board meeting - north shore hospital...the following aut university post graduate clinical...

BOARD MEETING

Wednesday 30 May 2018

9.45am

AGENDA

Items to be considered in public meeting

VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna

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Karakia

E te Kaihanga e te Wahingaro

E mihi ana mo te ha o to koutou oranga

Kia kotahi ai o matou whakaaro i roto i te tu waatea.

Kia U ai matou ki te pono me te tika

I runga i to ingoa tapu

Kia haumie kia huie Taiki eee.

Creator and Spirit of Life

To the ancient realms of the Creator

Thank you for the life we each breathe to help us be of one mind

As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware

Of the need to be fair and transparent in all we do.

We ask this in the name of Creation and the Living Earth.

Well Being to All.

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Waitemata District Health Board, Meeting of the Board 30/05/18

MEETING OF THE BOARD

30 May 2018

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Tce, Takapuna Time: 9.45am

WDHB BOARD MEMBERS Kylie Clegg – Chair Max Abbott - WDHB Board Member Edward Benson-Cooper – WDHB Board Member Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Dr Matire Harwood - WDHB Board Member Brian Neeson – WDHB Board Member Morris Pita - WDHB Board Member Allison Roe - WDHB Board Member

WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant – Deputy Chief Executive and Chief Medical Officer Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Cath Cronin – Director of Hospital Services Tamzin Brott – Director of Allied Health Fiona McCarthy – Director Human Resources Peta Molloy - Board Secretary

APOLOGIES:

REGISTER OF INTERESTS

Does any member have an interest they have not previously disclosed?

Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

PART 1 – Items to be considered in public meeting

AGENDA

1. AGENDA ORDER AND TIMING

2. BOARD MINUTES

9.45am 2.1 Confirmation of Minutes of the Meeting of the Board (18/04/18)

Actions arising from previous meetings

2.2 Circulated Resolution (26/04/18) – Approval of the Draft 2018/19 Statement of Performance Expectations

3. EXECUTIVE REPORTS

9.50am 10.00am 10.10am

3.1 Chief Executive Officer’s Report 3.2 Health and Safety Report 3.3 Communications Report

4. DECISION ITEM

10.15am

10.25am

10.35am

10.55am

4.1 Integrating Governance, Leadership and Planning Arrangements for Maori Health

4.2 2018/19 Annual Plan Approach

4.3 Amendment to Official Information Act Policy - Charging

4.4 Appointment of Catherine Abel-Pattinson to healthAlliance NZ Limited Board

5. PERFORMANCE REPORT

11.00am 5.1 Financial Performance

6. COMMITTEE REPORTS

11.10am 6.1 Minutes from the Hospital Advisory Committee Meeting (28/03/18)

6.2 Minutes from the Community and Public Health Advisory Committees (04/04/18)

7. INFORMATION PAPERS

11.15am 11.20am

7.1 Health and Safety Marker Report

7.2 Briefing on Waitemata DHB Activity in the Minister of Health’s priority areas

11.25am 8. GENERAL BUSINESS

11.30am 9. RESOLUTION TO EXCLUDE THE PUBLIC

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Waitemata District Health Board

Board Member Attendance Schedule 2018

Apologies given *Attended part of the meeting only # Absent on Board business ^ Leave of Absence

NAME Mar Apr May Jul Aug Oct Nov Dec

Kylie Clegg (Chair)

Max Abbott

Edward Benson-Cooper

Sandra Coney

Warren Flaunty

James Le Fevre

Matire Harwood

Brian Neeson

Morris Pita

Allison Roe

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REGISTER OF INTERESTS


Board/Committee Member

Involvements with other organisations

Last Updated

Kylie Clegg (Chair) Trustee - Well Foundation Director – Auckland Transport Director – Sport New Zealand Trustee and Beneficiary - Mickyla Trust Trustee and Beneficiary - M&K Investments Trust (includes a share of less than 1% in Orion Health Group)

29/04/18

Max Abbott Pro Vice-Chancellor (North Shore) and Dean - Faculty of Health and Environmental Sciences, Auckland University of Technology Patron - Raeburn House Advisor - Health Workforce New Zealand Board Member - AUT Millennium Ownership Trust Chair - Social Services Online Trust Board member - Rotary National Science and Technology Forum Trust

19/03/14

Edward Benson-Cooper Chiropractor - Milford, Auckland (with private practice commitments) 07/12/16

Sandra Coney Member - Waitakere Ranges Local Board, Auckland Council Patron - Women’s Health Action Trust Member - Portage Licensing Trust Member - West Auckland Trusts Services

15/12/16

Warren Flaunty Member - Henderson–Massey Local Board Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder - Green Cross Health Director - Life Pharmacy Northwest Director - Westgate Pharmacy Ltd Chair - Three Harbours Health Foundation Director - Trusts Community Foundation Ltd

