Welcome to the last edition of Connect for the year. I want to

thank you all for your hard work over what has been another big year for us and hope you will have the chance to enjoy some relaxation over the holiday season.

One of the big events of this year was seeing the vision for the Centre for Health Services Innovation – Ko Awatea become much more advanced. Ko Awatea means ‘new beginnings’ and that is exactly what it will mean for CMDHB. I want to tell you a little about this exciting project that will be the focus for the future of CMDHB’s goal towards being the leader of healthcare in Australasia by 2015.

Its Director is Professor Jonathon Gray, an international leader in health systems improvement,

DECEMBER 2010

Ko Awateaand New Zealand’s first Chair of Health Systems Innovation and Improvement. Jonathon started with CMDHB in November following a very distinguished record of healthcare improvement in Wales, which includes the much-lauded 1,000 Lives Plus programme which focussed on improving patient safety and reducing avoidable patient harm.

The purpose of the Centre is to create the ‘strategic hub’ for the Counties health system.

It will develop and implement the whole system improvements required, not just to deliver the Better Sooner More Convenient reform programme, but also to ensure that CMDHB meets its objective of becoming the leading health and healthcare system in Australasia by 2015.

To deliver this ambition, Ko Awatea has developed four key partnerships, which when aggregated together in the Centre, provides a significant strategic capacity. This will enable us to move from just identifying the problem to developing and delivering solutions.

Firstly, three major institutions – AUT, MIT and the University of Auckland have formed a partnership with CMDHB to co-ordinate tertiary training and make best use of university facilities such as the

Professor Jonathon Gray is New Zealand’s first Chair of Health Systems Innovation and Improvement and has just joined our team.

Jonathon, who will lead Ko Awatea, was the former director of healthcare improvement at Public Health Wales and co-director of the 1,000 Lives plus programme. His work was around creating a culture where improving patient safety and reducing harm was central to people working for NHS.

The programme has already helped organisations make improvements in a number of key areas, including improving critical care and reducing surgical complications.

“Everyone, wherever they live, deserves world-class healthcare,” says Jonathon. “I am particularly looking forward to sharing with colleagues in New Zealand the ground-breaking work that has been developed in Wales,” he says. “However, I have a lot more to learn and New Zealand brings some new opportunities for me to further my skills and experience as the director of its new national health initiative.”

“I believe that small countries such as Wales and New Zealand can punch above their weight and my 15 years in Wales has shown me this is true. Wales has been able to work across sectors and deliver change at an astonishing pace,” he says. “I know that I need to listen and learn but I want to create enthusiasm and energy within healthcare staff to really want to deliver improvements.”

Jonathon graduated in medicine from Dundee University before going on to complete a PhD in clinical and molecular genetics. A former clinical director of the All-Wales Medical Genetics Service, he completed a fellowship at the Institute for Healthcare Improvement and has a Masters of Public Health degree from Harvard.

But it’s not going to be all work – Jonathon is looking forward to fulfilling a few personal ambitions, such as improving his surfing, sampling our fine wines and watching Wales take the Rugby World Cup. (Yeah Right!).

CMDHB Welcomes Professor Jonathon Gray

continued

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Message from the

ChairmanAs we approach Christmas time and the end of the year, I want on behalf of the Board to acknowledge all of our staff who have contributed so much to the organisation in 2010.

That means every employee because each of you have contributed to the successes that Counties-Manukau have had this year. One of the measures of success is that we have been consistently reaching the target of 95% of patients seen within Emergency Care within six hours. This is a great achievement, not just because of the efforts of the staff of EC who have worked so hard to achieve this, but because it is

well known that the success in reaching this target is a reflection of the whole of the Middlemore Hospital staff who have worked together to get there.

Another success is in reaching the immunisation rate of 86% of all children immunised by the age of 2 years. This is important for the health of our children, and tells us more about the organisation of general practice and primary care nursing. But we still have the largest number of non-immunised children for any DHB in the country and that means that we will have to redouble our efforts to improve that situation.

We have some real challenges in managing diabetes and cardiovascular disease, with wide variation in performance amongst our PHOs. Next year the DHB will be working much more in an integrated way, to bring together the clinicians across the disciplines to improve the way that we deliver services for these chronic conditions. I know that our hospital clinicians are keen, and that same evidence of enthusiasm is being shown by the primary care

School of Population Health. Professor Gray is also the Director of the National Institute of Health Innovation (NIHI) based at University of Auckland, and as such, Ko Awatea acts as a research arm of NIHI.

Secondly, Ko Awatea brings together CMDHB’s nationally recognised capacity to lead change. Ko Awatea is restructuring existing teams and units into several centres of excellence. By co-locating them in a new purpose built centre, this allows for multi-disciplinary and innovative solutions for health systems improvement to be developed. Initially, Ko Awatea initially has the following centres:• CentreforClinicalQualityImprovement• CentreforClinicalLeadership&Engagement• CentreforHealthIntelligence• CentreforWorkforceDevelopment• CentreforResearch&Innovation

It is also planning to expand the number of centres in the near future.

Thirdly, Ko Awatea has established an Advisory Board which seeks to bring leading international thinking to New Zealand, and link it to our local environment. The range of expertise of the Board covers the whole breadth of the health spectrum, and has overseas experts from Australia, the UK and the USA as well as New Zealand leaders.

In addition, Ko Awatea is establishing a formal strategic partnership with the Institute for Healthcare Improvement (IHI) in Boston, and with Dartmouth Medical College in New England. It already has a formal link with the Oxford Centre for the Healthcare Transformation and Public Health Wales. Currently, a Counties wide Faculty of Health System Improvement is being established with local clinical, managerial and community leaders to create “in house” policy and implementation capacity.

