

Commencing at 9.10am

BOARD PUBLIC SECTION

HUTT VALLEY DISTRICT HEALTH BOARD

PRESENTVirginia Hope ChairWayne Guppy Deputy ChairKaty Austin MemberDavid Bassett MemberPeter Douglas MemberSandra Grieg MemberRon Mark MemberDavid Ogden MemberJohn Terris MemberJaimes Wood Member

IN ATTENDANCEGraham Dyer Chief ExecutiveNadine Mackintosh Board SecretaryAshley Bloomfield Director Service Integration Development UnitJill Stringer Communications ManagerBridget Allen Chief Executive Te Awakairangi Network

PUBLICTwo members of the press

PRESENTERSTofa Gush 2DHB Director of Pacific HealthSharon Ritchie Hutt Valley Emergency Management ManagerCate Tyrer General Manager Quality and Safety

1.0 PROCEDURAL BUSINESS1.1 KARAKIA

The meeting was opened with a Karakia by Mr P Douglas.

1.2 APOLOGIESNo apologies were required for the meeting.

1.3 CONTINUOUS DISCLOSURE

1.3.1 INTEREST REGISTERAmendments to the interest register were received from Sandra Greig, David Ogden, Ken Laban and Ron Mark as follows:


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Sandra Greig - President Woburn Probus, Member Greater Wellington Regional Council and Cousin is a Midwife in Napier

David Ogden – Daughter is an Intern Psychologist with a Health Board outside this region

Ken Laban – Member Greater Wellington Regional Council, Commentator for Sky Television, Broadcaster for numerous Radio Stations, member of Christmas in the Hutt Committee, member of Hurricanes Rugby Board, member of Wellington Rugby Football Union and Trustee for Tana Umaga Foundation.

Ron Mark - Trustee & Lead Negotiator, Ngati Kanhungunu ki Wairarapa Tamaki Nui A Rua (Treaty Settlement) Trust

The Board RESOLVED to ADOPT the amendments to the interest register.

MOVED David Bassett SECONDED James Wood CARRIED

1.3.2 CONFLICTS RELATED TO AGENDA ITEMSSandra Greig and David Bassett declared a potential conflict of interest with respect to agenda item 3.3 on the DHB position statement for community water fluoridation with the Chair advising the Board would consider how we address the conflicts when the item is discussed.

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


1.4 CONFIRMATION OF MINUTESRESOLVED to ADOPT the minutes of the members’ (Public) meeting held on 11 February 2013 as a true and accurate record of the meeting.


1.5 MATTERS ARISINGAmendment: The Board requested that AP74 be broadened to organisational service visits.

2.0 PRESENTATION

2.1 PACIFIC HEALTHPresenter: Director of Pacific Health

Tofa Gush presented a detailed update on the Pacific Health Sector:- The establishment of Pacific Health sector- Population of the community and leadership- Engagement with key contacts in the community- Health improvement results- Health condition concerns.- Workforce development


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The Board discussed- that DNA had been a concern with this group and were content with the significance of the

reporting and engagement with the people- the measurement and evaluation of the impacts of the work- the importance of quality experiences for people attending the appointments - their support for the plan- acknowledgment of the experience that Director of Pacific Health’s brings to the DHB.

ACTIONB08 The Communication Manager is to provide a positive media story on the joint Wairarapa and Hutt

Valley Pacific Health Director appointment.

The Board NOTED the contents of the presentation.

3.0 DECISION PAPERS

3.1 GOVERNANCE MANUALPresenter: Chair

The paper was taken as read. The Board supported for the 3DHB Governance Manual noting its that the manual will be regularly reviewed and the next version will address any comments raised adopt this as a working document.

The Board RESOLVED to ADOPT the attached Board manual as being applicable for Wairarapa DHB, Hutt Valley DHB and Capital & Coast DHB.

MOVED Jaimes Wood SECONDED David Bassett CARRIEDAGAINST David Ogden and John Terris

ACTIONB06 Develop an Engagement Plan for the DHB including the 3DHB work.B05 Review Institute of Directors practice on the technical matters of meeting procedures and test with

legal Counsel.

3.2 BOARD COMMITTEE MEMBERSHIPS WITHIN THE LOWER NORTH ISLAND (LNI)Presenter: Chair

The paper was taken as read acknowledging the movements of Capital & Coast member representives:Board CPHAC HACCCDHB David Choat

Chris LaidlawHelene RitchiePeter Douglas (FRAC Chair)

Sue KedgleyNick LeggettDerek Milne

HVDHB Virginia Hope Wayne Guppy (FRAC Chair)Sandra GreigRon Mark

Virginia Hope John TerrisKaty Austin

WDHB Derek Milne (Chair)Leanne Southey (FRAC Chair)Helen KjestrupJanine VollebregtLiz Falkner

Rob IrwinFiona SamuelAlan Shirley


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* CPHAC and HAC will retain the Maori representation and HAC a PHO representative.

Wairarapa Hutt Valley Capital & CoastLeanne Southey (Chair)Rob IrwinRon KaraitianaRick LongDerek Milne

Wayne Guppy (Chair)David BassettPeter DouglasVirginia HopeKen LabanDavid OgdenJaimes Wood

Peter Douglas (Chair)Judith AitkenRoger JarroldDarrin SykesDerek MilneVirginia Hope

The Board RESOLVED to:

a. AGREE to co-opt members from either Wairarapa, Hutt Valley and/or Capital & Coast as set out in this paper for the CPHAC/DSAC and HAC committees, as applicable.

b. NOTE the membership change for the Capital & Coast FRAC committee.

MOVED Wayne Guppy SECONDED David Bassett CARRIED

3.3 POSITION STATEMENT - COMMUNITY WATER FLUORIDATIONPresenter: 3DHB Director of SIDU

The Board discussed fluoridation of the council water supply. The Board members agreed that the matter of fluoridation was treated as a “concience vote” at council meetings and Board members who were also council members were at liberty the exercise their votes independently of council decisions.

The Deputy Mayor of Hutt City Council reported that this has been an issue for a number of years and that there has been a small increase in support for removal of fluoridation amongst the councillors. Hutt City Council has a provision of two aquifer taps in the City and installation of two additional taps for those members of the community that are against fluoridation.

The Board members views on the subject of fluoridation or non-fluoridation policy discussed were:- Benefits to dental care- Consumption of tap water- Fluoride in toothpaste- Upper Hutt City Council endorsement of fluoridation of water- Anti-fluoridation evidence- Aquifer water supplies non fluoridated water in the Hutt City Council region providing opportunity

for those who don’t wish to use fluoridated water in Petone and Dowse.

It was noted that anti-fluoridation groups are well prepared for meetings of discussion groups and that these meetings need to include the contradicting view in order to allow sound decision making.

The Director of SIDU advised this paper provides a position statement for a District Health Board from a public health perspective. The last paragraph reports that the Council receive good balanced evidence on the matter in order to support their vote.

There was a request to add an amendment to move the decision of water fluoridation to National policy.

MOVED David Ogden SECONDED John Terris NOT CARRIED


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The Chair confirmed that there had been value in having a free and frank discussion on this item with all Board members noting the potential conflict of some members and that discussion was from a personal perspective.

The Board RESOLVED to:a. NOTE the endorsement from the Community and Public Health Advisory Committee and Disability

Support Advisory Committee for the Position Statement regarding Community Water Fluoridationb. ADOPT the Position Statement regarding Community Water Fluoridation

MOVED Wayne Guppy SECONDED Sandra Grieg CARRIED

Dr Hope noted a linkage between RPH and her workplace in relation to gathering evidence on the impacts of fluoridation and indicated a wish to abstain.

ABSTAINED Virginia HopeAGAINST David Ogden and John Terris

4.0 DISCUSSION PAPERS

4.1 CHAIR UDPATEThe Chair provided a verbal reporting on key discussions attributed to recent meetings.

- Board Induction processes with a number of planned information sessions to be held throughout the year

- The Minister opening the new dialysis unit located at Kenepuru Hospital which services the region. The facilities are among the best in the country and will service our communities well.

ACTIONB04 Arrange a tour of the dialysis unit at Kenepuru Hospital when practicable.

The Board RECEIVED the update.

4.2 CHIEF EXECUTIVE’S REPORT – MARCH 2014 Presenter: Chief Executive

The report was taken as read with the Chief Executive discussing key highlights of the report.- The DHB is continuing to make good gains on the Health Targets- The key issues reported in the Balanced Scorecard: Theatre Utilisation and DNAs- Appointment to the role of Executive Director of Maori Health across the 3DHBs- Improved vertical health integration in particular health pathways and ALT frameworks - High levels of hepatitis A in the Hutt Valley- Quality of drinking water and role of public health for health protection- Financial pressures

Board member discussion ensued on: - The current over delivery of elective targets being required to compliment the move to a four month

elective wait time target, acknowledging there is still further work required to achieve the four month requirement. The financial impacts of over delivery were also noted.

- The Cardio Vascular Disease indicators and processes should further improve results in primary care.- Support for the 3DHB programme at Committee meetings.

The Board NOTED the information contained in this report.


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5.0 INFORMATION PAPER

5.1 EMERGENCY MANAGEMENT UPDATEPresenter: Quality and Risk Manager and Emergency Preparedness Manager

A detailed update on plans was presented highlighting the DHB are working toward a coordinated approach for integrated health responses across the sub-region in preparation of an adverse event. A trial exercise will take place in October 2014.

Board discussions ensued on- workforce management across the sub-region for an adverse event- the national health emergency plan that feeds to the regional and local plans, particularly

communications- lessons learnt from last years severe weather conditions and earthquakes

The Board RESOLVED to:

a. RECEIVED the report

b. SUPPORT the heightened level of activity in the plan

c. NOTED that there are contingency plans in place in the event of a major incident

d. NOTED that there are improvements in resilience being achieved through a 2D and 3D approach

MOVED Virginia Hope SECONDED Sandra Grieg CARRIED

6.0 COMMITTEE VERBAL REPORT BACKS

6.1 CHPAC-DSAC REPORT BACKThe paper was taken as read. It was noted that this committee is working effectively after a year of establishment.

The Board NOTED the contents of this report.

6.2 HAC VERBALThe Chair reported the meeting had a particular focus on the areas of- Health of Older People- Presentations at the Provider Arm

Future reporting will work toward the alignment of reporting across the committees to the Boards with an emphasis of performance based reporting.

The Board NOTED the verbal reporting.

7.0 OTHER

7.1 GENERALNil


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7.2 RESOLUTIONS TO EXLUDE THE PUBLICRESOLVED: The Board resolved to 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:

Agenda Item Reason Reference

Chief Executive ReportProject the privacy of the naturals persons and to enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(a) (i)

Sustainability Plan

Board RepresentationOpportunity to discuss availability including personal commitments Section 9(2)(a)

Governance ManualPaper contains information and advice that is likely to prejudice or disadvantage negotiations

Section 9(2)(j)

Lab Information Systems (LIS)

Draft Annual Plan

Subject to ministerial Approval Section 9(2)(f) (iv)

Draft RSP

Draft 2014/15 Budget

To enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(i)

Funder Commitment List 2014/15

Loan Rollover

Insurance Premium

PHO Funder Delegation

CRISP Paper contains information and advice that is likely to prejudice or disadvantage negotiations Section 9(2)(j)

Board Work Plan

MOVED David Bassett SECONDED Wayne Guppy CARRIED

THE MEETING CLOSED AT 11.11 AM


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8. DATE OF NEXT MEETING

Friday 2 May 2014, Boardroom, Pilmuir House, Lower Hutt

CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting.DATED this day of 2014

VIRGINIA HOPECHAIR


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Hutt Valley District Health Board Page 1 MAY 2014

SCHEDULE OF ACTION POINTS FOR PUBLIC BOARDOriginal Meeting Date

Ref Topic Action Resp How Dealt with Delivery date Completed Date

21 March 2014 B08 Pacific Health The Communication Manager is to provide a positive media story on the joint Wairarapa & Hutt Valley Pacific Health Director appointment .

Jill Stringer Local Paper March Completed

B06 Governance Manual Engagement Plan to include 3DHB work Board Secretary and Legal

Update Paper 1 March 2015

B05 Review Institute of Directors practice on the technical matters of meeting procedures & test with the legal council.

B04 Chair Update Arrange a tour of the dialysis unit at Kenepuru Hospital Board Secretary Future HAC or next Board workshop

July or later

B03 Overview of Heart Disease and Diabetes

Management to request that the PHO report back on the cardio vascular disease and risk programme as part of their bi-annual reports to the Board.

Bridget Allan & Justine Thorpe

Presentation May In presentation

1 November 2012 AP74 Organisational Service Visits

Management to review the annual work plan and integrate organisational service visits when when agenda is light.

Board Secretary Annual Work plan Ongoing

4 October 2013

AP69

Maori Health Targets

Management to request TeAHN to provide an update at their next presentation on the strategy for addressing Maori health targets. Maori Health Service could be requested to assist with this strategy.

CE TeAHN Presentation May

In presentation


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards Page 1 MAY 2014

BOARD INFORMATION PAPER

Date: 28 April 2014

Author Sandra Williams, Group Manager, Service Integration: Population Health, Mental Health and Addiction

Endorsed By Ashley Bloomfield, Director Service Integration and Development

Subject Wairarapa, Hutt Valley and Capital & Coast DHBs Primary Care Update

RECOMMENDATION

It is recommended that the Boards

a. Receive & Note the contents of this update report on Primary Care and the work programme of the Alliance Leadership Teams (ALTs)

b. Note Primary Health Organisation (PHO) and ALT representatives will be in attendance at the meeting to discuss this paper and respond to any questions.

ADDENDA

2.1.1 PHO Funding Streams (additional information)2.1.2 PHO Performance2.1.3 TeAHN Annual Report2.1.4 TeAHN Board and DHB 6 month Report

1 PURPOSE

The purpose of this paper is to provide an overview to the Boards about primary care and the work of the Alliance Leadership Teams (ALTs) across the sub-region of Wairarapa District Health Board(Wairarapa DHB), Hutt Valley District Health Board (Hutt Valley DHB) and Capital & Coast District Health Board (CCDHB). This report includes:

ß An overview of Primary Health Organisations (PHOs) and their performance (section 3 and Appendix 1 and 2)

ß An overview of the sub regional enablers common to each of the ALTs including (section 4):o HealthPathwayso Shared care records (Manage My Health (MMH))o E referralso Common Primary Options for Acute Care (POAC) activity across the three

DHBs.ß An update on the work programme and activity of each ALT (section 5).

2 BACKGROUND

PHOs were established as the vehicle for implementing the Government’s Primary Health Care Strategy 2001. This strategy focussed on six key directions:

ß To work with local communities and enrolled populations; ß Identify and remove health inequalities; ß Offer access to comprehensive services to improve, maintain, and restore people’s health;

Hutt Valley PUBLIC 2 May 2014 - PRESENTATION

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Wairarapa, Hutt Valley and Capital & Coast District Health Board Page 2 MAY 2014

ß Co-ordinate care across service areas; ß Develop the primary health care workforce; and ß Continuously improve quality, using good information.

Wairarapa DHB has a single PHO managed by Compass Health (Compass). Hutt Valley DHB has one PHO, Te Awakairangi Health Trust (TAH) and a practice participating in Cosine Primary Health Network (Cosine), a cross boundary PHO. Capital & Coast DHB has four PHOs: Compass , Well Health Trust (WellHealth), Ora Toa PHO (Ora Toa), and Cosine.

In 2008, the National-led Government introduced its health manifesto of “Better, Sooner, More Convenient” (BSMC). For primary care, this was intended to accelerate delivery of the previous Government’s primary health care strategy, with a focus on delivering a more personalised primary health care system that provides services closer to home, makes Kiwis healthier and reduces pressure on hospitals. The “how” included Integrated Family Health Centres, services shifted out of hospitals, increased focus on long-term conditions management in the community, increased clinical engagement and leadership, and reduced management bureaucracy (fewer PHOs).

A new national PHO Agreement developed collaboratively with Primary Care was implemented 1 July 2013. This Agreement better reflects the role of primary care in an integrated health system. The changes are designed to improve people's health and individual patient experience, while supporting the clinical and financial sustainability of the health system. The Agreement includes a new introductory section providing background and context to the relationship between PHOs and DHBs, and sets out the policy objectives for health care and primary health care services. It details the objective that health services should be provided on a “best for patient” and "best for system" basis.

It also describes the parties' respective roles and responsibilities, including reinforcing the requirement of DHBs and PHOs to work together in Alliancing arrangements, developing the DHB Annual Plan and agreeing the explicit contributions the PHO will make to the successful delivery of the plan.

The Agreement sets out the new minimum requirements that all PHOs will meet, the functions of the PHO and the outcomes that the PHO will endeavour to achieve, including facilitating and promoting service development, co-ordination and integration. It also provides a transition process into the new Flexible Funding Pool arrangements associated with Alliancing which were agreed by Cabinet earlier in 2013.

Each of the three District Health Boards now have Alliance Leadership Teams (ALTs) that are tasked with providing a whole-of-system view across the health system, while looking for opportunities for greater integration. The Wairarapa was one of the nine original BSMC business cases and has had an Alliance Agreement and an ALT since 2010. This programme of work is called Tihei Wairarapa. Hutt Valley DHB and CCDHB established their ALTs in July 2013. The HVDHB ALT is called Hutt Inc and was developed out of the Primary Secondary Strategy Group (PSSG), while at CCDHB the Integrated Care Collaborative (ICC) has evolved into the ALT.

3 PRIMARY HEALTH ORGANISATIONS

3.1 Demographic Information

Wairarapa DHB

There are seven general practices in the Wairarapa. Over half the population is enrolled with the largest practice, Masterton Medical. There are two other small practices in Masterton, one of which is a VLCApractice and one practice in each of the four South Wairarapa towns.

Hutt Valley DHB

There are currently 24 General Practices in the Hutt Valley. Of these 24 practices, 23 are members of Te Awakairangi Health Network and one, Ropata Medical Centre, is a member of Cosine.


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Capital and Coast DHB

There are currently 61 funded General Practices in the Capital & Coast District with 338 GPs including locums. Of these 61 practices,

∑ 52 are members of Compass Health, ∑ Four are members of Well Health Trust, ∑ Four are members of Ora Toa PHO, and ∑ One is a member of the Cosine Primary Care Network.

Sustainability of solo (or very small) general practice providers in this funding, and broader primary care, environment is a challenge for PHOs. Although the majority of practices in CCDHB are classified as medium (four to six working GPs) or large (6+), there are 20 practices that have one to three GPs working currently.

PHO/Primary Care Core Services Funding

PHO core funding covers first contact care (standard visits to general practice), very low cost access, free under-sixes visits, services to improve access (SIA) and health promotion. In addition, they receive PHO quality performance payments throught the PHO performance progamme (PPP), funding for managing patients with long-term conditions (Care Plus), and funding for primary care mental health services.

Table 1: Sub-regional PHO information, Jan-Mar 2014 registers

DHB Area PHONo. of

practices

No. of VLCA#

practices

Total enrolled

populationHigh needs population

% high need

patients

Capital & Coast

Compass Health 53 6 247,842 48,682 20%

WellHealth 3 3 12,791 9,326 73%

Ora Toa 4 4 12,587 10,117 80%Cosine -Karori MC 1 0 14,319 1,508 11%

Hutt Valley

Cosine -Ropata MC 1 0 18,997 3,513 18%Te Awakairangi 24 6 116,537 43,161 37%

WairarapaCompass Health 7 1 41,884 11,590 28%

Source: MOH PHO Enrolment Datamart

# VLCA = Very Low Cost AccessVLCA is based on practices receiving very low cost access capitation payments for the January 2014quarter.High needs is defined as Maori, Pacific and non-Maori non-Pacific living in quintile 5HUCHS in Te Awakairangi has two sites and has been counted twice as per the MOH register


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards Page 4 MAY 2014

Table 2: PHO funding via the PHO Agreement by DHB region (includes SIA, Care Plus Management fee)

Budget information 2013/14

SIDU DHB

First contact care$000 SIA $000

Health promotion (incl DHB support)$000 VLCA $000

Free under 6s $000

Care Plus$000

PPP$000

Management fee $000

Rural$000 Adjuster $ Total $000

CAP 41,414 2,686 865 962 1,067 3,062 1,369 2,622 - - 54,046

HUT 16,333 1,502 280 940 476 1,060 419 804 - - 299 21,514

WRP 6,080 374 177 102 196 632 214 350 36 - 8,162

TOTAL 63,827 4,562 1,322 2,004 1,739 4,754 2,002 3,776 36 -299 83,722


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Page 5 of 9

All three DHBs contract for a range of additional services over and above these eight key funding streams:

∑ Wairarapa DHB: $1.6m for services including rural primary care, after hours, Primary care sustainability, B4School Checks, Sexual Abuse Assessment and Treatment (SAATs), diabetes, Cardiovascular Disease Risk Assessment (CVDRA), Immunisation, Tobacco Control, Sexual Health, and Primary Mental Health.

∑ Hutt Valley DHB: $4m for services such as VLCA, Community Radiology, Primary Mental Health, after hours and free under 6, reducing inequalities, Primary Care Sustainability, Tobacco Control, CVDRA and Diabetes.

∑ Capital & Coast DHB: $14.9m for services such as Retinopathy screening (3 DHB), Specialist Sexual Health (Hutt and CCDHB), Community Radiology, CVDRA, VLCA, Diabetes, Podiatry, SAATs, primary sexual health, smoking cessation, refugee health, after hours and free under 6, and improving access.

Further information on PHO funding streams are contained in Appendix 1.

Information on PHO performance is contained in Appendix 2.

4 COMMON SUB-REGIONAL ENABLERS

4.1 3D HealthPathways

HealthPathways is a clinically-driven progamme of work that provides guidance to clinicians on managing over 500 clinical conditions. The pathways, available through a website, contain medical guidance on the assessment and management of clinical conditions, and administrative information on access to diagnostics, specialist opinion, specialist treatment services, and other supports. On 20 February around 170 clinicians and managers from across the sub-region attended a planning seminar with the Canterbury Health Pathways team to introduce the Health Pathways process to the three DHBs.

Initial priority has been given to reviewing existing clinical pathways in use in one or more of the 3 DHBs and completing and publishing pathways that are priorities for the ALTs. Currently 15 pathways have been finalised and are on the 3D Health pathways site, while a further 14 are in the process of being translated from individual DHBs to the 3D site. A further four are currently in development as they are priorities for the ALT’s.

4.2 Shared Care Records (Manage My Health)

ManageMyHealth (MMH) is a secure website that receives an individual’s personal health information uploaded from their doctor, or health practitioner’s practice management system. It can allow access to this personal health record summary to other authorised clinicians, such as hospital clinicians, removing the boundaries of patient health information silos. Privacy issues have been well canvassed at a national level, including an opinion from the Privacy Commissioner. The key benefits include:ß reducing delays and time to diagnose patients by having access to patient’s medical information ß enabling safe and secure sharing of patient medical information outside normal GP clinic times

with after hours and emergency cliniciansß advancing the delivery of care by making it easy to access patient information at the point of care ß enhancing patient experience and continuity of care

The provider portal has been in use at Wairarapa DHBsince 2011, where six of the seven practices are participating in ManageMyHealth covering 95% of the enrolled population. All six participating practices are live with the shared care record module which provides key health information to hospital staff and pharmacies. Masterton Medical Limited and Carterton Medical Centre are currently trialling the provider


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portal module which allows health professionals from rest homes to access patient notes for palliative care patients. This portal can also be expanded to other community health providers. Both Masterton Medical Ltd and Carterton Medical Centre have commenced enrolling patients to use the patient portal, which at this stage is being used to make appointments, order repeat prescriptions and check lab results.

In CCDHB primary care, most practices are participating in ManageMyHealth covering over 80% of the enrolled CCDHB population. The Shared Care Record went live in the hospital in April 2014 and can be accessed by selected senior clinicians, nurses and pharmacists in the hospital. The shared care record has been well received and there is consideration being made about widening access in the hospital, which should create further improvements in information flow and therefore patient care.

The Hutt Valley is planning to implement Manage My Health and build on the successful implementation in both Wellington and the Wairarapa. The timing of contract renewals with the software vendor at the other two DHBs may extend the timelines for implementation in the Hutt Valley. One large local practice intends (subject to negotiation) to go live with the MMH patient portal in advance of any wider arrangement.

4.3 E referrals

Electronic ‘E’ referrals allow GPs to electronically submit outpatient referrals to the DHB Booking Centre from within ractice software, rather than by fax or post. There are benefits to both primary and secondary care including time efficiency, cost reductions and accuracy.

In WDHB, e-referrals are working well and medical practices also find the e-advice function valuable. GPs have requested improvements to the e-advice function as currently it only allows for an initial response not a secure conversation if required. The top priority for further development in the Wairarapa is to the FOCUS (NASC) service.

In the Hutt Valley, e-referrals have been in place for several years with an on-going process of improvement and development.

In CCDHB a generic e-referrals was initially rolled out in 2011. Since then more service specific referrals have been developed and the platform has been upgraded in 2014.

4.4 Activities to reduce acute demand for hospital level care

Reducing acute demand is one of top three top priorities for 2013/14 for all three DHBs and features in the work programme of all three Alliance Leadership Teams (ALTs). To support this, a ‘Primary Options for Acute Care’ (POAC) process is being put in place to support delivery of and payment for services delivered in primary care that would previously have been delivered in a hospital setting.

In Wairarapa, Compass Health has funded intravenous (IV) treatment of cellulitis in the community since 2010 as part of the BSMC business case initiative. In 2013 this was extended to treatment of deep vein thrombosis (DVT) in the community. These two initiatives have made a significant contribution to the reduction of triage 4 and 5 (low acuity) attendances at the Emergency Department. Discussion has commenced on how to make these services sustainable and develop a more formalised POAC structure.

The CCDHB ICC Acute Demand workstream has explored alternative options to ED attendance and avoidance of unnecessary admissions for people presenting with urgent or unplanned care needs. To date, clinical pathways for management of adult cellulitis and acute DVT have been completed (with input from clinicians at Wairarapa and Hutt Valley where pathways were already in place). HVDHB currently funds IV therapy for cellulitis via Ropata Medical Centre following a successful trial at Silverstream Medical Centre.


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A POAC programme has been developed in both DHBs to ensure that primary care has the capacity to deliver the treatment as per the pathway. The programme includes an agreed funding mechanism as well as audit capacity to ensure providers are working within the scope of clinical pathways and also audit of claiming practices.

5 SERVICE INTEGRATION WORK PROGRAMMES

SIDU plays a key role in ensuring links across the three ALT work programmes and other subregional initiatives. By identifying workstreams and project areas across the region that align, resources and learning’s can then be shared to enhance outcomes for populations across the region. As an initial start in this area sub regional service level alliances on Youth and Health of Older People are currently being scoped.

5.1 Tihei Wairarapa

The Tihei Wairarapa Integration Programme was established as one of the nine BSMC business cases in 2010. As an Alliance, Tihei Wairarapa aims to provide increasingly integrated and co-ordinated health services through whole of system service improvement that is clinically-led. The approach that the alliance takes to service improvement is underpinned by the triple aim and ensures that improvement initiatives improve the patient experience (quality and safety), improve the health of the Wairarapa population overall (equity) and make best use of health resources (effectiveness and efficiency).

The Alliance Leadership Team consists of hospital and community based clinicians, Iwi and community representatives and both the PHO and DHB CEO’s. Current work streams are Integrated Care, Technology, Maternal and Child Health, Youth and Mental Health.

Tihei Wairarapa has had many successes since its inception including:

• Reduced triage 4s and 5s at the emergency department

• Mental Health Service Integration - in particular the two PHO employed mental health nurses now work in practices and part of the secondary care crisis team afterhours

• Integration of the National Immunisation Register Administration/District Immunisation Facilitator roles within the PHO, supporting improved childhood immunisation rates for Wairarapa children

• B4 School Check coordination integrated into the PHO team and clinics held at the practices has been key to Wairarapa’s success in this area

• The implementation of the shared care record, which includes hospital and pharmacy access

• E-Referral and E-Advice implementation

• A successful RFP for two IFHC Business Cases within the context of a Wairarapa Integrated Family Health Network

More recently, a key focus of Tihei Wairarapa has been on further developing the concept of an Integrated Family Health Network for the Wairarapa. As part of the RFP to develop the IFHC business cases an extensive consultation process with hospital and community based health professionals has been undertaken. The process has included 16 patient journey mapping exercises to identify key themes for service improvement, a variety of meetings with community health providers and hospital services, and three overarching workshops to bring it all together.

A series of seven proposals for improving the model of care have emerged from this process and are grouped into two categories (1) Improving integration between services and (2) Integrating care (see diagram below). Some of these proposals are not new and have been discussed for a number of years and already some progress has been made. During April and May 2014 the ALT will be undertaking a process of prioritisation which will inform the integration work programme for the next three years.


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5.2 Hutt INC

The Hutt INC work programme is grouped into the following areas:1. Enablers2. Acute Demand3. Clinical Pathways4. Long Terms Conditions5. Quality.

Key achievements of Hutt INC include:

ß Implementation of initiatives within the Ambulatory Sensitive Hospitalisations (ASH) program to reduce the number of bed days in Cellulitis, Gastroenteritis and Chronic Obstructive Pulmonary Disease (COPD) has lead to the following reductions in hospital bed days:o Cellulitis discharges have reduced with a target of less than 56 per month the monthly average

over the life of the project is 54.7 o Gastroenteritis bed days target of 10 per month has been achieved with a monthly average

9.7 bed days over the life of the projecto COPD monthly bed days has reduced to 100.8 from 132 per month.

Other achievements include:ß A Primary Care Sustainability project in progress: engagement with primary and secondary care

has commenced with co-design workshops planned for May and June ß An Afterhours Working Group has been established to provide options to Hutt INC on future

provision of after hours services in the region;ß this is especially important to the Hutt Valley given the current issues facing primary care sustainability and increasing utilisation of after hours in the Under 6 age group.

ß Community Pharmacists now have access to the Hutt Hospital Concerto system

Improving integration between services

Systems, infrastructure and culture

3. Active communication; enhance existing communication channels, and consider establishing new ones

1. Managing change: capacity, capabilityand a structure for on-going system improvement

2. Use technology to make it easier to communicate and improve services

6. Extend Guided Care services for high risk/use patients – such as frail elderly, and/or those with complex long term conditions

5. Integrate (virtual or otherwise) services that visit or work with people in their own home and

Integrating careServices, and the way they are organised

7. Move towards a patient-centred health home model

4. Provide clinicians with information about available services and pathways


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Hutt INC is looking at establishing a flexible services pool for 2014/15 to further support greater integration, and work is underway to identify services to be included within the pool.

5.3 CCDHB Integrated Care Collaborative (ICC)

The aim of the ICC Programme is to provide the best health care for our patients and population through improved experience, safety and quality of care with easy access and equity to all populations. The effect of the approach is to remove barriers between the hospital and community to create a single health service.

The Programme Sponsor for the ICC Programme is the CEO of CCDHB, Debbie Chin and the ICC overall management and clinical leadership of the Programme is provided through the ICC Alliance Leadership Team.

The ICC has five work streams identified to determine the work to be completed in integrated care over the next few years as follows:

These work streams were designed to cover key areas of interest from the Collaborative and the areas that could be significantly improved. A standard process is to be practiced to determine issues and initiatives. These work streams will involve key clinicians, managers and support from primary and secondary care.

Within each work stream, specific projects have been developed and implemented through the integrated collaborative approach. Projects that have been completed in the first stages of the programme were:ß Free Under Sixesß Diabetes Care Improvement Planß Shared Care Record in primary careß Oxycodone Prescribingß Advance Care Planning

More recently projects that have been developed and completed include: ß Implementation of the Shared Care Record (Manage My Health) in the hospital (as above)ß Primary Options for Acute Care (as above)ß Clinical pathways for cellulitis, lower limb Deep Vein Thrombosis (DVT), frail older person,

dementia, diabetes nutrition and childhood obesity

These pathways have been developed through the Acute Demand, Health of Older People and Child Health work streams. As with all ICC developments they have been developed through collaboration of clinicians from across the DHB. These pathways have been forwarded to the wider 3DHB Clinical Pathway programme for localisation across the sub region.

Enablers

ICC Programme

Living Well with Long-Term Conditions

After Hours and Acute Demand

Health of Older People

Child Health


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Hutt Valley District Health Board Page1 MAY 2014


Date: April 2014

Author Peter Gush, Service Manager, Regional Public Health

Endorsed By Debbie Chin, Interim CEO, CCDHB & Acting CEO HVDHB

Subject Regional Public Health Update

RECOMMENDATION

It is recommended that the Board NOTE this report.

ADDENDUMS

2.2.1 March 2013 CPHAC Information paper and 2.2.2 RPH presentation

1 WHAT IS PUBLIC HEALTH?

1.1 A definition

“The science and art of promoting health, preventing disease and prolonging life through organised efforts of society.”

C E Winslow, American Bacteriologist

As someone who came into the management role within Regional Public Health (RPH) with no public health background this appeals as it encapsulates the different dimensions within which we aim to work.

“The science…” Holding onto an evidence base for our actions and interventions.“…and art…” The ability to be innovative, adapt and be responsive, particularly

when working in community settings.“…through organised efforts of society.”If we are to make a difference to the lives (health outcomes) of those in our communities RPH has to work well with many organisations, some within the health sector, but also other sectors which affect the wider determinants of health for our communities.

1.2 So what’s ‘hot’ at the moment?

o Alcohol – The Sale and Supply of Alcohol Act 2012 with a particular emphasis on reducing alcohol related harm.

o Housing – and all that can be achieved through the provision of warm, secure housing (disease prevention and improved social outcomes).

o Nutrition and physical activity; obesity, diabetes and cardiovascular disease.o Tobacco – continuing the battle towards “Smokefree Aotearoa 2025”o Community Water Fluoridation


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These are just five of the many areas that the team at RPH are involved with and I provide a brief snapshot of some others at the end of the paper.

2 THE TOP FIVE

2.1 The Sale and Supply of Alcohol Act 2012

This piece of legislation amongst other provisions requires each Territorial Local Authority to develop a Local Alcohol Policy (LAP) for their area, and increases the responsibilities of the Medical Officers of Health and public health units in this setting. The legislation includes in its ‘Object’:(a) The sale, supply, and consumption of alcohol should be undertaken safely and responsibly; and(b) The harm caused by the excessive or inappropriate consumption of alcohol should be minimised.

In the Hutt Valley, Hutt City has developed its provisional LAP which is subject to a number of appeals which will not now be heard until November by the Alcohol Regulatory and Licensing Authority. The DHB has appealed the Hutt City LAP in particular seeking a reduction in the off-license hours for supermarkets and large food stores. Upper Hutt City will be considering their draft LAP in June.

In March RPH took the lead in a new off-license application in Upper Hutt where we opposed a new licence because the location was known to be a popular “hang out” for young people in the vicinity of McDonald’s family restaurant and a major bus stop. Our opposition was supported by the police and by key community leaders. The Authority refused the application and this illustrates how when we have strong support from the community it is possible to achieve decisions on alcohol that in the past were unthinkable.

2.2 Housing

Our Housing Assessment and Advice Service offers a home visit by a public health (housing) nurse, links clients with housing interventions that make a home warmer and drier, provides education about healthy housing, and follows up each family to check on completion of the referrals made.

The service can be referred to through both primary and secondary care pathways – criteria is financial (Community Service Card, or financial hardship), and one of the following health conditions -Rheumatic Fever (acute or past history), communicable disease (Meningococcal disease), respiratory conditions (Asthma, COPD, Bronchiolitis, Pneumonia, Bronchiectasis), and skin infections. In particular the programme is focussed on:

• new cases of Rheumatic Fever (sub-regional), • cases on the Bicillin register (sub-regional), • Hutt Valley DHB Paediatrics, and Community Paediatrics,• Hutt Valley DHB Respiratory Service,• Hutt Valley DHB Social Work team.

Referrals identified by RPH at secondary care will be linked back to their primary care provider and in the first instance a joint visit will be offered (Primary care and RPH). If a joint visit is not possible, RPH will complete the referral and an update on the client will be provided to the primary care provider.

Sub-regionally our Housing Public Health Nurses also offer an Advice Service to support the health sector address housing need with their clients. This service is available via phone and email.

We are currently working towards this service being extended to CCDHB Secondary care by integrating this work with the agreed actions in the Integrated Care Collaborative Housing subgroup.


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2.3 Nutrition and Physical Activity

Please note the Addendum on this topic which was considered by CPHAC at their meeting on 7 April 2014.

Our efforts in this space are well documented in the Addendum and I draw your attention to the ‘Maternal and Infant Physical Activity and Nutrition’ description (paragraph 4.1 of the Addendum) as this partnership is a great example of both the art of public health, as well as the organised efforts of society with many providers coming together to influence improved health outcomes. This is a sub-regional initiative.

On 14 March 2014 the Minister announced another initiative under the Healthy Families banner seeking Registrations of Interest (by 14 May) from a locally-based lead provider responsible for bringing together a partnership of key organisations in the community, and a dedicated health promotion workforce. These health promoters will work across schools, early childhood education centres, workplaces, and sports clubs, supporting New Zealanders to make healthy living choices. They will also work with other key organisations to implement initiatives supporting healthy living.

Hutt City is one of the ten communities selected nationwide to be part of this new initiative. In partnership with Te Awakairangi Health Network RPH hosted a meeting of interested organisations on 15 April to facilitate initial conversations around identifying a lead provider and seeking expressions of interest about what role they saw themselves playing in this initiative. A follow up meeting is scheduled for Tuesday 29 April.

At the CPHAC meeting members sought clarification regarding the DHB policies on the sale of ‘fizzy’ drinks in particular; referencing the comment in paragraph 2.1 of the Addendum regarding a ‘food environment paper’ that is to be presented to the two Executive Teams for the DHB’s. The policies or guidelines between each of the DHB’s are different and the paper mentioned above seeks to introduce a sub-regional approach to nutrition at DHB sites.

2.4 Tobacco

As part of the Central Region Services Plan an initiative has been developed involving all those in the tobacco control and smokefree spaces looking to develop a Central Region Tobacco Control Plan. This initiative involved the three public health units, six District Health Boards, primary care organisations, non-government organisations and others coming together to share resources, agree best practiseand make the most of the collective experiences and learnings. RPH took a lead in bringing this group together. An example of this sharing is that the RPH produced quarterly ‘Tobacco Retailers Newsletter’ which would normally be circulated to 700 retailers sub-regionally will now be circulated to all retailers in the Central Region.

The Health Select Committee recently called for submissions on the ‘Smoke-free Environments (Tobacco Plain Packaging) Bill, which RPH submitted on in March and an oral submission was made to Select Committee on 16 April. Amongst the recommendations in our submission was support for the passage and full implementation of the Bill without any delay.

2.5 Community Water Fluoridation (CWF)

Since the Board approved the CWF Position Statement at your last meeting we have circulated it to the Mayors and Chief Executives for the two TLA’s in the valley.

Sub regionally the Kapiti Coast District Council has circulated statements from CCDHB and those opposed to CWF with their Annual Plan asking their residents to answer the following question:


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“Do you think we should keep adding fluoride to the drinking water in Waikanae, Paraparaumu and Raumati? Yes / No “

3 OTHER

3.1 School Based Public Health Nursing

With the development of a computerised Patient Management System for the school nurses last year we are now starting to see good data regarding activity levels and referral areas. Additionally the care being provided by our nurses is now ‘visible’ to both primary and secondary care clinicians, and we already seen stories of improved joined up care as a result of this visibility.

School Health and Immunisation Group

Capital and Coast

Hutt Valley Wairarapa

Total629 466 77 1,172866 630 88 1,584

1,274 1,211 131 2,61640 52 12 104

565 478 48 1,09128 28 8 64

3.43 5.18 3.46

1.56 1.86 1.57

Top 5 Referrals for Open Referrals by DHBDHB Condition Rank NumberCCDHB Vision 1 143CCDHB Behavioural 2 93CCDHB Hearing Concerns 3 83CCDHB Developmental 4 61CCDHB Eczema 5 55HVDHB Behavioural 1 136HVDHB Developmental 2 78HVDHB Hearing Concerns 3 73HVDHB Vision 4 72HVDHB Learning difficulties 5 51Wairarapa Dental 1 12Wairarapa Sexual Health and Puberty 1 12Wairarapa Eczema 3 11Wairarapa Head lice 4 9Wairarapa Hygiene 4 9

Average Contacts per Open Referral

Average Time Spent per Open Referral (hrs)

Highest Time Spent for an Open Referral (hrs)

Highest Number of Contacts for an Open Referral

Number of Closed Referrals

Number of Open Referrals

Number of Conditions Associated with Open Referrals

Statistics Report - by DHB

Number of New Referrals

From 01-Oct-2013 to 31 Mar2014

3.2 Webpage

Our webpage has many resources including our submissions – www.rph.org.nz


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Wairarapa and Hutt Valley District Health Board


Date: 22 April 2014

Author Pete Chandler, Chief Operating Officer

Endorsed By Debbie Chin, Acting Chief Executive Wairarapa and Hutt Valley DHBs

Subject Chief Executive’s Report – May 2014

RECOMMENDATION

It is recommended that the Boards

a. Note the information contained in this report.

ADDENDUMS

1. Balanced Scorecard

2. Finance Report

3. 3DHB Health Services Development Programme Update

4. Communications Update

5. Official Information Act Requests

1 GOVERNMENT PRIORITIES AND HEALTH TARGETS

1.1 Hospital Health Targets

Wairarapa and Hutt Valley DHBs are continuing to perform well in all hospital health targets.

Both DHBs are:

∑ Meeting or exceeding the national ED 6 hour wait time target – this position has now been held for four successive quarters at Hutt for the first time ever. Wairarapa remains one of the top performers in the sector

∑ Exceeding the elective surgery volume targets for the year to date – for both DHBs this is the best year of elective surgery performance achievement so far. Surgical pathway efficiency improvements are beginning to yield productivity benefits in both DHBs. Work to reduce cancelled operations by over 50% at Hutt has been successful, with similar effort now being applied at Wairarapa

∑ Exceeding the hospital smoking cessation advice target.