06/12/16

Dr Matire Harwood Senior Lecturer - Auckland University Director - Ngarongoa Limited, which is contractor providing services to National Hauora Coalition GP at Papakura Marae Health Clinic Advisory Committee Member - State Foundation NZ (Maori Health) Member Te Ora, Maori Medical Practitioners Step-daughter is a surgical registrar at Waitemata DHB

10/05/18

James Le Fevre Board Member - Auckland District Health Board Emergency Physician - Auckland Adults Emergency Department Pre-hospital Physician - Auckland HEMS – ARHT/Auckland DHB Trustee - Three Harbours Foundation Member - Medical Protection Society Member - ACEM Hospital Overcrowding Subcommittee Member - Northern Region Clinical Practice Committee Shareholder - Pacific Edge Ltd DHB Representative (Auckland and Waitemata DHBs) - Air Ambulance Co-design Procurement Governance Board James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society

28/03/18

Brian Neeson Member – Upper Harbour Local Board Member – Human Rights Review Tribunal Member – Auckland District Licensing Committee Managing Director – BK & VS Neeson Limited Managing Director – Apollo Property Investments Limited Property Development Consultant Brian’s son-in-law is employed by the Housing Corporation and is undertaking work for Unitec related to its Mt Albert site development.

18/04/18

Morris Pita Owner/operator – Shea Pita and Associates Limited Shareholder – Turuki Pharmacy Limited Member - Eden Park Trust Board Shareholder and Director of Healthcare Applications Limited Morris’ wife is member of the Northland District Health Board and the Auckland District Health Board

08/12/16

Allison Roe Chairperson - Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council

02/11/16

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2.1 Confirmation of Minutes of the Board meeting held on 18 April 2018 Recommendation:

That the Minutes of the Board meeting held on 18 April 2018 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Wednesday, 18 April 2018

held at Boardroom, Level 1, 15 Shea Tce, Takapuna, commencing at 9.49am

PART I – Items considered in public meeting

BOARD MEMBERS PRESENT:

Kylie Clegg (Board chair) Max Abbott Edward Benson Cooper Sandra Coney Warren Flaunty Dr Matire Harwood Brian Neeson Morris Pita Allison Roe

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) Andrew Brant (Deputy Chief Executive Officer and Chief Medical Officer) (from 10.06am, item 3.1) Robert Paine (Chief Financial Officer and Head of Corporate Services) Debbie Holdsworth (Director, Funding) Jocelyn Peach (Director of Nursing and Midwifery, Emergency Systems Planner) Cath Cronin (Director Hospital Services) Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Fiona McCarthy (Director Human Resources) Karen Bartholomew (Acting Director Health Outcomes) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

The following AUT University Post Graduate Clinical Governance Quality Students were in attendance, along with AUT Senior Lecturer, Paramedicine Dr Karen Webster: Tammy Jowsey, Victoria Christian, Shailar Chhaya, Prabavakey Jagadeesh and Jean Classey. Also in attendance was Akesa Halatanu, Ministry of Health Tonga. There were no media representatives present.

WELCOME

The Board Chair welcomed the Board members and all those present at the meeting.

APOLOGIES:

An apology was received and accepted from James Le Fevre.

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DISCLOSURE OF INTERESTS

Matire Harwood advised that her step-daughter was now a surgical registrar at Waitemata DHB. There were no declarations of interest relating to the open section of the agenda.

1 AGENDA ORDER AND TIMING Items were taken in same order as listed in the agenda.

2 BOARD MINUTES

2.1 Confirmation of Minutes of the Meeting of the Board (07/03/18) (agenda pages 6-18)

Resolution (Moved Brian Neeson/Seconded Allison Roe)

That the Minutes of the Board meeting held on 07 March 2018 be approved.

Carried Actions arising from previous meetings (agenda pages 19)

The action arising was noted.

3 EXECUTIVE REPORTS

3.1 Chief Executive’s Report (agenda pages 20 - 38)

During the discussion of this item, Warren Flaunty noted his registered interest as a Trustee (Vice President) of the Waitakere Licensing Trust and the potential conflict with the update on the fundraising by the Well Foundation.

Dale Bramley summarised this report. Matters covered in discussion or response to questions included:

Noting the visit from the new Minister of Health, Hon Dr David Clark to the North Shore Hospital site in March 2018.

Noting that for the past six years a refurbishment of the North Shore Hospital tower block (built in 1984) has been undertaken, with Wards 6 and 7 completed over the Christmas period.

Acknowledging the excellent fundraising of the Well Foundation who raised $100,000 through the Trusts’ Million Dollar Mission programme. Fundraising will go towards assisting the DHB to fund a transport incubator for the Specialist Care Baby Unit.

Noting that the funding envelope from the Ministry of Health is still awaited.

That while health targets are no longer being published in national papers, they are still in effect. The DHB will continue work towards achieving the targets as a national priority.

Noting the recent media attention towards DHB facilities nationwide. The Waitemata DHB has a number of significant capital cases in process.