Fourthly, Ko Awatea is establishing an Innovation

Hub which will greatly strengthen Research and Development culture and capacity. This Hub will be focusedonthreeaspects–R&D,HealthSystemsInnovation and commercial device development. In so doing, its aim is to partner with external organisations to create intellectual and commercial value for the system as a whole. A key objective in creating the Hub is to attract and retain the best staff in New Zealand, rather than lose them overseas becauseofalackofanR&Dbaseathome.

Ko Awatea represents both a huge opportunity to design the changes to the NZ health sector

required to ensure high quality care in the future. It already has in place much of the significant strategic capacity to deliver this.

I am sure you will join me in welcoming Dr Gray to CMDHB as we look forward to probably the most exciting future we could possibly conceive.

Have a happy holiday season and I look forward to seeing you in the New Year.

Best wishesGeraint MartinCEO, CMDHB

partners in GAIHN and the other primary care initiatives.

Best wishes for a happy Christmas and New Year.

Prof Gregor CosterChairman

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My Visit to Manukau Surgery Centre - A Kidz Eye ViewKathryn Skadiang has worked for Counties Manukau District Health Board for the last 21 years and is the Associate Clinical Nurse Manager for the Post Anaesthetic Care Unit at Manukau Surgery Centre.

Kathryn feels that MSC is a children and family-focussed centre with its dedicated children’s pre-operative and post operative areas but is always trying to add that ‘little something extra’.

Kathryn’s latest ‘little something extra’ is a

wonderful book about a child’s peri-operative journey. It is known that to reduce fear of the unknown

promotes a safer recovery for and this in turn helps to promote a positive outcome for the child and their parent/caregiver.

Kathryn enlisted the assistance of members of the PACU team, their families and other members of the greater Manukau Surgery Centre team to assist her in the production of a pictorial story book.

Through colourful pictures we follow a little girls journey from her arrival at the hospital, she has a little name band put on her wrist, then a doctor listens to her chest through a funny thing, we see the funny clothes she changed into and her sitting on her mummy’s knee to have anaesthetic medicine and eating a yummy ice block before she waves good

bye when she leaves to go home. Kathryn hopes the book will give children and their parents / care givers an increased level of comfort in an unfamiliar environment.

Sponsorship from Hector Trust has enabled Kathryn to realise the first publication of her book “My Visit to Manukau Surgery Centre”.

Kathryn recently presented her book at the Peri-operative Nurses Conference and was the winner of the free paper award.

Congratulations to Kathryn in realising the publication of her book “My Visit to Manukau Surgery Centre” and further congratulations on her winning achievement at conference.

With anticipation we look forward to your next “little something extra”.

New Outpatient Chronic Pain Service

Chronic pain is defined as pain which lasts for longer than the usual time of healing with a timeframe often set as more than six months. One in six adults in New Zealand (16.9%)* reported that they experienced chronic pain, which equates to 528,100 adults.

Chronic pain sufferers reported that the part(s) of their body affected by pain were: • joints(57.6%)• neckorback(47.5%)• abdomen/pelvicregion(12.5%)• head(12.0%)• chest,includingheartandlungs(6.1%)• stomach(8.3%)• face/jaw(4.5%)• teeth/gums(1.7%)*

Recently people with chronic pain who live in the CMDHB area have been assessed and treated at Greenlane hospital by the team at The Auckland Regional Pain Service (TARPS). The intention is to bring the Counties population back to South Auckland to clinics held at Manukau Superclinic. The two services will consult together and TARPS will continue to provide intensive pain management programmes to a small group of CMDHB patients.

The foundation staff for the new chronic pain service include Frances James (Clinical psychologist and Clinical Leader), Martyn Seay (Anaesthetist). Aislinn Carr (CNS), Lisa Ford (Physiotherapist), Lynnette Dalglish (Health Psychologist) and Anita

Left to right: Lynnette Dalglish (Health Psychologist), Lisa Ford (Physiotherapist), Martyn Seay (Anaesthetist), Annie Tyson (Service Manager), Anita Piiti (Scheduling Appointment Coordinator and Service Assistant), Fran James (Clinical Leader, Clinical Psychologist), Ash Carr (Clinical Nurse Specialist)

Piiti (Scheduling and Administration). The chronic pain team will be recruiting new staff and building services over the next year and services will be introduced in a stepwise fashion as staff are employed.

Chronic pain services are based on high quality assessment covering medical, psychosocial and functional impact of pain. Treatment focus looks at improving quality of life and maximising control of pain where possible. It is expected that some patients will be referred by inpatient services for CPS follow up in the community after discharge.

The chronic pain team hope to work with the community leaders in the Pacific Island and Maaori communities to provide up to date education regarding chronic pain management. We also aim to develop ongoing relations with the community so that those patients who are in need receive timely and appropriate care.

*A Portrait of Health – Key results of the 2006/07NewZealandHealthSurvey

CMDHB is pleased to announce a new out-patient chronic pain service (CPS) with an interdisciplinary focus.

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A number of CMDHB Maternity Unit staff attended the annual PMMRC workshop. The day was attended by expert international and national speakers commenting on the main features of the report.Everymaternaldeathandperinatallossupto42

days after the birth for maternal death and up to one year for neonatal death that occurs in NZ is recorded by and lodged as a confidential report to the PMMRC.

The data is collated and classified as to why the death occurred. The annual workshop enables professionals involved with Maternity Care to reflect on the previous year’s data and extract information which can be translated to improving clinical practice or systems and processes to prevent a reoccurrence of these deaths. The key points are shared here.

Review of Current report-2008 data• Theintrapartumstillbirthrateisaconcernas

the majority of babies are term and not small for gestational age so may be preventable deaths.