Both DHBs have a plan to achieve the new four month waiting time target by the end of the year. Reduced numbers of anaesthetists at Hutt, and last year’s fire at Wairarapa, have presented considerable challenges in this to date. However, recruitment has been successful in both DHBs and a number of new anaesthetic Senior Medical Officers (SMOs) have now joined our services which will considerably support the four month wait plan - a key priority for the rest of 2014.

Hutt Valley PUBLIC 2 May 2014 - DISCUSSION PAPERS

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1.2 PHO Health Targets

Te Awakairangi Health Network (TeAHN)

Practices across the Network have been working hard over the last year and have achieved good results. Since April 2013, there have been significant improvements in “More Heart and Diabetes Checks”, where CVD risk assessments have gone from 38.4% to 69.4% (almost 10,800 checks) and in “Help for Smokers to Quit” where the brief advice indicator has doubled (from 32.2% to 65.5%). These are excellent results.

A growing number of practices have achieved the target percentage for some or many of the indicators. TeAHN will continue to support the practice teams to make the next improvement step.

1.3 Balanced Scorecard (BSC)Please find attached as Appendix One the BSC.

2 IMPROVING PROCESS AND CULTURE

2.1 Distributive Clinical Leadership

Last month, the Association of Salaried Medical Specialists (ASMS) published their Specialist newsletter which contained a synopsis of results from one of their more recent surveys of Senior Medical Officers (SMOs) on the subject of distributive clinical leadership. This term describes the involvement of the wider SMO workforce at grass roots level, in organisational development and clinical service changes rather than simply involving formal clinical leaders. The expertise of our SMO workforce is a critical component in shaping our organisation to meet the changing demands within healthcare such as meeting the needs of the ageing population and improving models of care.

ASMS comment that one of the greatest barriers to distributive clinical leadership is the availability of non-clinical time, and to assess this across the sector the previous survey (2011, which was re-published in December 2013) looked at this aspect of clinician resources in some detail. Wairarapa and Hutt Valley DHBs did not fare well, however in the three years since then considerable improvements have been made.

The most recent survey (undertaken in the latter part of 2013 and published in February) assessed SMOs perceptions of the genuine level of commitment to progressing distributive clinical leadership across the DHBs. Whilst there was a relatively low sector response rate of 30% of DHB employed SMOs, and the results present some mixed messages, we see the survey as an opportunity for improvement and have committed to making significant improvements in this area over the coming year.

At our Joint Consultation Committee (the formal, quarterly ASMS-DHB engagement forum) meetings over the last six months this has been a significant topic of discussion and we are working with ASMS, our Clinical Directors and our clinical teams to determine effective means to improved organisational involvement of our medical workforce.

In addition, we are taking advice from Professor Robin Gauld at the University of Otago, an acknowledged New Zealand expert on the topic. Robin was involved in the original ASMS clinical engagement survey and has been very helpful in providing a steer, along with some complimentary feedback on our current approach. It is becoming clear that the very specific ASMS survey questions do not provide us with enough local perspective on wider SMO workforce opinion and therefore we are considering undertaking our own clinical engagement survey later this year at both Wairarapa and Hutt DHBs.


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2.2 Healthy Workplace initiative

The recent Kings Fund summary of the Francis enquiry into the UK Mid Staffordshire NHS Trust re-emphasises the importance of organisational culture in ensuring excellent and safe care delivery, and provides useful prompts to us.

Starting in April, we will be working through an ‘organisational culture refresh’ series of activities which will continue for the rest of the year. This will involve a more focussed approach to engaging the whole organisation, with unions, in working together to improve workforce morale, improve communication and transparency, and galvanise strong collective effort to enhance quality, safety and efficiency. This stream of work links wholly to the envisioning activities which have been underway for some months, involving our union partners, facilitated by Tom Schneider.

Our first action was a trial, to see if we could shift organisational thinking to focus on our ‘Healthy Workplace’ areas, where morale and team spirit were especially high, celebrate these and use as models of excellence to inspire other areas. This has created considerable postings on our intranet blog, a competitive spirit between departments and been very well received by staff and unions. The final results of the nominations were as follows:


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We’ll be celebrating the winner (our Endoscopy service) and asking staff from the top voted three services to share with the organisation what’s great about working in their departments. In summary, staff comments about their department were:

∑ They have a great manager

∑ Everyone works hard, and really well together as a team

∑ Workplace relationships between staff are excellent

∑ The team are proud of the service they offer and they believe they provide a very efficient model of care based on the ‘Valuing the Patient’s Time’ principle adopted from Canterbury DHB

∑ Patient feedback on the service, it’s efficiency and the outstanding level of patient care by the staff is consistently excellent.

This is an exciting focus and has stirred up considerable discussion within the DHB, with more celebratory opportunities being planned for the rest of the year. A similar activity will be launched at Wairarapa in May.

3 FINANCIAL SUSTAINABILITY

3.1 Financial Result Wairarapa

The DHB is currently $115k unfavourable to budget year to date, (Funder $249k unfavourable, Governance $168k favourable, Provider $34k unfavourable). Savings not being achieved year to date are mostly being offset by other underspends however this is not expected to continue for the remaining months of this financial year.

Further information can be found in the Wairarapa DHB Financial Report attached as Appendix Two.

3.2 Financial Result Hutt Valley DHB

The Hutt Valley DHB is currently $799k behind plan year-to-date, original plan lines are $2,871k behindtarget and are partially offset by other underspends and new initiatives. There remains a significant challenge for the last quarter of the year. The year-to-date total financial position for the DHB is anunfavourable variance to budget of $1,572k, (year-end forecast deficit $1,546k).

Further details can be found in the Hutt Valley DHB Finance Report attached as Appendix Two.


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4 WORKING WITH OUR NEIGHBOURS

4.1 3DHB Health Services Development (HSD) Programme

Attached as Appendix Three is an update on work undertaken under the 3DHB Health Services Development (HSD) Programme to the end of March 2014, outlining programme highlights, key planned activities and emerging priorities.

5. INTEGRATING HEALTH SERVICES INTO A MORE UNIFIED SYSTEM

5.1 Hutt INC

Hutt INC had its regular monthly meeting on Thursday 17 April 2014. The main items of discussion are set out below:

∑ An approach to POAC (Primary Options for Acute Care) in the Hutt Valley continues to develop. The focus of this work is improved pathways around cellulitis and DVT, and the possibility of adopting co-ordination functions for community based care. Any such co-ordination function would best be considered part of a sub-regional approach to get the best value for any investment.

∑ ENT pathways developed sub-regionally are now available to GPs on the HuttHealthPathways website, with communication and training for primary clinicians being organised.

∑ A workgroup has started developing a clinical governance approach that brings primary and secondary care together to consider the journey of patients across different aspects of the health system. Clinical Governance is already strongly embedded in both secondary and primary care, but there are opportunities to improve visibility of patients that move through both parts of the system.

∑ Advice was sought and provided in relation to several workstreams, including radiology criteria, the best way for Hutt INC to contribute to sub-regional work, and the use of “Yellow Card” medicines lists.

∑ Hutt INC is considering whether there is any opportunity to think in a more collaborative way about how the Hutt health system works to deliver care in the community. The DHB, PHOs, and primary practices all provide services in the community, but it is not clear how well these services are aligned, and whether greater linkages between staff would assist in supporting and driving earlier care in the community.

∑ Te Awakairangi Health Network, under the sponsorship of Hutt INC, is working on finding ways to improve the sustainability of primary care in the Hutt Valley into the medium and long term. A brief presentation was received from Synergia on the general approach and the importance of addressing sustainability as a “whole of system” issue, and on developing options that support services increasingly being provided to patients closer to their homes.

∑ Additional resource for workstreams has been provided by SIDU, which was welcomed by the Group. Sarah Eames, who has previously worked in primary care in the Hutt Valley, was welcomed to

Hutt INC as programme manager.

5.2 Hutt Valley DHB Laboratory Information System

Hutt Valley DHB has successfully implemented Sysmex Delphic, the new Laboratory Information System (LIS). Over the next few weeks the focus will be on supporting the Hutt Lab and bedding in the system and process changes. Post go-live support arrangements are in place to ensure any issues are identified and resolved in a timely manner.

The team work and commitment across Labs and ICT for this project has been fantastic and I’d like to acknowledge all those involved.


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5.3 New Finance System

Hutt Valley DHB was the first DHB in New Zealand to transition to a new shared service being put in place by Health Benefits Ltd on behalf of all DHBs. Essentially the aim of this project is to streamline finance, procurement and supply chain processes so that all DHBs are speaking a common language when it comes to how goods and services get ordered, delivered, paid for and stored.

The Hutt Valley Phase 1 Implementation went live on 1 April 2014, with the cut down version of the finance system including; accounts receivable, accounts payable, general ledger and cash management. There were some minor issues to resolve but in general the go live went to plan. This is a significant milestone and its success is a credit to the team at Hutt and in ICT who worked on this project, often in very difficult circumstances. Work continues on streamlining processes and completing some minor issues unable to be resolved in time for go live. The month end process is yet to be fully tested with the first MoH reporting due from the new system on 12 May.


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6. OTHER MATTERS OF INTEREST TO THE BOARD

6.1 Wairarapa Clinical Board

The Wairarapa Clinical Board met on Wednesday 16 April. The format of the meetings has changed to including summary reports from the Allied Health, Nursing and Medical representatives.

The main focus for the meeting was a discussion on the Terms of Reference which are in need of review. Further discussion will take place at the next meeting.

6.2 College Accreditation Visits

Australian & New Zealand College of Anaesthetists (ANZCA)

The Chair and two representatives of the ANZCA accreditation committee visited Hutt Hospital on 28 March as a formal follow up to their visit in December 2012. Many changes have occurred since then. The visit went well and informal feedback was positive. Formal feedback is awaited.

Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG)

The Hutt Hospital was accredited as a training site in the College’s Integrated Training Program (now known as the Core Training Program) in 2011 for a period of four years, following a recommendation by the RANZCOG New Zealand Training Accreditation Committee. In accordance with College process, a team from the RANZCOG visited the hospital approximately one year after the first trainees were appointed to review the site’s performance as a newly accredited unit.

This review was conducted on 18 February 2014 by a team from the RANZCOG including the Chair of the New Zealand Training Accreditation Committee. The Hutt Hospital is a Level 2 site and is a peripheral rotation for the Wellington Hospital.

The Hutt Hospital was granted an initial four-year accreditation period in July 2011 (expiring July 2015). The current progress review, which would normally have taken place approximately 12 months afterwards (late 2012), was delayed so that sufficient trainees had rotated to the site to provide adequate feedback. Because of this delay, the current accreditation rating is extended to the end of January 2016. The next re-accreditation visit will fall due in February 2016.

Royal Australian & New Zealand College of Radiologists (RANZCR)

The college undertook an accreditation visit in October 2013. Hutt is linked to Wellington for training and currently has one trainee on rotation. Hutt was noted to be a valuable and complementary rotation to the Wellington training program but the training opportunities were not being fully utilised at present. Good teaching and supervision was available despite workload pressures on SMOs but could be improved significantly with increased SMO staffing. The presence of a solo trainee and the rotation duration of 6 months resulted in the trainee missing out on teaching and education opportunities, formal or otherwise. RANZCR felt this would be alleviated by the addition of a second trainee and/or an increased rotation length however increased staffing would be required to support this. In view of this Hutt was downgraded from a ‘A’ unit to a ‘B’ training unit pending the recruitment of an additional full time equivalent SMO. Therefore Hutt Hospital was granted Level B Linked accreditation, valid to 31 December 2018 and for a maximum of one trainee.

6.3 Wairarapa Hospital Maintenance and Storage Facility

With the sod turning earlier in March 2014, the Holmes Construction Group led construction of the storage facility is in full swing.

The construction is expected to take between four to five months and is well underway with forestation removed and the ground prepared for foundations with sub base compaction completed.


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6.4 Elective Services Patient Flow Indicators (ESPIs)

We are currently working towards the next milestone goal of achieving a maximum four month waiting time for first specialist assessment (FSA) and elective treatment by the end of December 2014. Below is an update on the national and local picture against elective waiting time goals.

National performance improved in February. There are, however, very few DHBs across the country who are managing to sustain performance against the maximum five month waiting time expectation on a consistent basis, with only two DHBs having met the five month expectation for both FSAs and treatment (ESPI 2 and ESPI 5) in February. The Ministry will expect to see waiting time performance managed more tightly, with good improvement achieved by the end of this financial year. Both Wairarapa and Hutt Valley DHBs have plans in place to support reductions.

The following graphs show last year's improvement against the five month goal (dotted lines), and current progress towards four months (solid lines) for Wairarapa and Hutt DHBs, and at a national level. The blue lines relate to the number of patients waiting over the respective time frame for first specialist assessment, and the red lines relate to elective treatment. The most recent data is for February 2014, extracted from National Collections on 7 April 2014.


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6.5 Family Carer Policy

In May 2013, as part of the Budget legislation, Parliament enacted the New Zealand Public Health and Disability Amendment Act 2013 that inserted a new Part 4A in the Act called ‘Family Care Policies’.

As a result, the Ministry of Health developed a new Funded Family Care Policy that applied from 1 October 2013. As well as applying to the Ministry, Part 4A requires any DHBs that are paying, or are intending to pay, family carers to provide support services to family members to have an explicit, lawful family care policy to that effect in place by 21 May 2014.

When the legislation, was passed the Ministry advised DHBs that it would provide further guidance to DHBs on the matter to ensure DHBs met legal obligations. A national stocktake was undertaken by the Ministry, which then provided a policy template for DHBs to use for drafting their policies. SIDU has developed a draft policy for the 3DHBs, based on the template, and this is now with the Ministry awaiting their feedback.

Currently Wairarapa DHB has an operational policy through their NASC service, while Hutt Valley and Capital & Coast DHBs Home and Community Support (HCSS) providers have a policy related to family members as paid carers. These policies enable family carers to be paid through the contracted Home and Community Support Agencies in certain circumstances and when certain conditions are met, which is in essence the intent of the new ‘lawful’ policy.

As all DHBs have had a policy in place around paying family carers already, it is anticipated that any financial impact of the new policy will be minimal.

6.6 Hutt Hospital 70th Birthday

In 2014, we celebrate 70 years since Hutt Hospital was officially opened on 15 May 1944. The 70th

Anniversary committee has been meeting since late 2013 to organise activities for the week of the 70th, as well as how to tie in other events throughout the year with a 70th theme.

Formal activities scheduled for the week commencing 12 May include

∑ Afternoon tea on the afternoon of 15 May, to be attended by notable past staff members, ELT/DLT and other guests

∑ Cake decorating competition to be judged at the afternoon tea

∑ 70th focus for International Nurses Day celebrations on Monday 12 May


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∑ Exhibition display of history boards/uniforms and other memorabilia to be situated in the corridor by the auditorium for the week of the 15 May

∑ Plastics reunion dinner on Friday 16 May

∑ Nurses reunion dinner on Saturday 17 May

Other activities include

∑ Three large A0 size canvases featuring photos of the hospital taken by the clinical photographer Ric Croasdale (canvases donated by Pixelpaint) – these will be placed in high traffic areas and the caption will acknowledge that they were donated for the 70th

∑ Special grand round featuring 70th memories (organised by Peter Barnes) scheduled for June/July

∑ Wearable art competition around September

∑ Ongoing digitisation of historical assets (photos, videos and stories) to preserve them for the future

∑ Follow-up photo essay by Eunice Mowles profiling members of staff who were originally photographed for the series of portraits in the Learning Centre corridor.

An article appeared in the Hutt News asking for help in identifying a group of student nurses, this was successful and a follow up has been published on our public internet page. A feature article will be pitched to Hutt News and we will also use Health Highlights to cover. Facebook/Twitter/Intranet/Internet coverage will intensify in the week before the 70th.

6.7 Pacific Health Scholarship Awards

The Pacific Health Awards were held on 22 April 2014. As background the Awards started in 2004 as a way of Hutt Valley DHB’s “growing your own initiative”. Pacific young people looking for careers in the health sector. The DHB in partnership with the Hospital Foundation Trust has provided support to enable this initiative to continue to date.

We have assisted and supported up to 23 Pacific young people from the Hutt Valley in their tertiary studies during the last ten years, all have graduated and are either serving here in the Hospital and or in the community setting or working in the sector in other centres.

This year we have 19 recipients of the Awards, which range from $1,000 to $5,000, most are in their final year of studies and some in their first year. The range of studies are from nursing/medicine/policy analyst/social work/physiotherapy/Master of Physics (in imaging) Health management/environment officer.

A panel made up of a Community clinician, nursing development unit and member of Hutt Foundation deliberated on the final decision. This initiative is well known in the Hutt Valley Pacific community as we market this very well with information provided to churches and Pacific leaders to encourage their young people to look to health as a career option.

The celebration of the Awards was well attended by many including the Minister of Pacific Island Affairs, Hon Peseta Sam Lotu-Iiga, who was our guest speaker, Board members, Interim Chief Executive of CCDHB, Pacific Community Leaders, Award recipients and their families.


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Hon Peseta Sam Lotu-Iiga, centre, congratulates recipients of the Pacific Health Scholarship6.8 Communications Update

I have included as Appendix Four the projects and initiatives the DHBs’ Communications Team have been working on locally and in the 2DHB and 3DHB space.

6.9 Official Information Act Requests

Attached as Appendix Five are details of requests for information the DHB has received under the Official Information Act since the last Board meeting and our responses.


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards

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

9.35am Monday 07 April 2014

PRESENT: IN ATTENDANCE:

Committee Management & Externals

Derek Milne (Chair)Virginia Hope (Deputy Chair) - lateWayne Guppy (Member)David Choat (Member)Chris Laidlaw (Member)Helene Ritchie (Member)Helen Kjestrup (Member)Janine Vollebregt (Member)Sandra Greig (Member)Liz Falkner (Member)Peter Douglas (Member)

Debbie Chin (Interim CEO, CCDHB) - lateSandra Williams (Group Manager, Service Integration)Dr Pauline Boyles (Senior Disability Advisor)Nicola Ryan (Minute Secretary, SIDU)Peter Gush (RPH Service Manager, SIDU)Joanne Reid (RPH Group Manager, SIDU)

APOLOGIES:

Committee Management & Externals

Ron Mark (Member)Leanne Southey (Member)

Carolyn Cooper (Director, People & Culture)Dr Ashley Bloomfield (Director OF SIDU)

Peter Douglas opened with a Maori Prayer

Wayne Guppy advised he will leaving at 11am for Royal introduction.

Interest register – one change from Derek. Brother in Law on Health Care NZ ltd. Daughter working at Auckland Hospital.

1.0 CONFIRMATION OF MINUTES

The Committees

Agreed that the minutes of the meeting held on 24 February 2014 are a true and correct record of the proceedings

Moved: Derek Milne Seconded: Peter Douglas CARRIED

The Committees noted the apologies.

2.0 ACTION POINT UPDATE:

∑ PHO presentations need some thought and priority – staff with discussion with CEO’s and Chairsto consider in light of the presentations to the Boards at May 14 meetings.

Hutt Valley PUBLIC 2 May 2014 - COMMITTEE VERBAL REPORT BACKS

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∑ RPH information on Fluoridation handed out. Check with Ashley as to whether the link in the action point has been covered off.

3.0 CPHAC-DSAC TERMS OF REFERENCE

Terms of Reference noted. These were covered off last meeting, but will remain on the agenda for the future as a reminder for people.

4.0 DIRECTOR, SIDU REPORT

9:45am Janine Vollebregt arrived

Receipt of report.

Moved: Derek Milne Seconded: Helene Ritchie

Discussion Points:

∑ P20. Pathways care – were discussed. It was noted that some GPs had presented a counter view as to the usefulness of Pathways.

∑ Pathways are enablers not prescriptive pathways. It’s a very useful enabling tool for health professionals to see what choices they have.

9:49am Peter Gush and Joanne Reid arrived

∑ Sub regional Community Pharmacy Forum - further work to be done in terms of GPs and Pharmacists working together more closely and in an integrated way. A comment was made thatthere was a lot of information in the papers and too little time to discuss and make the points each member wanted.

∑ Health of Older People. Interest expressed in the work being done. Noted it was working well in the Wairarapa and that work is underway in the other two DHBs. Noted that monthly there would be an update on the work with a full briefing to come to CPHAC-DSAC in due course.

10:10am Sue Kedgley arrived

Action Points:

∑ Report back on discharge care planning for vulnerable and frail elderly. Identify a date for havinga discharge policy in place with tight rules.

The Committees noted the contents of the paper.

4.0 Annual Plans 2013 / 14 – Six Month Report & Performance Reporting

Discussion Points:

∑ The work on a sub-regional mental health advocacy service is behind schedule due to other work having been prioritized first. However it is expected that this work will be back on track before the end of the year..

∑ P41 and 42. A member raised the recollection that there is another mental health performance measure. Used to be proportion of people with crisis management plans in place. Clarificationrequired about the measure and whether the information was still being collected and could be reported.


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Action Point:

∑ Report back on whether the Mental Health Performance Measure – proportion of people with crisis management plans in place is still reported.

It is recommended that the Committees:

Note the six-month report against the Annual Plans for Wairarapa, Hutt Valley and Capital & Coast DHBs;

Note the most recent results against Government Health Targets and other key performance measures for 2013/14.

Note the actions being taken to improve performance across the sub-region on the two primary care targets – heart and diabetes checks and smoking cessation.

Derek Milne moved that the recommendations are noted.

5.0 Nutrition and Physical Activity Initiatives including those to prevent Cardiovascular disease and Diabetes

Discussion Points:

∑ Peter Gush and Joanne Reid (Regional Public Health) were in attendance to answer any questions around this paper.

∑ Clarification was sought about the work RPH did in schools in terms of prevention and promotion particularly nutrition. Work in some individual schools such as the Health Promoting Schools programme. Work is more about wellbeing, social and physical health. Also public health nurses in schools around the region. Working with about 32 schools across the Hutt and Capital & Coastareas. Health Promoting Schools is more of a framework, focus on lower decile schools. Nutrition is a common topic and teaching on healthy food options. Looking at school lunch packs sold in schools around the region and looking at how we can promote the sale of healthy food nearby.

∑ It was raised that the DHBs should be starting with their own hospitals. Fizzy drinks, cafeteria foods were two areas staff were advised to consider develop a sub-regional policy for.

∑ Staff advised that a sub-regional policy is being worked on for the Executive Leadership Teams.Further information to come back to CPHAC-DSAC. It was drawn to staff’s attention that some years ago there was a report identifying that the leading cause of health issues is a poor diet and the cause of obesity issues particularly in children.

∑ It was noted that guidelines are available, although voluntary. As there was no baseline, it is not possible to comment on whether schools have maintained at the guidelines.

∑ There was a request from members of the Regional Council to work closely with that entity and also local councils given the agreement of the Committees was that good nutrition was important and impacted significantly on the health system.

10:36 – Virginia Hope arrived.

The Committees recommended to the working group developing a sub-regional DHB food policy that all fizzy drinks should be excluded and that there be reporting back to individual Boards.

Action Points:

∑ Sue Kedgley to receive a copy of Capital & Coast food policy.


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Note the range of activities underway to improve nutrition, promote physical activity and prevent cardiovascular disease and diabetes across the sub-region.

Recommendation noted.

6.0 PROGRESS ON SUB-REGIONAL DISABILITY PLANNING referred to Pauline Boyles

Discussion Points:

11:05 Debbie Chin arrived

∑ Report taken as read.

∑ There is a need for data to measure inequalities for people with disabilities. By June 2015 there will be baseline data although we cannot yet do that in the Wairarapa. We can measure health passport uptake in the Wairarapa.

∑ Icon - implementation of icon on track with the first set of baseline data to be produced for CCDHB June 14 and for Hutt Valley June 15. At this stage Wairarapa does not have appropriate software to use the icon.

∑ Passport - It was noted that the passport in the Wairarapa is invisible at present. In response itwas noted that the DHB buys them, does the communication, trains staff and works with communities. The Passport is the patient’s tool and it’s their responsibility to use it.

∑ The move of the Masterton Medical Centre has affected the leadership from Primary Care.

∑ It is clear project management is required on the ground as well as community buy in.

∑ Sub-regional Forum May 2014 – planning is going well. All members are encouraged to engage.

∑ P76 3.31 – the indicator access improved and monitored across all 3D sites is currently red, and why is this? Reds are not a worry in themselves as this is 13/14. Hutt Valley and Wairarapa access for people with a disability needs to be addressed. There are also issues with car parks but there should be a simple solution.

∑ Sandra Greig is on the Regional Council’s disability committee and wondered how she could assist. Engagement is more than an accessibility committee.

Action Points:

∑ Review the one sentence statement on the Regional Council’s Disability Committee, to provide more context.


a) Note the progress against Sub-Regional NZDS Implementation Plan for 2013/14;

b) Note the Sub-Regional Disability Advisory Group (SRDAG) report back;

c) Note the plan for a Sub-Regional Disability Forum May 2014.

Noted: Derek Milne. Seconded: Virginia Hope.


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7.0 3D WORK PROGRAMME FEBRUARY UPDATE

Discussion Points:

∑ The Committee noted there was a lot of information contained in the appendix to the paper.

∑ There was a query as to the sub-regional work and where it fitted within the regional work. It was clarified that the sub-regional work is part of the regional plan. Although a lot of sub-regional work is occurring in this region there was less sub-regional work occurring in other areas due to either geographical or infrastructural differences.

∑ Clarification was sought form the CEO about the children’s hospital p174. In response, paediatricians have been discussing how to best service children. Paediatric services and resources are scare resources but the future model will be a more community-based model that a hospital model around inpatient beds. There is not a sufficient-sized population to support another Starship hospital.

It is recommended that the committees:

∑ Note and provide feedback on the 3DHB HSD report as attached and progress against the work programme for February 2014;

∑ Note the attached 3DHB Project Register.

Moved: Derek Milne. Seconded: Helene Ritchie.

10 GENERAL BUSINESS

10.1 Ethics

Discussion Points:

∑ It was suggested that it may be useful to have a presentation at some stage on ethical issues that clinicians face, noting that many clinicians need training.

Action Point:

∑ Invite CEs to consider how they could most appropriately get onto the work plan a presentation on concept of ethics.

10.2 Legal Highs

Discussion Points:

∑ Legal highs were discussed – it was acknowledged that considerable work had been done in this area by other parties who were better placed to do this analysis and consideration.

∑ Chair noted that there is an issue but it is the Government’s role to regulate.

11 RESOLUTION TO EXCLUDE THE PUBLIC

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

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


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Subject Reason Reference*

Community & Public Health and Disability Services Advisory Committees Public Excluded Minutes

For the reasons set out in the 2 September 2011 Board Agenda

DIRECTOR OF SIDU REPORT Enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Enable a Minister …, negotiations (including commercial and industrial negotiations)

Section 9(2)(I);

Section 9(2)(j)

DHB ANNUAL PLANNING AND REGIONAL SERVICES PLANNING UPDATE

Enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Enable a Minister …, negotiations (including commercial and industrial negotiations)

Section 9(2)(I);

Section 9(2)(j)

* Official Information Act 1982.

Moved: Derek Milne Seconded: Virginia Hope

The meeting finished at 12:10pm

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

DATED this day of 2014

Derek MilneCHAIR


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Hutt Valley District Health Board Page 1 MAY 2014

DECISION PAPER

Date: May 2014

Author Virginia Hope

Subject Resolution to Exclude the Public

RECOMMENDATION

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

Agenda Item Reason Reference

Draft Annual Plan

Subject to ministerial Approval Section 9(2)(f) (iv)

Draft RSP

Final 2014/15 Budget and Capital Plan

To enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(i)

Chief Executive ReportProject the privacy of the naturals persons and to enable a Minister of the Crown or any department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities

Section 9(2)(a) (i)

Sustainability Plan

Hutt Valley PUBLIC 2 May 2014 - OTHER

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Wairarapa, Hutt Valley and Capital & Coast District Health Board

APPENDIX One: PHO funding Streams (additional information)

1. Very Low Cost Access & Free under Sixes funding

Eligibility for the Very Low Cost Access payment is limited to PHOs/practices currently charging or prepared to reduce their fees for standard consultations to the thresholds specified below:

ß Zero fees for children 0 - 5 years.

ß $11.50 maximum for children 6 - 17 years.

ß $17.50 maximum for all adults 18 years and over.

ß New practices to the programme must meet the eligibility criteria of 50% high needs population (defined as Māori, Pacific or New Zealand Deprivation Index quintile 5).

As of 1 July 2012, all CCDHB practices offer zero fees for under sixes. In CCDHB, 13 practices offer very low cost access fees. Similarly all HVDHB practices offer zero fess for under sixes while six practices offer very low cost access fees. All Wairarapa practices offer zero fees for under sixes and one practice offers very low cost access fees.

Additional funding has been released for VLCA practices in 2013/14. Two pools were made available:

∑ VLCA sustainability funding (multi year)

∑ VLCA Nurse funds (this is one off for 13/14).

2. Co-payments: PHO general practice providers are able to charge a co-payment for their services.

Table 1: Co-payments currently charged by practices in Wairarapa DHB as at May 2013

Under 6 6-17 yrs 18-24yrs 25-44 yrs 45-64 yrs Over 65

Lowest to Highest $0.00 $11.50 - $29 $17 - $33 $17 - $36.50$17 -

$36.50 $17 - $32.50

Average Co-payment $0.00 $25.57 $28.71 $30.90 $31.57 $29.20

Table 2: Co-payments currently charged by practices in Hutt Valley DHB as at February 2013

Range $ Under 6 6-17 yrs 18-24yrs 25-44 yrs 45-64 yrs Over 65

Lowest to Highest $0.00 $5-$45 $15-$45 $15-$45 $15-$45 $5-$40


Table 3: Co-payments currently charged by practices in CCDHB as at April 2013

Range $ Under 6 6-17 yrs 18-24yrs 25-44 yrs 45-64 yrs Over 65

Lowest to Highest $0.00 $0-$53 $0-$57 $10-$63 $10-$63 $5-$58


Hutt Valley PUBLIC 2 May 2014 - ADDENDUMS

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3. General Practice Fee (co-payment) Increases

General Practices are able to increase their fees based by a nationally determined allowable percentage each year. This percentage is based on an analysis of cost pressures carried out independently and set at a national level. Practices are also able to carry forward any unused percentage from previous years. PHOs are required to notify their DHB of any fees increases, and these are approved if they are equal to or less than the allowable percentages. Fee increases can be approved or sent to a Regional Fees Review Committee to review.

In 2013/2014, all GP fee increases received by HVDHB have been within the reasonable increase as defined by the annual statement therefore no increases have been referred to the Central Region Fees Review Committee.

In 2012/13 CCDHB has received three proposed GP fee increases above the allowable increases. These have been referred to the Central Region Fees Review Committee (CRFRC). Two fee increases were accepted by the committee and the third was initially rejected by the committee. Following discussion with the PHO and resubmission of a lower percentage increase this has also been accepted. SIDU staff have been working with the PHO to minimise fee increases, particularly for young people.

A full list of GP fees as at 2012/2013 is attached as Appendix 4.

4. After Hours

All children under the age of six years have access to free after-hours care for acute presentations. CCDHB is currently undertaking a survey on the impact the under sixes project has had on the region and data to date suggest a reduction in the number of six year olds presenting at the Wellington Hospital Emergency Department and that GPs are comfortable with the level of presentations they are receiving.

Wairarapa, Hutt Valley, and Capital & Coast DHBs all receive additional funding from the Ministry of Health for a range of afte-hours services. The Ministry of Health has devolved this funding to DHBs for the 2014/5 year.

Wairarapa DHB uses the funding to reduce after-hours fees for children and young people and all those with a Community Services Card. Some of the funding is also used to communicate primary care arrangements (including after-hours) to Wairarapa residents and visitors to the region.

Currently, Hutt Valley DHB invests in a Telephone Nurse Triage service. Patients are able to access advice twenty four hours a day by ringing their own general practice. The total funding for Telephone Nurse Triage service in 2013/2014 is $197k. The balance of the funding is utilised to support Free Under Sixes access to after-hours care. The Telephone Nurse Triage service is currently being reviewed under the Hutt Inc After-Hours work stream.

CCDHB invests the additional funding ($502,500) in subsidies for high needs after-hours patients at Wellington After Hours Medical Centre, Kenepuru Accident and Medical Centre, extended hours for Newtown Union Health Service, and a discharge planning service in Kapiti. A review of after-hours spending is planned during 2014.

5. Services to Improve Access Funding

Services to Improve Access (SIA) are core PHO services designed to reduce health inequalities by improving access to primary care services for high need groups in the enrolled population (i.e. Maori, Pacific peoples and those living in NZDep 9 and 10 decile areas). PHOs obtain approval for their SIA spending from the DHB as part of their annual business planning processes.

Wairarapa

Wairarapa SIA funding is now part of the flexible funding pool with delegation for its use devolved to the Alliance Leadership Team. Currently the amount of funding used to reduce access barriers is the same as that determined through the funding formula. A small proportion of the funding is used for pharmacy vouchers and the Red Cross transport services and the balance is distributed to the practices to use as they see fit to ensure their high needs population is able to access care. The practices are using the funding in a variety of ways including a Marae-based drop in clinic (for enrolled patients) and Whanau funds.


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Hutt Valley DHB

Te Awakairangi Health Network utilise their Services to Improve Access (SIA) funding to provide programmes outlined below:

∑ Outreach nursing ∑ Community Health Workers ∑ CVD risk assessment subsidy for high needs population ∑ Dietetic services∑ Transport (so patients can access services)∑ Language Line (interpreters).

Capital and Coast DHB

Compass Health utilise their funding to employ a Whanau Navigation team (Clinical leads, Nurses, community health workers, project managers) to work across programmes contributing to their identified strategic directions, as well as applying funding to specific programmes. The other PHOs invest in a number of activities.

1. Care Plus

Care Plus provides additional funding to PHOs for people who have to visit a GP or nurse more frequently because of a chronic condition, such as diabetes or heart disease, acute medical or mental health needs, or a terminal illness. A total of $244.09 (GST Excl) annually is available for each Care Plus Client.

As of 1 July 2012, 98% of the Care Plus eligible population in CCDHB was enrolled.

Te Awakairangi Health Network’s Care Plus programme enables patients to receive four Care Plus sessions. The first and the fourth Care Plus session are face-to-face contact with either the GP or Practice Nurse. Sessions two and three may vary depending on the practice, however these sessions can be face-to-face or in some cases phone consultations.

Wairarapa Care Plus funding is included in the Flexible Funding Pool and is being used to fund Guided Care. Over 100% of the eligible population was enrolled into Care Plus prior to the establishment of the Alliance, and a similar number of people are now enrolled in the Guided care programme. Under Guided Care, practices are bulk funded to assess the needs and plan for the care of their LTC population, with increased discretion about how they use the funding allocated.

2. Primary Mental Health Services

The Ministry of Health funded these services separately in 2013/14 and has indicated that this funding will be devolved in 2014/15 to DHBs. The Minister has announced that new investment will be put into extending the primary mental health initiative to all youth including un-enrolled youth (i.e. non-Maori, non- Pacific and non-High needs youth who are already covered by the existing funding). There is also an expectation that 18% of existing funding will already be targeted at Maori, Pacific and high needs youth (12-19 years).

Wairarapa DHB

In Wairarapa, Compass Health employs two mental health nurses who work in the practices, closely linked to the DHB mental health services. One of these positions was devolved from the DHB as part of the Tihei Wairarapa integration initiatives. The PHO also coordinates additional primary mental health services, including packages of care and extended consultations with GPs and practice nurses.

Hutt Valley DHB

Te Awakairangi Health Network provides the Wellbeing Primary Mental Health Service. This service is based on a model that is both centralised and community based. Te Awakairangi Health Network has formed formal partnerships with community providers to deliver services in agreed community locations. Patients can access


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the service from a centralised location based within Te Awakairangi Health Network, and also via an outreach service, based in the network but delivered in community setting. Community based services are embedded within agreed community settings i.e. General Practices, or NGOs.

HVDHB utilises the youth non-high need funding to fund Hutt Valley Youth Health Trust (VIBE) to provide services to ensure all youth 12-19 years within the DHB are able to access youth mental health and AOD services.

Capital & Coast DHB

All four CCDHB PHOs deliver Ministry of Health funded Primary Mental Health services for clients with mild to moderate mental illness. Each PHO employs a number of mental health practitioners to provide assessment and treatment for clients using evidence based therapies, provide education for practitioners and manage the referral process. PHOs also contract for packages of care and brief interventions, which can include counselling sessions, medication management reviews, psychological therapy and behavioural therapy.

Table 4: Primary Mental Health funding 2013/14

Total PMHI

funding$000

Subset targeted at

12-19 years high need $000

New youth non-high

need funding

$000

Total funding 2013/14

$000

Capital & Coast DHB

$1,851 $333 $166 $2,017

Hutt Valley DHB $1,018 $183 $71 $1,089

Wairarapa $344 $43 $26 $370

3. More Health and Diabetes Checks

On 13 May 2013, the Minister of Health announced that additional funding would be made availableover four years for the health target and DCIP implementation. The national funding allocation is:∑ $35.5m extra nationally for diabetes and heart disease prevention and management∑ $15.9m for more heart and diabetes checks (the national target)∑ $12.4m for diabetes care improvement package∑ $7.2m for green prescriptions

New investments were made available to the three DHBs as outlined below:

1. More Heart and Diabetes Checks (2 September 2013 to 30 September 2017). The expectation is that the national target will be achieved and maintained and the following funds were allocated to PHOs:

a. Wairarapa DHB $43.4k pab. Hutt Valley DHB $126.5k pac. CCDHB $233.5k pa

2. Diabetes Care Improvement Plans 2013/14 (October 13 CFA). Table 5 outlines the following amounts have been allocated for 2013/14 for activities agreed with the Ministry.


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Table 5: Diabetes Care Improvement Plan Funding allocated to PHOs

DHB Amount To be spent onWairarapa $29.6k ∑ Delivering structured self-management programmes with a

focus on Māori and Pacific people with diabetesHutt Valley

$96.3k ∑ Delivering structured self-management programmes with a focus on Māori and Pacific people with diabetes

∑ Workforce development for primary care teamsCapital & Coast

$160.5k ∑ Supporting implementation of PHO DCIP practice management plans

∑ Delivering structured self-management programmes with a focus on Māori and Pacific people with diabetes

∑ Supporting insulin starts in a primary care setting∑ Workforce development for primary care teams

Note: Funding levels for 2014/15 and out years have not yet been confirmed.

4. Rheumatic Fever Funding

During 2013 the sub region prepared a rheumatic fever prevention plan. CCDHB had funds made available to it previously from the Ministry of Health and the plan enabled the DHB to continue these investments. Funds are invested with Regional Public Health and Compass Health to support the initiative in the Porirua area.

Additional dollars have been made available to Hutt Valley DHB $15k 2013/14, $60k in 2014/15 and $60k in 2015/16.

Rheumatic fever in the Waiararapa DHB has not been identified as a significant issue at this point by the Ministry of Health and no additional funds are currently available.

5. Primary Care Support Services

In addition to the PHO funding, there is a range of additional support for PHOs either through Ministry of Health funded initiatives or directly by the DHB.

6. Provider Audits

Routine Audits of Primary Care are carried out each financial year on behalf of the three DHBs by Central Region TAS. Which providers receive a routine audit are determined by the value of contracts held by the provider, known issues, time since their last audit and the level of risk associated with a provider.

In 2012/13, two routine Primary Care audits were carried out on behalf of CCDHB. Well Health Trust was audited in February 2013. The final report was positive and the audit uncovered no major issues. Te Whanganui a-Tara Youth (Evolve) was audited in May 2013; again, no major issues were reported.

During March 2013, a routine Primary Care audit of Te Awakairangi Health Network was carried on behalf of HVDHB. The final report showed no major issues with only eight recommendations. All recommendationshave now been finalised and a final report has been made to FRAC. The audit process is now closed .

Wairarapa Community PHO was audited in 2012, prior to the dissolution of the PHO and merger with Compass Health. A positive audit report was received.


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APPENDIX TWO: PHO PERFORMANCE

1. Information on the three primary care heath targets is presented in the PHO league table attached.

1.1. Increased Immunisation: The target is 90% of 8 month olds will have their primary course of immunisation at on time by July 2014. All 3 DHBs are doing well in the overall target. The national performance average for the 8 month target is 92%. Compass Waiararapa, Cosine and Well Health all achieved the target as at the end of Quarter 2. Compass CCDHB at 94% and Te Awakairangi at 93% are close to the target and expected to reach the target by 30 June 2014. Ora Toa is sitting at 82% and is ranked at 35th out of 36 PHOs. This is an uncharacteristic result for Ora Toa which has previously maintained performance within the top 10 PHOs (last quarter they were at 95%). Ora Toa has already reviewed its systems and processes and is tracking to restore its previous achievement.

1.2.Better Help for Smokers to Quit: The target is 90% of patients who smoke and are seen by a health practitioner in primary care are offered brief advice and support to quit smoking. The national performance is 66% at the end of quarter 2 2013/14. Compass Wairarapa has achieved the health target and is number one on the league table. Compass CCDHB at 81% is above the national average performance. The other four PHOs are below the national performance level. Progress is slow but a steady improvement is seen each quarter.

1.3.More Heart and Diabetes Checks: This target is that 90% of the eligible population will have had their cardiovascular risk assessments in the last five years by July 2014. The national average performance is 73%. Compass Wairarapa is at number 5 on the league table at 84%. Compass CCDHB (81%), Cosine (81%), Ora Toa (74%) are all above the national average while Well Health at 70% is not far behind. Te Awakairangi is number 34 on the league table at 58%. The PHO has developed a recovery plan at the request of the Ministry of Health and the PHO has further improved its result in the 3rd quarter ended 31 March and is sitting at 69.4%.

2. Additional relevant information was presented in the CPHAC-DSAC February Equity report on ASH, primary care access and Diabetes.