• TheNeonatalencephalopathygroupareinvestigating the causative factors around these babies who suffer hypoxic ischemic encephalopathy as a result of intrapartum hypoxia.

• 10neonataldeathsduetoSUDIwithcosleepinga factor in 8 and 9 babies had mothers who smoked.Nochangeinnumberform2007data.

• Acombinedanalysisof2007and2008datafound Maaori and Pacific women were more likely to have a stillbirth or neonatal death compared with NZ European and Asian women (not including Indian).

• MaaoriorPacificwomenandthoselivinginareasof high socioeconomic deprivation are more likely to have a stillbirth or neonatal death as a result of a spontaneous Preterm birth.

• Therewere9maternaldeathsin2008.Combinedfiguresfrom2007and2006datashowthatoutof35Maternaldeaths,8weremotherswithpre-existingmedicalconditionsand7weresuicides.

Maternal Mental healthPsychiatricadmissionismorelikelyinfirst3monthspostpartum than at any other time in the female life span. Mental illness can be precipitated by childbirth or make an existing mental illness worse e.g bi-polar disorder. Women with an existing mental health disorder however well-controlled should be reviewed by a psychiatrist and a plan shared with the women, family, midwife and GP.

Symptoms of mania or mental health disorder can appear to be ‘normal’ during the antenatal period and after childbirth;• Insomnia• Depressivesymptoms-poorappetite,increased

appetite, lack of self care• ChangesinSleep/Wakingcycle• Mania-excitable,awakeallnighttalking,elevated

moodSuicide is a result of under recognised serious mental illness.

Feedback from Healthy Mothers Healthy Babies Perinatal and Maternal Mortality Review Committee Annual Workshop 23/11/2010 in Christchurch

Assessment Centres, which are a number of selection assessments or exercises used whilst recruiting staff help to determine future staff performance. Candidates typically come in on the same day and may experience workshops, role-plays, scenarios, psychometric assessments and panel interviews.

To date the team have helped the business with recruitment assessment centres for:• NurseEntryToPractice• AnaestheticTechnicianTrainees• OrderliesandCleaners

• TeamLeadersinNonClinicalSupport• PsychiatricAssistants• HealthCareAssistants• Receptionistsandadministrationstaff• HumanResourcestaff(WorkforceDevelopment

and Recruitment).Assessments centres are internationally proven

to be one of the best indicators of future on the job performance at recruitment/selection stage. The team strives to simulate real working environments and job samples.

The support of the CMDHB staff has been fantastic – without help from Charge Nurses and managers these assessment centres would not be possible – so a big thank you and acknowledgement goes out to all who have helped.

If you would like to know more about assessment centres, please contact your recruitment consultant – details can be found on our intranet site http://southnet/recruitment or feel free to call your recruitmentcentreon2760083

An Innovative & Engaging Way of Recruiting StaffSince 2009 CMDHB’s Recruitment centre have been designing and running assessment centres for the recruitment of staff.

Recommendations for Clinical practice• Askaboutanypreviousmentalhealthissues

or family history at booking. If a family member has bi polar the risk increases for the pregnant woman despite any previous history

• Enquireaboutmentalhealth,stressorsandsocialsupport as a normal part of antenatal care and revisitat3-6weekspostpartum

• FindoutaboutlocalreferralpathwaystoMaternalMental Health service

Issues which contribute to Maternal and Perinatal mortalityDelay in accessing careDelay in seeking careDelay in recognition/provision of care

Recommendations for Clinical practice• Weighateveryvisit• Encourageearlybookingi.e.before10weeks

gestation• Addressriskfactorsforpretermlabour• Askaboutsocialsupport• Talkaboutsmokingandrevisitateachinteraction

Report available at http://www.pmmrc.health.govt.nz.CMDHB holds a confidential monthly meeting at

MiddlemoreHospitalonWednesdaysat9.30hrs.Please contact Dr Sarah Wadsworth, Obstetrician and Gynaecologist and PMMRC Co-ordinator, if you are interested in attending via email: swadsworth@middlemore.co.nz

If you have any queries about or referrals for women who have a had a perinatal loss over 20 weeks gestation then please contact Dr Wadsworth via email.

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Opening of Kowhai Health (Integrated Nurse Clinic) Mangere

New Microscope Helps Hearing

Pacific Nurse Practitioner Training

Children who can’t hear can’t learn and new equipment is ensuring nothing prevents youngsters from keeping up with classroom activities.

The Counties Manukau District Health Board team at Clendon Clinic proudly showed off a new OPMI pico microscope to Rotary club donors, who raised funds for the equipment.

Public health nurse Josephine William demonstrated the new microscope to Ken Haines and Simon Gleeson from the Rotary Cub of Alfriston.

Josephine says the microscope is used to detect and remove foreign bodies and wax build-up from the ears of young patients.

Children such as six-year-old Vipashi Sami have their ear canals examined while their caregivers watch the process on a monitor above the microscope.

“You’d be amazed what we find – crayon tips, cotton buds and even small silver batteries,” says Josephine. “The monitor helps educate families because they can see everything.”

Gentle suction removes wax and foreign bodies and fewer patients are referred to Manukau Super Clinic because they can be treated at Clendon.

The microscope has a teaching arm, which allows students to observe the procedure at the same time as the nurse.

TEACHING: Public health nurse Josephine William demonstrates the new OPMI microscope with her patient Vipashi Sami, 6.

THANKS: Lorraine Bailey explains to Rotary guests how the new equipment improves the lives of children, from left, Ken Haines, Lorraine Bailey and Simon Gleeson.

Simon was the former president of Afriston Rotary and has volunteered for the organisation for more than27years.

He says: “Rotary members seldom have the opportunity to see the result of their fundraising. It is fabulous to see the equipment in action.”

The current Alfriston Rotary president Ken told the Clendon Clinic staff how the group consists of only 17members.

They coordinated a book fair, sold raffle tickets and managedcarparkingattheClevedonA&PShowtoraise money for the community health initiative.

In 2008 Primary Health Care Innovation funding was awarded to develop a new initiative to bring together nurses working in the Mangere Community. The clinic will provide the opportunity to increase access of nursing roles and allied health practitioners to the Mangere community. The clinic is located in the Mangere Health Centre occupying the previous Medlab rooms and is a pilot for further Better, Sooner, More Convenient healthcare as envisaged by the Health Minister.

Clinic sessions will be available to nurses andalliedhealthprofessionalsforupto3hours.30minutesofthistimeisopenforinter-clinic referrals or opportunity to provide clinical advice for other health care professionals in the clinic or local area. Primary care will refer patients to community nursing care as they usually do. Local practices will be able to contact the Nurse Coordinator to arrange shared consultations or see the nurses/allied health practitioners when they are scheduled to be in the clinic.

There will be shared professional development sessions each month which all nurses in the local area will be invited to participate in. Manukau Institute of Technology are a key partner in the pilot to increase student placements, give them exposure to Primary Health Care Nursing and Allied Health Practitioner roles and to increase their involvement in the community of Mangere.

Recruitment is underway for the Nurse Coordinator and Administrative support for the clinic. Key contacts until this time are Karyn Sangster092629584orPamWilliams092550618 if you wish to register your interest in using the clinic space.

Funding has been secured from Pacific Provider Workforce Development at the Ministry of Health to support training for two Pacific Nurses to become Nurse Practitioners. Dr Api Talemaitoga, Chief Pacific Adviser for the Ministry congratulated CMDHB on this initiative, particularly looking towards nurse-led developments within the new primary health environment.

Angeline Hekau will be working to become the first Pacific Nurse Practitioner in Primary and Community Mental Health and Mary Roberts in Primary Health. These candidates have the support of the Director for Nursing Denise Kivell and her team as well as the Managers in Mental Health and the Pacific Nurse Leader within Alliance Health Plus PHO.

Angeline who has completed her Masters in Health Science will work on gaining pharmaceutical papers towards prescribing and Mary will work on completing her Masters in Health Science that also includes pharmaceutical papers.

Elizabeth Powell said that this is a two year initiative and it was a very exciting for Pacific health and particularly the Pacific and nursing leadership within CMDHB.

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Changes in Primary Care in CMDHBIn 2009, the Government sought to speed up the 2001 Primary Health Care Strategy of Better Sooner More Convenient services and care.

Better Sooner More Convenient (BSMC) is aimed at a sustainable New Zealand health system. It has the following objectives:• Developamorepersonalisedprimarycare

system• Provideservicesclosertohome• MakeKiwishealthier• Reducepressureonhospitals

The government aims to achieve large and capable community organisations in primary care in order to achieve these goals. Better, Sooner, More Convenient provides opportunities for clinicians to establish a joined-up system that truly puts patients first.

In order to do this, change is required including:• Shiftingspendingfromoverheadstofront-line

services through PHO consolidation;• EstablishingIntegratedFamilyHealthCentresand

Whanau Ora Centres that consolidate primary health care services;

• Shifting services from hospital to primary health care;

• Developing,togetherwithprimaryhealthcare,anew environment for more flexible funding that supports joint leadership in decision-making.

Primary Care Alliances between PHOs and DHBs are currently being put in place in response to the Crown’s direction. The two most significant changes are development of Regional Alliances and PHOs that cross DHB boundaries.

Business Cases in AucklandThree of the nine national Business Cases are

based in the metropolitan Auckland region and all three cross DHB boundaries. In addition there are a number of cross-boundary PHO mergers occurring withinthese3Alliances.

CMDHB has therefore been working closely with ADHB and WDHB over the last 6 months to develop joint strategies and policies on key issues such as contracting, inter-district flows (IDFs) and responsibilities of the ‘Host’ DHB. The intention of the Host/Partner DHB concept is to minimise the administrative burden for both DHBs and PHOs in x-boundary situations and is in response to PHO requests for a single DHB contact person. The day to day relationship will primarily be with the Host DHB who will manage all the administrative functions associated with PHO and Alliance management. Strategic planning and its associated relationship

Merged PHO

Merge Date

Previous PHOs

Host DHB

Partner DHB(s)

Te Kupenga o Hoturoa (TKOH)

1/01/10•TeKupenga•Peoples Centre

n/a n/a

Te Hononga o Tamaki Me Hoturoa

1/10/10•TeKupenga•TamakiPHO

AucklandCounties Manukau

Alliance Health+

1/01/11•TaPasefika•AuckPac•Langimale

Counties Manukau

Auckland

ProCare Networks

1/01/11

•ProCare Network Manukau•ProCare Network North•ProCare Auckland

AucklandCounties ManukauWaitemata

Alliance Live Date Member PHOs Host

DHBPartner DHB(s)

Alliance Health+

1/10/10•TaPasefika •AuckPac•Langimale

Counties Manukau

Auckland

GAIHN 1/01/11

•ProCare•TotalHealthcare Otara•EastHealth•TeHononga•MangereCHT•AucklandPHO•HealthWest•HarbourHealth

AucklandCounties ManukauWaitemata

NMPHOC (Auckland region)

1/01/11•TeHononga•TePuna•NthWaikato

Counties Manukau

Waitemata Auckland

management and performance monitoring will be done jointly. The Host DHB function will not preclude individual DHBs from continuing to work and develop relationships with their PHOs on specific locality initiatives.