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53

1 | P a g e

Te Awakairangi Health Network

2012/13 Annual Report

September 2013


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2 | P a g e


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3 | P a g e

Contents

Chair’s Report Page 4

Management Report Page 5

The People We Serve Page 6

Our Provider Members Page 7

Our Community Services Page 8

Community Services Page 9

Service Highlights Page 10

Looking Ahead Page 16

Audited Financial Statements Page 18

Our Vision

A healthy Hutt Valley for all

Our Mission

To be a community leader for

health in the Hutt Valley

Our Values

People centred

Aiming for equity

Excellence in all we do

Working co-operatively


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4 | P a g e

Chair’s Report It is with pleasure that the Board of Trustees of

Te Awakairangi Health Network (TeAHN) submits

its 2012/13 Annual Report.

As Board Chair, I look back on the past year with

a sense of real achievement and progress. It has

been a year of consolidation and coming

together for our governance Board, our TeAHN

team and our different provider members.

During 2012/13, we have brought together the

programmes, activities and provider members

from five former organisations: Piki te Ora ki te

Awakairangi PHO; Valley PHO; Family Care PHO;

Tamaiti Whangai PHO; and Kōwhai Health Trust.

The reshaped Board of Trustees reflects our

history and the diversity in the Hutt Valley.

Working with the community representatives we

have on our Board - Teresea Olsen, Brendon

Baker, Tofa Suafole Gush and Muriel Tunoho –

our Board is helping to ensure our organisation

has a positive impact on the health and wellbeing

of the people of the Hutt Valley. I also want to

acknowledge the contribution of the new

primary care physician representatives who have

joined Dr David Young on our Board – Dr Lise

Kljakovic, Dr Hans Snoek and Barry Cooper.

As a Board, we have developed a common vision,

mission and strategic direction. In reshaping our

mission and vision, we have maintained our focus

on the needs of our population, providing

excellent services for all our patients, and

targeting additional services to those with the

highest health needs and poorest access to care.

We have strengthened our Clinical Governance

Committee to better enable it to advise the

Board on clinical matters.

We have also been fortunate to appoint a new

Chief Executive, Bridget Allan, who brings

considerable knowledge and health experience

to this important role.

The past year has seen us maintain our focus on

intervening early. Our health promotion

programmes are helping people quit smoking,

our population is having more heart checks, and

we have a real focus on promoting better

nutrition and physical activity, and reducing

obesity.

We have better integrated and consolidated our

our community health worker teams, our

outreach nursing activity, our transport

programmes and our different models of primary

mental health service delivery.

We have reshaped some programmes, and have

seen a significant improvement in the number of

people being enrolled into Care Plus. Looking

forward, we will better align our various long

term conditions programmes.

Without question, we recognise and

acknowledge the importance of our Network

general practices. In 2012/13, the TeAHN team

has actively supported practices with

Cornerstone accreditation, staff recruitment,

training and education, and enhancement of

their information systems. The Network has also

worked on behalf of our primary care provider

members to strengthen the primary care voice at

local, sub-regional and national levels.

Finally, we are working more closely with our

PHO neighbours in Wellington and Wairarapa.

Our relationship with Hutt Valley DHB continues

to strengthen, with primary care clinicians and

managers participating strongly in Hutt INC, the

new Alliance Leadership Team.

M N (Joe) Asghar Board Chair


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Management Report

From the Chief Executive’s Desk As the new CE of Te Awakairangi Health Network

(TeAHN), I welcome this opportunity to reflect on

the year that has been. It has been a busy year

but also a year in which I believe we have made

good progress. I would like to thank my Board

and the team at TeAHN for their support and

dedication during my first year in the role.

Our 2012/13 Annual Plan committed Te

Awakairangi Health Network to bring together

the programmes, activities and provider

members of five previous organisations.

It committed us to makes these changes whilst

living within budget.

Our 2012/13 Annual Plan also had a strong focus

on how we can best support those in our

community who have the greatest health need.

We have remained true to this focus.

Highlights Looking back over the year, we can see progress

in a number of areas:

Health targets – excellent child immunisation

rates have been maintained and we have

made good progress with smoking cessation.

Some progress has been made against the

health targets for heart and diabetes checks

but further improvement is required

Strengthened our Clinical Governance

Committee, with additional general

practitioner, practice nurse, practice

manager and community pharmacy

representation on this independent clinical

grouping, ensuring we have stronger links

with our front line provider members

Maintained our support to practice members

Better integrated our PHO programmes for

high needs populations

Strengthened our working relationships with

Hutt Valley DHB and other providers

Successfully managed additional DHB

funding for service programmes.

Our Focus Looking ahead, we want to:

Provide affordable health care to our

populations with the greatest need

Work more closely with our Māori and

Pacific communities

Encourage more people to make healthy

choices

Support people with long term conditions to

pro-actively manage their condition and gain

greater independence

Continue to build primary care’s financial

sustainability, capacity and capability

Advocate for change on behalf of our

population and practice members

Continue to reshape local health services

through our work with Hutt Valley DHB as

part of the local Alliance Leadership Team

known as Hutt INC (Hutt Integrated Network

of Care)

Work more at a sub-regional level with

neighbouring DHBs and PHOs

Live within our means.

“By working with our general

practices to secure a strong and

sustainable future, we can better

support the people within our

community who have the poorest

health outcomes.”

Bridget Allan Chief Executive Office


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6 | P a g e

The People We Serve

Te Awakairangi Health Network (TeAHN) has

an enrolled population of 117,200.

The population we serve is slightly younger and

we have slightly more Māori and Pacific people

than the national average. In total, TeAHN has

almost 20,000 Māori and over 10,000 Pacific

people enrolled across its practice members.

From a deprivation perspective, 43,000 people

or over a third of our population is considered

to be high needs – either Māori, Pacific or living

in high deprivation areas.

Many of our high needs populations are

clustered in Pomare, Taita, Naenae, Stokes

Valley, Moera and Wainuiomata. This creates

particular challenges for the general practices

located in these areas.

Typically, people with high needs are more

likely to:

Be admitted to hospital for an avoidable

hospital admission

Have a long term condition such as

diabetes, heart or respiratory disease

Have less ability to pay for medical care

We respond to our high needs populations in

three different ways:

We support practices, particularly those

operating in high needs areas, as they

respond to the health needs of their

populations on a day-to-day basis.

We support high needs populations

directly through the programmes we

deliver. Our outreach nurses, community

health workers, dietitians, primary mental

health workers and our health promotion

and healthy lifestyle coaches deliver face-

to-face services to people most in need.

We advocate at a local, sub regional and

national level on behalf of our population.

This includes working with the DHB

through Hutt INC and with other local

providers, working with neighbouring

PHOs, working with the local whanau ora

collectives, Te Runanga O Taranaki Whanui

and Takiri Mai Te Ata, to support the

implementation of whanau ora

programmes, and enhancing our networks

within the Pacific community.

“As a Network, we must focus on

what it means to deliver health

services which are both affordable

and accessible to people who are

more likely to have significant

health issues, for the financial

viability of these practices, and for

the staff working within them.”

17%

9%

11%63%

Te Awakairangi Network Patient Profile

Maori Pacific Non-Maori Pacific Non-LCAF


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Our Provider Members

In 2012/13, Te Awakairangi Health’s enrolled

population was spread across our 24 practice

members1 in the Hutt Valley:

Avalon Medical Centre

Dr Dunn’s Surgery

Dr Hans Snoek

Epuni Medical Centre

Fergusson Drive Surgery

Fitzherbert Road Medical

Gain Health

Hutt Union and Community Health Services

(HUCHS) – Petone and Pomare sites

Hutt City Health Centre (HCHC)

Kopata Medical Centre

Main Street Surgery

Manuka Medical Centre

Muritai Health Centre

Naenae Medical Centre

Petone Medical Centre

Pretoria Street Surgery

Silverstream Health Centre

Soma Medical Centre

Stokes Valley Medical Centre

Strand Care (now HCHC Wainuiomata)

Taita Medical Centre

Upper Hutt Health Centre

Waiwhetu Medical Centre

Whai Oranga O Te Iwi

Our practice members provide comprehensive,

accessible, culturally appropriate, high quality

primary healthcare services to Te Awakairangi

Health’s enrolled population.

Together, our practices have 68.9 FTE general

practitioners (including locums) and 53.1 FTE

practice nurses as well as other health workers

and administrative staff.

These health professionals provided a total of

423,000 patient contacts in 2012/13, with

145,000 of these being for high need clients.

Eight practices have a high needs population

percentage of greater than 40% and one practice

has 87% of its enrolled population falling into the

high needs category.

“Our goals are to be a strong

Network, with sustainable practices

and providers, a culture of innovation

and integration, comprehensive and

connected services, and wise use of

funds.”

Te Awakairangi Health has continued to work

with practice members to improve performance

and sustainability. Of our 24 practices, 11 have

fewer than 2 FTE general practitioners.

In 2012/13, our practice liaison and support

activity included:

Supporting practices to make progress

against the PHO health targets

Supporting practices to achieve Cornerstone

and Te Wana accreditation

Facilitating professional education and

workforce development

Assisting practices with business and

information system issues

Specific project work supported by Hutt INC

looking at practice sustainability.

1 Up until 6 June 2013, there were 24 practices making up the Network. From June 2013, the Hutt City Health Centre began running the established Strand Care

practice as a satellite practice, reducing the number of practices down to 23.


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Our Community Services Te Awakairangi Health Network offers a wide

range of community based services and

programmes. These are in addition to the

regular visits people make to GPs and practice

nurses in our Network.

These include programmes focused on

improving the health of the whole population

while at the other end of the continuum, other

activity focuses on working with particular high

need families and individuals:

Population education and prevention

services: Services to promote healthier

lifestyles

Screening, diagnostic and early

intervention services: Early disease

identification and intervention

Long term conditions: Services to help

people better manage conditions such as

heart disease, diabetes and respiratory

conditions

Primary Mental Health: Services to treat

people with mild to moderate mental

illness, and foster better mental health and

wellbeing within our community

Wrap around services: Services to improve

the health of people with the highest

needs and to assist them better access

existing services.

Feedback from our community shows strong

support for these services.

These services also help our general practice

network and the Hutt Valley DHB’s hospital

based services by reducing the potential

demand for acute care and by supporting

people to live healthier and more independent

lives in the community.

Taken together, our outreach nurses,

community health workers, primary mental

health teams, dietician service and healthy

families coach delivered a total of 35,526

patient contacts in 2012/13.

These contacts included a mixture of face-to-

face client contacts, phone calls, follow-up

visits including home visits, group sessions and

client referrals to other agencies.

“I cannot ever underestimate the

difference this has made to our lives.

Sarah (our Healthy Families Coach)

and dietitian Jan have been very

encouraging and have gently

pushed us into losing weight.

My confidence and self esteem, well

being and sense of purpose has

changed dramatically. I feel my life

has changed and I find myself

wanting to shout to other people that

they need to be aware of this

fantastic community support network,

so we can help ourselves, improve

ourselves, so we can be better

people.”


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Community Services

Leve

l o

f n

ee

d a

nd

in

ten

sity

of se

rvic

e e

ffo

rt w

ith

in

div

idu

al c

lie

nts

Wrap around

services for

people with high

needs

Helping people

access services

Primary mental

health services

Helping people

with diagnosed

long term

conditions such

as heart disease

and diabetes

Screening,

diagnostic and

early intervention

services

Population

education and

prevention

services

Outreach Nurses

Work with at risk patients in the community providing advice, health

education, advocacy and support

Community Health Workers

Facilitate access to primary care services and to community organisations

and social support agencies such as WINZ and Housing NZ

Wellbeing Service, HUCHs and Whai Oranga

Primary mental health and addiction services to people living in the Hutt Valley,

with a focus on high needs populations with mild to moderate mental illness

Hutt Valley Youth Health Service (Vibe) and Lower Hutt Women’s Centre

Specialised primary mental health service providers for specific population groups people and women

living in the Hutt Valley

Healthy Family Coach

Physical activity and lifestyle

programmes for at risk

populations

Dietitians

Provide dietary information and

advice to at risk populations,

including individual patient

interventions

Pacific Healthy

Lifestyles

Focuses on healthy lifestyle

activities for Pacific

Sexual Health

Educating and providing

free sexual health

services to under 20 yrs

Skin Lesions

Funds GPs to remove

skin lesions for high

needs patients

Community

Radiology

Access to imaging services

in the community

Cervical Screening

Encourages high needs

women to have a cervical

smear

Immunisation Support

Supports practices to maintain

high immunisation levels and

prevent diseases (e.g. measles)

Transport Services

Free transport to primary and secondary

services for high needs patients

Language Line

Telephone interpreting service for people who

do not speak English

CVD Risk Screening

and Education

Assessing at risk population for

heart disease

Care Plus

Helps people better manage a long

term condition, an acute medical

need or terminal illness

Cardiac Continuum Helps people with a cardiac condition better manage

their situation by offering free GP visit and nurse

education sessions following a hospital admission

Diabetes Care

Helps high needs people with diabetes

better manage their condition, with a

focus on those newly diagnosed

Respiratory Services

Helps high needs people with asthma or

respiratory disease better manage their

condition, with a focus on those newly diagnosed

Rheumatic Fever Reduce the incidence of

rheumatic fever and

prevent reoccurrences

Medicines Management

Facilitators provide support and

advice to prescribers

Warfarin

Monitoring

Helps people use warfarin

Podiatry

Free foot care for

high needs people

with diabetes

Smokefree

Supports practices to use

the ABC approach to

encourage smokers to quit

Health Promotion

Healthy lifestyle events, promote healthy

lifestyles and help population reduce risk of

developing chronic diseases


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Our Service Highlights

Our Practice Member Services In 2012/13, the 24 practice members within Te

Awakairangi Health Network (TeAHN)

provided a total of 423,000 patient contacts.

This included a total of 307,000 GP visits and

116,000 practice nurse visits.

Of these visits, 35% of the visits to nurses and

34% of the visits to GPs involved people with

high needs.

TeAHN supported the practices as they

delivered these front line services, including

making our clinical programme facilitation,

immunisation support and medicines

management services available to practices.

TeAHN also offered assistance with

information technology issues such as the

better use of decision support tools, PHO

performance targets, register management,

and claims management.

In the early part of 2013/14, all practices will

have Patient Dashboard installed. This will

provide them with information from their

patient management systems about each

patient as the consultation takes place. It

offers the opportunity to address outstanding

health screening or follow-up issues and to

make progress against the PHO performance

targets.

“We continue to perform well with

childhood immunisations, being

amongst the top in the country.”

Looking to the future, use of the Dashboard

should also assist practices make

improvements with our smoking cessation

efforts and the number of cardiovascular

disease (CVD) risk assessments we are

providing.

73%

27%

Nurse and GP Visits 2012/2013

GP Visits Nurse Visits

GP Visits Nurse Visits

Other 203025 74928

High Needs 104471 40903

0%

20%

40%

60%

80%

100%

Nurse and GP Visits 2012/2013

0%

20%

40%

60%

80%

100%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2011/12 2012/13 2013/14

CVD Risk Assessments(Total Population)

Programme Target

TeAHN Target (CVD Plan)

Actual


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“Whilst we are improving our CVD and

smoking cessation performance, we

need to do much better in 2013/14.”

We have also been able to help some of our

practice members consider practice

sustainability issues and assist them address

their workforce development and education

needs. This will remain a priority focus in

2013/14.

Changing People’s Lifestyles During 2012/13, Te Awakairangi Health

Network’s Health Promotion Team was very

active in the community. It worked with

practice members and community groups to

deliver heart checks in community settings and

to encourage people to have heart checks at

their medical practice.

The Health Promotion Team assisted local

communities to run “Good Food Programmes”

in Petone, Pomare, Wainuiomata, Taita and

Stokes Valley.

The Team helped a variety of organisations to

deliver a range of community health

promotion projects including heart checks at

Te Ra o Te Raukura and Tumeke Taita, Chinese

Health and Wellbeing Day, WelTec Health

Promotion events, Pacific Kirikiti Tournament,

Refugee Health and Safety Day, Upper Hutt

Teen Unit’s healthy eating programme, and

World Smokefree Day Quit stall at Queensgate

Shopping Centre.

In 2012/13, the Team also worked with existing

support groups focused on long term

conditions such as diabetes, and was involved

in the development of new groups such as the

gout leadership group.

0%

50%

100%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2011/12 2012/13 2013/14

Brief Advice to Quit Smoking(Total Population)

Programme Target TeAHN Target

Actual


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The Team expanded the Valley Fit gym

programme to Wainuiomata and was also

instrumental in making the Te Awakairangi

TRYathlon happen.

This saw 126 people complete the event, with

many of those attending health education

sessions prior to the event.

The Pacific Health Lifestyles Programme sits

alongside the work of the Health Promotion

Team, the Healthy Families Coach and the

dieticians. This programme, run by the Pacific

Health Service, involves daily Pasifika style

aerobic exercise classes.

In 2012/13, our Healthy Families Coach

delivered a total of 2,221 patient contacts and

our dietitians delivered 3,113 patient contacts.

People were seen in their own home, at their

GP practice or in the gym. For many people,

this contact can be the start of a life changing

journey.

Long Term Conditions In 2012/13, many of our programmes and

funding streams focused on supporting people

with a long term condition, some of these

directly funded by the Hutt Valley DHB.

These “long term conditions programmes”

included Care Plus and our specific disease

management programmes which have been

separately focused on diabetes, heart disease

and respiratory disease. For people with heart

disease, these programmes have been

supported by initiatives such as warfarin

management.

These different programmes have helped

many people better manage their condition.

However, we have come to recognise that this

siloed approach to different long term

conditions has led to fragmentation and is not

necessarily best meeting the needs of our

patients. We need to be able to respond to

patient needs in more flexible ways rather than

focus on individual disease programmes.

National changes to diabetes programmes

have seen local efforts refocus on the needs of

Māori, Pacific and people living in high needs

areas who have diabetes. Whilst there is an

underlying expectation that all people with

diabetes should receive an annual clinical

review, this is no longer funded for people

outside the target group. There has been a

drop in the number of annual reviews being

provided.

This is of concern as it is possible that health

outcomes will deteriorate for people with

diabetes who are outside the target

population. In 2013/14, together with our

practice members, we will address this

situation.

Meanwhile, there continues to be good access

to podiatry sessions in the community. Te

Awakairangi Health manages the payment for

these sessions which are funded by Hutt Valley

DHB.


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Care Plus Our Care Plus services focus on people with

high health need due to a long term health

condition such as diabetes, respiratory or heart

disease. GPs and practice nurses delivering

Care Plus help to educate and support people

better manage their condition.

At the start of 2012/13, clinicians from our 24

Network practices were seeing a total 3,502

Care Plus clients. By the end of the financial

year, they had dramatically improved the

number of Care Plus clients they were

managing, with 5,492 people being cared for.

“This represents an increase of 57

percent – a great achievement.”

We are getting close to the total number of

people who can be seen under the current

Care Plus programme funding. We see benefits

to the whole Hutt Valley health system from

.providing this level of support to more people.

Therefore, we are excited by the opportunity

that is emerging in 2013/14 to explore how we

can consolidate the different disease

management programmes into a more

integrated long term conditions programme.

Under Hutt INC, we expect there will be

greater flexibility in the way we can use Care

Plus funding and other funding for long term

conditions, to better meet the needs of the

community.

Making a Difference in the Community In 2012/13, our community based service

teams delivered a total of 35,526 patient

contacts.

Community Team Patient Contacts

Outreach Nurses 9,791

Community Health Workers 8,330

Primary Mental Health Service 1,2071

Dietitian Service 3,113

Healthy Families Coach Service 2,221

Total Community Contacts 3,5526

These services all focus on our high need

populations. They support people to live

healthier lives within the community.

They are able to devote

time to people, to

understand not only

their health issues but to

also understand the

social and environmental

factors which may be

impacting on people’s

lives.

Community Health Workers: Vaiula, Mere, Dina, Hana, Beau,

Natasha, Sisi and Lisa Gully (Team Leader)

“(My community

health worker)

showed me the

utmost respect, so

friendly, happy

natured and very

helpful – there are not

enough words for me

to explain how happy

I am with the service I

received”.

Community Health

Worker Client


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14 | P a g e

For instance, our

community health

workers help

people with social

and housing issues

and advocate with

Work and Income

on their behalf.

These community

and outreach

services

complement the

services which our

practice members

deliver. They also

work with general

practice to better co-ordinate people’s health

needs, connecting people with programmes

such as Care Plus where this is appropriate.

Better Mental Health and Wellbeing In 2012/13, Te Awakairangi Health Network’s

various primary mental health and addiction

service providers collectively delivered a total

of 12,071 contacts to people living in the Hutt

Valley, with a focus on high needs populations

with a mild to

moderate

mental illness.

The primary

mental health

service is valued

by service users

and by local GPs

who make

referrals to the

service.

The Wellbeing

Service provides

primary mental

health services

to the population enrolled

with Te Awakairangi

Health Network’s 24

practice members and the

population enrolled with

Ropata Medical Centre.

Vibe and the Lower Hutt

Women’s Centre provide

primary mental health

and wellbeing services to

specific population groups

including young people.

The service responds to

the primary mental health

needs of Māori, Pacific,

young people and those in

high deprivation areas.

However, there is also

demand from the wider

Hutt Valley population.

Te Awakairangi Health will

continue to target

resources at priority population groups. This

will require close monitoring as the number of

referrals can exceed service capacity.

We will continue to identify and explore

opportunities for how our primary mental

health services can better integrate with

services provided by Hutt Valley DHB’s Social

Work Department and its more specialised

mental health services.

Medicines Management On average, each practice received three visits

from the clinical pharmacist team during

2012/13 with all practices receiving at least

one visit.

These visits give the clinical pharmacists an

opportunity to share clinical information and

advice with practice staff, and to sort through

any medication queries.

“Our PHO patients

have access to a

professional and

financially

accessible service

and I have only had

positive feedback

from patients. The

main response has

been that someone

took the time to

listen to them and

offer options to

cope. In this current

health arena of

"Better, Faster,

Sooner" the pressure

to attempt to

address patients

mental health needs

are limited in 15 min

consult time slots.

The Wellbeing

Service is an

invaluable service”.

Local GP

“I found [therapist] to

be a life line when I

was at my lowest over

a situation I found

myself in. Although the

situation is still on-

going I probably

would have still been

in my bed if not for

therapist … I cannot

say how much I

appreciate my time

with her. Thank you so

very much”.

Wellbeing Service

Client

“I have been listened

to and been made

aware of what is

happening inside of

me. The doctor has

never told me about

my medical

conditions - they just

tell me what to do.

The outreach nurse

took the time and

explained it to me

and now I am aware

of my illnesses and

what can happen to

me”.

Outreach Nurse Client


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15 | P a g e

Feedback surveys indicate this support is

valued by the Network’s practice members.

“The Clinical Advisory Pharmacists are

making a significant and positive

impact on the prescribing of

medicines in general practice.”

Comment from GP survey

During 2012/13, the clinical pharmacists also

delivered a range of education sessions to local

pharmacists, practice nurses and the local

diabetes support group.

Sexual Health Services This programme, previously funded by the

Hutt Valley DHB, allows young people to access

free sexual health consultations. The service

continues to be well utilised, with

approximately two thirds of the 4000

consultations provided in 2012/13 being

delivered by GPs. However, this service will be

funded at a lower level in 2013/14 and will be

available to a smaller age range (12 to 19 years

inclusive).

Language Line and Transport These two relatively small programmes make a

big difference in some people’s lives.

In 2012/13, the transport service made a total

of 1097 trips involving 339 unique patients.

More than half these trips were to secondary

health care appointments while most of the

balance was to primary health care

appointments.

As the transport service is meant to improve

access to primary care, the use of the service

to access secondary healthcare appointments

remains an on-going concern, particularly as

this is putting pressure on the relatively small

budget available for the service.

In 2012/13, 237 calls were made to Language

Line, giving patients and GPs access to an

interpreter during the patient consultation. 15

of the Network’s 24 practices used Language

Line over this period.

Partnering with Hutt Valley DHB In 2012/13, we have made significant advances

in our partnering work with Hutt Valley DHB.

Over the past two years, primary and

secondary clinicians supported by senior

management, have met regularly to improve

services and integration across the Hutt Valley.

This group (previously called the Primary

Secondary Strategy Group) is now called the

Hutt Integrated Network of Care (Hutt INC).

In 2012/13, this joint work has involved a focus

on reducing avoidable hospitalisations, with

activity to address skin infections,

gastroenteritis, and respiratory conditions in

our community; improving access to diagnostic

services; reducing pressure on specific

services; and improving enablers, such as

pathways development, and improved

information systems to support shared care.

8691

71

86

106

87

75

96 95 94

122

89

405060708090

100110120130

Number of Transport Service TripsJuly 2012 - June 2013


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16 | P a g e

Looking Ahead

Quality Systems and Processes In 2013/14, Te Awakairangi Health Network

will continue to support quality initiatives

which benefit our practice members and

enhance the services they deliver.

We will continue to encourage the use of

information systems and information tools

that support good clinical practice. The Patient

Dashboard which is being made available free

to all Network members is one such tool.

The new Clinical Governance Committee will

play a crucial role in identifying and addressing

clinical quality and patient safety issues across

the Network, drawing on the skills of the

diverse multidisciplinary membership of the

committee.

We will continue to support the Network

members seeking to achieve practice

accreditation.

Through our on-going commitment to training

and workforce development, we will ensure

our practice members can access the support

they need to get the maximum benefit from

these decision support tools.

Te Awakairangi practices continue to have

higher patient to GP ratios than the national

average, and slightly higher patient to practice

nurse ratios than the national average.

We will support practices wanting to expand

the number of general practitioners and/or

nurses they have. In the first instance, we will

do this by promoting the Hutt Valley as a good

place to live and work.

In 2013/14, we will continue to work with

practice members who want our assistance to

address sustainability issues. This may include

advice on business planning and potential

practice consolidation.

Our practice support will also continue involve

advocating on our Network members behalf at

a local, regional and national level.

Long Term Conditions In 2013/14, we will work with Hutt Valley DHB

and our practice members to explore how the

various funding streams available to support

the management of long term conditions and

Care Plus can be used more flexibly.

This will be a critical piece of work for the

future given our ageing population,

particularly those aged 75 years and over, and

the need to manage increasingly complex and

unwell people in the community.

This will involve work with Hutt INC on patient

pathways and the most appropriate way of

delivering care to people, including how we

support people to manage their own health

better. It will also involve more emphasis on

prevention and early intervention.

In exploring how we can make a positive

difference in people’s lives, we will be

improving our CVD risk assessment rates, our

diabetes care, and the number of smoking

cessation interventions being delivered across

our Network.


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17 | P a g e

“We want to support our Network

members to achieve our PHO

performance targets in 2013/14.”

Our Strategic Relationships We already have a strong working relationship

with Hutt Valley DHB and with other PHOs in

the Greater Wellington region.

In 2013/14, we will continue to reshape local

health services through our participation in the

local Alliance Leadership Team known as Hutt

INC (Hutt Integrated Network of Care) .

Hutt INC is focused on better integration using

a whole-of-system approach. This involves

work on new ways of delivering value: new

models of care; more wrap-around services;

new use of workforce; more services in

community settings; shifts in the funding for

long term conditions; new information

systems with clinicians accessing shared views

of patient information; and continuing the

emphasis on value-for-money and achieving

efficiencies.

We expect this work will deliver better

outcomes for the Hutt Valley population, with

fewer hospitalisations for preventable

conditions such as cellulitis, gastroenteritis,

and respiratory conditions; improving access

to elective surgery and diagnostic services; and

more integrated services for people with

complex conditions. We also expect that this

work will improve the systems that support

clinicians (e.g clinical pathways and and

information systems) and make better use of

the resources available within the Hutt Valley.

In 2013/14, we will build further on these

strategic relationships. In prioritising what

joint activity we will become involved in, we

will be guided by what will most benefit the

health and wellbeing of our population and

what will best assist our Network members to

succeed.


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18 | P a g e

Financial Statements

(available on request)


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Te Awakairangi Health Network

Six Monthly Report to Hutt Valley DHB

(Period: 1 July 2013 to 31 December 2013)

January 2014


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TABLE OF CONTENTS

1. Executive Summary ......................................................................................................................... 4

2. Our Context ..................................................................................................................................... 7

3. Programmes................................................................................................................................... 11

Long Term Conditions Coordination ........................................................................................... 11

Cardiovascular Risk Assessment Programme ............................................................................. 11

Diabetes Care Improvement Programme (DCIP) ........................................................................ 16

Tu Kotahi Asthma Service ........................................................................................................... 19

Abc Smoking Cessation Programme ........................................................................................... 21

Cervical Screening Programme ................................................................................................... 23

Immunisation Support ................................................................................................................ 24

Care Plus ..................................................................................................................................... 26

Clinical Pharmacy Services .......................................................................................................... 27

PHO Performance Programme ................................................................................................... 31

4. Services .......................................................................................................................................... 33

Outreach Nursing ................................................................................................................................... 33

Community Health Workers ................................................................................................................. 43

Primary Mental Health .......................................................................................................................... 52

Health Promotion ................................................................................................................................... 58

Dietitians .................................................................................................................................................. 65

Healthy Families Coach .......................................................................................................................... 69

Transport Service .................................................................................................................................... 73

Language Line.......................................................................................................................................... 75

5. Practice Support ............................................................................................................................ 76

Practice Liaison And Support ................................................................................................................ 76

Quality Improvement ............................................................................................................................. 77

Workforce Development And Liaison.................................................................................................. 78

Primary Nurses Reference Group ........................................................................................................ 79


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EXECUTIVE SUMMARY

This report outlines the activities of Te Awakairangi Health Network for the July to December 2013 period. It

reports on achievements and service provision, and outlines key issues and risks, across the services and

programmes delivered by Te Awakairangi staff and contracted practices and providers. It has been prepared to

provide information to the Board of Te Awakairangi Health Network (TeAHN) and Hutt Valley DHB.

This six month period has been one of growth and development, with skilled and experienced teams now in

place across the organisation with a consolidated strategy to guide their work arising from work by the Board to

confirm its strategic direction. The alliancing approach is building momentum with Hutt INC providing a key

forum for shared planning, the development of a consolidated work programme and establishment of a number

of key projects. These include a Primary Care Sustainability initiative, an Information Systems (shared electronic

health record) project, an Acute Demand workstream and a unified planning process to support the

development of the annual plans. Hutt INC is also linked into a number of 3D initiatives including Health

Pathways which is expected to lead to a number of clinically focussed projects aimed at streamlining the referral

and management of people with common conditions. TeAHN is actively engaged in these projects, working

closely with counterparts in other PHOs with the aim of developing a locally relevant but regionally consistent

approach to service delivery.

ACHIEVEMENTS

Some notable outcomes for the July to December 2013 period include:

TeAHN staff are now actively involved in a number of the work streams flowing out from Hutt INC,

including the new Primary Care Sustainability Initiative, Information Systems, Medications

Management, Acute Demand and Health Pathways;

TeAHN continues to perform well with childhood immunisations, being amongst the top in the

country for both the 8 month and 2 year old targets;

There have been significant improvements in performance against the other two health targets, with

CVD risk assessments rising from 44 % at June 2013 to 58% at December 2013, and brief advice for

smoking cessation rising from 50% at June 2013 to 63% at December 2014;

TeAHN’s programme team, working with DHB and SIDU partners, have prepared and agreed a service

implementation plan outlining the approach to investing the additional MoH funding (close to

$500,000 over four years) made available for “More Heart and Diabetes Checks”. The plan includes

business proposals being developed for every practice, based on the number of people still to be

screened. This has been well received by practices;

Utilising some of the funding made available through the “More Heart and Diabetes Checks” we have

commenced an evaluation of BPAC’s decision support tools. These will provide timely data feeds to

practices and TeAHN on a range of the health indicators as well as offering a range of clinical

templates to facilitate diabetes checks and long term condition management;

Our Clinical Advisory Pharmacists have completed a round of visits to practices delivering topics on

non-steroidal anti-inflammatories and a number of new therapeutic agents;

Our Care Plus enrolments have dropped off slightly toward the end of the period after a surge earlier

in the year. We are expecting to undertake a review of our long term conditions management during

2014 that will include the allocation of Care Plus funding.

The outreach nursing team were joined by another experienced team member. Talesha Sculley brings

a wealth of acute and community skills to the team, fresh from a period working with boat people

being housed on Christmas Island. Across the Network, the Outreach Nurses and Integrated Case


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5 | P a g e

Management Nurses carried a caseload of at least 130 patients per month, and provided over 1250

contacts and 3400 services in the six month period;

Across the Network, Community Health Workers carried an average caseload of 134 patients per

month, and provided a total of 1562 contacts and 5140 services covering a wide range of services

(including case management, education and support, phone calls, follow up visits and contacting

other agencies);

The primary mental health team provided 6343 services to more than 1000 unique individuals in this

period (including client sessions and face-to-face contacts) , slightly up on the last period;

The dietician service looked after an average caseload of 116 patients per month and provided 1535

contacts in the period, up around 500 on the last period with a significant number of these over the

July to August period. The team engaged in specialised training to improve their expertise in dealing

with “food addiction” and in cognitive behaviour therapy to assist people in modifying their lifestyles;

Over July to December period, the Healthy Families Coach service made 1496 contacts with patients,

seeing them in their homes, at Te Awakairangi Health Network, at their GP practice or in the gym.

Patient caseloads have continued to increase , this period up to an average of 130 patients at any one

time, reflecting the increased capacity in the team;

The health promotion team have continued to run programmes (Heart Check health promotion, the

Good Food Programme, the Valley Fit Programme) and support groups, and participate in many

community projects and events;

The health promotion team has worked closely with the clinical facilitation team over the past 6

months on raising the profile of cardiovascular risk assessments and heart health. See the

Cardiovascular Risk Assessment section of the report for information about the various community

and practice based activities. They completed three Good Food programmes during the period.

TeAHN are a partner in Health 4 Life, a joint project of Regional Public Health (RPH), Service Integration

and Development Unit (SIDU) of Capital and Coast DHB, Hutt Valley DHB and Wairarapa DHB; Te

Awakairangi Health Network; and Compass Health. Health 4 Life is an early intervention programme

aimed at improving nutrition and physical activity in the pre-school population starting in pregnancy. It

requires participation across a wide range of providers who deliver services to women during pregnancy

and infants in their first year of life;

During the July to December period, the transport service funded 741 trips by 280 unique patients. The

proportion of trips to secondary care rose to 60% (443) with the remaining 40% (298) to primary care

appointments;

Workforce Development has continued with TeAHN formally taking over the role of CME provider

from GP Services. A CME committee has been established to oversee this work, and a framework

established for the activities in 2014. An interim nurse professional education calendar has been

released which has a stronger emphasis on the use of online learning and topics that have been

requested by practices nurses or been identified through a needs assessment/gap analysis.

ISSUES AND RISKS

We are concerned that:

Care Plus is not being well targeted and requires review but we are recognise this needs to be done in

the context of a wider review of long term condition management. We have been constrained by

limited staff resources but expect to be able to address this in the first half of 2014;

The uptake of Diabetes Care Improvement Plan (DCIP) has remained a challenge and the MOH have

now announced more funding to support the extension of self-management programmes and

professional education. Although there been improvements in our systems to make it easier to record

assessments as they occur, we are still not seeing a systematic embedding of diabetes annual reviews

across our network;


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6 | P a g e

We remain concerned at the gaps in community mental health services for people discharged from

secondary care and we are continuing to work with our DHB colleagues to identify solutions. The

primary mental health service continues to target the priority referral groups, but there have been

challenges in establishing contact, impacts on volumes of contacts and an increase in the DNA rates for

a group of clients with multiple stresses and more chaotic lives. The situation is being monitored and

we are proactively working to reduce barriers to high needs clients.

NEXT STEPS

The Network is rising to the challenge and the opportunity of demonstrating to its key stakeholders (our

population, our practices and providers, and Hutt Valley DHB and other funders) how we add value in all our

activities. The priorities for 2013/14 are:

Building capacity and capability in primary care, with a special focus on practice sustainability, business

models, and workforce development;

Performing well, continuing to deliver excellent services across the Network and achieving Health

Targets and PPP indicators. While we are making good progress on the CVDRA and Smoking Cessation

targets, it is proving an ongoing challenge to lift the number of diabetes reviews and overall uptake of

the DCIP. We recognise this may require a shift in mindset and to this end, we are working to introduce

training aimed at encouraging nurses to work to the top of their scope, and empowering them to take

a greater lead in managing people with diabetes. At the same time, the new funding from the MOH is

seen as a potential game changer, to support practices to cross the threshold of 90% CVDRA,

embedding these assessments as part of their day to day work;

Innovating, with a special focus on integrating the wide range of services and programmes within the

current TeAHN responsibilities and in conjunction with more DHB services. We will continue to be very

actively involved with the new alliance leadership team, Hutt INC, exploring new opportunities

especially for managing Long Term Conditions, reducing avoidable hospitalisations and addressing

acute care;

Enabling, working to equip our clinicians with skills, tools and systems that help them manage their

risks, deliver better care and keep a track of people in their practice who are at greater risk. Examples

include implementing new decision support tools aimed at making it easy to do the right thing at the

right time.


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OUR CONTEXT

WHO WE ARE

Te Awakairangi Health Network (TeAHN) was established on 1 July 2012 bringing together the programmes,

activities and provider members of four former Primary Health Organisations (PHOs): Piki te Ora ki te

Awakairangi, Valley PHO, Family Care PHO and Tamaiti Whangai PHO, and the management services

organisation, Kowhai Health Trust. It has an enrolled population of more than 117,000 people and includes 23

member practices within the Hutt Valley.

The practices are based in communities across the Valley and include some serving high needs areas, along with

other city based practices with less high need populations. We have three large multi partner/doctor practices,

a number of solo doctor practices and most with 3-5 doctors. There are a number of business models operating

within this cluster of practices ranging from not-for-profit Trust based entities through to large commercially

focussed, shareholder owned practices.

One of our key challenges for 2013/14 is supporting the positive development of these practices, aiming to

strengthen and extend their capacity as the system increasingly looks to primary care for an expanding range of

services. A key contribution is likely to be around helping them explore new models of care, providing stability

and certainty of revenue (as far as this is possible) and investing in clinical leadership that is sensitive to the

pressures these teams face yet able to inspire and support change.

OUR PEOPLE

The Network works with its 23 member practices and a range of community provider organisations across the

Hutt Valley. On a daily basis TeAHN is working with practice teams to both support their delivery of front line

services as well as providing a number of direct patient services ourselves in areas such as our Wellbeing Service

(primary mental health), Outreach Nursing and Community Health Worker Services.

OUR REGION

A series of changes occurred in 2012/13 within the sub-region with the establishment of the Service Integration

and Development Unit (SIDU) across three DHBs, and the merger of the Executive teams of Wairarapa and Hutt

Valley DHBs. These changes have affected a number of the DHB teams we interact with, but the new teams are

now settling down and engagement is improving.

TeAHN practices have been generally stable within the July to December 2013 period. Hutt City Health Centre is

now running one practice across their two sites (in central Hutt and Wainuiomata) and will be moving to new

premises early in 2014. Three practices prepared proposals to access additional Very Low Cost Access (VLCA)

funding. One (HUCHS) was successful in attracting funding for a New Entrant to Practice (NETP) nurse under the

VLCA scheme. We expect all three to receive the additional ongoing funding, as agreed with Hutt Valley DHB in

the proposals.

The primary care sustainability project (mandated by Hutt INC and funded by the MoH) is now underway. This

project will support a range of discussions between primary and secondary clinicians re sustainability, and will

support practices exploring opportunities around co-location and establishing closer working arrangements.

TeAHN has continued building its linkages with local government in the Hutt Valley, supporting new migrant

seminars run by Hutt City Council, and participating in regular meetings of health and community agencies,

hosted by the Upper Hutt City Council. TeAHN has maintained its connections with the two Whanau Ora

providers within the Hutt Valley and the Maori Health Service Development Group of Hutt Valley DHB.


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ENROLLED POPULATION

REGISTER AND CLAIMS MANAGEMENT

As at 31 December 2013, TeAHN had 116,870 funded patients. The difference between submitted and funded

patients was 2213. This number has increased over a couple of quarters so there needs to be some work done

with practices to help them tidy up their registers.

All of TeAHN practices are either participating in the free under 6 contract or are receiving Very Low Cost Access

funding.

Oct to Dec 2013 Karo Data

As at 31 December 2013, Te Awakairangi Health has 43,240 (37%) enrolled people who are Māori, Pacific, and/or

Quintile 5 (i.e. high needs). There is no change in the percentage from the previous report.

11

71

74

11

72

69

11

73

38

11

72

03

11

68

91

11

68

70

116600

116700

116800

116900

117000

117100

117200

117300

117400

Q112/13

Q212/13

Q312/13

Q412/13

Q113/14

Q213/14

Funded

19

24

16

95

16

12 18

64 21

73

22

13

0

500

1000

1500

2000

2500

Q112/13

Q212/13

Q312/13

Q412/13

Q113/14

Q213/14

Not Funded

Maori17%

Pacific9%

Q5 - Non-Maori Pacific11%

Non-LCAF63%

Distribution of Patients by LCAF Criteria Te Awakairangi


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9 | P a g e

Oct to Dec 13 Karo data

Eight practices have a high needs population percentage of greater than 40% and one practice has 87% of its

enrolled population falling into the high needs category.

GENERAL PRACTICE WORKFORCE

FTE figures from TeAHN Provider Lists as at 20 November 2013. National averages are taken from

www.healthypractice.co.nz correct as at January 2013.

Period Enrolled

Population

GP FTE Nurse FTE

1 Jul to 31 Dec 116,870 63.9 59.4

Period Ratio of GPs to Enrolled

Population

Ratio of Nurses to Enrolled Population

1 Jul to 31 Dec 1:1829 1:1967

Te Awakairangi practices continue to have significantly higher patient to GP ratios (with 1828 patients per GP

FTE) than the national average (1708 patients per GP FTE). Note: As part of our work on practice sustainability,

we have reviewed the data collection for workforce numbers. Previous analyses may have underestimated the

number of GP FTEs in the Hutt Valley.