Primary Care Alliances, cross boundary PHOs, and new funding models have required review and modification of historical working arrangements. The revised contracting models, Alliances, and cross boundary PHOs, require DHBs to work together in a collective and collaborative way under a new regional contracting framework

The tables below outline the PHOs involved in either Business Case Alliances or PHO mergers (or both) in Auckland. They include the implementation or ‘go live’ dates and identify the Host and Partner DHBs.

Table 1 – PHO Mergers

Within Counties Manukau, PHOs have gone from 9 to 6 and further PHO consolidation is expected over the next 6-12 months. The following organisations have given up their individual PHO status via consolidations/mergers:

The Peoples’ Healthcare Trust, Te Kupenga and Tamaki PHOs have all been consolidated into a new PHO - Te Hononga o Tamaki Me Hoturoa, with a combined population of around 90,000. Te Hononga is currently a member of both The Greater Auckland Integrated Health Network (GAIHN) and the National Maori PHO Coalition (NMPC).

Ta Pasefika PHO will no longer exist after 1 January 2011 and will become part of a new PHO called Alliance Health+ (AH+) with a population of almost75,000.

ProCare Network Manukau PHO will no longer exist as at 1 January 2011 and will be amalgamated with the two other district ProCare PHOs to form ProCare Networks Limited PHO with a population of around 685,000. ProCare is a member of the GAIHN Business Case.

Table 2 – Business Case Alliances

1. Alliance Health Plus (AH+) AH+ is a consolidated entity made up of AuckPac

Health Trust Board, TaPasefika Health Trust and Tongan Health Society Inc. It crosses the boundaries of Auckland and Counties Manukau DHBs. On 1 October 2010, AH+, ADHB and CMDHB signed the first Alliance contract in theAucklandregion,althoughtherearestill3individualPHOagreementsbetweenthe3PHOsand 2 DHBs.

From 1 January 2011, the Host DHB (CMDHB) will contract directly with AH+ which will be fully functional as a single PHO entity with a merged registerofapproximately75,000enrolledpatients. Ta Pasefika will cease to exist.

2. Greater Auckland Integrated Health Network (GAIHN)

GAIHN is a network of three DHBs and 8 PHOs within the Greater Auckland area. The Network is responsible for the health needs of a population of approximately 1.26 million people. Counties Manukau PHOs involved in GAIHN are ProCare, Manukau, Total Healthcare Otara, East Health Trust, Te Hononga and Mangere Community Health Trust. The expected ‘go live’ date for the GAIHN Alliance is 1 January 2011.

3. National Maori PHO Coalition (Coalition)

The Coalition Business Case operates within the context of the wider Whanua Ora Kaupapa. It is a national Alliance involving 11 PHOs and 8DHBsincludingthe3AucklandbasedDHBs.Counties Manukau PHOs involved in the Coalition are Te Hononga o Tamaki Me Hoturoa and North Waikato PHOs. The expected ‘go live’ date for the Coalition is 1 January 2011.

Our charity: The South Auckland Health Foundation is a registered charitable trust that supports and raises funds for the health services of Counties Manukau District Health Board.

Collaboration Closes Gaps

VICTIMS of violence no longer have to travel to various agencies to ensure they receive comprehensive services to improve their rehabilitation.

Te Pou Herenga Waka is Counties Manukau’s latest a Multi Agency Facility (MAC) that combines the services of police, Child Youth and Family and Kidz First child protection service.

SKYCITY Auckland Community Trust chairman Jock Irvine opened the CMDHB Health Clinic in November – completing the services available at Te Pou Herenga Waka.

CMDHB project manager Frances Watkinson says the arrival of health care services at the MAC was possible thanks to the funding from SKYCITY Auckland Community Trust. The charity donated $100,000 to the project.

“We first discussed the idea more than 10 years ago but it didn’t happen,” says Frances. “Three years ago John Tims from Counties Manukau police came on board and became a driving force behind the project.”

The collaboration of different services means victims of violent crime and sexual assault can be cared for at one location. Previously women and children visited various facilities and often had to travel to central Auckland.

Returning to familiar faces and surroundings helps families engage in the health component of their care.

Sometimes an adult and child are both victims of the same perpetrator. Now the vicitms can be seen at the same facility without fear of crossing paths with the person they most fear.

CMDHB clinical nurse specialist Julie Carroll says the health component of the MAC was designed specifically for the needs of children and young people, and considered their cognitive and therapeutic needs.

Chairman of South Auckland Health Foundation John Maasland says SKYCITY Auckland Community Trust is a principle sponsor of the Foundation.

“The MAC is a unique project for South Auckland Health Foundation,” says John. “We recognised the need and drive for the MAC and thank SKYCITY for the financial support.”

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OPEN: People behind the development of the multi agency centre Te Pou Herenga Waka, from left, John Tims, Pam Tregonning, Jock Irvine, Frances Watkinson and Julie Carroll.

TECHNOLOGY: Nurse specialist Diane Murray demonstrates the colposcope to Jock Irvine.

Detective sergeant Sharon Price shows where children engage in play therapy.CHILD FRIENDLY: Rooms are designed to put children at ease.

He acknowledged the commitment Jock Irvine has made for many years and says he will be sadly missed.

Jock says the trust board often debates how funds should be spent but they always find it hard to turn down South Auckland health Foundation.

He says the trust frequently receives many applications from groups working in isolation for the same goal. However, SKYCITY was delighted to see the collaboration of a number of groups working towards the MAC.

Te Pou Herenga Waka means bringing together three waka.

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Ministry Appoints CMDHB Clinician to National Programme Health Minister Tony Ryall is concerned that the Diabetes Get Checked programme is not reaching enough of the people it is designed to be helping.

Mr Ryall says, “In the 2009/10 year, 55 per

cent of people diagnosed with diabetes had their free annual check. While this is a high, the Get Checked programme does not appear to be connecting well with the people for which it is intended.

“Better Diabetes and Cardiovascular Services is one of the Government’s six national Health Targets, and we want to see better diagnosis and management of diabetes.

“The Ministry of Health has appointed a National Clinical Director Diabetes, Dr Brandon Orr-Walker, who is Clinical Head of Endocrinology and Diabetes at Middlemore Hospital.

“One of Dr Orr-Walker’s first activities in the new role is to fix the seemingly poor uptake of services for people with diabetes.”

“The Government recognises that diabetes is a growing problem, and we want to make sure that the treatment and management programmes that we are paying for are delivering good results.”

A recent report by the Office of the Auditor General also had suggestions on how DHBs might think about improving their diabetes services.

Eclair Pharmacy Update

Regional Clinical Pathways Project - Nov 2010 Update

To Udate DHB StaffIn November 2010, the medication dispensed

to patients from community pharmacies will be available in the Éclair database.

The key benefit to DHB staff is to make it easier for clinicians to determine what medications a patient has been dispensed and the contact details of the prescriber and pharmacy they were dispensed from. This will allow you to focus on reconciling this information with what the patient is actually taking.

“Quick access to dispensing information using Eclair saves time and helps identify errors. In one case I had an elderly patient who was taking a number of drugs prescribed by specialists he had seen. His GP didn’t know about these medicines so they weren’t on the referral letter, but I noticed them when checking the pilot Éclair system.”

Pilot user, Paula Gazzard, Lead Pharmacist Medicines Reconciliation, Auckland City Hospital.

The best way to view the medication list will be by using the “By Service” tab, under then click “Pharmacy” in the Éclair database – viewable via the Concerto microscope.

Users of Eclair will be given reminders when the information becomes available in November. For more information visit http: intranet URL TBA – Deborah Ross Counties, Karen Mead Waitemata

New! Lists of dispensed medication from Community Pharmacies

The Regional Clinical Pathways project started in July and is one of the key ‘Better Sooner More Convenient’ workstreams. The purpose is to define and standardise best practice for common conditions across the Auckland region.

“A clinical pathway is a standardised, evidence-based multidisciplinary management plan, which identifies the appropriate sequence of clinical interventions, timeframes, milestones and expected outcomes for a homogenous patient group. Variance is defined as any deviation from the proposed standard of care listed within the Clinical Pathway.”(Dalton,Macintosh,Pearson2000,Queensland

Clinical Pathways Board 2002.)

The first six clinical pathways to be developed are;• Dyspepsia• IronDeficiencyAnaemia• DVT

• COPD• CommunityAcquiredPneumonia• TIA

Following completion of these pathways further condition groups that will have maximum impact on demand, overall population health, and health inequality will be selected. All will be developed as Integrated Pathways delivering the right care, at the right place, at the right time.

After consulting with GP’s and hospital clinicians we have been told that a big part of success in using pathways will be the ease of access and ‘usability’ of the pathways. In other words if they’re not at your finger tips when you need them they won’t be used.

As a result we are developing an electronic solution that will enable clinicians to access the pathway they need within two or three mouse clicks, from their desktop.

Each pathway development workgroup is composed of 8-10 primary and secondary care clinicians. The development process takes place over five meetings.

The development team will be presenting to the DHB’s, PHO’s and GP peer groups and cell groups as the project progresses.

If you have an interest in pathway development and would like to contribute please email the project manager, Kris Vette (vettek@middlemore.co.nz)

CONNECT | PAGE 9

Teeth Getting a New Focus in CMDHB

Otara health Inc. Kohanga Reo whanau oral health education

Auckland’s DHBs are replacing traditional school dental clinics with new, state-of-the-art facilities.

Modern, new facilities are just one aspect of good oral health, for all, for life. The government’s Oral Health strategy, with its focus on community-based services, also promotes better access; extended opening hours; greater involvement of parents in their children’s dental care; a strengthened oral health workforce; and improved service provision for preschoolers and adolescents.

The CMDHB Oral Health Business Case programme to reconfigure Oral Health services and rebuild the dental clinics is under way.Constructionofthefirst4newdentalclinics

is expected to commence in early 2011 and the building programme of the remaining clinics will continue until June 2012. The new Buckland Road Dental Clinic has been open almost 2 years with great success stories of parents preferring to take their children to the new clinic as it “looks and feels like a proper health clinic”

Child and Adolescent Dental Services offer a new model of care, with better reach, open all year, a prevention focus, and mobile services flexible to meet community needs.

Preschool and primary school children’s dental services will be delivered from:•CommunityhubclinicsatSchoolorDHBsites-3or4or6dentalchairclinics

•Satelliteclinicsof2dentalchairstoofferfullrange of dental services

• Mobiledentalservicestaketheservicesoutto the community

• TransportableDentalUnits(TDU),offerafullrange of dental services on smaller school sites for periods from 1 month to 6 months

• MobileDentalDiagnosticVans(MDV),driveon to school sites to perform diagnostic services including x-rays and a range of preventative treatments

• Childrencanstillbereferredtodentalclinicsin between mobile services visits. Parents can phone 0800 TALK TEETH (0800 825 583)togetnearestavailableappointmentsif they have a concern about their child’s or adolescent’s teeth. For more information go to www.letstalkteeth.co.nz

New Dental Clinics confirmed for Counties Manukau• 13dentalclinicshavebeenconfirmedat

schools to be rebuilt or refurbished• 2DHBsitesareinconsiderationforadental

clinic – Botany Downs, Manukau Super Clinic• 3areasarestilltoconfirmahubclinicsite,

Papakura central, new Ormiston Road area, central Papatoetoe.