Te Awakairangi practices have increased the number of nursing FTE over the last six months, leading to a

decrease in the patient to practice nurse ratios. TeAHN now has a lower patient to nurse ratio than the national

average.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

m t v n x o c p d q j k e r h s a l b g w y u f

Percentage of High Needs Patients across Te Awakairangi HealthGeneral Practices Oct to Dec 13


80

http://www.healthypractice.co.nz/

10 | P a g e

Data is from Provider Lists at 20 Nov 13, Karo and Healthy Practice Subscriber Analysis Report Jul 13

2184 22151828

1715 1708

0

500

1000

1500

2000

2500

12/13 Q3 12/13 Q4 13/14 Q1 13/14 Q2

Ratio of Patients to GPs

TeAwakairangi Health Network National Average

2208 22071967

21932166

2166

0

500

1000

1500

2000

2500

12/13 Q3 12/13 Q4 13/14 Q1 13/14 Q2

Ratio of Patients to Nurses

TeAwakairangi Health Network National Average


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PROGRAMMES

LONG TERM CONDITIONS COORDINATION

To provide and facilitate a coordinated approach to long term condition management to the enrolled population

of Te Awakairangi Health Network with a focus on preventing additional co-morbidities.

To assist practices to support their high need populations with long term conditions within the primary care

setting and assist the uptake and coordination of existing programmes.

KEY ACTIVITIES

TeAHN has commenced work to identify a preferred provider for clinical decision support tools.

BPAC has been identified and we have started to pilot their systems in a number of practices. This is

intended to provide practices with a new set of tools to assist in the management of long term

conditions.

A revised advanced form has been installed in all TeAHN practices to support the Diabetes Care

Improvement Programme (DCIP) and enable more streamlined data capture, reporting and payments.

TeAHN attended a National Diabetes strategy workshop in Auckland in early December at which the

concept of a revised approach to long term conditions, commencing with a revised DCIP was

discussed.

We have agreed a new data template to underpin the agreement we have with Tu Kotahi for work on

respiratory conditions. They have embarked on a major upgrade of their data systems to enable this

and other reporting.

Work in the dementia pathway is now well underway.

TeAHN has completed a review of its Continuing Medical Education (CME) strategy and appointed a

CME Advisory Group to oversee the selection, development and delivery of topics. We expect to see

a number of LTC related topics presented during 2014.

The work of our Clinical Advisory Pharmacists continues to focus on Long Term Condition

management as they visit practices and work with pharmacy teams to promote best practice.

CARDIOVASCULAR RISK ASSESSMENT PROGRAMME

The aim of the TeAHN Cardiovascular Disease Risk Assessment (CVDRA) Programme is to increase the rates of

cardiovascular risk screening and management for Hutt Valley people, particularly those identified as being at

higher risk ( Māori, Pacific, Indo-Asian people and/or people living in Quintile 5 areas, referred to as “high

needs”).

PROGRESS THIS PERIOD

The overall eligible total population for the CVDRA programme is 34,072 (composed of High Needs population

of 12,227 and ‘Other’ population of 21,845). Provisional data indicates that cumulatively (to the end of

December 2013) 58.3 % of the Total Population of TeAHN who are eligible have received a CVR assessment.

This means that TeAHN has met the MOH target of 58% for December 2013.

TeAHN has done even better for the High Needs population, achieving 65.2% uptake. TeAHN has therefore met

its PPP targets for the High Needs (62.9%) and Total Population (53.9%) indicator for the 2013 year.


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There have been some significant highlights in this reporting period:

In December the Network achieved a record 494 target CVDRAs in one week

Soma Medical Centre became the first TeAHN practice to screen 90% of its eligible population for

CVDRA

Patient Dashboard was introduced to TeAHN practices in June 2013, and was fully implemented in the

first quarter of 2013/14. The tool has helped to increase the number of opportunistic CVDRAs and

ensure that they are recorded correctly.

There has been a significant increase in CVDRAs in all TeAHN practices in the last six months which is attributed

to initiatives in the Indicator Improvement Plan and a customised approach with each of the practices. The key

initiatives in the last six months have included:

1. In August TeAHN hosted Buck Shelford (Patron of the ‘More Heart and Diabetes Checks’ national

programme) for a day to promote CVDRA to the Hutt Valley community, workplaces and medical

practices. This helped raise the profile of the importance of CVDRA and received significant media

coverage including an article on Maori TV. Many of our larger workplaces held their own heart health

promotional events. A follow up visit from Buck is being planned for early 2014.


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Buck Shelford visits the workers at Pak’n’Save Petone as part of their workplace heart promotion week

2. TeAHN has invested considerable time and energy into the marketing and promotion of the importance

of CVDRA for health and well-being. This includes press releases, Facebook promotions, local radio,

workplace promotions and community events. The whole of July/August 2013 was dedicated to CVDRA

promotions in the community and promotions were set up in all TeAHN practices. TeAHN also worked

closely with the Health Promotion Agency and used their resources in local promotions.

Mayor Ray Wallace and Scribe get their hearts checked by Harley Rogers at the Taita Polynesian festival

3. TeAHN has made significant improvements to the training of staff in TeAHN practices around CVDRA.

In conjunction with the Heart Foundation, TeAHN developed and ran both basic and advanced training

for nurses on CVDRA. This included improving skills in using the Predict decision support tool to

accurately record and manage CVDRA. Advanced training has been provided on giving lifestyle advice

and education in a CVDRA consultation as well as referring patients to TeAHN wellness programmes.

4. Each week the practice with the most CVDRAs completed that week has received an award and

recognition as the leading practice. This has created a competitive spirit amongst the practices and has

been a very effective incentive to improve and maintain performance.


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The staff at Stokes Valley Medical Centre receive the weekly CVDRA award

5. TeAHN has continued a customised approach with all TeAHN medical practices to meet the specific

needs of the practice population and health providers. Practices in the past which have had little

increase in CVDRA are now beginning to catch up to their peers with close support from the Clinical

Programme Facilitators.

Kopata Medical Centre staff and their CVDRA practice promotion during the Christmas period

6. TeAHN has created a voucher for high needs people eligible for a free CVDRA and promoted these

vouchers widely via workplaces, health professionals and community events. This voucher has helped

to reach significant numbers of high needs patients and raised awareness in the Hutt Valley.


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Sample of our Free Heart Check voucher

%CVDRAs per practice-half year comparison

NEXT STEPS

Based on the impressive performance of practices over the past six months, TeAHN is confident that the plan

developed to achieve 75% by June 2014 and 90% by June 2015 (as agreed with the DHB) will be effective.

The recent additional funding being provided by the Ministry of Health will allow TeAHN to provide subsidised

CVDRA to more of the eligible population (people in Quintiles 3 and 4) and assist the practices to establish

0%

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a b d e f g h i j k l m n o p q r s t u v w x y

Results Sep to Jul 13 Results Oct to Dec 13


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systems that will enable them to both reach and sustain the gains being made. TeAHN has developed a new

service delivery model to guide the use of the additional Ministry funding and achieve the agreed targets in

2014/15. There are six key strategies within this model:

1 .Improved access to testing equipment

2. Building strategic partnerships and capacity with other providers of CVDRA

3. Continuing to develop the workforce providing CVDRA

4. Supporting practices with resources such as additional nursing

5. Building a sustainable business case for each practice to be involved in CVD risk assessment and

management

6. Creating effective partnerships with secondary health care

The ultimate aim is still to embed CVDRA into all of the practices as an established programme with a reducing

reliance on additional funding over the next four years.

Taking every opportunity to promote heart checks we have decorated our floor windows for all to see

DIABETES CARE IMPROVEMENT PROGRAMME (DCIP)

The Diabetes Care Improvement Programme has a particular focus on high need population groups

including Maori, Pacific and people living in Quintile Four and Five areas. This programme commenced

on 1 October 2012 at all Te Awakairangi Health Network practices.


Under the Diabetes Care Improvement Plan, TeAHN has undertaken a range of initiatives in the July

to December 2013 period:


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In December TeAHN reviewed and reconfigured its nurse professional development courses

and set a new programme and timetable for 2014. Significant changes have been made to

diabetes training with the introduction of advanced workshops to increase skill level. These

include retinopathy, pharmacy and insulin initiation, foot screening, early nephropathy, care

for Maori and Pacific peoples and health promotion. An advanced half day workshop for cardiac

condition management has also been created.

Plans are in place to increase the use of online training in the Network with the introduction of

the diabetes online training module. All Network nurses will be encouraged to complete this

training to supplement a one day diabetes introductory course.

The Patient Dashboard Tool was introduced to practices in June 2013. Dashboard prompts the

practice team to complete the diabetes review, makes it easy to complete opportunistically

and then automatically files the data in the correct screening table. This will help provide a

more accurate picture of how many reviews are occurring and ensure the work practices

complete is reflected in their records.

A new Medtech based Diabetes Annual Review form was introduced into practices in

November and provides a much more comprehensive record and review process. The new

review form contains a full cardiovascular risk assessment, automated linked referrals for

health services and expanded examination sections including a more comprehensive foot

assessment. The previous review form will be removed from Medtech in February 2014 as user

training is completed and the form is adopted by the Network.

Together with the HVDHB Diabetes Team, we have identified and mentored four nurses in the

Network who have a high level of diabetes knowledge, skills and experience. TeAHN plans to

expand this number of highly skilled nurses to 12 by the end of the year through training,

mentoring and support.

Diabetes Annual Reviews

The number of Diabetes Annual Reviews in the last two quarters has remained fairly consistent. At

December 2013, TeAHN had not achieved its PPP target for the total population group (with 71.1%

achieved compared to a target of 84.3%). TeAHN also did not achieve its PPP target for the high needs

group although the gap was much smaller (with 76% achieved compared to a target of 79.4%).

TeAHN will continue to promote diabetes annual reviews (as per our Practice Indicator Improvement

Plan) and practices are now well aware of their targets and progress. In addition we plan to undertake

the following activities in 2014 to increase the number of annual reviews:


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There will be a special focus on the practices which are not meeting their targets for diabetes

annual reviews and we will customize an improvement plan together with each practice and

its clinicians.

We will provide practices with assistance to invite patients overdue for an annual review

including a text reminder campaign. Strategies such as booking the patient for their next annual

review at the end of their current review may be effective.

We are developing a programme to improve the self–management of diabetes by our network

patients. This strategy will help to engage our patients with diabetes about the importance of

annual reviews and encourage them to be proactive so that they drive demand themselves.

We will develop an education programme for General Practitioners to reinforce the importance

of diabetes annual reviews.

Alongside the introduction of the Patient Dashboard Tool to practices in June 2013, TeAHN is now

planning to implement the BPAC Best Practice Intelligence system to improve the delivery, recording

and reporting of clinical programmes. These tools, along with other activities outlined above, will

assist us to increase the number of Diabetes Annual reviews in 2014.

Nurse education sessions

Nurse education sessions continue to increase compared to the same period last year but are still

below the target level. TeAHN will be providing new advanced skills workshops for Network nurses to

improve their confidence and ability to provide more nurse education sessions in the future.

Podiatry

Podiatry services remain unchanged from those previously provided in the Hutt Valley. This service

is however volume constrained and there is evidence of unmet need in this area, partly due to the

fact that many patients require ongoing podiatry input and so tend to remain on the programme.

A new Comprehensive Foot Assessment and an At Risk Foot Care Pathway has been developed which

will see improved screening provided in primary care.

In conjunction with the DHB Podiatry Services team a plan is being created to streamline the referral

process for podiatry, aiming to reduce the waiting time for patients and freeing up the HVDHB podiatry

service to focus on more serious podiatry cases.


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NEXT STEPS

New funding recently announced by the Minister will provide some transitional support to assist with

the establishment of more nurse-led diabetes clinics within practices, with a key focus around

enhanced patient self-management within a sustainable model of care. Part of this funding will go

towards improving the skills and training of practice nurses over and above what is already provided,

including the new training programme of advanced diabetes skills modules.

These include:

Insulin Initiation

The new foot care pathway

Retinopathy

Nephropathy

Engaging high risk populations

Promoting health in a primary care setting

There should be a corresponding increase in both the number of annual reviews and nurse education

sessions following this training programme.

TU KOTAHI ASTHMA SERVICE

Tu Kotahi Maori Asthma Trust aims to improve the quality of life of those with asthma through improved

understanding of respiratory illnesses, management, education and support. Tu Kotahi focuses specifically on

the PHO populations with asthma and respiratory conditions and their whanau including those with a new

diagnosis of asthma and those with poor asthma control, primarily Maori, Pacific Island and low income whanau.

Clients can be visited at home to help manage their asthma until they have developed independence in their own

asthma management. Management plans are personalised to each client.

This section relates to a service that is contracted by Te Awakairangi Health Network for the provision of asthma

services to our high need population. This section is drawn from a detailed quarterly report provided by the

team at Tu Kotahi Asthma Trust.

Following detailed discussions between TeAHN and Tu Kotahi Asthma Trust, agreement has been reached on

the implementation of a new data reporting capability aimed at improving the level of data related to activities

they undertake under this agreement. The implementation of these changes has meant the quantitative data

is not available for this report, at this time. As part of these negotiations Tu Kotahi has developed and very

recently implemented a research quality database written in Microsoft Access specific to Tu Kotahi’s data

capture requirements. We expect to see a much more accurate set of data reported from this provider going

forward as they refocus the data collection to better report on the contract obligations.

KEY ACTIVITIES

WAINUIOMATA HIGH SCHOOL CLINIC

The school clinic has successfully been running once a month during the school year. Students are able to book

an appointment at the student services. Education is provided to students individually or in groups. Feedback

from staff, teachers and parents of the students continues to be very positive.


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Because of the complex needs of teenagers an asthma kit has been developed aimed specifically for teens.

Students participated in the development of the teen kits. The education booklet includes whanau goals that

will complement the other resources given to the student at each monthly appointment.

Benefits of the school based asthma clinic and teen asthma pack:

The clinic is based where the students are.

Supports students by providing a safe place to talk about sensitive issues that may be interfering with their ability to take care of their health.

Supports the school environment by helping student’s attendance and by identifying and addressing health problems that may intervene in the learning process.

Since there are less sick days it supports families by allowing parents to stay at work.

Saves money by keeping children out of hospitals and emergency rooms

If asthma is well managed it is more likely that students will be able to take part in physical activities.

Teaches students to be better health care consumers. Parents are informed of their child’s progress. A consent form must be signed by a parent or guardian if

Rangatahi are under the age of 18.

WAINUIOMATA COMMUNITY CENTRE CLINIC

The free monthly asthma clinic at Wainuiomata Community Centre continues to operate. Wainuiomata

Community Centre has a variety of services available free to their community, including internet and computer

services, Y-Nui youth group, Nui FM, budget advice and Kokiri Marae health and social services. Clients can

access spirometry tests, asthma management plans, asthma education, healthy housing home visits, advocacy

support letters to WINZ and GPs and accompany whanau to appointments. Whanau can either book an

appointment at the community centre or walk in. Clinic services are advertised on the local radio station and in

the local newspaper.

HEALTH SKIN PROGRAMME MEMBERSHIP

A Healthy Skin Focus Group meets every three months. These meetings include a variety of topics around skin

disorders, medications, guest speakers and case studies. As a member, Tu Kotahi Maori Asthma Trust receives

weekly healthy skin updates from Regional Public Health.

There is a lot of research that links asthma and eczema. Both are inflammatory disorders, an allergic reaction

occurring when the body's immune system overreacts to substances that are usually not harmful. These include

allergens that are the same as asthma allergens such as dust mites, pollen, animal dander and certain foods.

Our clients with asthma usually also have eczema and atopic dermatitis. Being part of this focus group enabled

the service to link up with agencies such as Work and Income who provide additional support in relation to skin

disorders e.g. financial support around:

Household items (bedding, towels, bleach, washing machine, vacuum cleaner)

Living environment (pet treatments, pest services)

Medical supplies (skin care products, dressings, prescription costs).

PRESENTATION TO OSCAR HOUSE

Oscar House provide after school and before school care for children ages 5-13 years old. They have 6 providers

in the Lower Hutt area. Oscar House invited Tu Kotahi to do a two hour presentation to their staff and parents.

22 staff and parents attended the presentation.

Topics presented included:

Asthma

Triggers

Signs and symptoms

Asthma medication.


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A question and answer session was included as well as instruction on using emergency asthma kits with a role

play.

TU KOTAHI PEER NURSE HUI

Continued attendance at a monthly hui to share and discuss research articles and debrief about nursing matters

with in our service.

STATISTICS

As outlined although the service is operating as usual the statistics have not been reported. The data is being

collected through a new programme and is only just being implemented

ABC SMOKING CESSATION PROGRAMME

TeAHN is committed to helping make New Zealand smokefree by 2025. The TeAHN ABC Smoking Cessation Programme aims to decrease smoking prevalence in the Hutt Valley, by encouraging all primary health practitioners to offer brief advice and cessation support to smokers at every consultation.


Supporting the delivery and recording of brief advice and cessation support has been a key focus for TeAHN over the previous six months. This focus has resulted in a significant improvement in the brief advice indicator as illustrated below. TeAHN has improved its placing from 32nd place (of 35 PHOs) at September 2012 to 17th place at September 2013.

Karo data

Provisional results for Quarter 2 2013/14 have just been received. Smoking status ever recorded for the Total Population was 84% at September 2013 and 86% at December 2013, an improvement from the same time last year. The delivery and recording of brief advice for the Total Population was at 64% at September 2013 and is estimated to be at a similar level (63%) at December 2013. This is a significant improvement (greater than 30%) from the same time last year.


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While the improvement over the past year is pleasing, TeAHN recognises that continued effort and innovation is needed to reach the national Health Target of 90% for brief advice. The Indicator Strategy Group (comprising key Te Awakairangi staff and the DHB Smokefree Coordinator) continues to meet fortnightly to progress work detailed in the ABC Smoking Cessation Plan. In early 2014, work is focussing on a new initiative where practices with high numbers of smokers offer patients cessation support over the New Year period by sending text messages to current smokers.

SYSTEM IMPROVEMENTS

The installation off Patient Dashboard in all practices has supported practice staff to obtain smoking status for more patients and prompted the delivery and recording of more brief advice conversations. Additional nurse resource was provided to many practices to identify patients with no smoking status recorded

but who had mention of smoking in the PMS. Lists were generated and updated in several practices.

BRIEF ADVICE

A key focus in the reporting period has been the completion of the ABC Brief Advice Project. This project aimed to highlight the importance of increasing the delivery and recording of brief advice as part of everyday general practice. In acknowledgement of the brief advice ‘catch up’ required to progress towards meeting the primary care tobacco target, TeAHN supported practices to contact a large number of smokers and offer brief advice and cessation support over the telephone. Practices chose whether to contact smokers by phone or to work with Quitline who contacted smokers on behalf of practices. Seven practices opted for the Quitline provision, one practice worked with Aukati Kaipaipa to contact smokers and all other practices contacted smokers themselves. Quitline contacted 684 smokers as part of the Brief Advice project, and of these, 107 have been referred on to cessation support. Also as a result of this project, TeAHN had its first practice reach the 90% target for Brief Advice. Over December 2013, TeAHN worked with nine practices who have the highest proportion of smokers in their practice population. In recognition of the greater challenge faced by these practices to reach the 90% target, TeAHN will work these practices to offer patients cessation support over the New Year period by sending text messages to current smokers.

A poster resource was developed to show the financial benefits of quitting smoking and to highlight the 2014 tobacco price increases. The poster which has been shared with all practices with the wider Smokefree Network around New Zealand has received a lot of positive feedback.

ABC TRAINING

Nineteen of the total 25 practice sites have at least one nurse who is ABC trained. In the instance where a practice does not have any Quit Card providers, this issue is given priority in discussions with practices.

Ongoing ABC updates and training opportunities have been well promoted. Training options include monthly training held at the DHB, in-practice updates and online e-training.

TeAHN worked with the Heart Foundation and DHB Smokefree Coordinator to run two ‘Lighting the Fire’ training sessions, one in the afternoon, and one in the evening, to optimise access. The training was offered to all nurses and midwives in the Hutt Valley. The sessions aimed to motivate staff to intervene with every smoker with enthusiasm and conviction, and to ensure staff were confident with the provision of NRT and referring to support provider/s. Lighting the Fire training was attended by 12 nurses, 4 midwives and 2 community health workers.


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SMOKING INNOVATION PROJECT

TeAHN is partnering with Otago University on the ‘Taking the Best NRT Direct to Smokers’ project. Two additional health promoters will be employed fixed term to work on the project. They will be based at the TeAHN offices and Queensgate Shopping Centre.

CERVICAL SCREENING PROGRAMME

The National Cervical Screening Programme goal is that 75% or more of enrolled women 20 to 69 years have received a cervical smear in the past three years. Te AHN has a local initiative to increase the rates of Cervical Screening for Hutt Valley women in the ‘high needs’ population, (i.e. Māori, Pacific and low income), by removing the cost barrier, and promoting women’s health in the target population. The programme encouraging practices to focus on women’s health and increases the workforce able to provide cervical screening by providing training and refreshers.


TeAHN continues to maintain strong links with the practices, to ensure that all eligible women receive a cervical

smear.

The preliminary DHBSS performance report for the period 1 July 2013 to 31 December 2013 (drawing on the

National Cervical Screening Programme data) shows that TeAHN has achieved 73.56% for the Total Population

which is better than the target (71%) but is still short of the programme goal of 75%. The Hutt Valley has achieved

68.36% for High Need which is also better than the target (67%). These figures are similar to those in the

previous reporting period.

To support the national programme and the target for High Needs women, Te AHN funds free smears for priority

women (Maori, Pacific and low income). TeAHN also promotes the free smears by the use of vouchers.

In the July to December 2013 period, a total of 954 funded cervical smears were carried out. This was a 15%

increase from the 832 carried out in the January to June 2013 period.

The breakdown for women receiving funded smears was:

• 388 were Māori

• 173 were Pacific

• 274 were Quintile 5 and not Maori or Pacific

119 demonstrated exceptional circumstances.

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

Total 127 134 113 114 134 210 154 151 134 173 187 155

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Number of funded Cervical Smears 2013

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TeAHN has also made funding available for nurses wanting to complete the smear takers training course.

Annually TeAHN funds the training of three primary care nurses. The funding is advertised periodically

depending on the uptake and there is criteria applied by TeAHN to ensure we can support the areas where

practices have the highest need e.g where there is no female smear taker.

PROMOTING UPTAKE OF SCREENING

TeAHN recently partnered with Mana Wahine and Regional Screening Service to run a Wahine Ora Breast and

Cervical Screening event. The October 2013 event involved identifying Maori and Pacific women who were

overdue for Breast and Cervical screening and inviting them to take part in a Saturday Screening Day. Transport

was provided for those who required it. The successful event screened 22 women for mammograms and 13 for

cervical screening. A further 24 women made appointments to be screened on another day. There was only one

DNA on the day.

NEXT STEPS

TeAHN is working with practices and the National Cervical Screening Register to review those women who are

identified on the Register as overdue for a cervical smear. Once the data held on practice databases and on the

National Register has been matched and accurately recorded, the practice will update their records. This will

enable practices to see where the cervical smear has been carried out by another provider or incorrectly

exempted in their records.

Once the status being held by practices is up to date, work can progress to target more of the “hard to reach”

women who are overdue for a smear. Te AHN will discuss options with RPH and Mana Wahine.

IMMUNISATION SUPPORT

This programme targets children in the first two years of life, with a particular focus on those who are “hard to

reach”. The aim is to reach the Health Target of 90% of 8 month olds being fully immunised (in 2013/14) and to


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achieve the indicator target of 95% of 2 year olds being fully immunised. The aim is also to support practices to

implement the annual flu vaccination campaign with a focus on older and at risk people.


TeAHN continues to maintain strong links with the practices, Regional Public Health (RPH) and the National

Immunisation Register (NIR) to ensure that all eligible children are fully immunised, and to maintain the high

level of performance for children in high needs groups.

AGE APPROPRIATE VACCINATIONS FOR 2 YEAR OLDS

The Ministry of Health’s latest reports show that the Hutt Valley continues to maintain a high level of

immunisation coverage for 2 year olds.

From the provisional PPP data to the end of December 2013, TeAHN practices have achieved 94.4% for the total

population and 92.7% for the high needs population. These are similar to the results in the previous six month

report.

The final immunisation results from the National Immunisation Register (NIR) for the period to 31 December

2013 will be released by DHB Shared Services later in February 2014. TeAHN will review this report once these

results are available. TeAHN is keen to get more timely reporting of immunisation results, so we are working on

getting direct access to NIR data ourselves.

AGE APPROPRIATE VACCINATIONS FOR 8 MONTH OLDS

The Ministry of Health’s latest reports show that the Hutt Valley continues to maintain a high level of

immunisation coverage for this new indicator.

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2011/12 2012/13 2013/14

Immunisations 2 yr Olds(Total Population)

Programme Target TeAHN Target Actual


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From the provisional PPP data to the end of December 2013, TeAHN practices have achieved 92.9% for the total

population and 94.6% for the high needs population. These results remain above the 90% target for this indicator

and show a small improvement on the previous six month period.

65 YEARS AND OVER FLU VACCINE COVERAGE

Based on the provisional PPP results to the end of December 2013, TeAHN has achieved the PHO Performance

Programme target for 2013 comfortably, achieving 68.9% for total population and 67.9% for high needs.

NEXT STEPS

We plan to obtain NIR access to enable easier and more timely monitoring of progress. We will also review

instructions for practice nurses on recording immunisations in practice management systems to ensure practices

have the most up to date information available to them.

CARE PLUS

Care Plus aims to improve chronic care management, reduce inequalities, improve primary health care teamwork

and reduce the cost of services for high-need primary health user, by:

• improving access to care for people with long term conditions

• improving patient self-management.

CURRENT SITUATION

The graph below identifies the enrolments and the assessments carried out in the year January 2013 to

December 2013.

0%

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2011/12 2012/13 2013/14

Immunisations 8 month Olds(Total Population)

Programme Target Actual TP


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Overall the enrolments are sitting at 100% (6559 patients) 1at the end of the last quarter. We note there are

still significant variations across our practices in terms on their enrolments and some high enrollers have

continued despite our advice. We will be looking to provide these practices with more specific advice, likely

managing a cap on their enrolments as we seek to address some of the underlying issues.

KEY ISSUES

Due to staff changes and the unexpected departure of some key people, we have been unable to advance the

issues underpinning the Care Plus programme. We remain concerned that some practices have high enrolments

and may not have sufficiently robust systems to manage the assessment prior to re-enrolment. We have begun

to meet with these practices and to work through their processes aiming to lead a change in behaviour.

Te Awakairangi Health network sent a representative to the recent long term condition forum and also to the

diabetes forum where the role of Care Plus was discussed. There are a number of new models emerging around

the care of people with long term conditions that uses the Care Plus funding differently We are expecting to be

in a position be able to engage with our practices to explore these options from March when we are back up to

full staffing and have capacity to advance this work.

CLINICAL PHARMACY SERVICES

The clinical pharmacy facilitation activities focus on working with practices and other primary care professionals

to optimise medicines related health outcomes for patients in the Hutt Valley. The services offered work within

the Triple Aim approach.

ACHIEVEMENTS

The following is a summary of the clinical pharmacy facilitation activities undertaken within Te Awakairangi

Health Network (TeAHN) practices by the pharmacy team in the July - December 2013 period.

1 Karo_Reg_AnalysisPHO_TeAHN Oct 13 Report.

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Number of enrolments and C+ assessments Jan 13 to Dec 13

Enrol and C+1 C+2 C+3 C+4


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PHARMACY FACILITATION VISITS TO PRACTICES AND COMMUNITY PHARMACIES

During this period, all TeAHN practices (23 practices over 25 sites) were visited by a clinical pharmacist as part

of the scheduled pharmacy practice visits. In addition, all (30) community pharmacies were visited or the

community pharmacists attended the scheduled visit at the neighbouring practice. The clinical information

package has been well received by general practice teams and community pharmacists. TeAHN is confident that

the inclusion of community pharmacists in these visits is contributing to strengthening the linkages between

general practice and community pharmacy in the Hutt Valley.

The following information was developed by the pharmacy team or sourced for inclusion in the clinical

information package taken to practices and pharmacies:

Clinical Update on NSAIDs – with a focus on recent concern over the increased cardiovascular risk

associated with diclofenac use

Medicines Update on benzbromarone - a newly funded medication for the chronic treatment of gout

when allopurinol and/or probenecid are not tolerated, contraindicated or ineffective despite optimal

treatment doses

Medicines Update on ticagrelor – a newly funded oral antiplatelet agent that is indicated (in combination

with aspirin) for the prevention of atherothrombotic events in adults with acute coronary syndromes

(ACS). The medication is now being prescribed more frequently in secondary care.

A SaferX bulletin on melatonin (newly funded) – sourced from Waitemata DHB.

Health Quality and Safety Commission (HQSC) patient information leaflet “Taking your medicine safely”

(for community pharmacies only)

BPAC Antibiotic Guide (2013 Edition) – a consensus guide to help assist in the appropriate selection of

antibiotics for infections commonly seen in general practice.

A query build to assist with the bpacNZ audit: Renal function testing in patients on dabigatran (see below)

CLINICAL AUDITS

Renal Function testing in People Taking Dabigatran

bpacNZ data indicated that only 28% of patients started on dabigatran in TeAHN had their renal function

tested prior to starting the medication (a recommended requirement). This was lower compared to

the national data of 58%. The limitation of the bpacNZ data was that it did not include hospital lab

testing data.

In response to this data, bpacNZ has produced a MOPs accredited audit for identifying patients on

dabigatran who require an annual renal function test. The TeAHN clinical pharmacy supported GPs with

participating in this audit by developing a query build to assist with identifying patients suitable for

inclusion in the audit. Practices were also offered the option of assistance from a TeAHN pharmacist

to run the audit.

The dabigatran audit was specifically offered in the July – Dec period with 3 practices requesting

clinical pharmacist input into running the audit and other practices choosing to run the audit

themselves.

In total the pharmacy team responded to 10 requests (by practices) to run a number of available in-house clinical

audits i.e. dabigatran, gout and appropriate prescribing of self-monitoring blood glucose strips.

A clinical audit tool for benzodiazepine use in the elderly has also been developed and has gained MOPs

accreditation in preparation for the next round of visits (in 2014).


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Onsite Pharmacist Facilitator Feedback

A member of the pharmacy team spent a day a week at one of the VLCA practices for a period of 6 weeks during

August –September. The intention was to explore the value added to services provided by the practice with the

addition of an onsite clinical advisory pharmacist. Very positive feedback has been received and to quote from

a GP “It was great having you here, quite helpful. It makes our lives way easier with your meds interactions checks

and safer for older patients. I think it would extremely helpful if we could have you here maybe once weekly or

so on a permanent basis.”

PRACTICE CONTACTS OVERALL

The number of direct contacts made between each practice and the pharmacy team over the 6 month Jul-Dec

2013 period ranged from 1 to 12 contacts (average = 2.7 ).

0

2

4

6

8

10

12

q i g n w d t x m b u e a j c k r p v s f y l h o

Practices

0

5

10

15

20

25

30

Clinical Audit Clinical Visit MedicationQuery

Peer Review Other

Key Reason for Clinical Pharmacist contact with Practices1 July – 31 Dec 2013

No of Clinical Pharmacist Contacts with Practices

1 July – 31 Dec 2013


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PRESCRIBER TIPS

Prescribing (Rx) Tips are produced to complement Continuing Medical Education (CME) sessions. While no new

bulletins were prepared within the July to December 2013 reporting period, the clinical pharmacy team reviewed

existing resources relevant to the topic that was provided to participants. Community pharmacists have been

invited and have attended the CME sessions for collaborative learning with GPs.

MEDICATION QUERIES

During the July – Dec 2013 period, 34 medication queries were researched and answered. Medication enquires

undertaken by the team varied in their complexity and research requirements. Enquires took from 15 minutes

to up to 3 hours to complete.

EDUCATION SESSIONS

TeAHN clinical pharmacists continue to make a significant contribution to helping patients understand their

medicines better, and assisting practice nurses with their continuing professional development. Five education

presentations were given in the period between July-Dec 2013:

Patient Education Session to Kaumatua Group (Wainuiomata Marae) on general medication use

Patient Education Session on use of respiratory medicines at Pacific Health Services

Two Respiratory education sessions for practice nurses

One Cardiac Continuum education session for practice nurses.

PRESCRIBING ANALYSIS

In October 2013 a report was prepared to inform members of the Hutt INC’s Medicines Management

workstream of TeAHN’s pharmacy-related facilitation activities for January to December 2013. This report

included an analysis of patterns/trends identified from BPAC practice-level data and the MOH Cube Tool

prescriber-level data. The prescribing analysis confirmed that the 2013 pharmacy facilitation activities

undertaken were relevant to prescribers. The analysis also identified areas of deviance from national prescribing

trends that were more relevant to secondary care prescribing. The 2012/13 practice-level reports (BPAC) are

now available and will be analysed in a similar way to identify future topics for facilitation activities. It is

anticipated that local prescribing patterns could be incorporated (where relevant) into the GP/Pharmacy CME

sessions.

HUTT INC MEDICINES MANAGEMENT WORKSTREAM

TeAHN has made a significant contribution in supporting Hutt INC’s Medicines Management workstream since

August 2013. TeAHN has provided meeting support and staff from its senior management and pharmacy team

as members of the workstream. Representatives from hospital pharmacy, SIDU and community pharmacy are

included. The group has met twice. The first project aimed at improving the accuracy of medication lists will be

looking at the implementation the commonly known “yellow card”. Hospital pharmacy, community pharmacy

and TeAHN pharmacy facilitators will work across the interface to promote this. The workstream is chaired by

a GP, Dr Lise Kljakovic. Lise is also a member of the Board of TeAHN and the Chair of Hutt INC.

HVDHB HEALTH PATHWAYS

A workshop on the care of frail older person with complex needs was organised by TeAHN in November. The

TeAHN pharmacy team made a significant contribution at this workshop by presenting on medicines utilisation

data and organising the evening. Feedback from the workshop clearly indicated the need for a tiered Medicines

Management Service that frail older people could be referred into when an issue with medications was

identified. Referrals would be as part of a Comprehensive Geriatric Assessment which is a best practice approach


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to improving the quality of care provided to these patients. Hutt INC has endorsed the establishment of a

workstream on the Care of Frail Older People and the workstream will require ongoing involvement and

resources from the TeAHN pharmacy team.

STRENGTHENING LINKAGES BETWEEN GENERAL PRACTICE AND COMMUNITY PHARMACY

CARDIOVASCULAR DISEASE RISK ASSESSMENT (CVDRA)

A proposal for an integrated provider model aimed at increasing the HVDHB’s CVDRA performance was

made to HVDHB in this period. The model proposed would see a community pharmacy offering/undertaking

CVDRAs at the pharmacy. The community pharmacy would work in collaboration with the local medical

centre to identify eligible people who have not yet had a CVDRA. The model offers choice and greater access

to people who may not otherwise present at their general practice for a CVDRA. CVDRA data from the

community pharmacy will be entered into the practice PMS. A pilot of this model in intended to be trialed

in 2014.

RHEUMATIC FEVER SCREENING AND TREATMENT

Another example of an integrated model of care involving community pharmacy is being developed to help

identify and treat children at risk of rheumatic fever in the Hutt Valley area. In collaboration with their

general practices, three community pharmacies will be trialing the feasibility of community pharmacists

assessing and treating (as enabled by PHARMAC’s recent PSO changes). The feasibility trial will occur in

early 2014.

PHO PERFORMANCE PROGRAMME

The PHO Performance Programme (PPP) is a quality programme which aims to support improvements in the

health of enrolled populations and reduce inequalities through supportive clinical governance and continuous

quality improvement processes.

KEY ACTIVITIES

TeAHN has given priority to working with practices to achieve a significant improvement in the numbers of

patients who have received smoking brief advice/cessation referral and/or CVD risk assessment. We are very

close to reaching the programme goal of 95% for the number of childhood immunisations given. See the relevant

sections of the report for more details.

ACHIEVEMENTS

This report refers to preliminary data from the DHBSS performance report for the period 1 July to 31 December

2013. During this period Te Awakairangi Health Network achieved 15 of the 21 funded indicators (against the

targets set for our Network).

The funded indicators achieved were:

cardiovascular risk detection for both total and high need populations

cardiovascular risk assessment for the total and high need population

diabetes detection for both total and high need populations

smoking status ever recorded for the high need and ‘other’ populations

flu vaccine coverage both total and high need population

breast screening high need population


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age appropriate vaccinations 8 months total and high need

cervical screening for both total and high need populations.

Funded indicators not achieved

brief advice and/or smoking cessation support high need and other

age appropriate vaccinations 2yr total and high need

diabetes annual review for both total and high need populations

Childhood immunisations for 8 month olds and for two year olds remain high. As immunisations tend to decline

in December and over the holiday period, this result is better than expected. There has been significant

improvement in the CVD risk assessment results, with the Total Population result increasing significantly from

44% at the end of June 2013 to 58% at the end of December 2013. There has also been a significant improvement

in the brief advice for smoking cessation indicator, which has increased from 50% to 63%.

The DHBSS data indicating the definitive results and the national data for comparison will not be available until

February 2014.

KEY ISSUES AND IDENTIFIED RISKS

1. Cardiovascular risk assessment: The CVD risk assessment programme has had a significant increase in the

number of people who have had an assessment but considerable work is still required to achieve the

programme goal. Additional strategies are being put in place to assist with this work (see 3.2 for further

detail).

2. Smoking cessation: the programme has had a significant increase in the number of people who have

received brief advice but considerable work is still required to achieve the programme goal. Additional

strategies are being put in place to assist with this work (see 3.5 for further detail).

3. Childhood Immunisations: TeAHN is keen to get more timely reporting of immunisation results, so we are

working on getting direct access to NIR data ourselves. This should assist us to reach the programme goal

(see 3.7 for further detail).


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SERVICES

OUTREACH NURSING

To reduce health inequalities and improve health outcomes by improving access to primary care services for high

need groups within the PHO, who are not currently accessing care or accessing it in a limited way proportional

to their health needs in particular.

KEY ACTIVITIES

Work across the Network’s 23 Practices (over 25 sites) to identify people who are not accessing primary

care or requiring education and support to work with their primary care provider.

Work collaboratively with wider community organisations; Pharmacies and NGOs, to identify people who

are not accessing primary care or who are requiring education and support to work with their primary care

provider.

Work in close collaboration across the wider Network team such as the Wellbeing Service, Community

Health Workers and Health Promotion to identify people who are not accessing primary care or who are

requiring education and support to work with their primary care provider.

Provision of assessment, follow-up, health education and promotion, community liaison, advocacy services

and disease-management visits for identified individuals and their whānau.

ACHIEVEMENTS

A major achievement during this reporting period was successfully recruiting a third experienced Outreach Nurse

into TeAHN central team, which brought us up to a full complement of staff.

Work is continuing around linkages and reporting templates for the Integrated Case Management Nursing

(ICMN) services within the Network, with further discussions having been held with clinical leaders, Outreach

Nurses (ONs), Integrated Case Management Nurses (ICMNs) and managers at Whai Oranga and Hutt Union and

Community Health Services (HUCHS).

The team are maintaining close contact with practices as part of their day-to-day activities. This includes liaising

with staff for specific patient issues and updates, meet-and-greets for new staff, supporting patients with

transport to and during appointments, and delivering providing information such as brochures. One ON has

developed a system with one of her allocated practices for regular referrals to help locate patients for urgent

DNA recall appointments such as cervical smears and mammograms.

In addition to accompanying patients to practice based consultations, the ONs also receive many requests from

patients to accompany them to various secondary care appointments e.g. podiatry, breast screening,

paediatrics, respiratory, diabetes, audiology, sleep tech, renal, plastics, ENT, OPRS, OT and ACCESS. As part of

patients’ care plan discussions, staff ensure their roles (e.g. advocate, adviser or facilitator) at these

appointments are carefully defined and agreed upon beforehand, so as to make best use of the time.

Our ON team have assisted the Health Promotion team on the Pacific Wellbeing Day, and provided Island food

for their ‘fat kit’ photo shoot.

The ON team continue to participate in the Hutt Valley Primary Health Nurse Reference Group, Samoan Nurses

Association, Vibe, and contact with the Pacific Health Service nurses. These contacts improve working

relationships, share information and training opportunities, and assist with peer reviews of practice. Training is

an ongoing requirement for our nurses’ role to ensure they practice competently, both independently and in

collaboration with other health professionals. Some of the training they have undertaken during this reporting


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period includes Smoking Cessation, Public Health Law: Duties and Human Rights, CVDRA (online training),

Medicines and Controlled Drugs, Respiratory Update, Resuscitation, Health Mentor (online diabetes training),

Safe Sleep, Viral Hepatitis and Coronial Inquiries.

PATIENT CASELOAD

The information below relates to unique patients seen by service wide ONs (TeAHN) and ICMNs (HUCHS, UHHC

and Whai Oranga) in the 2013/14 year. Whai Oranga did not provide a monthly breakdown of their patients

numbers for this reporting period, but common reporting templates will be in place for the next reporting

period. The decrease in numbers reported from Upper Hutt Health Centre reflects lower staff availability due to

health issues and leave.

All ON and ICMN services are well used by the target population, being Māori, Pacific and Quintile 5. The use by

Māori people has increased for TeAHN and HUCHS registered patients, and the use by Pacific people has

increased for Whai Oranga registered patients during this reporting period.

The ONs and ICMNs see all eligible patients throughout the age continuum, with middle aged and elderly people

being the biggest users of HUCHS service, young adult to elderly people being the biggest users of TeAHN service,

and birth to 14 years being the biggest users of Whai Oranga’s service.

Age Group of Patients Seen Jul 13 to Dec 13

Age Group HUCHS UHHC TeAHN Whai Oranga

0-4 11 0 5 11

5-14 9 0 6 10

15-24 26 0 24 3

25-44 41 0 44 5

45-64 185 4 45 3

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

TeAHN 56 50 59 29 44 45 65 72 51 63 50 58

HUCHS 32 19 27 38 36 42 66 55 41 59 60 53

UHHC 23 27 25 27 36 21 14 17 26 4 5 9

Whai Oranga 30 19 18 16 27 5

0

10

20

30

40

50

60

70

80

Patient Case Load


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65+ 62 5 33 0

Unknown 0 57 2 5

PATIENT CONTACTS AND SERVICES

The table below shows the number of ON and ICMN patient contacts and services provided in this period, with

numbers from TeAHN and UHHC pertaining to outreach services, and HUCHS and Whai Oranga numbers based

on nurse-led projects undertaken within practices (Cervical Smear and Skin Clinic projects respectively).