Great progress achieved in Child and Adolescent Dental Services

This year we have had a full team of Dental Therapists due to a very successful CMDHB 2009-10 Voluntary Bonding Scheme to attract new Dental Therapist Graduates. The CMDHB Dental Therapist Voluntary Bonding Scheme is being repeated in 2010-11 to help fill new clinics being built.

Additional Dental staff has enabled great progress in reduction of arrears (children not see within30daysoftheirrecalldate),andincreasedtreatments at the same time as increased enrolment of preschool children

Preschool enrolments and examinations are increasing as a result of moving to a preventative model of care, and to support this we have a range of “brush-in” programmes, and have appointed a Preschool Oral Health Coordinator to work with preschool centres, Kohanga reo, Language nests, to manage the dental visits for enrolments and on-site initial examinations.

We have increased coverage of “Lift the Lip” training of Well-Child Providers, GP practice nurses, community health workers; with further training planned to include staff at preschool centres and Marae and Church health committees, and this will assist in the enrolment of children, increased detection of dental decay and referrals to the dental services.

The profile and presence of the dental service at community health events has increased our preschool enrolments and distributed toothbrushes and toothpaste to children in highest need and risk for dental decay. A major role to improve Oral Health outcomes for Counties Manukau children has been the Sky City Auckland Community Trust funding support. We couldn’t have attracted the attention of children and their families at the many events, at schools, and at preschool centres without the resources kindly funded.

We have achieved increased utilisation of the free adolescent dental services for the last year at 62% of adolescents utilising dental services inCMDHBvstargetof57%.Howeverourgoalis 85% of all adolescents in Counties Manukau to participate in free dental services. To support this an Adolescent Oral Health Promoter has been appointed to connect with the community agencies and improve registration of hard-to-reach adolescents for free dental services.

Counties Manukau Mental Health and Addiction Providers (CHAMP) is a partnership group representing NGOs and clinical provider services in the mental health and addictions sector working across the Counties Manukau region.

This group has allowed for collaborative solutions to share and resolve issues since its inception in2003.Thestructureisbasedonanon-legaland non-binding agreement to cooperate with all members to promote the coordinated, effective, efficient delivery of services to meet the needs of service users.

The Counties Manukau District Health Board has a reputation for the development and implementation of innovative ideas within the Mental health and addictions sector. In order to encourage and

support this community of innovation CHAMP has recently sponsored the second “Innovations and Excellence Awards”. The calibre of entrants this year was very high, reflecting the quality of the work occurring across the mental health and addictions sector. Thank you to all involved. For the complete list of award winners and to find out more about the CHAMP collaborative please visit our website www.champ.org.nz

CHAMP Counties Manukau Mental HealtH and addiCtion PaRtneRsHiP

CONNECT | PAGE 10

World Spirometry Day

Spirometry is the most common of the Pulmonary Function Tests, specifically measuring the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important assessment tool and is helpful in assessing conditions such as COPD, asthma, bronchiectasis, pulmonary fibrosis, and cystic fibrosis.

World Spirometry Day at Middlemore was very successful with many people from the respiratory and physiotherapy department helping out on the spirometrystand.Wehadatotalof140peoplecomeand have their lung function tested, including staff, patients, visitors and onsite contractors.

It was a good opportunity for increasing awareness on lung health. We had great success in raising smoking cessation awareness and perhaps being the catalyst for change for some current smokers with sub-optimal spirometry results. Information packs were offered regarding COPD, smoking cessation,

optimisinglunghealthandspirometry.Quitcardsand nicotine replacement therapy samples were also prescribed to people who were ready to give up smoking with some additional help.

The European Respiratory Society (ERS) and the European Lung Foundation (ELF) coordinated the worldwide organisation of the event. Worldwide therewereatotalof89,768testsperformedfrom355differentevents.Formoreinformationonother events that took place you can look online at www.2010yearofthelung.org

In October this year the first international Spirometry Day was celebrated. Counties Manukau participated with an event at Middlemore Hospital in the main foyer of the AMC.

The Manukau Teaching Garden ProjectManukau Parks’ work on the The Manukau Teaching Garden Project won it the New Zealand Recreation Association’s (NZRA) 2010 Outstanding Project Award at last month’s NZRA annual awards ceremony.

The project is a community collaboration among a wide range of people and organisations including Manukau Parks, City Parks Services, mentors, caretakers and volunteers. It uses gardening as an opportunity to address physical activity and nutrition goals through providing families with secure access to affordable food; and at the same time it supports the Counties Manukau District Health Board’s Let’s BeatDiabetes–Gardening4HealthInitiative.

NZRA Chief Executive Steve Gibling said the judges especially liked the leisure education approach of the project and the innovation used, including looking at redundant sportsfields for future gardens.

“Give a man a plant and he’ll feed himself, teach a man to garden and he’ll feed the community. This project is a great example of people helping people,” Gibling said.

He added that the judging panel was very impressed as well with the unprecedented scale of this new form of recreation with 2ha of garden areaproposed,400plotsavailableand800 students annually.

The NZRA Outstanding Awards were presented during NZRA’s annual conference awards dinner, which was held at Wellington’s Te Papa National Museum. Recreation professionals from all around the country attended the conference, entitled “Connect…the dots”, which focussed on connecting policy and practice, politics and programmes, as well as different sectors within the community.

“Recreation is essential to our physical and mental health,” says Gibling. “We are lucky in New Zealand that we have access

to fantastic outdoor parks and reserves, we have modern recreation facilities and a dedicated group of professionals who strive to deliver appealing, safe, appropriate and enjoyable recreational services.

“The awards are about thanking those people, and recognising those among them who raise the bar, develop innovative solutions and inspire New Zealanders to get active and healthy,” he says.

CONNECT | PAGE 11

Creating a Better Future

These are some of the findings in two recently-released surveys from the Counties Manukau District Health Board’s Creating a Better Future strategy. The surveys – the “Let’s Beat Diabetes Tracking Survey” and the “Living with Diabetes in Counties Manukau Survey” – give us important information about the health of the Counties Manukau population, particularly in relation to healthy eating, physical activity, body weight, quality of life and experiences of diabetes.

For example, the surveys tell us that:• 6outof10adultsinCountiesManukaureport

eating fast food or takeaways in the last week, many eating takeaways twice during that period

• LessthanhalfofadultsinCountiesManukaudo the recommended amount of physical activity on a regular basis (for adults, this is at least30minutesmostdays)

• 6outof10peopleareatriskofdevelopingdiabetes because they are obese or

overweight (according to weight and height measurementsprovided),dolessthan30minutes of physical activity each week, have a family history of diabetes or had diabetes during pregnancy

• Only1in3adultswithdiabetesinCountiesManukau have been to an education or training course about managing their condition

• 3outof10peoplewithdiabeteshavestayedovernight in hospital in the past year and two-thirds of them thought the hospital staff were very helpful with their diabetesTheTrackingSurveyinvolvedalmost2400

participants and was considered alongside an earlierBenchmarkSurvey(undertakenin2007)todetermine whether people’s knowledge, attitudes and behaviours about their health had changed over time.

Approximately 1200 people with diabetes participated in the Living with Diabetes Survey, which has helped the CMDHB better understand

their knowledge, attitudes and behaviours about their diabetes, and also their experiences when accessing health services. This is important information to gather because of the size of the probleminCountiesManukau-over31,000people are thought to have diabetes.

The results of both surveys are being used in the development and delivery of health services in Counties Manukau, particularly the Creating a Better Future strategy. This strategy, which has evolved from Let’s Beat Diabetes, is focused on reducing the rates of diabetes, heart and lung disease, and many cancers in our community, and on improving the care of those people living with these conditions.

If you would like to access full versions of the surveys (which include results for Maaori, Pacific, Asian and other ethnic groups), please visit the Creating a Better Future website - www.betterfuture.co.nz – and click on ‘About Us’ and ‘Creating a Better Future Resources’.

Are you among the 63% of adults in Counties Manukau interested in eating more healthily? Or the 66% of adults interested in being more physically active?

New Workforce Development Award for Science Fest 2011Did you realise that CMDHB’s annual Science Fest awards are just around the corner (14 April 2011)? This year there, for the first time, there will be a separate category for workforce development projects. Applications are being invited from both within the DHB as well as from primary care and community providers. Prize money is $2000 for the oral section and $1000 for the poster section.

In line with the aim of celebrating workforce innovation there will also be an update to the Counties Manukau DHB Organisational Workforce Initiatives report coinciding with Science Fest. The current report can be found at http://www.cmdhb.org.nz/About_CMDHB/Planning/Planning-documents.htm#WorkforceDocs

So that’s double the incentive to promote your projects if you’re involved in this type of work. Watch the CMDHB website for details on how to enter Science Fest, and contact Elizabeth Ryan, Workforce Consultant(Elizabeth.ryan@middlemore.co.nzor2760044ext6079)ifyou would like to know more information about the workforce awards at Science Fest and the report.

CONNECT | PAGE 12

We are prioritising families and older adults who meet the housing, health and income criteria. We need your help to identify families and older adults with poor health outcomes due to living in cold, damp, mouldy un-insulated homes.

Eligibility CriteriaTo be eligible for these programmes applicants must:• liveintheCountiesManukau,Papakura,orFranklinarea;• resideinaprivatehomebuiltpriorto1stJanuary2000(i.e.NOTHousing

New Zealand);

• thehomeownerortenantMUSThaveaCommunityServicesCard;• Weareprioritisinghouseholdsthathavechildren(under14yearsofage)or

older adults (aged over 65) with housing related health conditions such as respiratory disease (we recommend that a letter of support is obtained from a health professional to assist with the application).

Income eligibility for Community Services Card

Free Home Insulation Programmes forEligible Families

SNUG HOMES Counties Manukau & Warm Up-Counties Manukau

Snug Homes & Warm Up – Counties Manukau urgently needs referrals. We are still requiring 1800 more referrals from families who reside within the Counties Manukau, Papakura or Franklin areas.

HOUSEHOLD COMPOSITION YEARLY INCOME (BEFORE TAX) IS

Single-living with others $23,576.00orless

Single-living alone $24,995.00orless

Married, civil union or de facto couple- no children $37,336.00orless

Family of 2 $45,078.00orless

Familyof3 $54,589.00orless

Familyof4 $62,154.00orless

Family of 5 $69,563.00orless

Family of 6 $77,843.00orless

Forfamilieswithmorethan6,thelimitgoesupanother$7,295.00foreachextraperson.

Opportunities like this don’t come along very often - Start referring suitable families now!! This could be the gift you give families that keeps on giving for years to come.ForanyotherenquiriesorapplicationformspleasecontactKerryBruce092629583oremailkerry.bruce@middlemore.co.nzatthe Counties Manukau District Health Board

We are especially interested in contributions from our community partners.If you have a story you would like to contribute for Connect please email it to the Editor at: lauren.young@middlemore.co.nz

Rates as at 1st April 2010