Provider Patient Contacts Services

Te Awakairangi Health Network 734 2963

Upper Hutt Health Centre 119 119

HUCHS 334 334

Whai Oranga O Te Iwi 66 66

Service Wide 1253 3482

TEAHN OUTREACH NURSING

In the July to December 2013 period, TeAHN ON service provided a total of 734 patient contacts, and 2,963

services (on average, 494 services each month) to patients who accessed the service.

Their work covered home and clinic visits, telephone calls, and meetings with practice staff to discuss patient

health issues and barriers. They also provided support and information on disease and medication education,

organised visits to podiatry services, arranged smoking cessation support and organised transport to various

168134 136

70

14991

133 143104 123 119 112

673

608

529

193

494

407

501

608

485449

581

339

0

100

200

300

400

500

600

700

800

Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec

Volume of Work - TeAHN Outreach Nurses1 Jan to 31 Dec 13

Patient Contacts Services Provided


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appointments which have possibly not been attended previously. As most patients who are referred to the

service have one or more long-term conditions, the nurses carried out basic measurements, blood pressure,

blood sugar levels, and diabetes assessments as routine tasks.

TeAHN Outreach Nurses

Service Type

Jan to Jun 13 Jul to Dec 13

Patient Contact 1103 1084

Facilitation Service 1006 901

Liaising Agencies 456 811

Measurements 122 149

Referrals 213 18

Unknown 4 0

TOTAL 2904 2963

WHAI ORANGA O TE IWI HEALTH CENTRE

The ICMN contract has allowed Whai Oranga O Te Iwi HC to continue supporting their nurse-led Skin Clinic and

services, as well as the mobile nursing services/home visits. The ICMNs are helping to make improvements with

PPP targets, including vaccinations, cervical screening, mammograms and CVD assessments.

The Skin Nurse continues to run Skin Clinics during weekly set sessions as well as running a late Wednesday

evening Clinic. This allows a more convenient time for patients to visit her, and also the evening is the best time

for her to call patients when follow up is required. The service is specialised, accessible and affordable, with

patients aged 6 years or older only being charged a nurse consult fee of $5.00.

The Skin Nurse has been very involved with intense dressing changes and education to whānau groups. She

liaises closely with District Health and Public Health Nurses to assess home situations that involve flea infections,

dampness, and overcrowding that cause skin infections and asthma. She also helps to prepare Work and Income

application forms for patients to assist with the financial cost of dressings.

The Skin Nurse is very proactive with the GPs and encourages them to refer all patients with skin conditions to

her for education and wrap around support for the patient/whanau. She continues to educate new clinical staff

and has gained the respect and acknowledgement of her peers, other health providers and our patients for her

extensive knowledge and skills. Recent referrals have been received from the Hospital’s Paediatric Team and

Plunket, with excellent relationships having been established with key staff.

Often referrals are sent to the Skin Nurse from a GP to follow up a baby with a related skin problem. The nurse

will find that other family members are also experiencing the same problems in the home, so all can be treated

at the same time. Patients and their whānau are provided with a Care Plan. They also receive information on the

creams and treatments, how they work, the benefits and when to use them. Skin packs are also provided, which

includes information on care for covering open sores and advice on when further treatment may be required.

The nurse provides education and support, and follows up with a recall system, which reduces the risk of further

infection, spread or recurrence of the problem and avoids hospitalisation.

The nurse is now using the new screening/auditing tool that has been set up and installed by TeAHN, which will

help keep a record of patients’ seen in the Skin Clinic and will enable provision of more in-depth reporting.


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Sessions/Contacts

Jan to Jun 115

Jul to Dec 66

TOTAL 181

HUCHS

During this reporting period, the ICMNs have continued to provide intensive case management to patients who

have complex medical or social situations, have multiple problems within whānau, and/or high utilisation. The

service is offered to patients who do not qualify for CarePlus or require intensive services over and above

CarePlus requirements.

HUCHS holds monthly MDT meetings at each of their sites (Pomare and Petone) which are attended by GPs,

primary health nurses, community health workers, and a physiotherapist. Members of the team identify

complex clients and whānau, discuss concerns, and make and monitor management plans. The ICMNs play a key

role at these meetings as frequently new clients to the service are identified as needing coordinated approaches

and care. The ICMNs have close working relationships with other team members and use both formal meetings

and informal discussions to ensure wrap around care is provided to clients.

Key outcomes from the service include case coordination, managed utilisation and improved access, with key

achievements including seamless care within the service for those who need it most, reduced appointment DNAs

and increased cervical screening rates.

Sessions/Contacts

Jan to Jun 13 349

Jul to Dec 13 334

TOTAL 683

The nurse-led project focus for this reporting period has been to improve the cervical screening rate by

intensively focusing on women who have not responded to routine smear recalls - particularly women who have

had previous abnormal smears. This involved the ICMNs prioritising which women to contact, making contact

by phone or text, booking appointments at the time of contact, and running an additional smear clinic on a

Sunday. As these are very hard to reach women, HUCHS still get a large proportion of DNAs from these

appointments but are having significant success. The table below shows the increase in the total number of

smears in the second half of the year, with 70% of eligible women now having had routine smears.

0

20

40

60

80

100

HUCHS smears monthly 2013


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Relationship with key nurses leads to better compliance, coordination of care and access to appropriate services.

Education and support is a key focus of the service along with effective integration within the HUCHS team of

doctors, nurses, community health workers, physiotherapists, primary mental health and family violence

worker.

UPPER HUTT HEALTH CENTRE

Upper Hutt Health Centre ONs continue to provide nursing care to enrolled patients with complex health needs

e.g. patients with physical, psychological and/or social issues, or those requiring end-stage care have been

recipients of our outreach service this reporting period.

Health care for these patients has been enhanced by the ONs facilitating interdisciplinary and family meetings

to minimise clinical risk and maintain patient safety. With the appropriate support services put in place by the

outreach service, patients have been able to continue living independently in the community.

The ONs also respond to situations more acute in nature, and liaise with both primary and secondary care

providers to ensure patients are receiving the best health care. Various funded services are utilised to enhance

patient care and promote good outcomes e.g. TeAHNs: Transport, Dietitian and Healthy Family Coach Services.

The ONs have been involved in cases where patients needed to go to hospital or hospice and this process was

facilitated by them through liaising with the patient’s GP.

The ON service at UHHC is pivotal in providing health care to patients who have high clinical and social needs.

They play a significant role in linking patients with the services they need and this has subsequently resulted in

patients receiving appropriate interventions and a reduction in complications and hospitalisations

Sessions/Contacts

Jan to Jun 13 251

Jul to Dec 13 119

TOTAL 370

RHEUMATIC FEVER

From 1 July 2013, the ON service has been fulfilling a SIDU contract for follow-up of clients aged 16 to 21years

residing in the HVDHB area with rheumatic fever (RF), who need support to ensure they receive their monthly

prophylactic antibiotic.

Patients have responded well to the change from Hutt Paediatrics to TeAHN’s service, with the ON having

formed great working relationships with her 17 RF patients and whānau to date. The ON has met monthly with

Shennan Brown (Compass Health Rheumatic Fever Mobile Nurse) and Barbara Eddie (RPH) as a regular forum

for ongoing support and review of this programme.

TeAHN wishes to thank all the staff at Hutt City Health Centre, for their medical oversight of the service, for the

use of the vaccine fridge for the bicillin injections, and being so accommodating toward our nurse (who will rush

in at times to grab an injection after confirming the whereabouts of her elusive RF patients).

PACKAGES OF CARE

This programme is used to reduce the financial barrier to access health services for our high-needs enrolled

population. It is managed by the Outreach Nurse service.


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During the July to December 2013 reporting period, packages of care funding was used for 54 patients.

During the July to December 2013 reporting period, we saw a decrease in the expenditure for the prescriptions

funding stream. This is largely due to patients having tallied up 20 items from the annual prescription subsidy

scheme cycle (1 February), entitling them to zero prescription co-payments ($5) until 31 January 2014.

Over this reporting period, patients who met the SIA criteria and had a clinical classification of Chronic

Obstructive Respiratory Disease were eligible to receive a funded pneumococcal vaccine under this programme,

as it had previously been recommended as a best practice prophylaxis.

Following a review of the evidence in support of this intervention, our Clinical Director and Clinical Advisory

Pharmacists have advised that the latest literature has highlighted a very limited role for this vaccine, with a

Cochrane review published in January 2013 stating: “The available evidence does not demonstrate that

pneumococcal polysaccharide vaccines prevent pneumonia (of all causes) or mortality in adults.” Please see

more at: http://summaries.cochrane.org/CD000422/vaccination-for-preventing-pneumococcal-infection-in-

adults#sthash.W59389GR.W6crdHys.dpuf

Consequently we are no longer routinely funding the pneumococcal vaccine, and will be advising practices that

funding for the 2014/15 year will only be considered on a case by case basis, noting the very limited clinical

indications for the vaccine.

KEY ISSUES AND RISKS

During their course of work, the ONs come across some potentially risky situations that they have managed

extremely well. Some examples include:

Helping a young adult who had been assaulted the evening prior to the nurse visiting, by transporting

the person to their General Practice for a check-up, then to a whanau member’s home for ongoing

support, and encouraging the young adult to make a formal complaint with the Police (which they did

the following day).

Due to previous experience of less than ideal secondary care consultations (i.e. poor communication

and rushed consultations) and at the request of whānau, an ON supported a mother and child during

the child’s scheduled appointment. The ON identified a lack of cultural awareness and respect from

some of the secondary specialists who come from overseas, which is the underlying reason why some

patients choose not to attend appointments.

Medication safety issues for our elderly patients living in their home environment. When this issue

arises, ONs undertake a thorough assessment, and organise support and advocacy in conjunction with

ITEM No. of Patients

Accessing Funding Total Amount funded

Jan to Jun 13 Jul to Dec 13 Jan to Jun 13 Jul to Dec 13

Prescriptions 34 33 $681.67 $625.16

GP/Practice Nurse visit 13 14 $347.37 $345.19

Pneumovax Vaccine 4 3 $563.50 $260.87

Rheumatic Fever 1 4 $50.43 $69.56


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http://summaries.cochrane.org/CD000422/vaccination-for-preventing-pneumococcal-infection-in-adults#sthash.W59389GR.W6crdHys.dpuf

http://summaries.cochrane.org/CD000422/vaccination-for-preventing-pneumococcal-infection-in-adults#sthash.W59389GR.W6crdHys.dpuf

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alternate service providers and whānau. With a large percentage of our target population being in the

65+ age bracket, we are now updating our current nursing assessment tool for new patients.

CASE STUDY 1

Client

86 years old, of European decent and Quintile 5. Residing alone in a Housing NZ home with minimal family

support in Wellington, referral received from the client’s Practice Nurse outlining concerns regarding medication

management.

Current health issues

Insulin dependent diabetes mellitus type II

Essential hypertension

Vascular dementia

Osteoarthritis

Recent fracture NOF Left 2012 Right 2013

x 3 amputated toes 2013

Acute renal failure

Outreach Nurse Assessment and Role:

Client’s short term memory loss is largely impacting upon her ability to manage independently at home,

especially her medication management. Client claims to administer her insulin each morning and record her BSLs

prior, however on weekly monitoring the ON noted that the patient has not been taking BSL recording prior to

insulin administration. On discussion, it becomes evident that the patient is unaware how to treat hypoglycaemic

episodes.

Her three children live in the upper North Island and client is adamant she will not leave the home at any point

to move into a rest-home. The family have Enduring Power Of Attorney and at this stage respect her wishes,

hoping for all to be done to ensure she can stay at home for as long as possible.

Actions

On discussion with and consent given by family, referral made to Mission for Seniors for further

support networks within the home

Fortnightly visits to assess BSL recordings and provide education regarding insulin administration

Contact made with Enlivens’ Care Coordinator to query regarding re-assessment of current care plan

Further discussion had with Enliven Coordinator to change the timing of personal care to include

medication prompt early morning

Liaison with nephew who lives locally and is also an insulin dependent diabetic, to assist with support

of his Aunt

Regular visits and liaison with Practice Nurse and GP regarding care

Transport to pathology.

Service Input

Number of phone calls to client: 4

Number of home visits to client: 6

Number of practice visits and liaisons: 5


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Number of liaisons with NOK: 5

Number of liaisons with alternate service: 3

Number of referrals: 1 (Wellington City Mission’s, Mission for Senior’s programme)

Providers Involved:

GP - Regular visits and liaison regarding care

Practice Nurse - Regular visits and liaison regarding care

Enliven - Personal care daily visit to assist with showering and dressing, and domestic assistance fortnightly

District Nursing- Fortnightly visits to dress toes

Outcomes:

Client continues to manage independently at home with the input of several stakeholders. Her monitoring and

management of her diabetes has improved. Her family are fully aware of the risk, concerns and current services

that are made available to her. The client is happy with how the services are running currently and wishes for

no further changes to this. Ongoing monitoring by all stakeholders will continue on a regular basis.

CASE STUDY 2

Client

A referral was received from the Practice Nurse at Hutt City Health Centre (HCHC). The client was a 48 year old

Māori woman who had been bitten by her neighbour’s dog on 28 August 2013. She had initially presented to

the Emergency Department, where the wound was sutured. She did not attend any follow up appointments at

the Dressing Clinic at HVDHB due to lack of transport and financial difficulties.

Current health issues:

She presented to HCHC on 19 September 2013 to get the sutures removed from the wound. The wound was

infected and she could not afford to pay for her script for antibiotics at the time, so she was referred to our

Service for assistance to pay for antibiotics via Packages of Care Prescription Subsidy.

Outreach Nurse Assessment and Role:

Visited at home, wound assessed. As client lives with her 3 pre-school mokopuna, ON educated her

on how to keep wound clean and dry, and how to dress it properly, to avoid cross infection.

Packages of Care Prescription Subsidy issued x 2 for her to get her antibiotics.

Regular home visits to ensure medication compliance and education to client and whānau as client

not 100% compliant with taking antibiotics as directed and had missed a few doses. Client also has

some alcohol abuse issues.

Client required follow-up with GP for review after finishing first course of antibiotics. Wound still not

resolved.

Regular monitoring via home visits to ensure completion and correct compliance of taking antibiotics

and care of wound.

Referral made to CHW to follow up with any financial and alcohol issues.

Final visit made when wound was fully healed up. Educated regarding getting prompt treatment in the future

for any health issues for her or whānau.

Service Input



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Number of phone calls to client: 4

Number of Packages of Care Prescription Subsidy: 2

Number of referrals: 1 (Community Health Worker, TeAHN)

Providers Involved

GP

Practice Nurse

Pharmacy

Community Health Worker

Outcomes

The work alongside this client highlighted the need for some clients and whānau to be closely followed up and

supported, even though the initial referral was just for financial assistance regarding collecting script. The client

was under the ON service for a period of 3 months, from referral to discharge. A very good result was achieved,

as the patient did not end up having to be admitted to hospital for infected wound, debridement and possible

plastic surgery.

CASE STUDY 3

Client

Patient is a 61 year old woman with diabetes, hypothyroidism, lipid disorder and somatisation disorder. She is a

highly anxious lady who requires a lot of input from health services. She has a history of extremely high ED

attendance (1-2 times weekly), and frequent specialist outpatients appointments and inpatient admissions. She

has poor stress management strategies and has in the past thrown things at visiting DHB nurses, and shouted

and hit other patients with her stick in hospital and GP waiting rooms.

ICMN Nurse Assessment and Role

ICMN has focused on building a relationship of trust which is reassuring and allays anxiety, managing ongoing

health issues, and having a planned and agreed programme of general practice contacts. The current contact

plan is two phone calls per week with the nurse, fortnightly appointments with nurse case manager, and six

weekly appointments with the doctor. The plan is developed and shared in monthly MDT meeting, and agreed

with patient.

Outcomes

This is a significant reduction in contacts compared to previously. The arrangement has helped to monitor and

manage the patient’s long-term conditions, reduced the number of hospital presentations and admissions,

reduced the number of primary care presentations and helped promote more appropriate behaviour. Recently

the patient has started to discuss childhood traumas as well as her ongoing somatic conditions, which is the first

time she has discussed these with anyone.


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COMMUNITY HEALTH WORKERS

The purpose of this service is to develop and maintain collaborative relationships with Te Awakairangi Health

Network practices and other health providers to enable the facilitation of appropriate access to primary health

care for at risk patients.

KEY ACTIVITIES

• Patient Care e.g. advocating with Work and Income and other Government agencies.

• Community Development and Health Promotion e.g. assessing current social problems and difficulties

and helping to address these needs through agreed individual Care Plans.

• Working with General Practice e.g. coordinating health needs.

• Working alongside other Service Providers, for example, referring to appropriate health providers,

community groups and organisations.

ACHIEVEMENTS

The CHW team has successfully kept the service running smoothly despite a couple of members from the team

requiring extended leave (one each at HUCHS Petone and TeAHN). This was made possible by TeAHN managing

to quickly acquire a skilled person to fill in for three months.

The virtual CHW team continues to meet regularly (15 July, 19 August, 16 September, 21 October, 18 November

2013) with venues being rotated between work sites (HUCHS Pomare, Whai Oranga and TeAHN). Guest speakers

are invited and provide pertinent presentations to enhance the work the CHWs undertake with patients.

Examples include:

TeAHN Health Promoter and Clinical Programmes Facilitator presenting on Smoking Cessation ABC

Project and Free Heart and Diabetes Checks and the role the CHWs play in supporting our target

population to take these up (15 July).

The Naenae Work and Income Service Centre Manager presenting on the significant changes to

the benefit system from July 2013 (19 August).

Ministry of Education’s Early Childhood Education & Early Learning Taskforce team speaking about

CHWs assisting vulnerable children and parents to participate in some sort of ECE learning to

prepare them for school (16 September).

These meetings continue to prove invaluable for discussing and agreeing on expected activities, outputs, activity

reporting, referral and discharge criteria and processes, and an opportunity for staff to share modalities used in

day-to-day practice. The reporting systems have been fine-tuned over the last few months, with two common

reporting templates being installed in TeAHN, HUCHS and Whai Oranga patient management systems. This has

enabled easier manipulation and compilation of reporting requirements.

With every meeting held, the CHWs gain significant traction on working collectively as one cohesive service,

including recognising team member’s strengths e.g. local networking knowledge, work interests and passions,

fluency in Te Reo or Pacific languages and being well versed in Māori and Pacific cultures.

The Outreach Team Leader and TeAHN CHWs have made various service presentations at the request of the

following groups: Upper Hutt Health Centre, HVDHB Social Work, Alzheimer’s Carers, Te Umiumiga Parents As

First Teachers and Valley Fit Exercise Group. These presentations were well received with respective audiences

asking many questions, resulting in referrals to the service.


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The experienced team of CHWs continue to actively participate in many different intersectoral groups, networks

and forums e.g. Suicide Intervention, Cohesive Communities Working Together - Upper Hutt, Hutt Valley

Community Response, HVDHB Violence Intervention Programme Steering Group, HVDHB Māori Health Services

Development Group, HVDHB Maternity Clinical Governance Group, Naku Enei Tamariki, Āhuru Mōwai O Te

Awakairangi (Family Violence), Northern Community Committee Hutt City Council, Rimutaka Māori Women’s

Welfare League, Taita Community Trust, White Ribbon Day and Tumeke Taita. When CHWs share their

experiences and stories of work with patients, the groups can identify trends and recommend appropriate

pathways.

The Outreach Team Leader has been actively involved in Manderson Grove’s community residents’ hui regarding

housing and health concerns e.g. gas leaks, street clean up, upgrade of playground, earthquake assessment,

insulation, pest eradication, fencing, flood and drainage, health and safety audits. Other partners involved in the

project include Waka Moemoea Trust, Housing NZ, Hutt City Council (HCC), ACC, Kokiri Marae, and Epuni Primary

School (venue for hui). Over the past four months, a great deal of work has been achieved collectively e.g. HCC

and ACC developed and undertook health and safety audits, HCC erected a ‘No Exit’ sign and cleared blocked

drains, Housing NZ addressed some housing concerns, and residents were given gift packs made up of donations

from partners (slip mats, energy efficient light bulbs, Healthlink fridge magnets, brochures for self-referring to

services, lip balms, bottles of water and balloons).

A regional home insulation programme targeting low-income households is currently being rolled out,

particularly for those who experience health challenges such as respiratory conditions, asthma, skin infections

and rheumatic fever which are exacerbated by living in damp and cold housing. CHWs are actively seeking those

who meet the financial and health criteria as they recognise that by improving the warmth of housing, we

improve peoples’ health and wellbeing.

A blessing of Pomare land being redeveloped was carried out by local iwi. In attendance were local community,

organisations and schools, HVDHB staff, Minister of Housing, Real Estate Agents, Building Contractors, Social

Housing Providers and the Property Developers. The redevelopment project has begun with the show home

being ready for viewing by beginning of March.

The community around the Jackson Street Flats in Petone has had difficult times in recent months. There have

been two tragic deaths in the community, and HUCHS Petone Clinic has been under threat of closure. A

community meeting hosted by Mayor Ray Wallace passed two unanimous resolutions. The first was to keep the

HUCHS Petone Clinic open, and the second was to start a “Positive Petone” group similar to the successful

Positive Pomare group. The aim of this group is to bring community members, community groups and health

and social service agencies together to respond to community issues and to work with the community on

projects which will have a positive impact on the local area.

HUCHS CHWs met with a local lawyer who specialises in Family Law, CYFS and Domestic Violence. He is

interested in running clinics at Petone and Pomare Clinics for people from the local communities who need

assistance with anything to do with family law. CHWs recognise that our communities do not always have easy

access to a service like this, so bringing it to our community provides access and builds positive relationships and

trust.

Whai Oranga CHWs have five families using the community garden, with a bumper crop this year of vegetables

varying from corn, potatoes, rhubarb, bok choy, carrots, beans, tomatoes, strawberries, broccoli, zucchini, salad

greens, herbs, chives, parsley and celery. It has been particularly exciting for one family as this is their first ever

attempt to grow vegetables, facilitated by a ‘one on one’ education session, including planting, with the CHW.

Another family with a garden bed have been garden volunteers since the very beginning of the project. They

have helped on all working bees, planting sessions and general tidy up chores. The youngest member of this

family - a 10 year old boy – is showing a keen interest in gardening. He is able to explain and demonstrate to his


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siblings the planting process and the best way and time of day to water plants, and to describe the different

materials needed for composting. He credits his knowledge to time spent with CHWs in the garden.

The CHW has also utilised opportune moments via organising a seedling workshop with a group of youth, which

was a great success. They were shown how to plant seeds by recycling and reusing everyday containers like egg

cartons, yogurt and butter containers. The CHW also organised an informative organic gardening education

session with a kuia, who shared a wealth of knowledge that has been instilled in her from birth.

Following Whai Oranga’s Smoke Free Cars Campaign launch in February, there has been another study to 'count'

the smokers in cars. This count found that just under six months after the launch and after counting over 5700

vehicles, smoking in cars in Wainuiomata decreased from 11% to 6%. This is a great result, and comes from being

out in the community and helping to make small but significant changes to the local smoking culture. The CHWs

invested time preparing for a day to celebrate this success. Plans are now in place to help those still smoking in

cars (the 6%) to change, to give the tamariki a better start to life, and to give the matua longer and better quality

lives.

This year’s local White Ribbon Day (WRD) was attended by the WRD Chairperson, Judge Peter Boshier. WRD is

a great way to reinforce the messages that “Family Violence Is Not OK” and it was great to hear what was being

done in our communities to keep families safe. There were speeches from Dr Mathew Shaw who is part of the

Family Violence Death Review Committee, and a performance by youth group, Taiohi Morehu, who deliver

messages around family violence through dance, drama and kapahaka.

The team have been assisting DHB and RPH staff with appointments to key positions. The Outreach Team Leader

assisted HVDHB’s Māori Health Advisor with interviews for their new Family Support Coordinator - Acute role.

A HUCHS CHW was asked to be part of the interview panel for Regional Public Health’s new Public Health Advisor

- Community Liaison role. HVDHB and RPH recognise our team’s knowledge of the community and value our

input into how potential candidates will fit into their respective roles and ensure appointees have the right skills

and fit within a community setting.

SERVICES PROVIDED

Over the reporting period July to December 2013, the CHWs carried an average caseload of 134 patients each

month.

Provider Caseload / Unique Patients

Jul to Dec 13

Average Patients per month


HUCHS 182 40

Whai Oranga 137 46


The following graph outlines the caseload of unique patients each month in the July to December 2013 period.


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For the patients cared for in the reporting period, 54% were Maori, and 25% were Pacific. Most patients seen

were Quintile 5 (53%) or Quintile 4 (29%), with the remaining patients (18%) spread across Quintiles 1to 3.

In the July to December 2013 period, the virtual team of CHWs provided a total of 1,562 patient contacts, and

5,140 services to patients. The lower numbers in September and December were due to a couple of members

from the team requiring extended leave, and the resignation of one CHW and the recruitment of a new CHW in

December.

Provider Patient Contacts

Jul to Dec 13

Services (includes advocacy)

Jul to Dec 13


HUCHS 307 769

Whai Oranga 266 1220


6165

48

7165

70

36

47

19 2129 32

54

38

17

48 51

29

0

10

20

30

40

50

60

70

80

July August September October November December

Caseload / Unique Patients

TeAHN Whai Oranga O Te Iwi HUCHS

Māori 54%

Pacific25%

Other21%

Ethnicity Service Wide1 Jul to Dec 13

Q13% Q

Q311%

Q429%

Q553%

unknown

0%

Quintile Service Wide1 Jul to 31 Dec 13


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The following table shows the number of advocacy services undertaken with specific organisations this reporting

period, with the majority of outreach activities involving advocacy alongside primary and secondary care

practitioners, and Work and Income staff.

The graph below breaks down the various services provided to patients who accessed the service. Phone calls,

home based visits, education and support, contacting other agencies, and referring on to other services were

the five most frequent services provided this reporting period.

291 263168

287 327226

1002867

592

819

1130

730

0

200

400

600

800

1000

1200

Jul Aug Sep Oct Nov Dec

Volume of Work Service Wide1 Jul to 31 Dec 2013

Patient Contacts Services Provided

Advocacy Services TeAHN HUCHS Whai Oranga O Te Iwi

Service Wide

Government Organisations 48 0 0 48

Housing NZ 15 30 5 50

NGO (Non-Government Organisations) 71 21 5 97

Other Advocacy 102 28 38 168

Primary Care 84 62 74 220

Secondary Care 56 76 34 166

Work and Income 100 40 31 171

Service Wide 477 257 187 920


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As the new welfare reforms are implemented, the impact of the new Work and Income processes has become

more apparent. Many of the CHW clients need education on the changes and the implications for them.

The cost of prescription co-payments (the $5 per item charge) continues to be an issue for many patients. This

is particularly evident every February, when the counting of prescription numbers starts again, as many families

struggle to find the $100 needed before the cap comes into play.

BRIEF INTERVENTION 1

A client rings, as she needs to sort some business out with Work and Income and also tend to some personal

issues. She is unable to get a caregiver in to look after her husband who is currently having cancer treatments

and is unable to leave him alone. CHW assists by looking after husband while she tends to her business. Client is

grateful for help as she would have had to rebook her appointments which would have meant a week or two

wait.

BRIEF INTERVENTION 2

A female patient who suffers from multiple health issues and is on an Invalids Benefit made contact with the

CHW seeking help to get a food parcel. She did not have enough money left over after bills to buy enough food

for her and her two children. After a discussion with this patient, she disclosed to the CHW that she had not

picked up her prescription either, due to not having enough money.

The CHW identified that it was a priority for patient to get her medication due to severe health conditions. The

CHW had to find a way to fund the patient’s prescription. She spoke to one of TeAHN’s Outreach Nurses, who

was able to access the Packages of Care funding to pay this prescription charge.

24 31 55 59 72 75 97136 149 151 166

289

647

858

1186

0

200

400

600

800

1000

1200

1400Fa

xes

Wh

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/Aig

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eeti

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Tran

spo

rt P

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ded

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WFA

)

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Cu

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Text

Mes

sage

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Int/

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Ref

err

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Co

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ct O

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Age

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Edu

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on

an

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up

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Pat

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isit

- H

om

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Ph

on

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alls

Services Provided This Period1 Jul to 31 Dec 13


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CHW then organised a food parcel. She is now working with the Outreach Nurse to support this patient and her

kids to get a budget sorted. She is investigating whether this patient is entitled to a Work and Income Disability

Allowance that can help cover the costs of medication.

CASE MANAGEMENT 1

Client

A referral was received from a GP at Stokes Valley Medical Centre for an inpatient at Te Whare Ahuru. Support

and advocacy were required to assist the client upon discharge.

CHW Assessment and Role

There was a delay in gaining first contact, due to the client’s suicide attempts and lack of response to the initial

contacts. First home visit was made at the client’s mother’s home, where the client was visiting. The CHW was

advised that the client had Te Paepae Arahi already assisting her, so the CHW gained consent to meet with her

support person from Te Paepae Arahi to ensure we would not be doubling up on resources. At the meeting, it

was discovered that the client had a great deal of support already in place, and was going to be provided ongoing

support through supported living arrangements.

The CHW identified that much more support was needed, though, for the client’s children and their

grandmother. All the children were living with their grandmother in her overcrowded 2-bedroom flat. She had

no support or assistance for the care she was giving to the children, and her own health issues were escalating

due to all the stress. All family members were aware of the suicide attempts, with two of the teenage children

experiencing their own issues resulting in truancy, angry behaviour and ongoing issues at school and at home.

The client was spending some time with her mother and her children. However, because she was heavily

medicated, she was unable to deal with her own, her children’s or her family’s issues. This then created more

work and stress for the grandmother. The doctors, the school and the grandmother had also identified that the

children were feeling responsible for their mother’s ongoing mental health illness.

Actions

Once the support person at Te Paepae Arahi gained the grandmother’s consent to refer to our service, the CHW

talked to the grandmother about getting Strengthening Families on board to provide a coordinated response

and ensure ongoing wraparound supports were put in place for the whole whānau.

The referral for Strengthening Families was then completed and accepted, with the following issues and

concerns needing to be addressed:

Parenting

Child Management

Child/Young person’s literacy/numeracy

Behaviour at school

Stand down/suspension

Housing issues

Benefit entitlement

Accommodation for whānau as grandmother’s flat was overcrowded.

Health

Parents/Caregivers physical health/disability


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Young person mental health

Safety/Justice

Child’s behaviour

Young Person’s behaviour

Concerns

Children taking on the parenting role

Children’s safety (i.e. possible additional guardianship needed)

Service Input:

Number of visits to the client (mother): 14

Number of phone contact to client (mother): 13

Number of visits to the client (grandmother): 9

Number of phone calls to the client (grandmother): 5

Number of contacts and phone calls to organisations: 37

Number of referrals: 2 (Strengthening Families and Grandparents Raising Grandchildren)

Number of liaisons with alternate service: 28

Providers Involved:

General Practice staff

Work and Income

Housing NZ

X3 Schools

Strengthening Families

Birthright

Community Mental Health

Te Paepae Arahi

Grandparents Raising Grandchildren

Outcomes:

The mother of the 3 children is now taking an active role in her children’s lives. Housing NZ has placed the family

on a priority list for a 3 bedroom home just around the corner from the grandmother. The home will be allocated

to the mother, and resources have been provided for the mother to set up her new home. The two older children

will live with their mother in the new home, and the youngest will stay living with the grandmother. There will

be no overcrowding.

Ongoing appropriate supports are now in place for individual family members, and all Work and Income

entitlements are in place. Support for the grandmother is now in place and her health is improving.

The mother and grandmother have a coordinated approach with all the schools to monitor the children and

assist where needed. The schools are looking at ongoing options for the children. The children are more settled

at school and at home, and are all excited with the new plans.

The above work has been achieved in only 2½ months, and with the family having appropriate ongoing supports

in place, they have been discharged from the CHW service.


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CASE MANAGEMENT 2

Client

A referral was received from an independent Pacific consultant working in Pacific communities. She made a

phone call to one of our CHWs, regarding a 40 year old Samoan sole-parent father of two sons aged 13 and 15

years. Their mother had moved away and left the family in crisis. The father was about to lose his job, Housing

NZ were looking at terminating his tenancy, Inland Revenue had sent him a $3,000 debt notice, and his estranged

wife was still claiming for child support despite the children now being in his care.

CHW Assessment and Role

Provision of transportation and advocacy to a Housing NZ mediation meeting, where the CHW

successfully negotiated maintaining the client’s tenancy. A payment plan was put in place at $70 per

week for debt.

CHW arranged a Work and Income appointment were they approved a $150 food grant for some

much needed groceries for the aiga.

CHW organised a meeting with the client’s work supervisor to update them on his circumstances,

including being overwhelmed with personal issues which were preventing him from working and

making contact with them. The meeting was held at his place of work, with his boss proving very

supportive of his situation.

After numerous phone calls to Inland Revenue and assisting the client to fill out various forms, the

$3,000 debt was waived.

As English is the client’s second language, all communication to various departments involved were

arranged and translated by the CHW in the client’s presence.

Service Input


Number of liaisons with other professionals: 25

Number of transports provided to appointments: 4 (Housing NZ, Work and Income, Inland Revenue

and the patient’s place of employment)

Outcomes

A great deal of encouragement and empowerment based work was used for the client to gain the confidence

needed to move forward. He is now back at work and his arrears with Housing NZ have been paid in full.


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PRIMARY MENTAL HEALTH

The Primary Mental Health Service aims to improve health outcomes for people with a mild to moderate mental

illness and addictions. The primary mental health incorporates two Te Awakairangi Health Network (TeAHN)

providers (Wellbeing Service and Hutt Union and Community Health Service (HUCHS)) as well as Vibe (for youth)

and the Lower Hutt Women’s Centre, which offers groups and support for women.

TARGET GROUPS

People aged 13 and older affected by a mild to moderate mental illness or addictions. People who are Maori,

Pacific, from Quintile 5 areas or aged under 25 years are prioritised in accordance with the 2013-14 service

specifications. Referrals are also accepted where there is evidence of barriers to accessing suitable services,

such as low income and a Community Services Card. Where low income people who do not fall within these

groups are referred, they may be assisted to access alternative low cost services or accepted for services

depending on the referred person’s needs and resources and the capacity of the primary mental health service.

KEY ACTIVITIES

Assessment, brief talk therapy, information and resources, support, monitoring and group programmes are

available for clients while practice staff are supported to assist in their work with people affected by mental

illness and addictions.

The Wellbeing Service’s centralised multidisciplinary mental health team in Lower Hutt serves most TeAHN

practices plus Ropata Medical Centre. Wellbeing outreach clinics are available in Upper Hutt and Wainuiomata.

Whai Oranga O Te Iwi Medical Centre hosts the Wainuiomata clinics; these are available for all Wainuiomata

residents. In November, TeAHN also began offering appointments in Stokes Valley hosted by Koraunui Marae at

its Tui Glen School clinic. HUCHS embedded services are available for HUCHS enrolled patients. Vibe’s services

are primarily available at its Lower Hutt and Upper Hutt sites with some nurse appointments offered via Vibe’s

school clinics.

ACHIEVEMENTS

Delivering high quality primary mental health assessment, therapies and supports to referred clients and their

families/whanau continued to be the focus. Data showing referral numbers and characteristics, and services

provided, is presented later in this section.

Following feedback from a TAS audit earlier in 2013, a comprehensive informed consent form has been

introduced and processes for recording informed consent have been improved.

The team strengthened its capacity to work effectively with Maori and with people affected by addictions

through recruitment of two part–time staff with specific skills and experience in these respective areas, and by

contracting a DAPAANZ registered counsellor who had previously worked with Whai Oranga O Te Iwi Health

Centre.

The new premises for the Wellbeing Service’s Upper Hutt clinics secured in late June became operational in July.

Having sole use of these premises has enabled the Wellbeing Service to increase its Upper Hutt presence from

three to four days per week.

Through an agreement reached with Whai Oranga O Te Iwi Health Centre, the Wellbeing Service also took over

responsibility for delivery of primary mental health service to the Health Centre’s enrolled patients and through

agreement with Whai Oranga. The existing DAPAANZ counsellor was contracted to continue working one a day

per week, and a Wellbeing Service nurse has been based in the medical centre half a day a week for most of the

reporting period. Appointments from these Wainuiomata premises are now available to all residents of


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Wainuiomata. Establishing the service in Wainuiomata has improved access to primary mental health services

for people who faced transport barriers and cost barriers in getting to a Central Hutt location for appointments.

In November, a pilot clinic started operating in Stokes Valley. This was made possible through strengthening

our links with staff at Koraunui Marae who host our clinics in the Tui Glen School clinic rooms. The clinic itself is

in its early stages of establishment; however an immediate positive outcome has been regular opportunities to

link with Koraunui in ongoing collaboration regarding shared clients, community needs and increase mutual

understanding of what each agency can offer.

The July to December 2013 reporting period was marked by a higher than average rate of suspected suicides in

the Hutt Valley area through winter and spring. More intensive suicide prevention efforts were activated by

Regional Public Health and primary mental health representatives became core postvention group members

along with the police, DHB mental health services, city council and Koraunui Marae (as a small cluster of deaths

were in the Stokes Valley area). Key outcomes to date have been strengthening relationships among agencies,

and educating community representatives about agency roles and key suicide prevention messages which can

then be disseminated more widely into the community. Representatives from the Wellbeing team and our

primary mental health partner Vibe took part in a panel answering questions about suicide and access to support

services at a Stokes Valley Community meeting at Koraunui Marae in October.

In October 2013, practices were encouraged to promote Mental Health Awareness week and promotional

materials were provided to assist with this. The Wellbeing Service also partnered with the Health Promotion

team to hold a Mental Health Awareness day at WelTech, promoting the theme of building connections with

others as one way to build resilience and encourage positive mental health.

CLIENT NUMBERS AND NEW REFERRALS

The table below shows total client numbers and new referral numbers for each provider agency and totalled for

the primary mental health service as a whole. Figures from the previous six months are provided for comparison,

where available. Wellbeing figures include Whai Oranga numbers for both periods.

Overall service users decreased by 7% and referral numbers by 10% in the Jul to Dec 2013 period, when

compared to the previous six months, with variability between the providers. The reduction at TeAHN is an

expected result of the Wellbeing Service continuing to communicate with practices about referral criteria and

priority groups over the year. Non-priority group referrals have steadily reduced, except those with evidence of

other barriers to accessing services, such as a low income qualifying for a Community Services Card. The

144

612

88

244

1088

150

519

110229

1008

0

200

400

600

800

1000

1200

HUCHS WellbeingServiceTeAHN

and WhaiOranga

Vibe Lower HuttWomen's

Centre

ServiceWide

Unique Service Users


55

457

49148

709

75

387

58118

638

0

200

400

600

800

HUCHS WellbeingService

TeAHN andWhai

Oranga

Vibe Lower HuttWomen's

Centre

ServiceWide

New Referrals



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reduction in inappropriate referrals has reduced the workload involved with the intake process, freeing up

clinical time for client support and therapy.

Referrals are broken down by practice below.

New Referrals

Referral Practice Jan to Jun 13 Jul to Dec 13

Avalon Medical Centre 8 4

Dr Dunns Surgery 6 6

Dr Hans Snoek 12 5

Epuni Medical Centre 10 5

Fergusson Drive Surgery 7 3

Fitzherbert Road Medical 2 4

Gain Health Centre 7 12

HUCHS - Petone 2 2

HUCHS - Pomare 58 75

Hutt City Health Centre (incl. Wainuiomata site) 50 26

Kopata Medical Centre 26 22

Main Street Surgery 7 4

Manuka 4 3

Muritai Health Centre 11 7

Naenae Medical Centre 46 27

Petone Medical Centre 17 18

Pretoria St 10 5

Ropata Medical Centre 69 43

Silverstream Medical Centre 31 15

Soma Medical Centre 5 11

Stokes Valley Medical Centre 43 38

Taita Medical Centre 2 1

Upper Hutt Health Centre 44 54

Vibe Youth Health Service 47 54

Waiwhetu Medical Centre 8 22

Whai Oranga Health Centre 27 46

Unknown 2 1

SERVICE WIDE 561 513

After a significant rise in Maori accessing the Wellbeing Service since July-December 2012 the percentage has

remained consistent at 23% for the last 12 months. 41% of HUCHS and 28% of Vibe’s service users identified as

Maori, with13% at the Lower Hutt Women’s Centre. Primary mental health service specifications for 2013/14

include young people under 25 years of age as a priority target group. This age group made up just over 30% of

all service users, including all from Vibe, 29% of those accessing the Wellbeing Service, 18% from HUCHS and 9%

using the Lower Hutt Women’s Centre. A more detailed breakdown by ethnicity and age are provided in the

figures below:


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Of those who accessed the Wellbeing Service, HUCHS or Vibe, 76% of those referred or accessing primary mental

health care met priority access criteria (Maori, Pacific, Q5 or 13-24 years of age). Lower Hutt Women’s Centre

data is not included as quintile is not available.

SERVICES PROVIDED

The table below shows a summary of services and contacts across the primary mental health service for the

current reporting period. From July to December 2013, there were 1930 scheduled (including DNAs) and

unscheduled client sessions and face-to-face contacts via the Wellbeing Service, Vibe and HUCHS, compared to

2291 for the previous six months. Average number of sessions per client varied between 2.2 and 5.3 depending

upon provider agency. There were 1645 attendances at Lower Hutt Women’s Centre for group programmes

and individual support in the current reporting period, compared with 1546 in the previous six months. Overall

sessions and contacts were slightly higher (6343) than in the previous period (6171) however the Wellbeing

figures in particular included increased missed appointments and phone contacts. A detailed breakdown by

service and contact type will be provided in the Primary Mental Health Service six monthly report to the DHB in

February 2014.

Service Wide Total: 6343 Jul to Dec 13

Sessions (incl. DNAs and rescheduled)

1930

Intake Screening 282

Phone calls 1832

Letters 573

Referrals Made 55

Other Meetings 26

LHWC Group Session Attendances 993

LHWC Drop In & individual support 652

Māori, 24.0%

Pacific, 5.0%Other,

72.0%

Ethnicity of All Service UsersJul to Dec 13

0 to 11yrs0.2%

12 to 19yrs14.5%

20 to 24yrs16.0%

25 to 44yrs35.3%

45 to 64yrs28.2%

65+5.6%

unknown0.3%

Age Groups of All Service UsersJul to Dec 13


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The Wellbeing Service has worked to become increasingly targeted on priority referral groups over the last 12

months. There have been positive outcomes for many people as a result of having their mental health needs

addressed. However there have also been challenges in establishing contact, impacts on volumes of contacts

and an increase in DNA rates particularly for those with multiple stresses and more chaotic lives. For example,

the Wellbeing Service received 70 referrals in this period where no contact could be established with the client,

compared with 46 in the previous six months. The situation is being monitored and we are proactively working

to reduce barriers to higher needs clients. Included here are now being able to offer a choice of part-time

therapists who identify as Maori and Pacific; increasing capacity to work with those with addictions through

employing and contracting appropriately qualified and experienced clinicians; offering appointments in

Wainuiomata and Stokes Valley, and increasing to four days per week in Upper Hutt; increased capacity for home

visits. We continue to work closely with other TeAHN teams and have strengthened our relationship with

Koraunui Marae’s social services.

Work is currently underway within the DHBS on developing a 3DHB Mental Health and Addictions Strategic

Framework for the Wellington Region. It is expected that the resulting strategic framework will inform the

2014/15 Primary Mental Health Service Specifications. The Wellbeing team leader has represented Te

Awakairangi Health Network at two workshops which sought provider and consumer views and ideas on what

services should incorporate and potential models that could form the basis for the framework. A separate

process began in December with regard to youth health including youth mental health, with TeAHN and Vibe

representatives included.

In December Hutt Inc. approved a collaborative project between the Hutt DHB Mental Health Directorate and

TeAHN that aims to smooth transitions and improve outcomes for adolescents and adults discharged form DHB

mental health services to primary care. Scoping and project planning is expected to begin shortly.

CASE STUDY: MR A

A Wellbeing Service mental health nurse first saw Mr A. two years ago when he was referred by his GP for help

with his health anxiety and panic attacks. Mr A had used mental health services extensively in the past but for

many years his condition had been reasonably well controlled under the watchful eye of his GP. However Mr A

finds it hard to cope with stress and is particularly vulnerable when his wife’s own much less stable mental health

deteriorates significantly. When she has an admission to hospital or other crisis intervention Mr A is left at home

alone. He gets worrying chest pains triggering calls to the ambulance and visits to the emergency department.

He feels overwhelmed by concerns about his wide, his own health and feels unsupported despite reassurances

that he is physically ok.

Using a cognitive behavioural therapy approach the Wellbeing Service nurse helped Mr A understand the links

between his thoughts about stressful situations, his emotions, physical sensations and behaviour. They tracked

his cycle of the anxiety and Mr A learned to take a different perspective on his symptom, such as considering

the probability that his chest pain might be a heart attack pain, indigestion or anxiety-related. He developed

more helpful ways of responding to the sensations he experienced. Mr A formed a good rapport with the nurse

and found the sessions helpful. When he’d felt back in control of his anxiety and his life for some time he was

discharged.

Mr A self- referred back to the Wellbeing Service a year later after another very stressful time triggered by his

wife’s health. This led to an increase in calls to the ambulance and visits to ED again. Fortunately the same

nurse was able to see him again. First they revised the CBT work to ensure Mr A remembered what he’d learned

and he began to use the strategies that he remembered had helped. Then they wrote down his typical cycle and

a management plan in a way that made sense to Mr A. This included what helps, what doesn’t and steps to try

himself before deceiding if he needs to call an ambulance, seek extra help or support. He keeps copies on his


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fridge and in his wallet to be an ongoing reminder to himself, for times when he finds it hard to recall what to

do. Mr A and the nurse also shared the plan with his GP, practice nurse, ambulance service and emergency

department.

Mr A has found writing and sharing the plan validating and empowering. Feedback from other services is that

the plan is helpful for them too. Everyone understands the cycle better, so can remind him of what might help

and reinforce him in a consistant and respectful way. Mr A also finds his pain and suffering is decreasing as he

feels more in control and able to cope.

Even though his wife’s health remains of concern Mr A. is happy he doesn’t need to go to ED as frequently. He

hasn’t needed further appointments with the Wellbeing Service nurse but has been offered phone support as

he gains confidence to implement the plan for himself. Time on these calls is reducing and the emphasis is on

celebrating Mr A’s anxiety management successes.


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HEALTH PROMOTION

The health promotion team aims to develop and implement a range of health promotion initiatives to support

individuals, families and target populations to stay healthy and well. The initiatives emphasise healthy eating,

physical activity, being smokefree, and overall wellbeing, as well as encouraging people to get health checks.

The main programmes include:

Cardiovascular disease health promotion

Good Food Programme

Community health promotion events and presentations

Polyfest / Pacific Wellbeing Day

Communications and Media

Health 4 Life Project

Pasifika Choice Project

Support Groups including Valley Fit Programme

Pacific Healthy Lifestyle Programme

Provision of the Healthy Families Coach Service

CARDIOVASCULAR DISEASE HEALTH PROMOTION

The health promotion team has worked closely with the clinical facilitation team over the past 6 months on

raising the profile of cardiovascular risk assessments and heart health. See the Cardiovascular Risk Assessment

section of the report for information about the various community and practice based activities.

GOOD FOOD PROGRAMME

Three Good Food Programmes have been completed over this reporting period. The four week programmes

were run at the Te Aroha Complex in Waiwhetu (as part of the training programme for the Te Awakairangi

TRYathlon), at Orongomai Marae and at Trentham Community House. All three programmes were popular and

well attended with an average of 13 people per session.

Evaluation of the programme indicates that attending the

programme results in participants reporting increased

confidence and knowledge around preparing healthy meals for

their family. Evaluation also shows that participants report

increased understanding of key nutrition concepts such as

understanding of fat, fibre, salt and sugar in their diet and how

these impact on

our bodies.


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COMMUNITY HEALTH PROMOTION EVENTS AND PRESENTATIONS

TE AWAKAIRANGI TRYATHLON

The Te Awakairangi TRYathlon was held in September 2013. The event is aimed at encouraging inactive people

to ‘get off the couch’ and was completed by 100 people. The TeAHN health promotion team supported event

organisers (Te Aroha Trust) by facilitating weekly morning training sessions, supporting promotion and

enrolment, offering the Valley Fit Naenae and Wainuiomata sessions to participants, facilitating the Tane Hauora

Health evening and running a 4-week Good Food nutrition programme to complement the physical training.

GAMBLE FREE DAY

The team represented TeAHN at the Gamble Free Day celebrations (run by the Health Promotion Agency) at

Walter Nash Stadium in September.

STROKE AWARENESS WEEK

TeAHN worked with Rotary and Stroke Foundation to set up a

blood pressure testing stall at the Saturday River Bank Markets in

October. Over 200 people were tested over the morning. Thirty-

eight of those tested had stage 2 hypertension (blood pressure of

160+/100+). These patients were encouraged to contact their

general practices for an appointment, and TeAHN also passed

their names back to their general practice for follow-up.

WAHINE ORA DAY

TeAHN partnered with Mana Wahine and Regional Screening Service to run a Wahine Ora Breast and Cervical

Screening event in October. The event involved identifying Maori and Pacific women who were overdue for

Breast and Cervical screening and inviting them to take part in a Saturday Screening Day. Transport was provided

for those who required it. The successful event screened 22 women for mammograms and 13 for cervical

screening. A further 24 women made appointments to be screened on another day. There was only one DNA on

the day.


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HEALTHY LUNCH PROMOTION TRENTHAM SCHOOL

The health promotion team worked with Trentham School on a

healthy lunch promotion in November. The entire school was

focusing on healthy eating and completing a number of activities to

increase healthy lunches. Health promotion team members attended

‘Sandwich Day’ where each class made a salad sandwich and took

part in other activities such as Jump Rope for Heart.

WORKPLACE WELLNESS FORUM

TeAHN attended the Workplace Wellness Forum run by Health

Promotion Agency and Regional Public Health in November. The

forum was well attended by many Wellington and Hutt Valley

workplaces. Attending the event was a great opportunity to link with

local employers and explore ways that TeAHN could support their

workplace heath initiatives.

KAUMATUA DAY

The health promotion team attended the annual Kaumatua Health Day organised by Kokiri Health and Social

services at Wainuiomata Marae. The team focused on educating kaumatua about healthy eating.

MENTAL HEALTH AWARENSS WEEK AT WELTEC

CAMPUS

The health promotion and wellbeing teams set up a

‘Winning Ways to Wellbeing’ stall at Weltec to mark

Mental Health Awareness Week. Hundreds of staff and

students engaged in conversations about positive

mental health and were invited to spin the ‘Wellbeing

Wheel’ to win prizes donated by local cafes.

NAENAE FESTIVAL

Members from several TeAHN teams partnered with

the Pacific Health Service staff to promote heart checks and other services at the Naenae Festival in November.

RIMUTAKA PRISON HEALTH EXPO

The health promotion team attended the Rimutaka Staff Health Expo in December. TeAHN provided a healthy

lunch option for staff and spent the day talking about healthy lifestyles and performing blood pressure checks.

PUBLIC HEALTH CONFERENCE

Two members of the health promotion team presented at the Public Health Conference in Taranaki in

September. The presentation about TeAHN’s work on community based CVD risk testing was well received.


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POLYFEST/ PACIFIC WELLBEING DAY

The health promotion team

supported local primary and

intermediate schools to run a

Polynesian festival over two

evenings in July. TeAHN provided

financial support, and influenced

the event to ensure it was

promoted health messages such

as fizzyfree and smokefree. Over

the two evenings, TeAHN staff

talked to parents/audience prior

to the performances about

healthy snacks for children. Our

staff also provided free Heart

Health Check vouchers to people who meet the criteria.

COMMUNICATIONS AND MEDIA

The health promotion team is playing a key role in the development of the TeAHN communication plan which

aims to increase awareness of TeAHN and its services, celebrate organisational success and increase access to

healthy lifestyle messages and services.

HEALTHY MESSAGING ON ATIAWA TOA FM

The health promotion team has been increasing its presence on the local iwi radio Atiawa Toa FM. The team

worked with Vibe to script and record two advertisements on heart checks and youth mental health which have

featured regularly on the radio over recent months.

Planning has been completed for a six month health promotion programme which will run from January to June

2014. Each month will feature two health themes which will be profiled via advertisements and interviews.

FACEBOOK PAGE

TeAHN has launched its Facebook page which aims to increase awareness and access to healthy lifestyle services

and events in the Hutt Valley.

HEALTH 4 LIFE

Health 4 Life is a joint project by Regional Public Health (RPH), Service Integration and Development Unit (SIDU)

of Capital and Coast DHB, Hutt Valley DHB and Wairarapa DHB; Te Awakairangi Health Network; and Compass

Health.

This project is one of seven projects the Ministry of Health has funded to focus on improving nutrition and

physical activity in the pre-school population starting in pregnancy.

Health 4 Life is an early intervention programme that requires participation across a wide range of providers

who deliver services to women during pregnancy and infants in their first year of life.


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The aim of this project is to improve the quality and uptake of nutrition and physical activity advice given to

pregnant women, mothers of infants in the first year of life and their whanau. This will be achieved through the

development and delivery of simple common messages on maternal and child nutrition and physical activity.

The project is currently in development stage with several members of TeAHN’s health promotion and dietitian

teams contributing to the project working groups, and TeAHN senior management participating in project

governance.

PASIFIKA CHOICE

Pasifika Choice is a joint project by TeAHN, Pacific Health Services and Family Centre. Pasifika Choice is an early

intervention programme that will work with Pacific children and their families to lay the foundations for healthy

lives. This project is one of several projects the Ministry of Health has funded through the Pacific Innovation

Fund to focus on reducing the prevalence of risk factors affecting Pacific people’s health.

The project is currently in development stage. TeAHN’s Candice Apelu has been seconded to Pacific Health

Service to provide project management, and the project is also supported by the health promotion team.

SUPPORT GROUPS

MĀORI PACIFIC HEALTH SUPPORT GROUP

The Valley Health Support Group held three final meetings over July, August and September. Meetings were

attended by members of the outreach and wellbeing teams who discussed various health issues. The Group has

since been discontinued while the health promotion team works with other network staff to evaluate the

group’s format and to explore how resources may be better utilised to help more patients with, or at risk of

developing chronic disease. It is hoped that by working with practice staff and by aligning more closely with

existing primary care programmes such as Heart and Diabetes checks that we can develop a programme which

meets the education needs of patients and practices.

REGIONAL WELLINGTON DIABETES SUPPORT GROUPS

Coordination support continues for the Upper Hutt, Lower Hutt and Wainuiomata Diabetes groups. Activities

arranged for these groups in the last six months included:

Dietitian presentation

Optometrist presentation

Communication and education about new Diabetes meters

Late in 2013, the health promotion team worked with Sport Wellington to submit a Request for Proposal to

provide innovative Green Prescription (GRX) services to diabetic and pre-diabetic patients. If successful, the

team will work with Sport Wellington and targeted practices to deliver group education to patients newly

diagnosed with diabetes or pre-diabetes.

VALLEY FIT

The Healthy Families Coaches continue to run group exercise classes at Naenae Leisure Active Fitness Suite

(twice a week) and in Wainuiomata Way of Life gym (once a week). Valley Fit supports people who are

overweight and who do not feel comfortable working out in the gym on their own.


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Sessions are well attended. Over the past six month period the Naenae group has been attended 345 times by

38 individuals and the Wainuiomata class has been attended 115 times by 20 people.

TeAHN is in the process of expanding the Valley Fit exercise class to Upper Hutt. We expect to run the group in

collaboration with Sport Wellington with the support of Activation Upper Hutt. Planning is currently underway

with a venue provider and we plan to get this class underway in February 2014.

In December Valley Fit members from the Wainuiomata and Naenae groups completed the TeAHN TRYnui

triathlon. The event is an annual event for the Valley Fit attendees designed by the Healthy Families Coaches to

be a challenging yet achievable goal for the group. This year 15 people participated.

CONNECTIONS NETWORKS AND FORUMS

The health promotion team collaborates with many other agencies and organisations and regularly attends the

relevant meetings. Of particular note this reporting period has been strengthened relationships with the Health

Promotion Agency, Te Aroha Trust, Trentham Community House, Pacific Health Service, Koraunui School,

Trentham School, Vibe, Sport Wellington, Heart Foundation, Regional Screening Services, Upper Hutt City

Council, Arthritis Foundation, Otago University, Regional Public Health and Quitline.


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The health promotion team participates in a number of networks including Workplace Health and Wellness

Stakeholder Group, Regional Screening Coordination Group, Wellington Nutrition and Physical Activity Network,

Wellington Regional Smokefree Network, Primary Care Tobacco Teleconference and the Regional Smokefree

Hui.

Members of the Health Promotion team sit on steering groups for the Health 4 Life, Pasifika Choice and Alive

(Upper Hutt physical activity initiative) projects.

PRACTICE EDUCATION AND CONNECTIONS

Increasing practice connections is one of the team’s key goals over 2013/14. Currently each TeAHN practice is

visited by the healthy families coach or dietitians every six weeks.

The dietitian and healthy family coach team presented to practice nurses as part of the CVD education

programme. The talk focused on improving the nutrition and physical activity component of the CVD education

sessions.

PACIFIC HEALTHY LIFESTYLES PROGRAMME

This programme is facilitated and delivered by Pacific Health Service Hutt Valley based in Naenae and is open to

everyone in the Hutt Valley. It delivers healthy

lifestyle activities that are responsive and

accessible to the Pacific communities.

KEY ACTIVITIES

Daily Pasifika style aerobic exercise at Naenae

Community Hall. (Zumba, Contra-band,

Pacific style aerobics), with six-weekly Health

Education Group Sessions run in conjunction

with the exercise programme.

ACHIEVEMENTS IN JUNE TO DECEMBER

2013 PERIOD

31 New clients joined the programme during the period

120 1 hour exercise sessions

50 average attendants per day

Hosted 10 health education sessions were well attended by an average of 25 participants per

session

20% increase in number of completed health screening

Increase in middle aged participants.


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ETHNICITY BREAKDOWN

DIETITIANS

The Dietitians work alongside patients, health professionals, individuals, families and communities to provide

tailored interventions to resolve nutrition problems with the purpose of supporting lifestyle change and

preventing chronic illness.

ACHIEVEMENTS

The Dietitian service has been able to strengthen links with the Maori community through our Maori Dietitian.

Her ability to speak Te Reo has increased engagement with Kaumatua groups at Kokiri and Wainuiomata marae

and with individual patients. The Maori Dietitian and Healthy Family Coach ran a successful healthy lifestyle

session with a traditionally hard to reach group of Maori males. The group was respectful and very appreciative

of the interactive talk where they asked about artificial sweeteners, alcohol and carbohydrates.

One of the Dietitians contributed to research by the Health Promotion Agency to develop five behavioural

profiles for low income Maori, Pacific and NZ European families so that attitudes, needs and characteristics of

these audiences can be understood. This has a close synergy with the Health 4 Life project which has enabled

the Dietitians to provide input into nutrition and physical activity messaging for pre-pregnant, pregnant and

lactating mothers and infants in their first year of life.

In the July to December 2013 period, the Dietitian Service experienced an 18 percent reduction in DNAs when

compared to the January to June period. This can mainly be attributed to the text-to-remind messages that are

sent to patients the day before their appointment.

83%

6%

3%

1%1%

5%

1%

Ethnicity of attendees at Pacific Healthy Lifestyle Programme

Pacific

European

African

Indian

Latin American

Maori

Other


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Over the last six months (July to December 2013), the average caseload was 116 per month compared with 106

in the previous period reflecting the continuity of the service in this period.

REFERRAL SOURCES

A total of 203 referrals were received and of these, only 7 did not meet the eligibility criteria. Patients were from

21 of the 23 TeAHN General Practices. Eighty six percent of the referrals were from practices, 7% from other

TeAHN services, 3% from HVHDB, 2% were self- referrals and 2% were from NGOs (Tamariki Ora). The

predominant reasons for referral were weight management, followed by Type 2 Diabetes, then cardiovascular

disease and hypertension.

Of the 137 patients who were discharged in the period, 7% declined the service when contacted for the first

time. For those patients who accessed the service, 192 nutrition problems were diagnosed and 86% of these

were resolved or are resolving. Of the 54% of patients who aimed to lose weight, 12% lost greater than 5% of

body weight (clinically significant) and 41% lost less than 5% of body weight. A further 36% remained within 1kg

of their initial weight and 11% gained weight.

SERVICES PROVIDED

There were 1535 patient contacts recorded in the July to December period which is almost 500 more that the

same period last year. A further 704 contacts (almost a third of total contacts) were made with health

professionals, family members and other agencies related to the patient. This meant that a team of people

worked together to support the patient and in particular provided motivation and positive reinforcement.

98 102

68

98 97

125 124115 114

125136

117

0

20

40

60

80

100

120

140

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

Patient Case Load


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The graph below summarises the range of interventions that were provided by dietitians after assessing and

diagnosing nutrition issues. Food behaviour strategies such as motivational interviewing, problem solving and

contingency management were the most common interventions. During this period, the Dietitians received

training in ‘food addiction’ and cognitive behaviour therapy to improve their expertise in assisting people to

modify lifestyles. In addition to exercise education, goal setting and review was a common intervention and

assisted patients to make a series of achievable changes and self-monitor progress. The Dietitians made 10

referrals to other health professionals or agencies, both internal and external.

In addition to working with individuals, the Dietitians contributed to many of the Health Promotion Team

community events including the TryNui triathalon, the Naenae Festival, diabetes support groups and advising

on Nutrition Books for the Hutt City Library. Te Awakairangi staff requested an interactive session on healthy

eating which helped to provide a supportive healthy work environment for the staff.

231

189

98

201

259279

295

344

277262

237

12098 102

6898 97

125139

11397

129 126100

0

50

100

150

200

250

300

350

400

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

Volume of Work

Patient Contacts Liaising Services

45 34 28

144 150

370397

360

103

287

244

141

274

167

0

50

100

150

200

250

300

350

400

450

Facilitation Services Provided this Period


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As a result of performing increased numbers of cardiovascular disease risk assessments, practices found that

they needed more visual tools to illustrate the fat content of foods to Pacific people. In consultation with the

Pacific Health service and with the help of the Health Promotion team, the Dietitians have been developing a fat

resource for practices.

Patient Satisfaction surveys were not sent for several months while discussing a preferred method for gathering

information. The reception staff have now started sending surveys monthly and entering them into an online

database. Early feedback received from patients seen in the last 6 months (n=13) shows high scores for

satisfaction with the service and reported positive changes in lifestyle. A more detailed report will be presented

in the next period.

The dietitians have offered to assist practice nurses or GPs with nutrition consultations by offering to sit

alongside during lifestyle education sessions, run group sessions or help in any other way. More time will be

invested in the next period to work positively with practices in ways that provide the most benefit.

CASE STUDY

SB is a 22 year old, Maori, Quintile 5, female. She was referred to the Dietitian service for lifestyle advice by her

Practice Nurse who reported she was worried about her weight and out of control eating. She is obese with BMI

of 34.5.

On assessment SB reported a regular meal pattern of three meals and three to four large snacks daily. She

was meeting Ministry of Health (MoH) fruit recommendations. She was not meeting MoH recommendations

for milk and milk products and vegetables. SB was consuming in excess of the breads and cereals and meat and

meat alternatives to MoH recommendations. She often chose high saturated fat and high simple carbohydrate

food options, with high levels of butter and eating takeaways one or two times a week. SB did not have any

planned exercise, however, in the past she used to go for 6km walks, which had previously helped her lose 5-

6kg. She enjoys walking and will walk to drop and pick up her daughter from daycare.

The interventions that were used to resolve these problems were primarily motivational interviewing and self-

monitoring (8 contact hours). This enabled SB to discuss what triggered her to consume excess food and helped

her develop strategies for avoiding these triggers and problem solving what to do when she was faced with the

triggers. The Dietitian provided SB with nutrition information (salt, fat, sugar, snacks, portion sizes and meal

pattern), skills (label reading, meal planning) and exercise education (timing, intensity, types, importance) that

she could use. Goal setting and review enabled SB to monitor her progress and at the same time discuss areas

she was having difficulty with and/or did not understand. During the intervention the Dietitian gave her a lot of

encouragement, which helped to keep her focussed and ensured she realised the importance of these healthy

lifestyle changes for herself and her young family.

After intervention SB has lost 14.5kg or 12.7% of her body weight. She is very happy with her progress so far and

would like to continue to lose weight towards her goal weight of 85kg. She realised that this was a long way from

her original weight and knew it was important to take it in small steps. SB is now eating a regular meal pattern

of three meals and will only have snacks if she feeling especially hungry. She has talked openly with the Dietitian,

her friends and family about the skills, knowledge and strategies she had learned through TeAHN’s service and

feels confident in managing on her own. SB has treated herself to some of the higher fat, higher simple

carbohydrate snacks she used to indulge in, however she has limited these and works extra hard on her exercises

if she felt she had overindulged. She found the exercise easier than the food and will workout on her hired

machines for 50 minutes at night time.


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SB reported that she was very happy following these lifestyle changes and seems to have a higher self-esteem

also. Two months in to the lifestyle intervention, SB has managed to successfully quit smoking (now four months

Smokefree) - another brilliant achievement. SB is planning on studying this year and continuing her healthy

lifestyle changes towards her weight goal. This case highlights someone who is in the action stage of behaviour

change and who has made the most of our service.

HEALTHY FAMILIES COACH

The Healthy Family Coach (HFC) service enhances the health and wellbeing of the target population by working

alongside patients, health professionals, individuals, families and communities to provide tailored interventions

to increase physical activity with the purpose of supporting lifestyle change and preventing chronic illness. The

service provides physical activity and lifestyle advice to Maori, Pacific and low income individuals who have a

chronic condition or are at risk of developing a chronic condition.

ACHIEVEMENTS

The HFC service has strengthened links with the Maori community over this period. This has been partly

facilitated through the retention of our Maori HFC. It has also been beneficial having both male and female

coaches, particularly for reaching our Maori and Pacific men. The Maori Healthy Family Coach and Dietitian

jointly ran a successful healthy lifestyle session with traditionally hard to reach group of Maori boys (Tama Tu,

Tama Ora). The HFC provided information to the group about the benefits of exercise, how to build it into their

daily lives and answered questions from the group.

Over the past six months (July to December 2013) the average caseload was 138 per month compared with 89

in the previous period reflecting the increased staffing in the service and better recording.

REFERRALS

The HFC service continues to have steady referrals receiving 150 referrals from July to December 2013. This is

21 higher than January to June period and 50 more than in the same period last year.

67 6688

101 101 108123

143154

142 147121

0

50

100

150

200

Patient Case Load


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Of the 150 referrals received this period 71% came from 19 TeAHN general practices (up from 61% last 6month

period), 6% from other Te AHN services, 3% self-referrals, 15% from HVHDB (Community Dietitians and Public

Health Nurses, Occupational therapists, Physiotherapist and Maori Health unit) and 5% from NGOs including

Kokiri Marae and Sport Wellington.

Of note this period is the increase in referrals from HVDHB which have increased threefold compared to January

to June period, indicating the good reputation the HFC service has with a number of DHB services. An example

of the increased HFC-DHB collaboration is the coordinated joint appointments with a patient and her Specialist

Consultant Dr Carol. This approach has been very successful as the patient values both the HFC and specialist

assistance. It meant that the three of us were all on the same page and able to work together to provide the

appropriate advice and use that to set goals. Dr Carol also reported that he found this very beneficial and has

asked that the HFC attend the quarterly appointments with this patient.

Of the 128 patients who were discharged in the period, half are doing well (30% are able to continue without

support, 16% have achieved their goals, and 3% are getting alternative support). The remainder did not engage

with the service (with 25% not attending appointments, 12% not ready to make changes and 11% declining the

service).

SERVICES PROVIDED

There were 1,496 patient contacts recorded in the July to December period, and a further 314 contacts were

made with health professionals, family members and other agencies related to the patient. This meant that a

team of people worked together to support the patient and in particular provided motivation and positive

reinforcement.

The table below shows an increase in the number of unique patients receiving services, and an increase in the

total and average contacts per month. This partly reflects the increased HFC staffing as well as better recording

of services delivered. On average, 250 patient contacts were made each month, an increase of 20 contacts per

month on the previous period.

2013 Total Contacts Average no. of Contacts per

month

Unique Patients this period

Average no. of patients at any

one time

January to June 1380 230 215 89

July to December 1496 250 271 130


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The above graph details volume of work over the past year. The drop in volume over August and September are

due to the full time HFC staff member taking annual leave.

After assessing the patient’s life history (to gauge readiness for change, current activity levels, past weight loss

attempts and challenges, diet history, medication and medical history) the HFCs provide a range of interventions

as illustrated in the ‘Services Provided’ graph.

Fifty one satisfaction surveys were completed this period and the service received some very positive feedback.

“Home visits took a great deal of stress out of having to seek advice. My coach could not have been more

encouraging and I appreciate my coach listening without judging”

“They came to my home, were prompt, good communication and good rapport”

“The commitment in not giving up on me when some days I had totally given up on myself”

“I was so very grateful for the referral to this wonderful service”

The HFC Service has been working on ways to better evaluate the service by revising its measures of success. By

working with similar services in other regions the evaluation measures have been improved in an effort to show

159 150

239 248

282302

335

158173

292 280258

174209

318

293

380

322 336

233

191

339310

233

0

50

100

150

200

250

300

350

400

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

Volume of Work

Patient Contacts Services provided

57 39

131189

88

201

290337

419

050

100150200250300350400450

Ind

ivid

ual

exe

rcis

ese

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Services Provided July - December 2013


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more accurately where patients have or have not changed their physical activity levels. New MedTech assessment

forms will be implemented from 1 January 2014.

In addition to working with individuals, the HFC contributed to many of the Health Promotion Team community

events including TryNui triathalon, diabetes groups, Stroke Awareness Week, Kaumatua day, Pacific Wellbeing

Day, Healthy Messaging on Atiawa Toa FM and presentations. Te Awakairangi staff requested a work place

wellness initiative to provide a supportive healthy work environment for the staff, and the HFC staff organised

the speakers and events.


Patient Satisfaction surveys were not sent for several months while discussing a preferred method for gathering

information. The administration staff have started sending surveys monthly and entering them into an online

database. Early feedback received from patients seen in the last 6 months (n=31) shows high scores for

satisfaction with the service and reported positive changes in lifestyle. A more detailed report for 2013 is

currently being composed by our administration team and will be available once all surveys have been returned.

The HFCs and Dietitians have offered to assist practice nurses or GPs with nutrition and physical activity

consultations by offering to sit alongside them during lifestyle education sessions, run group sessions or help in

any other way. More time will be invested in the next period to work positively with practices in ways that

provide the most benefit.

CASE STUDY

The following case study is based on a letter received from a patient who has made many changes to her life since receiving support from both the HFC Service and the Wellbeing Service. “I have had many challenges to overcome in my life. I was born with Congenital Dislocation of both hips as well

as dealing with the injuries from being hit by a motorbike when I was 10 years old. This has resulted in many

surgeries and head injury resulting in Epilepsy and Bipolar II.

I realised in late 2012, I found myself losing what control I had over my Bipolar. I spoke to my GP in late February

2013 and was referred to [a primary mental health clinician] at Te Awakairangi Health in March 2013. What has

happened since that referral has been amazing. The skills that I have learnt from [the clinician] have given me a

life that once I only dreamed about.

[The clinician] suggested that I attend [HFC staff member’s] Valley Fit programme as I might find exercise of

value in controlling my anxiety levels as this activated my bipolar symptoms. Going to the classes twice a week

has been fantastic. I have gained confidence, my anxiety levels have dropped to pretty well non-existent. I even

completed a Tryathlon on 8 September 2013. This was amazing for me as I had always hated exercise and had

trouble with due to a hip replacement and prolapsed disk in my back.

In early December 2013, I was told I have Breast Cancer. The mastectomy and lymph node surgery was done in

early December. I am now awaiting Chemotherapy and Radiation to complete my treatment. With the skills

that I have learnt from [the clinician] and attending Valley Fit have meant that I have been able to deal with a

very emotional and frightening period in my life. I have good control over my bipolar symptoms. This is what

my attitude is to dealing with my cancer: “Cancer touched my breast so I kicked its butt!!!!!”.

My relationship with my family has changed. We have all become much closer. My family say how proud they

are of me with how far I have moved forward with my life. Before my breast cancer diagnosis, I had found part


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time employment. My family have also said how amazed they are at my positive attitude to dealing with my

breast cancer.

My life before being referred to [TeAHN staff] was spent waiting for life to come to me. I now have goals that I

set and attain. So now I grab life and run. Life is fantastic.

I still have up and down periods, but they are nothing now compared to what they were, as I now have the skills

to deal with them. Thank you [TeAHN staff] for showing me how wonderful and beautiful life can be.”

TRANSPORT SERVICE

The purpose of the transport service is to improve access to primary health services for the enrolled population

of Te Awakairangi Health Network by providing free transport to patients for whom lack of transport is a barrier

to attending primary health services.

SERVICES PROVIDED AND REFERRALS

Wellington Free Ambulance (WFA) is contracted to transport patients to and from health appointments.

For July to December 2013, a total of 741 trips were made, by 280 unique patients. This is a 29% increase on the

number of trips (571) made in the January to June 2013 period, when a total of 571 trips were made, by 230

unique patients.

TeAHN is aware that the transport service contract is now over budget and is looking at ways to reduce the

number of trips being delivered. Utilisation of the service to access secondary healthcare appointments has

increased disproportionately, remains high and is an ongoing concern.

248279 266

305

368 373

0

50

100

150

200

250

300

350

400

Q1 12/13 Q2 12/13 Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Q3 13/14 Q4 13/14

Number of Transport Service TripsJuly 2012 - June 2014


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We have had discussions recently with the WFA and they are still working on improving the data collection. Data

recording of patient eligibility continues to be an issue but has improved with help of TeAHN developing a data

systems for WFA to adhere to.

DESTINATIONS

During the July to December 2013 period, 298 trips (40%) were made to primary health appointments. 60% of

the trips (443) were to secondary health care appointments with 193 trips to Hutt Hospital, 223 to Wellington

Hospital, 11 to Kenepuru Hospital, 8 to Bowen Hospital, 7 to Boulcott Hospital, and 1 to Southern Cross Hospital.

Further investigation of the trips to private hospitals has shown that patients going to Bowen Hospital were

attending publically funded sleep apnoea clinics, and patients going to Boulcott Hospital were there for radiology

appointments at Pacific Radiology. There was a one-off transport to Southern Cross hospital for a client of Te

Awakairangi Outreach Nurse team. Careful consideration was given to transporting this patient due to

unforeseen circumstances.

The graph below shows the figures for the July to December 2013 period.

21%

9%

21%25%

24%

Ethnicity/Quintile of Transport Service Users

Maori Pacific Q5 not M or P Unknown Non Target

7 8

193

11

173

5367

5

223

1

BoulcottHospital

BowenHospital

HuttHospital

KenepuruHospital

MedicalCentre

other Podiatrist Radiology WellingtonPublic

Hospital

SouthernCross

Transport Trips by Destination July-December 2013


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RISKS

The utilisation of the service to access secondary healthcare appointments remains an ongoing concern. The

service has utilised 57% of the annual budget to 31 December 2013. This service is being closely monitored. If

the inappropriate use for secondary appointments does not decrease, TeAHN will need to take stronger action

to clarify access criteria.

LANGUAGE LINE

PURPOSE

To ensure that patients who speak a language other than English receive health information accurately and in a

culturally appropriate manner.

KEY ACTIVITIES

Provision of the 0800 Language Line number for practices to access free of charge

Promotion of Language Line and the importance of utilising the interpretation service for people for

whom language is a barrier to accessing primary health care.


From July to December 124 calls were made to language line an average of 20.6 per month, similar to the use

seen in 2012/13.

Eleven Te Awakairangi Health Network practice sites used Language Line over this period. The most frequent

users of the service were the Hutt Union and Community Health Services (HUCHS) whose usage accounted for

72% of the overall total.

As shown below a range of languages were requested. Spanish continues to be the language interpretation most

commonly required followed by Burmese/Myanmar.

7

31

11

210

252

2

41

2

Interpretors Requested by Language Arabic

Burmese/Myanmar

Cambodian/Khmer

Farsi/Persian

Hindi

Other Asian

Mandarin

Pacific Language

Serbian

Spanish

Tamil


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PRACTICE SUPPORT

PRACTICE LIAISON AND SUPPORT

Practice liaison covers a number of areas providing frontline support to all Te Awakairangi Health Network

practices that wish to receive this support.

Practice Liaison and Support involves supporting practices with the implementation of new services, and a range

of business advice applicable to general practices. During this period this has included:

Supporting Practices with the installation and use of Patient Dashboard.

Working with the team at Karo Data Management to improve diabetes review recording and

installing the new Diabetes/CVD advanced form into the Practices and working with the Nurses and

GP’s to encourage the use of this form.

Inviting our Practices to potentially help fund them to attend a PMAANZ and APPM combined

Education training weekend.

Working with Hutt City Health Centre and Manuka Health Centre with the change to a new PMS

(My Practice) and working with Karo Data Management and our IT team to enable them to be able

to send their monthly claims to TeAHN in the same way as they did in Medtech.

There are several components of practice liaison and support which operate as core functions and have been

carried out this quarter. These include:

Preparation for register uploads each quarter and register cleansing tools for practice staff, and

one-on-one support for practices as requested

Collation and submission of quarterly lists of practices opting in for Under 6 and Very Low Cost

Access funding

Reminding and supporting practices to download/upload patient registers within required

deadlines

Providing practices with information, support, advice and resources to enable them to make

informed decisions on:

o Very Low Cost Access or Under Six Funding

o Utilisation of TeAHN services

o Management of patient registers

o Claiming systems and processes

o Enrolment processes and eligibility

Assistance with day to day issues and troubleshooting.


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QUALITY IMPROVEMENT


TeAHN is committed to the fulfilment of its strategic vision, mission and objectives through the provision of high

quality, patient-centred, primary health care services with minimal risk to the population it serves. The quality

and safety of services delivered by TeAHN and its contracted providers are overseen by the Clinical Governance

Committee.

IMPLEMENT AND EVALUATE SYSTEMS AND PROCESSES

The Network has prepared a draft Clinical Quality Plan in a new format identifying a three year cycle of

development. The plan will be presented to the February 2014 TeAHN board meeting. This plan acknowledges

Te Awakairangi Health’s contractual requirements with Hutt Valley District Health Board to ensure the enrolled

population and casual users will receive a service that uses quality management principles through a framework

that incorporates the key dimensions of quality in the health and disability system. A three year Quality Action

Plan is included as an appendix.

CLINICAL FACILITATION SUPPORT FOR PRACTICES

Support to practices has included further implementation and education on the Patient Dashboard system to

assist practices to improve their performance against the Health Targets and other indicators. A new diabetes

advanced form has been implemented to assist with recording of diabetes reviews. Particular emphasis has been

provided to assist practices to work towards increasing their CVD risk assessments, providing smoking brief

advice/cessation referral and to reach the Health Target for immunisations.

A wide range of education and information sessions have been held for practice staff including Treaty of

Waitangi, Health and Disability Commission and Privacy Commission sessions.

SUPPORT FOR CORNERSTONE ACCREDITATION

Regular support meetings are being held to assist the seven practices who have registered for the Cornerstone

accreditation programme. Evening education and information sessions have been well attended. Individual

practice support has also been given as well as assistance with problem solving. Some practices have chosen to

implement the Healthy Practice system developed by the Medical Assurance Society (MAS) to assist with the

development of policies and guidelines, along with information provided by TeAHN.

TAS AUDIT OF CONTRACTUAL COMPLIANCE

TeAHN has met with Hutt Valley DHB to sign off all recommendations identified from the audit. One of the areas

of development included having all TeAHN staff vetted by Police, and this has now been implemented.

CLINICAL GOVERNANCE COMMITTEE (CGC)

The new Clinical Governance Committee is now well established and continues to provide expert clinical advice

to the TeAHN Board and management team. It oversees the quality and safety of the organisation, including

contracted practices and providers, and provides relevant reports to the Board of TeAHN. Guiding principles

include a Triple Aim approach.

The committee will continue to oversee the PHO Performance Programme including the changes that will occur

with the development of the new national Integrated Performance and Incentive Framework (IPIF). The

committee meets six weekly. In the six months to December 2013, the committee has discussed a number of


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clinical pathways, including the subregional ENT pathways, the local dementia pathway and the local COPD

pathway.

EMERGENCY MANAGEMENT

TeAHN has continued to make significant progress over the last six months with Emergency Management. The

newly developed Emergency and Business Continuity Plan has been completed and presented to the Board of

TeAHN.

All the Local Emergency Management Groups (LEGs) have now been established, with most having had their

second meeting. Barry Simpson, MoH-funded Emergency Planner, continues to work with practices in the

development or updating of their BCPs and to provide support to the TeAHN Emergency Managers. An emphasis

is being placed on the completion of practice BCPs by 30 June 2014. Regular stakeholder meetings were put on

hold in the middle of the year but were reactivated at the end of 2013. These will now be held three monthly.

TeAHN staff members have attended an EOC training exercise in the Wairarapa and an emergency management

exercise was held for all TeAHN staff in December 2013. With the assistance of the Emergency Planner, TeAHN

has scheduled the commencement of emergency management training for practice staff and LEG groups. The

goal is to complete this training by December 2014.

RISK MANAGEMENT AND ISSUES REGISTER

TeAHN maintains a risk register which is presented to the TeAHN Board quarterly. Items are updated and new

items identified as required.

TeAHN also presents its Issues Register to both the CGC committee and TeAHN six monthly (or more frequently

as required). The issues register records all health and safety incidents, complaints and other incidents as they

arise.

There is also a schedule for the review of all policies, procedures and guidelines.

WORKFORCE DEVELOPMENT AND LIAISON

Over the July to December 2013 period, TeAHN has continued to facilitate both nurse professional development

topics and Continuing Medical Education (CME) topics.

CME topics included Understanding Insomnia: Diagnosis and management of a common sleep disorder; Pain

Management; ACC – Fitness to Work - clinically determining safe levels of activity; Inflammatory Arthritis in

primary care and pearls in management of Gout; Decision Tools: Shared care records, practice sustainability,

clinical pathways; Orthopaedics – back and shoulder pain investigation and management in primary care

These sessions attracted a number of podiatrists and community pharmacists as well as the usual general

practitioner audience. Audiences ranked these sessions at between 4.21 and 4.65 out of a possible 5 with very

positive feedback in the comments.

In October General Practice Services Trust (Hutt Valley) formally handed over accountability for the running of

CME to TeAHN. This involved a transition agreement with the transfer of resources to enable us to continue

this work.


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More than 29 GPs, practice nurses and managers attended a session in 18 November to discuss a range of topics

including the way in which CME would be offered going forward. An invitation was extended to GPs present to

join a CME Advisory group which held its first meeting 17 December. This group will provide clinical oversight

of the programme going forward.

A revised nurse education calendar has now been published after some ongoing discussions and negotiations

with various hospital services that have traditionally provided input. We have significantly refocused our

Diabetes education, to align this with the requirement to have our nurses meet the required standards, while

taking advantage of the on line course material now available. We are in discussion with other services around

further refinements to their courses and continue to work closely with our nurses and practice teams to ensure

the content is relevant and valued.

Our work with the group of practices on the journey to Cornerstone accreditation continues and we have been

pleased with the attendance at the meetings arranged to assist with this.

We also continue to support our practice teams through the development of emergency plans and facilitating

the establishment of local emergency groups.

PRIMARY NURSES REFERENCE GROUP

Representatives from TeAHN have continued to contribute to this forum over the past six months.


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CPHAC INFORMATION PAPER

Date: 31 March 2014

Authors Regional Public Health and Shayne Nahu, Group Manager, SIDU

Endorsed By Dr Ashley Bloomfield, Director SIDU

Subject Nutrition and Physical Activity Initiatives including those to prevent cardiovascular disease and diabetes

The purpose of this paper is to provide the Boards with an overview of current activities undertaken by Regional Public Health (RPH) to improve nutrition and promote physical activity that will contribute to preventing heart disease and diabetes.

It responds to the February 2014 Action Point (4.1) of the Capital Coast DHB Board: A summary sheet outlining RPH involvement in sub regional nutrition and physical activity initiatives will be distributed to the Board for feedback to the Director SIDU.

Additional information on preventative activity within Primary Care to address cardiovascular disease and diabetes has also been included.

RECOMMENDATION


Note the range of activities underway to improve nutrition, promote physical activity and prevent cardiovascular disease and diabetes across the sub-region.

ADDENDA N/A

1 THE PROBLEM AND APPROACHES TO THE PROBLEM – BACKGROUND

Globally, non-communicable diseases (NCDs), mainly cardiovascular diseases (CVD), cancers, chronic respiratory diseases and diabetes, represent a leading threat to human health and development. The most prominent non-communicable diseases are linked to a common set of risk factors, namely tobacco use, harmful use of alcohol, an unhealthy diet and lack of physical activity. They are largely preventable by means of effective interventions that tackle these shared risk factors. Prevention of poor health and early deaths from these diseases is crucial to achieve the triple aim of improved population health (including reduced inequalities), a better patient journey and clinical, and financial sustainability.

Regional Public Health (RPH) takes a multi level approach to tackling risk factors based on the Ottawa Charter: building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and reorienting the health (and social) sectors. Where possible, RPH links its work on the major risk factors relating to tobacco, alcohol, and nutrition and physical activity. This paper outlines nutrition and physical activity preventive actions.


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The Government has recently announced the establishment of the Healthy Families NZ programme,based on the Australian ‘Healthy Together Victoria’ model to support reducing childhood obesity. Lower Hutt has been identified as one of the initial pilot sites and RPH and Te Awakairangi PHO are convening a meeting of interested groups in early April to initiate the development of a proposal for Lower Hutt.

Early identification of CVD and diabetes, is a key factor in better managing and delaying negative health impacts upon individuals. Primary Care is best placed to pick up these issues earlier with their patients to assist them with better management of their health.

Below are examples of public health activity undertaken by RPH and activity within primary care.

REGIONAL PUBLIC HEALTH (RPH)

2 POLICY LEVEL ACTIONS (BUILDING HEALTHY PUBLIC POLICY)

2.1 Nutrition and physical activity

Policy approaches have been identified internationally as the most cost effective, equitable and sustainable means of impacting population health. Healthy food procurement policies and environmental change are key strategies in obesity prevention. RPH’s actions at a policy level include:

∑ Submissions on food and nutrition documents:o Submissions in 2012 to sub-regional Territorial Local Authority Long Term Plans to highlight

ways to improve access to healthy food including zoning policies. We will continue to promote this approach with local authorities.

o Written and oral submissions in 2013 presented on the Wellington City Councils ‘Our Capital Spaces’ document (see also transport).

o Findings of the Food Environment in Eastern Porirua paper 2009 by RPH were presented to Porirua City Council, highlighting the lack of locally available healthy food.

∑ A food environment paper will soon be presented to the Executive Teams of the DHBs to engage their support for a food environment policy for all three DHBs.

∑ Work with Early Childhood Centres on the provision of healthy food for children under five and the development of food safety policies in their centres to meet the 2008 early childhood centre regulations.

∑ A food stall guideline/policy recently supported a ‘sugar free’ Te Ra o Te Raukura festival in Lower Hutt and a ‘fizz-free’ Creekfest festival in Porirua

∑ Future work includes looking at strategies to promote and influence improvements in the food environments. We are considering the development of a toolkit for writing and implementing food policy in a range of settings.

2.2 Urban environments including transport

RPH aims to influence regional transport and urban planning processes, which impact on active and public transport. RPH provides practical feedback on policies making the transition from walking and cycling to public transport more attractive and accessible. Submissions on transport and other urban environment policies include:

∑ New Zealand Transport Authority Basin Bridge Proposal: RPH recommended offsetting potential long-term traffic congestion with increased investment in active and public transport.


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∑ RPH is providing public health advice on detailed landscape management plans for the area below the Basin Bridge flyover which will impact on the walking and cycling environment.

∑ Public Transport Spine Study: RPH recommended that the Wellington public transport system is integrated with active modes such as walking and cycling.

∑ Contributing to the Porirua City Council Road Safety Plan, which has the potential to improve local neighbourhood environments for walking and cycling. We will continue to work with authorities to ensure that potential health and social impacts from the future Link Road from Transmission Gully into Waitangirua are addressed during planning.

∑ In 2013, written and oral submissions were presented on the Wellington City Councils ‘Our Capital Spaces’ discussion document (see also Nutrition section).

∑ RPH continues to advocate for lower speed limits in high pedestrian areas, through opportunities such as the Wellington Central City Safer Speed Limit Proposal.

∑ Submissions on Hutt City Council Draft Urban Growth Strategy 2013 and on Kapiti Coast District Council proposed District Plan 2013.

∑ RPH will provide feedback on the Hutt City Council Walking and Cycling Strategy.

∑ RPH is the only health organisation represented at the Regional Active Transport quarterly forums and provides a public health perspective to the group.

3 INFORMATION BASED ACTIONS (INFORMING AND CREATING SUPPORTIVE ENVIRONMENTS)


Information based actions include developing information and sharing this with others. RPH has undertaken the following;

∑ A number of papers have been developed by RPH to support working on the wider physical, economic, socio-cultural and political factors that impact food choices:

Food Desert or Food Swamp? 2009: An in-depth exploration of neighbourhood food environments in Eastern Porirua and Whitby

Discussion Paper | Disability Allowance 2014: Opportunities to improve access to Work and Income’s Disability Allowance (for food)

Identifying Ways to Impact Food Insecurity in the Wellington Region 2013: An analysis of potential actions on food insecurity

Factors Influencing the Stocking, Promotion and Pricing of Healthy Foods in Small Stores 2011: barriers and promoters of stocking, pricing and promoting healthy food by small store owners in Eastern Porirua

Food Costs for Families 2011: Analysis of the proportion of the minimum wage and benefit entitlements that families need to purchase a healthy diet


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Guide to promoting health and wellness in the workplace 2011: Healthy employees are productive employees – support for workplaces to implement health and wellness initiatives

Impact of Open Spaces on Health and Wellbeing 2010: Outlines the connections between health and wellbeing, and urban open spaces. In addition, it summarises the relationship between open space in relation to physical and mental health, and environmental, economic, social and cultural wellbeing.

∑ In 2013, along with the Health Promotion Agency; Accident Compensation Corporation; Wellington City Council and the Health and Productivity Institute of New Zealand, we ran a regional workshop for employers, Create a healthy workplace on a budget.

∑ The RPH website aims to empower communities in the Wellington region to make healthier and affordable food choices more readily available and accessible.

∑ We produce an electronic communication ‘Nutrition and Physical Update’ to inform stakeholders of key work, research and events in the region.

∑ We are working, along with other organisations, with the Office of the Commissioner for Children on a review of Food in Schools guidelines.


The Healthy Open Spaces Paper: A summary of the impact of open spaces on health and wellbeing(2010) provided urban decision makers with a summary of the impacts of open spaces on health and wellbeing, including the physical environment’s role in creating active lifestyles.

Work is ongoing with local authorities to provide public health information that supports healthy urban planning. Papers in development include: ∑ the relationship between health promoting urban environments and economic development∑ supporting Maori worldviews of the natural and built environment∑ child friendly and accessible environments

Local action on important urban design and housing matters include:∑ Pomare Draft Redevelopment – RPH Feedback Report (2012)∑ Pomare Redevelopment Project – RPH Response (2013)∑ Castor Loop Redevelopment Feedback Report (2102)

We also promote the use of existing frameworks to support healthy urban planning such as:∑ the New Zealand Urban Design Protocol∑ Health Promotion and Sustainability through Environmental Design Guide (HPSTED)∑ New South Wales Healthy Urban Development Checklist∑ Crime Prevention through Environmental Design (CPTED) and Maori Urban Design principles.

4 ACTIVITY BASED ACTIONS (COMMUNITY ACTION, PERSONAL SKILLS, REORIENTING HEALTH SECTOR)


RPH works in four broad settings to promote good nutrition and physical activity: community programmes and events; education based activities; workplace health and wellness; and maternal and infant nutrition and physical activity (Health 4 Life).


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Community Programmes∑ Support for communities to develop initiatives such as community gardens, markets and food

cooperatives that empower and strengthen ownership and responses to food security challenges, for example. o Food co-operative in Naenae (low cost accessible food)o Breakfast co-operative in Naenae school (low cost food)o A fruit and vegetable co-operative is to commence in May 2014 in Eastern Porirua in

partnership with Wesley Food Pantry, Corinna School and the Salvation Army.

∑ Support for a range of community events such as Creekfast and Te Ra o Te Raukura. A food guideline/policy recently supported a ‘fizz-free’ Creekfest and sugar free drinks at Te Ra o Te Raukura. RPH also funded a water tank at Te Ra o Te Raukura as a way of promoting ‘water as free and as the first choice of drink’ at the event.

∑ Workshops for store owners to support better chip frying practises.

∑ Increasing participation in recreation and physical activity includes contributing to: o Wellington City Council’s Ki o Rahi Poneke Project with the aim of increasing participation

in sport and recreationo HEHA Porirua’s ‘Pound the Pavement’ family evento Hutt City Council’s Connex project for 16 - 20 year oldso Te Awakairangi TRYathlon

∑ The Wairarapa Baby Friendly Community Initiative aims to increase breastfeeding rates in vulnerable families and in the wider community

Education based activities∑ We run training for cooks in early childhood education centres alongside food policy training for

Managers of these organisations

∑ We provide after hours workshops for Pacific Early Childhood Centre staff on nutrition, illness management and skin infections (one per DHB district)

∑ We are supporting Pasifika early childhood community leaders to hold a combined health and education conference during March 2014. This is a community led initiative.

∑ We worked with Ora Toa Health Services and the Heart Foundation to set up health focussed activities at Titahi Bay North Annual Gala.

∑ Our Health Promoting Schools staff members support schools that choose nutrition and physical activity as one of their health topics. Nutrition education sessions are held in Wairarapa on a request basis.

∑ The Early Childhood Health Bus in Wairarapa aims to improve health literacy through increasing health knowledge and interpretation skills at an early childhood level for children, parents and teachers

∑ With the Heart Foundation, we have supported Porirua College students in identifying the need to improve food consumed at their school. They are to present a paper to their School Board.

Workplace


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∑ In 2009, we worked with the Corrections service to assess if their menus were in line with the Ministry of Health nutritional guidelines. This process is likely to be undertaken again in 2014 and reaches vulnerable communities.

∑ Following on from the regional workshop for employers, Create a health workplace on a budgetwe will engage with and support workplaces with high Pacific, Maori and low income employees to initiate workplace programmes.

∑ We have recently worked with Rimutaka and Arohata prisons to provide workplace health and wellbeing programmes for their staff (which include physical activity and nutrition components).

∑ We participate in the local Workplace Health Forum.

Maternal and Infant Physical Activity and Nutrition

The Health 4 Life programme of work aims to improve maternal and child nutrition and physical activity through development and delivery of simple common messages for pregnant women, infants and their mothers (including support for breastfeeding) and their surrounding whānau as part of currently delivered antenatal and well child services, primary care and other health and social services. It will focus initially on pregnant women and mothers and infants in vulnerable families and in later years could extend to all pregnant women and infants.

This project is delivered by a partnership comprising RPH, SIDU, Te Awakairangi Health Network and Compass Health. The project was announced in October 2013 by Minister Ryall under the banner “Healthy Families NZ: $810,000 healthy start for greater Wellington families”.

General∑ We participate in a range of local and regional stakeholder meetings to widen the scope of

influence on physical activity and nutrition outcomes including:o Childhood Obesity and Type 2 Diabetes Prevention network o Integrated Care Collaborative Pathways for childhood obesity and type 2 diabetes o Public health dietitians meetingso Upper Hutt Councils ALIVE project, which aims to engage non active people in recreational

activities.


RPH provides ongoing advice regarding the natural and built environment in high priority areas, for example:

∑ Pomare is undergoing significant neighbourhood change. We are working with the community, Hutt City Council, social housing providers, Housing New Zealand, developers and urban designers to influence ongoing redevelopment processes. This work has included recommendations to: improve the environment for walking and cycling, enhance connections and access ways to public transport, recreation and community areas, and the development of high quality ‘multi-use’ public spaces.

∑ Work with the Wellington Regional Council on the Genuine Progress Index, which has a focus on health promoting environments and can act as a proxy for well-being. Relevant indicators for the Wellington region include: ease of walking and cycling; active transport uptake; access to open spaces; air quality; obesity; physical activity; and smoking.

∑ We work with agencies involved in safety including Safer Hutt Valley and Safe As Porirua


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∑ We work with Hutt City Council on place-based projects such as ‘Our Place Naenae’ to improve the local environment based on feedback from the local community,

∑ We participate in a range of local and regional stakeholder meetings to widen the scope of influence on urban environments and transport including:o Regional Active Transport Forumo Walk to Work day (12 March 2014)o Active a2b – a sustainable transport programme for workplaceso Safe and Sustainable Transport Reference Group.

4.3 Primary care

As noted in the Board paper on CVD and diabetes in February 2014, the primary care team has a key role in providing advice and support for patients to modify their lifestyles to prevent disease and/or reduce the risk of developing complications. At the same time there is an increasing recognition that patients can have a major part in self-managing their own conditions when provided with good information to make decisions.

Primary care teams can also prescribe their patients a Green prescription, which is supported by good evidence. There are two components to the GRx initiative one service for adults and another service for children and their families (known as GRx Active Families).

Through the GRx adult service, adults who are currently considered by their Primary Health Care providers to be physically “inactive” (that is less than two and a half hours of physical activity per week), are able to access physical activity opportunities and receive support for lifestyle changes from trained professionals.

The Green Prescription (GRx) initiative was established in 1998 Budget 2013 allocated new funding of $7.2 million over the next four years to support GRx adult patients referred because of pre-diabetes or type 2 diabetes conditions.


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Hutt ValleyDistrict Health Board

Peter Gush

Service Manager 2 May 2014


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What is Public Health?

“The science and art of promoting health, preventing disease and prolonging life through organised efforts of society.”

C E Winslow


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The Determinants of Health

Dahlgren & Whitehead


160

What do we do?

o Health Protection

o Health Promotion

o Healthy Public Policy


161

Our strategic priorities are:

- working with Maori- engagement with primary care- focus on children

What is our focus?


162

Who are we?

Wairarapa DHBHutt ValleyDHB

Capital andCoast DHB

MidCentral DHB

MidCentral DHBpublic health regulatoryservices contracted to

Hutt Valley DHB

Masterton

• Serve populations of 3 DHBs• 143.9 FTE (doctors/nurses/HPOs/PH advisors/admin/analysts/support staff)• From communicable disease investigation to influencing planning decisions by TLAs• From seeing young children in the ear van to working with youth at risk around alcohol

and drug use/abuse• Annual revenue of $14.5m


163

Ministry - Core53%

Other11%

District Health Boards36%

Expenditure –Personnel Costs $11m or 76% and Operating Costs $3.5m or 24%

RPH Revenue by Source


164

Bold Goal

“Halving the rate of avoidable hospital admissions for Maori, Pacific and children, by 2021.”


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Target Month YTD QTR3 Target Month Target YTD

Shorter Stays in Emergency Departments 95% 95% 95% 95% Inpatient Acute Readmission Rate Feb-14 8.0% 8.8% 8.0% 8.7%

Improved Access to Elective Surgery 100% 92% 106% 101% Mental Health Readmission Rate Feb-14 8.0% 12.2% 8.0% 10.6%

Better Help for Smokers to Quit 95% 94% 97% 96% Acute Inpatient Length of Stay 3.9 4.0 3.9 4.0

Target Month Target YTD Elective Inpatient Length of Stay (Surgical) 3.2 3.0 3.2 3.0

Mental Health Relapse Prevention Plans 95% 92% 95% 91% Elective/Arranged Day of Surgery Admission 95% 96% 95% 96%

HONOS Compliance - Inpatient 80% 97% 80% 84% Ward Bed Utilisation - Daily (Incl Weekends) 85% 89% 85% 89%

HONOS Compliance - Community 80% 84% 80% 71% Ward Bed Utilisation - Weekdays Only 85% 91% 85% 90%

Bed Days due to Cellulitis (Avg LOS) 3.0 4.5 3.0 2.8 Funded Theatre Sessions Utilised 95% 96% 95% 88%

Surgical Site Infections Reported 1 2 9 7 Theatre Session Utilisation (Time in Theatre) 85% 81% 85% 79%

Patient Falls Causing Harm 12 11 108 129 Theatre Sessions Starting on Time 90% 86% 90% 89%

Medication Errors 20 23 180 198 Acute Patients impacting on Elective Sessions 43 38 387 333

Pressure Injuries 3 1 27 14 Cancelled on Day of Surgery - Patient 12 10 106 87

Cancelled on Day of Surgery - Hospital 15 7 124 7

WAITLISTSWAITLISTSWAITLISTSWAITLISTS Cancelled on Day of Surgery - Percentage 5.0% 3.5% 5.0% 4.4%

Target Month Booked Outpatient DNA (FSA & Followup) 359 460 3110 4598

Waiting >150 days for Treatment (ESPI5) 0 7 5 2 Outpatient DNA (FSA & Followup) - DNA Rate 6.0% 7.7% 6.0% 8.9%

Waiting >150 Days for Outpatient FSA (ESPI2) 0 3 0 3 Ward Utilisation is General Wards Only: Surgical, Medical, Rehab, Orthapaedic, Plastics Wards

HEALTHY WORKPLACEHEALTHY WORKPLACEHEALTHY WORKPLACEHEALTHY WORKPLACE Target Month Target YTD

Target Month Target YTD Total Caseweight 1781 1859 15657 16446

Hospital Staff Turnover % (Headcount) 10% 7.4% 10% 9.8% Elective Caseweights 551 619 4755 5130

Sickness Absence - % Paid Hours Worked 2.3% 2.9% 2.3% 2.6% Acute Caseweights 1230 1239 10902 11316

Number of Staff having >24 Mths O/S Leave 180 209 Outpatient FSA Volumes 1340 1290 12436 11031

Physical Assaults U/D 9 U/D 56 Outpatient FU Volumes 2980 3464 27578 30199

Blood and Body Fluid Exposure U/D 1 U/D 13 Hospital FTEs inc overtime 1572 1582 1572 1559

Slips, Trips and Falls U/D 8 U/D 27 Hospital Operating Costs ($'000) 15,264 15,601 140,251 142,565

Hospital Personnel inc outsourced ($'000) 11,107 11,197 103,119 104,257

MOH Performance Measures KEY: N/A = Not available U/D = Under Development Alert MOH Health Targets

Waitlist Patients (ESPI5 and ESPI2)

Mar-14

Hutt Hospital Operational Services

Monthly Balanced Scorecard March 2014KEY PERFORMANCE INDICATORS 2013/2014

PATIENT EXPERIENCE PATIENT EXPERIENCE PATIENT EXPERIENCE PATIENT EXPERIENCE Period Mar-14

Good News

Mar-14 Period

PeriodPROCESS & EFFICIENCYPROCESS & EFFICIENCYPROCESS & EFFICIENCYPROCESS & EFFICIENCY

VALUE FOR MONEYVALUE FOR MONEYVALUE FOR MONEYVALUE FOR MONEYMar-14 Period

Unbooked

Key Issue


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HVDHB Monthly Operating Report Page 1 24 April 2014

Finance Report

March 2014

Graham Dyer Judith ParkinsonChief Executive Finance Manager


167


FINANCIAL PERFORMANCE OVERVIEW

Unfavourable variance to budget year to date of ($1,572k) has been reported. The bottom line result at the end of March was a deficit of ($2,733k) compared to a budget deficit of ($1,162k).

Key results year to date were: ∑ Funder ($1,666k) unfavourable (Feb ($1,510k))∑ Governance $17k favourable (Feb $42k)∑ Provider $78k favourable (Feb ($81k))

Material Variances Year to Date to March 2014

The key variances to budget were:

ß Interest income: favourable $629k due to higher cash balance than expected in the budget.

ß IDF inflows: ($1,203k), Acute ($911k) 196 less CWD than budgeted. Acute ED and dental are slightly up but acute plastic surgery is down by 185 CWD.

ß Infrastructure Depreciation: favourable $1,337k site improvements were valued downwards partly offset by building revaluations upwards.

ß Pharmaceuticals: ($466k) the financial Impact of Pharmac’s Hospital Medicines List (HML) national decision to provide equity of medicines across all DHBs.

ß Blood: ($786k) savings target not met however the Ministry of Health has indicated this will be seen as savings in community pharmaceuticals which will be realised in the funder arm by June.

ß IDF outflows: ($2,826k), Acute ($1,674k) 359 more CWD than budget. This result includes some specialties which are significantly over budget because of high volumes in particular cardiology, oncology and specialist neonates. There have been 22 cases so far this year attracting more than 15 CWD.

ß Personnel: Nursing ($2,371k): savings initiatives not achieved due to higher occupancy, particularly in general medical and reduced Christmas shutdown. Forecast to continue until year end. Management and Admin ($159k) the FPSC project is running behind the scheduled.

Year end forecastThe year end forecast deficit of $1.5m is a most likely position with a risk that it could be as high as $3.4m. The significant area of risk relates to Acute IDF outflow.

The following table provides a summary of the financial performance of the DHB at the end of March 2014.


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Table 1. Statement of Financial Performance: $000s Month Year to Date

Actual Budget Variance Actual Budget Variance Budget Forecast Variance YTD Variance AnalysisRevenueMoH Revenue 32,316 31,456 861 289,491 285,287 4,204 381,542 385,134 3,592 Funder $3.107m additional revenue includes:

$1,770k Recovery of capital charge; $94k PHO programmes; $142k sleepover settlements and cancer nurse co-ordinators; $154k home based support services; $103k dementia bed-day price, green prescription and diabetes funding additional funding is offset by additional costsProvider $935k additional revenue Includes:$361k Higher breast screening volumes; $452k Additional funding for regional public health ; $187k HWNZ phasing and contract

IDF Inflows 5,492 5,661 ( 168) 49,744 50,947 ( 1,203) 67,930 66,727 ( 1,203) IDF inflows include:Agreed Mental Health service change ($606k), $401k Before school check contract offset by reduced external provider payments; Elective CWD: $13k above budget - 22 CWD. Acute CWD: ($911k) below budget by 196 , ($560k) is for CCDHB residents

Other Revenue 1,110 1,337 ( 228) 11,370 10,614 756 14,585 15,342 757 Funder: $786k relates to the previous year Provider: ($30k) reduced revenue overall due to: $629k Additional interest received due to higher cash balances; $442k recovery of RPH Wairarapa staff; ($215k) reduced ACC revenue; ($650k) Not achieving additional electives from 3DHB realignment; $461k additional electives from MoH to come in June; ($239k) Community Radiology not gaining the addition revenue budgeted

Total Revenue 38,918 38,454 464 350,605 346,848 3,757 464,057 467,203 3,145ExpenditurePersonnel Costs (incl. Outsourced)

12,967 12,798 ( 169) 120,713 119,234 ( 1,480) 158,603 161,218 ( 2,615) Medical ($178k): vacancies offset by additional overtime and usage of outsourced personnel. Nursing ($2,371k): due to savings initiatives not achieved due to higher occupancy, particularly in general medical throughout the year and reduced xmas shutdown. Forecast to continue until year end. Allied Health $750k: 12 FTE savings across all directorates. Support ($259k): food services, orderlies and cleaners both base and overtime. Cleaners not budgeted for additional theatre area. Management & Admin $579k: Reduced FTE offset by FPSC delay; forecast $320k at year end.

Other Operating Costs

6,233 6,083 ( 150) 54,482 53,589 ( 893) 71,618 73,354 ( 1,736) ($1,340k) capital charge, offset by revenue; ($786k) Pharmac blood savings budgeted here but actually in provider payments; ($466k) Impact of Pharmac’s Hospital Medicines List (HML); $1,337k Site improvements were valued down partly offset by building revaluations;

External Provider Payments

12,948 13,084 136 117,426 117,296 ( 130) 156,647 153,812 2,835 External provider payments are slightly adverse to budget with the additional costs being offset by additional MOH revenue (Home based support, dementia care, Green Prescriptions, diabetes). $600k saving from Pharmac blood. This line includes allowance for CCDHB IDFs

IDF Outflows 6,736 6,432 ( 304) 60,717 57,891 ( 2,826) 77,188 80,364 ( 3,176) Acute: ($1,674k) higher than planned by 257 cases (359 CWD) Includes 22 cases over 15 CWD, (25 in total last year). ($1,802k) for acute at CCDHB. Elective: $529k, 113 CWD lower than budget with Orthopaedics being 125 less CWD than budget; Forecast ($1.0m) additional IDF costs for inpatient and outpatient activity. $484k at CCDHB. Other: ($1.14m) wash-ups for outpatient activity, ($457k) wash-ups for PCTs and ($105k) for other wash-ups

Total Expenditure 38,884 38,397 ( 487) 353,338 348,009 ( 5,329) 464,057 468,749 ( 4,692)

Net Surplus / (Deficit) 34 57 ( 23) ( 2,733) ( 1,162) ( 1,572) 1 ( 1,546) ( 1,546)Result by Business Arm

Forecast Variance

DHB Funder 152 309 (157) 1,777 3,443 (1,666) 4,345 4,109 (236)Governance & Administration (17) 8 (25) (15) (32) 17 0 5 (5)DHB Provider (101) (260) 159 (4,495) (4,573) 78 (4,344) (5,659) (1,315)Net Surplus / (Deficit) 34 57 (23) (2,733) (1,162) (1,572) 1 (1,546) (1,546)

Annual


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Table 2. Statement of Financial Performance – by Area (current month)$000s DHB Funder Governance & Administration DHB Provider Hutt Valley DHB

Actual Budget Var Last Yr Actual Budget Var Last Yr Actual Budget Var Last Yr Actual Budget Var Last YrRevenue Govt & Crown Agency 35,941 35,692 249 35,363 272 272 - 256 2,589 2,320 268 2,276 38,540 38,022 518 37,645 Other 46 - 46 10 - - - - 333 432 ( 99) 417 378 432 ( 53) 427 Internal - - 15,888 15,604 284 15,759 -Total Revenue 35,987 35,692 295 35,374 272 272 - 256 18,809 18,357 453 18,452 38,918 38,454 464 38,072Expenditure Personnel Costs - - - - 5 6 1 46 12,584 12,647 63 12,641 12,589 12,653 63 12,687 Outsourced Staff - - - - 18 378 145 ( 233) 343 378 145 ( 233) 361 Outsourced Services 552 263 ( 289) 251 168 167 ( 0) 82 690 506 ( 184) 335 858 673 ( 184) 417 Clinical Supplies - 10 0 ( 10) - 2,296 2,266 ( 30) 1,977 2,306 2,266 ( 40) 1,977 Infrastructure - - - - 52 34 ( 18) 35 3,018 3,109 92 2,409 3,069 3,144 74 2,445 Provider Payments 35,283 35,120 ( 163) 35,786 - - - - - 19,684 19,516 ( 168) 20,027 Internal Allocations - 15 17 2 15 ( 15) ( 17) ( 2) ( 15) - 0 0 -Total Expenditure 35,835 35,383 ( 452) 36,037 249 224 ( 25) 196 18,951 18,657 ( 294) 17,690 38,884 38,397 ( 487) 37,914

Surplus/(Deficit)Before Overheads 152 309 ( 157) ( 663) 23 48 ( 25) 60 ( 142) ( 300) 159 762 34 57 ( 23) 158

Corporate Overheads - 41 41 - 34 ( 41) ( 41) ( 0) ( 34) - ( 0) ( 0) -

Surplus/(Deficit) 152 309 ( 157) ( 663) ( 17) 8 ( 25) 26 ( 101) ( 260) 159 796 34 57 ( 23) 158

Table 3. Statement of Financial Performance – by Area (YTD)$000s DHB Funder Governance & Administration DHB Provider Hutt Valley DHB

Actual Budget Var Last Yr Actual Budget Var Last Yr Actual Budget Var Last Yr Actual Budget Var Last YrRevenue Govt & Crown Agency 323,866 321,655 2,211 316,406 2,452 2,452 - 2,346 21,707 21,218 489 20,651 345,662 342,961 2,700 337,147 Other 641 - 641 460 - - - 12 4,303 3,886 416 4,418 4,943 3,886 1,057 4,889 Internal - - 142,224 140,662 1,562 138,768 -Total Revenue 324,507 321,655 2,852 316,866 2,452 2,452 - 2,358 168,233 165,766 2,467 163,836 350,605 346,848 3,757 342,036Expenditure Personnel Costs - - - - 45 56 10 1,001 117,408 117,841 433 114,522 117,453 117,896 443 115,523 Outsourced Staff - 12 - ( 12) 34 3,249 1,337 ( 1,911) 2,492 3,260 1,337 ( 1,923) 2,526 Outsourced Services 4,222 2,363 ( 1,859) 2,256 1,508 1,505 ( 3) 315 4,768 3,719 ( 1,049) 3,453 6,276 5,224 ( 1,052) 3,768 Clinical Supplies - 10 0 ( 10) 5 20,916 19,975 ( 942) 20,368 20,927 19,975 ( 952) 20,373 Infrastructure - - - - 419 448 29 338 26,860 27,943 1,083 26,535 27,280 28,391 1,111 26,873 Provider Payments 318,508 315,849 ( 2,659) 314,621 - - - - - 178,143 175,187 ( 2,956) 175,853 Internal Allocations - 148 150 3 146 ( 148) ( 150) ( 3) ( 164) - 0 0 ( 18)Total Expenditure 322,730 318,212 ( 4,518) 316,877 2,142 2,159 17 1,839 173,053 170,664 ( 2,389) 167,206 353,338 348,009 ( 5,329) 344,897

Surplus/(Deficit)Before Overheads 1,777 3,443 ( 1,666) ( 11) 310 293 17 519 ( 4,820) ( 4,898) 78 ( 3,369) ( 2,733) ( 1,162) ( 1,572) ( 2,861)

Corporate Overheads - 325 325 - 300 ( 325) ( 325) ( 0) ( 300) - ( 0) ( 0) -

Surplus/(Deficit) 1,777 3,443 ( 1,666) ( 11) ( 15) ( 32) 17 219 ( 4,495) ( 4,573) 78 ( 3,069) ( 2,733) ( 1,162) ( 1,572) ( 2,861)


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Table 4. IDF Inflows Variance SummaryIDF Inflows

Variance

$000s YTD Variance Analysis

Elective Inpatients 13Elective caseweights (CWD) are down by 40. Higher CWD for plastics offset by lower CWD in rheumatology, orthopaedics and general surgery.

Acute Inpatients* (912)For the year acute CWD are down by 195. Emergency medical services and dental are slightly up but acute plastics surgery is down by 185 caseweights.

Regional Mental Health Contracts (606) Contract changes - offset by reduced external provider payments.

Plunket contract 401 Additional funding which is offset by external provider payments

Agreed changes and wash-ups (100)

Total Variance in IDF Inflows (1,203) Note: 54% of IDFs originate from CCDHB*IDF acute inflows are below plan for: Midcentral (down 30%), Capital & Coast (down 9%) and Whanganui (down 37%)

Table 5. IDF Outflow Variance SummaryIDF Outflows

Variance

$000s YTD Variance Analysis

Elective Inpatients 529

Elective IDF outflows are under budget by 114 CWD. Orthopaedics and Cardiothoracic are under budget offset by Ophthalmology, Urology, Vascular surgery and General surgery.

Acute Inpatients* (1,674)

Acute IDF outflows are over budget by 359 CWD. This result includes some specialties which are significantly over budget because of high volumes in particular cardiology, oncology and specialist neonates. There have been 22 cases so far this year attracting more than 15 CWD, there were a total of 25 in the whole of last year.The only significant flow is to Counties Manukau for a single burns case which is 46 CWD ($212k).

Other (1,682) ($1.114m) wash-ups for outpatient activity, ($475k) wash-ups for PCTs and ($105k) for other wash-ups

Total Variance in IDF Outflows (2,826) Note: 93% of IDFs are to CCDHB*IDF acute outflows are above plan for: Counties Manukau (up 64%), Capital & Coast (up 12%)


171


Table 6. Personnel Costs (including Outsourced) Variance Summary

YTD Actual

YTD Budget Variance

Full Year Budget

YTD Actual

YTD Budget Variance

Full Year Budget Reason for Variance

Total Personnel Costs

- Base Budget 1,761.16 1,832.92 71.76 1,885.03 97,182 100,329 3,147 133,869

- Allowances and Overtime 41.28 30.22 ( 11.06) 21.30 12,702 11,428 ( 1,274) 15,172

- Other Costs - - - - 8,406 9,569 1,163 12,694

- Leave Accrual - - - - ( 838) 127 965 170

- Savings Initiatives ( 62.65) ( 62.65) ( 69.68) ( 3,557) ( 3,557) ( 5,077)

Sub-total 1,802.44 1,800.49 ( 1.95) 1,836.65 117,453 117,896 443 156,828

- Outsourced 20.70 12.40 ( 12.30) 12.30 3,260 1,337 ( 1,923) 1,773

Total Personnel Costs 1,823.14 1,812.89 ( 14.25) 1,848.95 120,713 119,234 ( 1,480) 158,601

Medical ($178k): vacancies offset by additional overtime and usage of outsourced personnel; Nursing ($2,371k): due to various savings initiatives not being realised due to higher occupancy, particularly in general medical and emergency dept and reduced Christmas shutdown period; Allied Health $750k: 12 FTE savings across all directorates; Support ($259k): Mainly over FTEs in food services, orderlies and cleaners in base and overtime. No budget for cleaners for theatres built in 2011; Management & Admin $579k: 12 FTE under YTD across all directorates offset by staff reductions for FPSC being delayed.

Contract FTEs Costs (000s)


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Annual LeaveThe following graph shows the historical trends in annual leave for the last two years. The reduction in the accrual is close to budget and reflects the amount of annual leave taken over the summer period.

Accrued Annual leave $000

13,000

13,500

14,000

14,500

15,000

15,500

Jul -11

Sep-11

Nov-11

Jan-12

Mar-12

May-12

Jul -12

Sep-12

Nov-12

Ja n-13

Mar-13

May-13

Jul -13

Sep-13

Nov-13

Jan-14

Mar-14

May-14

Thou

sand

s

Actua l Budget

Note the reduction in budget in January which is incorporated into the sustainability plan


173


Chart: FTE Trends by Professional category

FTEs per month by Professional Category

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14Actual Medical Actual Nursing Actual Allied Health

Actual Non Health Support Actual Managemt/Admin Total Budget

Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14Medical 229 230 228 228 226 226 225 226 228 230 231 232 231Nursing 706 692 701 700 699 702 702 702 705 707 707 711 714Allied Health 435 430 433 433 418 419 419 420 422 422 423 423 424Non Health Support 139 135 138 138 134 134 135 136 136 136 134 134 134Managemt/Admin 327 294 320 316 278 288 294 295 298 299 298 298 298Actual FTE 1,835 1,781 1,821 1,815 1,754 1,769 1,776 1,778 1,789 1,794 1,792 1,799 1,802Budget 1,841 1,824 1,838 1,837 1,802 1,805 1,806 1,808 1,818 1,807 1,803 1,802 1,800

Act

ual

Tota

l

Note : SIDU 22FTE moved to CCDHB July 2013: Public Health 5.59 FTE from Wairarapa transferred to Hutt payroll from Nov 2013.


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Table 7: Statement of Financial Position

($000s) Variance Analysis (Actuals Current month vs. Actual Last month)Mar Feb Variance Mar Variance

Assets

Current assets

Bank 11,762 16,176 (4,414) 2,096 9,666 Clearing of all creditors accounts and non taking up of receipts for the last two days of the month due to conversion to Oracle system.

Bank - Non-Hutt DHB funds 5,402 6,801 (1,399) 5,172 230 Payments made out on behalf of the non-HVDHB funds.Accounts receivable 16,820 16,232 588 11,582 5,238

Stock 1,519 1,388 131 1,389 130Prepayments 1,169 1,293 (124) 1,114 55Total current assets 36,672 41,890 (5,218) 21,353 15,319

Fixed assets Fixed assets 200,194 199,886 308 180,081 20,113 Increase due to capitalisation of completed WIP slightly offset by depreciation charged in the month.Work in progress 5,102 5,889 (787) 6,742 (1,640) Reduced due to capitalisation of completed project i.e. dental clinic in Wainuiomata.Total fixed assets 205,296 205,775 (479) 186,823 18,473

Investments Investments in associates 1,280 1,280 - 4,698 (3,418)Trust funds invested 1,229 1,139 90 1,063 166Total Investments 2,509 2,419 90 5,761 (3,252)

Total Assets 244,477 250,084 (5,607) 213,937 30,540

Liabilities Liabilities

Current liabilitiesAccounts payable and accruals 35,693 40,296 (4,603) 34,450 1,243 Payments made to clear all accounts payable, and balance was higher last month due to higher accruals and deferred contract

revenue.Non-Hutt DHB liabilities 5,402 6,801 (1,399) 5,172 230 Payments made on behalf of the non-HVDHB funds.

Crown loans and other loans 10,914 10,914 - 11,492 (578)Capital charge payable 1,864 1,243 621 464 1,400 6-monthly capital charge was paid in Dec. March includes accrual for Jan to Mar'14 todate.Current employee provisions 19,462 19,811 (349) 18,026 1,436Total current liabilities 73,335 79,065 (5,730) 69,604 3,731

Non-current liabilities Crown loans 68,500 68,500 - 68,500Other loans 1,826 1,826 - 1,833 (7)Long term employee provisions 6,944 6,944 - 6,812 132Trust funds 1,228 1,138 90 1,063 165Total non-current liabilities 78,498 78,408 90 78,208 290

Total Liabilities 151,833 157,473 (5,640) 147,812 4,021Net assets 92,644 92,611 33 66,125 26,519

Crown equity Crown equity 44,877 44,877 - 45,817 (940)Reserves Reserves 79,807 79,807 - 50,368 29,439Retained earnings Retained earnings

Opening retained earnings (29,306) (29,306) - (28,863) (443)Surplus/(deficit) (2,734) (2,767) 33 (1,197) (1,537)Retained earnings - total (32,040) (32,073) 33 (30,060) (1,980)

Total Equity 92,644 92,611 33 66,125 26,519

2013/14 BudgetActuals

Note – Investment in associates includes Central Region Technical Advisory Service (TAS) and Health Benefits Ltd (HBL)


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Table 8: Statement of Cash flows

Description

Year to date actual ($000)

Year to date budget ($000)

Variance-Over/(under) budget ($000) Notes - Explanation for major variances

Operating activitiesReceipts 345,153 347,524 (2,371) Higher budgeted revenue from Crown and other DHBs.PaymentsPayments to employees 113,528 117,707 (4,179) Payments to suppliers 216,156 212,656 3,500 Capital charge paid 3,765 4,122 (357) GST (Net) 137 - 137 Payments - total 333,586 334,485 (899) Net cash flow from operating activities 11,567 13,039 (1,472) Investing activitiesReceiptsProceeds from Asset sales (3) - (3) PaymentsInvestment in associates - 2,178 (2,178) Budgeted payment for CRISP project is delayed.Purchase of fixed assets 5,635 9,569 (3,934) Delay in the purchase of MRI scanner and Citrix Farm & LIS projects.Net cash flow from investing activities (5,638) (11,747) 3,931 Financing activitiesReceiptsLoans - - - Equity injection 800 - 800 Equity injection for COH (Child Oral Health) project, not budgeted for.Receipts - total 800 - 800 PaymentsRepayment of loans 294 - 294 Capital repayments of financing leases for MRI scanner and ultrasound.Equity repayments - - Interest payments 1,638 3,006 (1,368) Lower interest for finance leases & Crown(CHFA) loans. Payments - total 1,932 3,006 (1,074) Net cash flow from financing activities (1,132) (3,006) 1,874 Net Inflow/(outflow) of Hutt Valley DHB funds 4,797 (1,714) 6,511

Opening cash 24,650 8,982 15,668 Movement in Non-Hutt Valley DHB funds:Primary Healthcare IT Grants fund (2,923) - (2,923) National Haemaphiliac Management Group Fund (2,977) - (2,977) NZ Universal List of Medicine Fund 170 - 170 Net cash flow of Non-Hutt Valley DHB funds (5,731) - (5,731) Payments made on behalf of other Funds not budgeted for.Ending cash 23,716 7,268 16,448

Summary ending cash positionHutt DHB funds 18,314 7,268 11,046 Non-Hutt Valley DHB funds 5,402 - 5,402 Total 23,716 7,268 16,448


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Table 9. Capital Expenditure (Asset) summary report 2014-15

Capital Plan 2012-13

carry forward

Full year capital plan

YTD approved capex

YTD Actual Spent

(invoiced)

Capital budget

unspent

Remaining budget

available to be allocated

Strategic Capex ($000) ($000) ($000) ($000) ($000)

Emergency Department & Theatre (ED&T) - 156 156 156 60 97 -Digital Mammography - 1,294 1,294 1,294 351 942 -Finance & Procurement Supply Chain (FPSC) System 736 - 736 736 377 359 -Novell Netware to MS Exchange - 168 168 168 172 (4) -Laboratory Information Systems ($1,000k from Prior Year) 747 275 1,022 1,022 1,008 14 -Child Oral Health (externally funded initiatives) - 3,466 3,466 3,466 82 3,384 -Central Region Information Systems Plan (PMS, EMR, PACS, RIS, ED, eReferrals, WhiteBoard) Programme

2,168 - 2,168 - - 2,168 2,168

Citrix Farm 1,000 - 1,000 1,000 731 269 -e-Pharmacy 500 - 500 - - 500 500MRI Scanner 2,300 - 2,300 468 - 2,300 1,832Non specified 1 - 1 - - 1 1

7,452 5,360 12,812 8,311 2,781 10,031 4,501

Baseline Capex Buildings & Plant 3,000 1,282 4,282 1,495 322 3,960 2,787Clinical Equipment 2,000 660 2,660 1,939 1,005 1,654 720Other Equipment 100 - 100 6 5 95 94Information Technology 850 780 1,630 1,535 1,059 571 95Intangible Assets (Software) 1,000 - 1,000 469 232 768 531

6,950 2,722 9,672 5,445 2,624 7,048 4,227

Total Capex 22,484 13,755 5,405 17,079 8,728


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Table 10. Treasury Summary Report

Year Amount 2013/14 $10,500

Current month Last month 2014/15 $4,0002015/16 $14,450

Average balance for the month $30,476 $27,200 2017/18 $19,000Lowest balance for the month $13,467 $9,450 2018/19 $20,950

2019/20 $5,000Average interest rate 4.00% 3.89% 2020/21 $5,100

Total $79,000Net interest earned for the month $102,832 $80,996

4) Hedges2) Debt

Term debt - Crown (formerly CHFA) loans Repayment date Amount Interest rateCore loan 15-Dec-17 $19,000 6.535% 5) Foreign exchange transactions for the monthLoan 1 15-Apr-14 $4,500 5.490% No. of transactions involving foreign currency 5Loan 2 15-Dec-18 $4,500 5.970% Total value of transactions $26,672 NZDLoan 4 15-Apr-16 $2,000 5.520% Largest transaction $15,280 NZDLoan 5 15-Apr-16 $5,000 5.020%Loan 6 15-Mar-19 $5,000 5.685% No. of Equivalent Exchange ratesLoan 7 15-Apr-15 $4,000 4.500% AUD 5 $26,672 0.927Loan 8 15-Dec-18 $5,450 5.090%Loan 9 15-Dec-15 $5,450 4.240%Loan 10 15-Dec-18 $6,000 3.710%Loan 11 15-Apr-14 $6,000 2.915%Loan 12 15-Jun-20 $5,000 3.355% Total 5 $26,672Loan 13 15-May-21 $5,100 3.450%Loan 14 30-Jun-16 $2,000 2.750%

Total $79,000

Weighted cost of funds 4.921%

1) Short term funds / investment

No hedging contracts have been entered into for the year to date.

HBL banking activities for the month

3) Debt repayment profile


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Appendix Three - 3DHB Health Service Development Programme Report 23 April 2014

March / April Programme Highlights;

Single Service Project Report In February 2014 the Sub Regional Clinical Leadership Group (SRCLG) received the first draft of the 3DHB Sub-regional Single Service Report. The development of this report had been guided by a Project Steering Group sponsored by the Chief Operating Officers (COOs). The objective of this project was to define what is meant by a sub-regional single service for the purpose of 3D HSD programme and list all the issue and requirements that need to be considered to support the development of sub-regional single services. The report outlined a number of actions that could be progressed to align services in the sub-region without significant service change.

Orthopaedics Concept Paper In February 2014 an Orthopaedics concept paper was presented to SRCLG by the Clinical Leader for this project. The recommendations in this concept paper were phased into short, medium and longer term considerations. The short term recommendations included addressing the acute and elective surgical service capacity and analysis on the viability of increasing orthopaedic surgical capacity at Kenepuru to provide elective orthopaedic surgery. Also being considered is the potential opportunity of theatre utilisation in the Hutt Valley to meet the same demand for the sub-region. A sub-regional approach to Orthopaedic Clinical Pathways is also under consideration. Any clinical pathway development will be directly linked to the regional elective project currently underway with TAS.

Single Integrated Child Health ServiceFollowing the approved mandate to progress an integrated child and youth health service for the sub-region, a project brief and comprehensive work plan has been established to co-ordinate the key activities that are required to progress a single service design. The work has been divided into three categories of Acute and Inpatient Care, Primary/Secondary Integration looking at Outpatients, models of care for children with chronic conditions, child development and services to provide care for children with disability. The third work stream is tasked with developing a Regional Paediatric Tertiary plan. Membership of each work stream includes clinicians involved in service delivery across the sub-region from medial, nursing and allied health. February and March have been spent consolidating the work into clear project briefs with defined objectives and deliverables. Each ‘work package’ has a clinical lead from the sub-region with wider membership identified to support service design. As part of this project, the 10 most common used paediatric clinical pathways have been selected for priority editing for the sub-region. We are now at a phase where we will be seeking primary care support in individual aspects of service design along with nominations for the project governance steering group. The Steering Group will be tasked with providing the strategic oversight to the project, the child health expertise will be provided through the three work streams. Vaughan Richardson remains the clinical lead for this project.Non Melanoma Skin Cancer


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This project is looking at the design of a sub-regional non melanoma skin cancer (NMSC) service that would provide equity of care and access to all patients across the sub-region for the diagnosis and treatment of non melanoma skin cancer. The 3D NMSC Working Group is chaired by Mr Chris Adams and includes operational and clinical membership from Plastics, Dermatology, and Radiology Oncology along with nominated representative from each of the Alliance Leadership Team (ALTs). The group recently held their second meeting where they reviewed available skin lesion removal data across the 3DHBs. The Group discussed different models of care for a sub regional NMSC service. Chris Masters, clinical lead for HealthPathways will also attend the next meeting, to update the group on the opportunity the new HealthPathways platform provides for the sub-region.

ENTThe sub-regional ENT Steering Group who developed 14 ENT clinical pathways are the fist clinical pathways to be loaded onto the soon to be launched 3D HealthPathways website. These have been adapted into the format for the HealthPathways website and are the foundation sub-regional pathways to be implemented. This has enabled a much quicker ‘go live’ date for the primary care role out of the new pathway tool. The ENT Clinical Leaders supported have presented to primary care teams in Wellington and Kapiti about the pathways, Hutt Valley and Wairarapa dates are being confirmed. Feedback from primary care has been very positive. A sub-regional ENT operational group has replaced the Project Steering Group.

Gastroenterology A sub regional project steering group have been meeting for over the past year with a key objective of agreeing a sub-regional approach to the management of colonoscopy. The results from this and the ENT Project Steering group provided the impetus for the Single Service Project. The working group has evolved to a point where the agreed emphasis that would provide the most benefit for the sub-region is the development of a single Gastroenterology Service which will be progressed through the COOs and Clinical Leader for this work.

Key Planned Activities/Emerging Priorities;o Single Service project to develop guidance and a tool kit to support clinical services designo HealthPathways implementation group working closely with the sub-regional clinical groups noted in this report.

New Risks/Concerns and Mitigation;N/A

Communication;

∑ The single service project will develop a communication tool kit to compliment the service design information and recommendations.


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Appendix Four - Wairarapa and Hutt Valley Communications Update April 2014

1 External communications / Media

Health Highlights

Now published post-Board meeting, with Board line-up and Chair’s column featured.

Both March pages focused on Pacific Health, affirmation of 3DHB direction, endorsing the Board’s pro-fluoride stance, flu vaccination and Emergency Planning. (Hutt) Evacuation training using new evac-chairs, 70th anniversary, children’s ward refurbishment. (Wairarapa) Masterton Medical Practice now on site, Deaf Interpreter service.

Media releases/enquiries 8 March – 17 April 2014

2 Primary Care, including Tihei Wairarapa and Hutt Inc

∑ Monthly advertising of the ‘ED or GP’ message, listing after-hours services and Healthline.

∑ Wairarapa – requirement for MML support now minimal, successful transition onto the hospital site.

3 Working with our neighbours

Sub-Regional (3DHB)

∑ Consultation paper proposing a 3DHB Communications function still being developed in HR

∑ Communications re: FPSC – including special edition of e-Link for new finance system, intranet pages and links to resources

∑ Single print room service project – site visits to two sites to evaluate providers in action

∑ Flu vaccination campaign underway

Wairarapa

Emergency Management

Health Targets

Coroner’s report

Patient condition updates

Breastfeeding awareness

Hutt Valley

Health Targets

Coroners report

Patient condition updatesAlcohol and ED

Antidepressants

New bladder scanner

Stolen gowns and towels

17yo pedestrian struck by vehicle on SH2

Dog attack victim

Hutt City Sports Awards

Health Highlights March

Long-serving midwives retire

Young smokers

Skill saw accident victim

Under-15 Alcohol & ED

Nurses in old photo (70th)

Too many hospital beds


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∑ Further workshop regarding labour/management partnership, now working on strategy of convergence with other initiatives in the sub-region including the Values Based Behaviours work done by the Organisational Development officer in CCDHB, organisational culture work underway within HR in Hutt, and a number of profession-based initiatives.

∑ Attended National Communications Managers conference which included presentations from Prof Swee Tan, a CCDHB Internal medicine specialist on ED wait times, Minister of Health, Director General of Health, HQSC, and a variety of national project managers.

∑ Radiology and Lab projects.

∑ Aligning the Early Warning Score initiatives.

2DHB

∑ Shared website successfully launched 2 March. Positive feedback. Stats tracking well.

5 Jan – 1 Feb 2 Feb – 1 Mar 2 Mar – 29 Mar

Users total 8,604 8,954 10,467

Pageviews total 30,678 31,455 41,357

Average duration of visit

00:01:46 00:01:35 00:01:52

Bounce rate (visited home page only)

63.97% 64.26% 55.13%

% Returning visitors

58.4% 59.3% 54.5%

% New visitors 41.6% 40.7% 45.5%

∑ Facebook presence updated on both sites. Twitter monitored

∑ User testing environment established for Shared workspaces. Need for webmeister/portal administrator role reaffirmed

∑ Response to Ministers office – emergency preparedness

∑ Version 7.2 Organisation charts published.

4 Internal communications

All staff memos

Shared

Mental Health Leadership Approach

Sub-regional mental health

Update for Perioperative Department


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Wairarapa

Advance Care Planning

Chaplain's leave

Masterton Medical invite

Wairarapa Alcohol survey

Flu vaccination for staff

Safe services the priority

Insite online

Farewell for Diane Brewster

Hutt Valley

Weekly staff eLink (emailed/printable newsletter)

Support Hutt Hospital Foundation Trust by shopping at Z-Vic Corner (good in the hood campaign - Hutt) Occupational Health – change to the case management process for non-work injuries – Hutt

Special edition of Staff News for the rollout of new Finance System - Hutt

Intranet stories 7 March - 16 April 2014

Shared

Confirmation of Perioperative Services Leadership Structure

3DHB Mental Health Proposal

Minister announces new DHB appointments

3DHB Radiology Service

National Administration Professionals Day

Flu vacc free for DHB staff

End of life care survey: Your views welcomed ‘Sign Up’ for better service

Sub regional Mental Health Services

Minister launches flu immunisation campaign Political affiliations register inappropriate

Wairarapa

National April Falls Quiz 2014

Flu vacc free for DHB staff

Health records champion

Coroner's Recommendations

Nurturing Baby - breastfeeding awareness

Safe services the priority

Going, going, gone.

'Health Pathways' project launched

Welcome to MML

Wairarapa Help Desk Calls being answered by Capital Coast Team

We welcome three new doctors

Latest results for health targets out

Community alcohol survey

Hutt Valley

Mystery nurses identified

New electronic ordering – Radiology requests

Election guidance for public servants from SSC

Easter payroll deadlines

New Finance System goes live

Conversations that Count Day –Advance Care Planning

Board members getting their flu shots

Microsoft home use program

Clown Doctors visit Hutt Hospital

New pricing agreement with Active Healthcare saves $110,000

Fire alarm trial evacuation

Midwives farewelled after 40 years of service

Coronial recommendations recap


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New Hutt Hospital Chaplain starts

February Balanced Scorecard (how we’re doing)

Health Pathways project launch

Pregnancy and yoghurt study – call for participants

Liz Sargeant visit – Allied Health

Healthy Workplace Awards – team morale/spirit

Freemasons donate bladder scanners to hospital

Betty Poot becomes Nurse Practitioner

7 Other Communications projects

Wairarapa

Influenza vaccination

Palliative Care – Kahukura/Hospice Wairarapa partnership – patient documentation

Shared intranet/workspaces

Patient information and brochure development

Launch of 5 things in the first 10 weeks of pregnancy campaign

Shared intranet/workspaces

Displays in foyer of Hospital: Stroke Awareness, falls, flu and Admin Appreciation


Redo site maps

Hutt Valley

70th anniversary of Hutt Hospital, including digitising several hundred archive photos

Updating image libraries


Pacific Health Scholarships

Annual report planning

Healthy Families initiative – how to support

Employee Recognition initiatives

Allied Health Intranet page reorganisation

Theatre Algorithms – loading onto intranet

Art Canvas project for hospital walls

Establishment of studio for clinical and corporate photographer in old ICU


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Appendix Four - Official Information Act Requests – Hutt Valley DHB

OIA 117

Andrea O’NealDom Post

11.02.2014 I'm seeking information on how many hospital gowns and towels have been taken home by patients and not returned, in each of the last 5 years. If we could categorise this by Hutt & Wairarapa DHBs that would be great.The total number of gowns and towels in circulation in the DHBs would be helpful to put it in context.I would also like to know the cost to replace a gown and a towel, and how much the DHBs spend on those items a year.Response:We cannot identify numbers of gowns and towels taken home by patients and not returned. All losses are classified as “unidentified”.Our Laundry/Linen service is provided by Allied Laundry for five District Health Boards. The stock is pooled and generic across all five District Health Boards and we do not have “loss” numbers separated out for MidCentral.The average losses per year over the last five years across all five District Health Boards are :2,622 gowns (average cost $18.56 per gown)6,800 standard bath towels (average cost $5.24 each)

Completed 06.03.2014

OIA 118

David Clark MP Dunedin North

13.02.2014 Request:1. The amount of mental health funding that was retained for provision delivered by DHB directly, for 2009/10, 2010/11, 2011/12 & 2012/13 financial years.ResponsePlease refer to Appendix 1 for details.2. A list of all the changes made by your DHB to the community provision of mental health since 2009. The information sought on the identity of the provider has been withheld. The information withheld is in accordance with section 9(2)(b)(ii), 9(2)(i) and 9(2)(j).

ResponsePlease refer to Appendix 2 for details.The information sought on the identity of the provider has been withheld. The information withheld is in accordance with section 9(2)(b)(ii), 9(2)(i) and 9(2)(j).3. Is the DHB required to ring-fence mental health funding now? If so, please provide a breakdown showing the way in which mental health funding is spent.Response


OIA Requestor Received Request/Response Status


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Please refer to Appendix 3 for details.4. For the community organisations that have received mental health funding from your DHB, please provide a breakdown of spending by organisation and by type of provision for the 2009/10, 2010/11, 2011/12 & 2012/13 financial years.

ResponsePlease refer to Appendix 2 for details.

The information sought on the identity of the provider has been withheld. The information withheld is in accordance with section 9(2)(b)(ii), 9(2)(i) and 9(2)(j).

You have a right to seek a review, under section 28(3) of the Official Information Act by way of a complaint to the Ombudsman(The Board is welcome to request the appendices)

OIA 119

Rebecca StevensonFairfax

17.02.2014 RequestI am seeking information about New Zealand hospitals and issues with sub-standard fire safety systems under the Official Information Act 1982.Is Hutt Valley DHB aware of any issues with sub-standard fire safety systems including passive fire protection systems at any of its sites?What sort of defects/faults have been found?Where/which facilities have been found to have sub-standard fire safety systems including compromised passive fire protection systems?What is being done about these sub-standard systems?What is the estimated cost to fix the systems?When did Hutt Valley DHB become aware of the first hospital with issues with its fire safety systems?When did the DHB become aware of further hospitals/sites with sub-standard fire safety systems? Dates and all detail available please.Is there a danger to the public using these hospitals in case of fire?Can the DHB b release all correspondence between it and contractors/fire engineers/certifiers related to sub-standard systems?Has the DHB commissioned any reports/enquiries/inspections into fire safety at its hospitals? If so, what are they, can I please see them.What emergency planning has been done in relation to these sub-standard fire safety systems, including passive fire protection, and the evacuation of patients in case of fire?Is any action - including seeking compensation/remedial work - being taken against contractors/fire engineers/certifiers for sub-standard fire safety systems in the DHB's hospitals?Response:Hutt Valley and Capital and Coast DHBs maintain their facilities, including fire protection and detection

Completed13.03.2014


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systems, to the requirements of the Building Warrant of Fitness regimes as administered by each local authority. All buildings have current Building WoF Certificates issed following the provision of signed off documentation by Independent Qualified Persons’ (IQPs) who provide maintenance and inspection services for these systems.Defects are identified as aprt of the reqular inspection regimes and, where non-compliances are found, these are addressed immediately. We are not aware of any current non-0compliant systems. There is no correspondence or reports relating to sub-standard systems as we have not been informed by the IQPs inspecting and maintaining these that any is in this state.Both DHBs have a comprehensive emergency management plan that has been developed to ensure the safety of patients and staff in an emergency. We are not engaged in any legal or remedial activity regarding sub-standard fire protection or detection systems.All queries relating to defects or non-compliance systems in any other DHB should be referred to the DHB in question. We cannot comment on their status.

OIA120

Nikki MacDonaldDom Post

20.02.2014 This is a request under the Official Information ActPlease forward a copy of your most recent register/declaration of gifts to staff.If possible, please send the information in electronic form, as an excel spreadsheet.In accordance with its sponsorship, gifts and donations policy, Hutt Valley DHB holds a gift register for ‘gifts’ over a $200 value. The only entry fro the last 12 months is sponsorship of one Diabetes Department Nurse to attend a 3 Day Diabetes conference. This was valued of approx $750 and was ‘gifted’ by Sanofi Aventis.Please also answer the following questions:Does your DHB engage in drug-company-sponsored continuing medical education onsite?Hutt Valley DHB departments do not as a rule engage in drug company sponsored education on site. One department does allow a specific company to provide suture technique training for RMOs.Does your DHB allow drug reps to visit staff in the hospital/on dhb grounds?In accordance with the Access of Pharmaceutical Representatives policy, HVDHB will extend cooperation to pharmaceutical companies where this is in the direct interest of patient care and the general aims of the DHB.Pharmaceutical representatives are not encourages to visit staff at Hutt but can request an appointment with Senior Medical Staff through their department administrators. A number of departments will meet with representatives. The aim of these meetings is to give advanced notice of new products and to provide information and literature on these products.


OIA 121

Mike Dooley

20.02.2014 1/ When does your DHB place a patient on the 5 month waiting list for surgery2/ Do you require a patient to attend an Education class for joint replacement3/ Is your joint education class compulsory before surgery will be done.4/ If your Education class is compulsory please supply the reasoning behind this5/ If your education class is compulsory would you decline a person surgery



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Response:1. Currently this is when the patient is listed for surgery following the First Specialist Appointment (FSA)

and a discussion with the Consultant. We are in the process of considering changes to the model of care with the clear intention to move to a "fit for surgery" before placing the patient on the wait list.

2. Yes we do.3. No. However there is a high expectation that all primary joints patients attend. Those that are having

a revision are advised of the class and are able to attend if they wish to do so.4. N/A.5. N/A.

OIA 122

Annette KingMP

24.02.2014 How many patients are currently waiting for ultrasound and how long are patients waiting?Response:Hutt Valley District Health Board currently has 11 patients waiting for an ultrasound. The average waiting time for these patients is between two days and one week.


OIA 123

Annette King MP

24.02.2014 The number of nursing vacancies as of 28 February 2014?The number of senior medical officer vacancies as of 28 February 2014?Details of the length of time it is taking to fill vacancies?Response:On 28 February 2014 there were four Nursing vacancies and no SMO vacancies. The length of time it has taken to fill the vacancies (from the date the Authority to Appoint form is received by Human Resources up to and including 28 February) for Nursing vacancies is one to two months. Mental Health Nursing vacancies can take longer to fill.


OIA 124

Annette KingMP

25.02.2014 Request : All Mix and match Part II reports of ‘Trend Care’ from January 2013Response:

1. Has the DHB performed any mix and match part 2 calculations?No.2. And;

a. Which wards and department have had the part 2 calculations done ?None as yet.b. How long the DHB has been implementing CCDM?Hutt Valley DHB is participating in the CCDM process. A Letter of Agreement was signed with the SSHW Unit and NZNO and PSA in August 2013 to undertake the programme.c. Explanation of why the calculations have been done in only some wards / departments (depending how long they have been on the programme).Hutt Valley DHB has completed the Mix & Match part 1 two week data collection phase in a pilot

Completed21.03.2014


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ward and are currently entering the data. At this time there is no Part 2 completed data or report.A robust selection process was used to choose the pilot ward in collaboration with the CCDM Council. SSHW Unit and NZNO staff were involved in the process.d. Summary of the information included for each report.N/A

I. How many shifts are understaffed?II. How many shifts have appropriate staffing?

III. How many shifts are overstaffed?IV. What numbers of staff are currently on the base roster per shift and day?V. What number of staff are recommended per shift and day from the reports?

N/A3. What DHBs are planning to do where there is a difference in the current base roster and the

recommended roster based on the report?We will follow the CCDM process through the CCDM Council. This will involve working with our union partners and the SSHW Unit together, providing any necessary recommendations at the time to the executive leadership team.

OIA 125

Iain Lees-GallowayMP for Pstn Nth

05.03.2014 I request the following information out for each of financial years 2012-13, 2011-12 and 2010-11.1. The number of surgical mesh implants carried out.

HVDHB is unable to provide this information as we do not capture the data.2. The number of complaints received about surgical mesh implants.

There have been no complaints noted at HVDHB.3. The number of surgical mesh implant removals carried out.

HVDHB is unable to provide this information as we do not capture the data.4. Any policies or reports prepared regarding the use of surgical mesh.

HVDHB do not have policies around the use of surgical mesh and use preferred suppliers, as most decision making is done by the clinicians, whether it be for general surgery, plastic surgery or gynaecology.

Completed21.03.2014

OIA 126

Alani VailahiNZ First

27.02.2014 All briefing notes, reports, memoranda, and other relevant papers that relate to complaints revieved by the DHB regarding elder abuse from 1 January 2013 to 31 January 2014 Response:We have not received any briefing notes, reports, memoranda, or any other relevant papers concerning complaints of elder abuse.


OIA 127

Annette KingMP

06.03.2014 What revenue has been generated for the DHB by the increase of prescription charges from $3 to $5 since its implementation?ResponseNo response has been generated for the DHBs. Increasing the co-payment decreases DHB expenditure

3 DHB response 14.03.2014


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rather than increasing DHB revenue.In Budget 2012, the Government re-priortised DHB funding ($20 million in 2012/13 and $40 million per annum from 2013/14) in line with the forecast reduction in DHB expenditure on pharmaceutical claims caused by increasing the patient co-payment to $5. Official information was released on this as part of the Treasury-led information release process for the budget. The information is already publically available on the Treasury website. www.treasury.govt.nz/publications/informationreleases/budget/2012

OIA 128

Annette KingMP

06.03.2014 The number of colposcopies undertaken from 2009/10 to 2013/14Response:

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

349 324 341 343 287 YTD

Hutt Valley DHB

475 560 644 640 426 YTD


OIA 129

Annette KingMP

06.03.2014 The Number of varicose veins treated by non-surgical methods eg UGS or EVLA from 2009/10 to 2013/14Response:Neither Wairarapa or Hutt Valley DHB carry out these types of procedures.


OIA 130

Clare SziranyiRadio NZ

07.03.2014 Request∑ How many pediatric oncology patients from Hutt Valley DHB have been diagnosed and sent to Auckland or Christchurch since Wellington ceased its service?

Answer: 26 patients∑ What has been the cost to Hutt Valley DHB in transporting these patients and their family members out of Wellington in order to receive oncology treatment in the other centres?∑ Answer: Total costs between July 2009 to December 2013 totals $250,885.90∑ What has been the cost to Hutt Valley DHB of accommodating family members in Auckland or Christchurch?∑ Answer: Total costs between July 2009 to December 2013 totals $146,014.86


OIA 131

Jared NicolHutt News

12.03.2014 How many people went to the Hutt Hospital's ED while intoxicated in 2008 and in 2013?How old were they?Were they male or female?How many people went to the ED for alcohol-related problems in 2008 and 2013? And how many were admitted?Board can request a copy of response as is a large spreadsheet.


OIA Iain Lees- 12.03.2014 I request the following information for each of financial years 2012-13, 2011-12 and 2010-11. Completed


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132 GallowayMP

1. The number of people with mental illness living in supported accommodation funded by the DHB.

2. The amount spent by the DHB on supported accommodation for people with mental illness.

3. The number people with mental illness assessed as able to transition from acute care to supported accommodation who have remained in acute care for any period of time due to unavailability of supported accommodation. This data is not readily available locally as the information is not part of any existing DHB reporting. To extract the information the DHB will need to review individual case files which will require additional capacity (time and personnel) including individual consumer approval and NGO providers input.As there would be considerable time involved by DHB and NGO staff to provide this information we would need to charge for the supply of this information. If you are able to refine your request we may be able to reduce any costs to you. Once you have confirmed your requirements we can advise the expected costs. 4. The average waiting time from referral to entering supported accommodation for people with mental illness.This data is not readily available locally as the information is not part of any existing DHB reporting. To extract the information the DHB will need to review individual case files which will require additional capacity (time and personnel) including seeking individual consumer approval and NGO providers input.

As there would be considerable time involved by DHB and NGO staff to provide this information we

15.04.2014

Hutt Valley DHB Residential Services:Comments

Provider PU service 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13Provider 1 MHA24 residential beds 8 8 6 4.9 4.8 4.8Provider 2 MHA24 residential beds 10 12 9 7.5 7.8 9.6

Provider 3 MHA25 residential beds 17 18 9 9.6 9.8 6.4

reallocation of beds to CSW Transition service occurred in 2012/13

Provider 4 MHA07 residential beds 7 7 8 6.4 6.9 5.1Total 42 45 32 28.4 29.2 25.9

unique clients beds used

PU code PU description $ 2010/11 $ 2011/12 $ 2012/13MHA24 Housing and Recovery Services Day time/ Awake Night support 657,000 402,072 407,340MHA25 Housing and Recovery Services Day time/Responsive Night support 764,688 519,000 526,236Total 1,421,688 921,072 933,576


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would need to charge for the supply of this information. If you are able to refine your request we may be able to reduce any costs to you. Once you have confirmed your requirements we can advise the expected costs. 5. Any reports prepared regarding the availability of supported accommodation for people with mental illness.

There are no such reports

You have the right to seek a review, under Section 28(3) of the Official Information Act by way of a complaint to the Ombudsman.

OIA 133

Megan SmithBeat Bowel Cancer

10.03.2014 The portion of Patients diagnosed with bowel cancer who are discussed at a multidisciplinary team meeting.(NB: this is a transfer from MoH)Response:Hutt Hospital have a Colo-rectal MDM here, but some cases could be discussed through the Wellington Hospital MDM. We are unable to supply the proportionate number of patients discussed, as we do not record this information.


OIA 134

Annette KingMP

12.03.2014 How many complaints has the DHB, through any mechanism, received relating to health and safety concerns in the last 12 months?Response:Wairarapa and Hutt Valley DHB have not received any complaints relating to health and safety concerns.


OIA 135

Mike Dooley

17.03.2014 In 2011 the Auditor general’s office released a performance audit report titled “ Progress in delivering funded scheduled services to patients”In this report it highlighted the following:The priority areas that we recommend they focus on are ensuring that:• patients are more consistently selected for first specialist assessments;• patients are more consistently prioritised for treatment;• a greater proportion of patients receive scheduled services within the expectedtime limits;• a greater proportion of patients are treated in priority order; and• progress is made in quantifying the level of unmet need for scheduled services.1/ Patients are more consistently selected for first specialist assessments. The report highlights:We found that patients are selected for an FSA using three main methods. Two of these methods are likely to achieve consistency within the DHB even if selection tools are not used.The three methods are:a) The first method involves a single individual, such as a GP liaison12 or semi-retiredsurgeon, who assesses all referrals received by a specialty. This individual accepts or declines patients for an



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FSA based on any criteria that have been agreed. They might use a specific selection tool. The individual might telephone the GP to find out more information about the patient and discuss care or treatment options available in the hospital or the community. If this individual declines a referral, they might tell the GP when the hospital would accept any new referral for that particular patient and/or similar patients.b) The second method is more commonly used when the number of referrals to a department is small. The specialists discuss all the referrals at a weekly meeting. They might use selection tools. The specialists jointly decide which patients they will accept, how quickly they will see each patient, and which specialist will carefor the patient. Alternatively, the specialists may agree that one of them will discuss the patient with the GP before deciding how to proceed.c) The third method involves hospital departments allocating the responsibility forselection referrals to the “on-call” specialist, who may or may not use selection tools. On-call specialists generally fi t this selection work around their other duties, such as out-patients’ clinics, ward rounds, operating theatre sessions, or assessing patients in the emergency department. On-call specialists do not usually set aside specific time to deal with GPs’ referrals. Q 1 WHICH OF THESE 3 METHODS DOES YOUR DHB USE TO ASESS PATIENTS FOR A FSA AND WHY DO YOU USE THIS METHOD?Q 2 Does your DHB use any prioritisation tool to determine priority for a First Specialist appointment?Q 3 Does your DHB make any allowances for patients with Bilateral joint problems and are they given any priority over patients with single joint problems?2/ Patients are more consistently prioritised for treatment. The report states:Currently, three sets of prioritisation tools are used – older national tools, more recent national tools, and local (DHB-level) tools. Some prioritisation tools address a single procedure, such as varicose veins, and other tools are used for all patients seen by a specialty, such as the tool for General (internal) Medicine.With regard to Joint replacement elective surgery which one of the above prioritisation methods does your DHB use?Q 4 With regard to Joint replacement can you supply the prioritisation tool that you use?Q 5 With regard to joint replacement has the priority tool that you use been approved by the Ministry of Health?Q 6 How does the prioritisation tool or process that you use comply with ESPI 8?3/ A greater proportion of patients receive scheduled services within the expected time limitsQ 7What has your DHB implemented since Jan 2011 to increase the numbers of patients receiving hip orknee replacements within the expected time limits?Q 8 What are the yearly figures for hip and Knee replacements for your DHB from Jan 2011 – Dec 2013?Q 9 How have you monitored this achievement and what are the relevant numbers?4/ A greater proportion of patients are treated in priority order


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Q 10 How does your DHB decide on priority order for Hip and Knee replacement and how accurate is it?5/ Progress is made in quantifying the level of unmet need for scheduled servicesQ 11 Unmet need has been a point of concern recently with announcements being made that these figures are not kept. Q 12 Does your DHB know what the unmet need for Hip and Knee replacement is?Q 13 If your DHB does not keep these figures why is this?ResponseIn Wairarapa and Hutt Valley DHB’s a mix of one individual or on call specialists triaging referrals is used. National tools are used for all triaging. Some are older, some are under review such as the orthopaedic tool (which includes all orthopaedic procedures) and some are new and are just being introduced – ENT and Gynaecology. National tools are approved by the Ministry of Health so ESPI 8 is compliant.Patients being referred for all joint replacements are triaged against the same criteria. Please see attachment.In regards to orthopaedic service delivery an additional FTE has been employed and additional theatre time provided for surgery. This is for elective surgery but hip and knee replacements are only part of this. We look at standard intervention rates per 10,000 population and this report was last done in December 2013. At that time the findings were:Wairarapa DHB’s standardised discharge rate is 24.75 and this ranks them 5 in New Zealand.Hutt Valley DHB’s standardised discharge rate is 23.15 and this ranks them 7 in New Zealand.Hip and Knee replacement at Wairarapa and Hutt Valley DHBs

Hip and Knee Joint replacements (including revisions)

2011 2012 2013

Wairarapa DHB 123 115 125Hutt Valley DHB 274 321 309

All patients on all elective waiting lists are treated in priority order looking at priority (urgent, semi urgent) and time waiting on the list. Patients are treated within the Ministry waiting times in both DHB’s.In regards to unmet need we have by specialty the volumes declined for an FSA. Hip and Knee referrals cannot be singled out of this volume as the information is generated from the comments of the GP on the referral – e.g. sore knee, OA knee, pain knee, ? knee replacement required, bilateral knees and a variety of other descriptors. Some referrals will be requests for advice for patients. We do not keep specific figures for hip and knee, as this is irrelevant. All those who meet the triaging criteria are seen. Those that do not meet the criteria regardless of their presenting complaint, are declined. In both DHB’s you can only see what you have capacity to see and treat so this is reliant on manpower, theatre access and beds


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all being available.


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OIA 136

Denise TairuaAPEX

17.03.2014 Pursuant to section 12 of the Official Information Act 1982, APEX requests the data and/or information held by Hutt Valley District Health Board, with regards to Clinical Physiologists. In particular, could you please provide the following information: a. The current numbers of Clinical physiology staff with a breakdown by specialty i.e. – Sleep, Cardiac, Respiratory and Renal, of Physiologists, Physiology Technicians and ECG Technicians and the number on each salary, this includes Renal Physiologists – formerly known as Dialysis Technicians.

Head CountEmployee Status

MECA Specialty Salary FULL PART CASUALGrand Total

APEX Clinical Physiologist $49,272 1 1Clinical Physiology Technician $49,272 1 1Clinical Physiologist Provisional $46,536 1 1

Grand Total 2 1 0 3

b. The number of Clinical Physiologists, including Renal Physiologists, formerly known as Dialysis technicians, who have successfully used merit progression. With a breakdown by specialty – Sleep, Cardiac, Respiratory, Renal, and by years i.e. the number in 2011, 2012 and 2013.

Merit Progression 2011 2012 2013

Head Count 0 0 0

c. The Continuing Medical Education/Continuing Professional Development budget for Physiology Staff as well as the actual amount used in 2011, 2012, and 2013 and excluding the amount used for training for Physiology related qualifications.

2011 2012 2013

CPD 943 2,191 4,442Educational Leave 1,022 3,527 1,103Total Spent 1,965 5,718 5,545


OIA 137

Denise TairuaNZ Med Lab Workers Union

18.03.2014 Pursuant to section 12 of the Official Information Act 1982, The New Zealand Medical Laboratory Workers Union (NZMLWU) requests the data and/or information held by Hutt Valley District Health Board, with regards to Laboratory Workers, including Medical Laboratory Scientist, Medical Laboratory Technicians, Specimen Services Technicians QSST, Phlebotomists, Mortuary Technicians and Medical Laboratory Assistants. In particular, could you please provide the following information:a. The current numbers of Laboratory staff on each step of the salary scale with a breakdown by Scientists,

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Technicians, Phlebotomists, Mortuary Technicians and Assistants b. The number of Laboratory Staff who have successfully used merit progression. With a breakdown by years i.e. the number in 2011, 2012 and 2013. c. What is the Continuing Medical Education (CME) /Continuing Professional Development (CPD) budget for Laboratory Staff, and how much was actually spent on CME/CPD with a breakdown by years in 2011, 2012, and 2013.

OIA 138

Florence KerrWaikato Times

19.03.2014 I would like to request information showing the amount of money Wairarapa District Health Board give to the Wairarapa branch of Alzheimers New Zealand annually.I would like to request this information for the period of 2009 to 2014.Hutt Valley DHB

Contract $ AmountDisability Information and Advisory Service

$13,967 pa 1 July 2011 to 30 June 2014

Disability Information and Advisory Service

$13,967 pa 1 July 2010- 30 June 2011

Disability Information and Advisory Service

$14,104 pa 1 July 2009- 30 June 2010


OIA 139

Mark Atkin 20.03.2014 All documents since February 1 2014 delineating a strategy to promote fluoridation in the greater Wellington Region until 30 Sept. 2014. The document(s) identifying the budgeted cost of running this campaign.All documents since 1 February 2014 mentioning a strategy to promote water fluoridation in the greater Wellington region.Response:In response to your first and third questions, there are no documents relating to a strategy to promote water fluoridation per se. However, a draft position statement or community water fluoridation has been developed for the two Boards to consider. Thos position statement is available in the public section of the two Boards’ March meeting papers, and I have enclosed a copy.In response to your second question, I can confirm that there is no budgeted cost to promote water fluoridation in the greater Wellington region.


OIA 140

Annette KingMP

24.03.2014 What funding did the DHB receive from the $10 million for additional elective surgery as announced by the Minister of Health on 29 January 2014 and what procedures will the funding be allocated eg orthopaedic, ear, nose, throat etc surgeries?Response:Hutt Valley DHB received $461,819 of this funding and has allocated this to undertake more procedures in orthopaedics, plastics and general surgery.



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OIA 141

Jo CoffeyNZNO

25.03.2014 I am hereby requesting under the Official Information Act 1982, any information held by the DHB that is relevant to the recent Part 2 Calculations done on Hutt Medical Ward and decisions around the FTE calculations be shared with myself as the members representative. This request is made pursuant to and in reliance upon the provisions of the Privacy Act 1993.In addition to the above the ED Department have been reviewing an escalation model that affects the hospital, with no NZNO consultation or NZNO delegate involvement in that process, which has also been raised with the CNM. This is an important process and has wider hospital implications for our membership. NZNO is also requesting that under clause 24.0 to be involved in this work through a proper co-operation, consultation and management of change process.

In Progress

OIA 142

Mary Bryne

26.03.2014 Please provide a copy of the Report on fluoridation that was given to the Hutt Valley DHB members last week.I am requesting this under the official Information Act.Response:Under Section 18(d) of the Official Information Act 1982, this information is publicly available on the Hutt Valley District Health Board website.http://www.huttvalleydhb.org.nz/contentClick on ‘Who we are’.Then ‘Board and Governance’, then ‘view meeting times and papers’.


OIA 143

Michelle DuffFairfax

26.03.2014 This is an Official Information Act request for a copy of your district health board's last ACC audit report, as detailed below."As Accredited Employers DHBs are required to have an approved independent auditor undertake an annual audit against ACC audit standards for Safety Management Practices and Injury Management."

In Progress

OIA 144

Janine Ryder

27.03.2014 • How many and which DHB's currently fund Practice Nurse Subsidiary for their Accidentand Medical Clinic(s);

• Which DHB's currently fund Practice Nurse Subsidiary for their Emergency Departments .

In Progress

OIA 145

Jonathon BrownNZ Taxpayers Union

01.04.2014 1. Has the Ministry/DHB adopted a standard definition of ‘front line staff’? If so, provide details2. Does the Ministry/DHB collect data on the number of staff that are/aren’t front line staff? If so we request that information3. What is the amount spent in the last financial year on employment of front line staff as a percentage of the total employee expenses of the Ministry/DHB?

Withdrawn 10.04.2014

OIA 146

Mary BullApex

01.04.2014 Requests a copy of all written documentation and communication relating to the 3DHB Radiology Project –including all notes, emails, letters, minutes, workshop material, proposals and any other documentation from: The 3DHB Plan, The 3DHB Radiology Project, The Radiology Working Group, and The 3DHB Radiology

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Steering Group.OIA 147

Chris Waggstaff

Request1. Any legislative changes to the "Smoke Free Environmental Act 1990", that has occurred from 2008 till the present2. Any and all public complaints,Any and all visits from the 'Public Health Service',Any and all outcomes that has affected Fidel's Cafe,Any other information that the "Public Health service" has on file3. a copy of the "Ministry of Health Smoke-Free Compliance and Enforcement Manual"

Response:1. There have been a number of changes to the Smokefree Environments Act. A copy of the Act can be found here: http://www.legislation.govt.nz/act/public/1990/0108/latest/DLM223191.html

A copy of the High Court ruling between the Cancer Society of New Zealand v The Ministry of Health is attached.

2. We have identified a number of documents as being within your request. This information, and my decision in respect of it, is set out in the table below:

Number Document Description Action2-8 Emails/ correspondence / letters

various dates between RPH and Fidels

Released

9 Pam Smith email from MoH Released with parts withheld under s9(2)(g)(i) to maintain the effective conduct of public affairs through the free and frank expression of opinions

10 - 15 Emails between WCC and RPH Released with parts withheld under s9(2)(a) to protect the privacy of natural persons.

17 - 26 DomPost article/ summary of facts Released27 -56 Complaints form Released with parts withheld under

s9(2)(a) to protect the privacy of natural persons.



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57 - 63 Diary pages Released with parts withheld which address appointments not related to Fidels. These are outside the scope of your request.

64 - 66 Letters/ fax correspondence (Fidels/RPH and RPH/MoH)

Released

67 Email between Cindy Crampton-Cains and Pam Smith

Released with parts withheld under s9(2)(g)(i) to maintain the effective conduct of public affairs through the free and frank expression of opinions

68 - 86 Calculator/ photos/ letters/ fax correspondence/ emails/ companies office information/ liquor license/ opening drawings/ notes

Released

87 Complaint form Released with parts withheld under s9(2)(a) to protect the privacy of natural persons.

88 - 102 Emails/ letters/ notes/ photos Released103 Complaints data entry form Released with parts withheld under

s9(2)(a) to protect the privacy of natural persons.

104 to 163

Various items of correspondence between Regional Public Health, Ministry of Health legal team and solicitors

Withheld to maintain legal privilege (s9(2)(h)).

Where I have decided to withhold, I have reached the view that the withholding of that information is not outweighed by other considerations rendering it desirable, in the public interest, to make that information available.

3. The Smoke-free Compliance and Enforcement Manual is a Ministry of Health document. I have accordingly transferred this request under s14(b)(c)) of the Act to the Ministry of Health on 7 April 2014. (See document 1)


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You have the right, under section 28(3) of the Official Information Act, to ask the Ombudsman to investigate and review my decisions in this matter.

OIA 148

Jared NicollHutt News

08/04/2014 The stats show that about six intoxicated kids under-15 are treated and discharged each year.What extra difficulty is involved with treating a drunk patient under-15 as opposed to a sober patient?Does it tend to take more time to treat an intoxicated under-15 than sober? Is this okay?Do hospital staff contact the kids' parents or family if they aren't around?May I ask if there are any sort of injuries that intoxicated under-15s are prone to?

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AGENDA - Hutt Valley District Health Board

Documents

Transcript of AGENDA - Hutt Valley District Health Board