Acknowledging the work of Dr Min Yee Seow and the results from the new orthogeriatric model of care as reported (page 29). It is intended to have the results of

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this work published. A presentation to the Board was requested once the data was compiled.

Noting that Riki Nia Nia (General Manager, Maori Health) will lead the coordination of recruiting up approximately 1,700 Maori into health study and then into the health sector workforce via the Hauora National Coordination Centre.

Maori immunisation will be a focus over the next three months with a number of initiatives in place to increase rates. It was noted that this is not a health target, but a focus for the DHB to provide protection to young children from disease.

Noting that pay rates by ethnicity can be provided and reported back to the Board.

That a Maori Cultural intelligence Application (App) is being developed and will be made available to Board members.

The report was received. 3.2 Health and Safety Performance Report (agenda pages 39-59)

Fiona McCarthy (Director of Human Resources), Michael Field (General Manager, Occupational Health and Safety), Nigel Ellis (General Manager, Facilities) and Andrew Brant (Chief Medical Officer and Deputy Chief Executive) were present for this time. Fiona McCarthy introduced the item noting the revised and updated reporting to the Board around health and safety, which includes new sections such as key highlights and a facilities update. The Board were invited to provide feedback on the proposed interim Board Health and Safety charter. Matters covered in discussion and response to questions included:

There is a 60% target for flu vaccinations. Waitemata DHB has introduced a new campaign model to achieve higher flu vaccination rates that is based on Counties Manukau DHB’s successful campaign that has resulted in a high achievement rate. The number of vaccinators at Waitemata DHB has increased from 50 to 100 across its hospitals and community service areas, including roving vaccinators on the wards.

In response to a question, it was noted that aged care facilities manage their own flu vaccination programmes.

In response to a question about the ‘work related injury claim data’ reported, Michael Field noted that the DHB self-manages injury claims (this is standard for many large organisations). The DHB has a return to work rate that is four times faster than ACC and is also personally invested in caring for its staff. The DHB is also able to determine if alternative options are available to assist someone with an injury to undertake light duties if appropriate. The DHB saves upwards of $3million annually in reduced levies through self-managing injury claims; ACC are not involved at all. It was noted, however, that staff pay an ACC levy to cover for injuries off site.

The Board Chair noted that Auckland Transport has undertaken work around aggression, being physical and verbal assaults for parking officers. She advised that a contact could be provided for the DHB to liaise with Auckland Transport on this work.

Noting the top three incident types report and how they are being dealt with. Fiona McCarthy advised that there would be a further update to the Board at its next meeting on this matter.

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In addition to the report presented, an update was provided on the recent storm in Auckland and the following was noted:

There was no damage to the DHB facilities and there was no loss of essential power services to each main campus. For critical systems, backup generators are in place to provide essential services power.

Jocelyn Peach (Director of Nursing and Midwifery and Emergency Systems Planner) advised that an Incident Management Team was established with many volunteer groups also out door knocking. Welfare checks have been undertaken as needed. Small generators are offered to those that may need them for electric beds, chairs and the like, however, they do not power an entire house. Not all those on the priority list had power restored quickly.

Residential aged care facilities have their own management systems in place.

There is no central database of vulnerable people, the DHB coordinates this through an event such as the recent storm and will be in contact with leads in key departments who have people registered. The list is very long and inclusive of those who are medically dependent on oxygen, home care for children, electric mattresses or other disabilities. In addition the DHB will contact those in primary care asking they do the same for their patient lists.

It was noted that people now often rely on social media in emergency situations for the exchange of information and updates. Many of these groups are ‘closed.’ It was suggested that the Communications team should be connected with as many of the social media community groups as possible to provide updates to the public if required.

The Board Chair thanked Jocelyn Peach for the work she has undertaken following the storm. The Board requested that recommendation b) be amended to note that approval is ‘subject to comments from Board members.’ Resolution (Moved Sandra Coney /Seconded Max Abbott)

That the Board:

a) Receives the report. b) Subject to comments from Board members, approves the interim updated

Board charter (attached at Appendix 2 of the report). c) Notes that a Board workshop will be convened in 2018/19 to consider an in-

depth revision of the charter document.

Carried

3.3 Communications Report (agenda pages 60-69)

Matthew Rogers (Director of Communications) summarised this item. Matters covered in discussion and response to questions included:

Noting that a national framework for proactive disclosure of information is being established with an agreed set of guidelines that will apply. Each DHB nationwide will proactively publish responses to Official Information Act (OIA) requests on their websites. Still to be agreed is the lag time between providing the OIA response and publishing the information. It is the intention of the three metro-Auckland DHBs to apply the same timeframe between release of the OIA response and publishing. The date of implementation for disclosure nationwide is 1 July 2018.

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Noting a new process has been set in place for release of the DHB’s videos on social media.

The report was received.

4 PERFORMANCE REPORTS

4.1 Financial Performance (agenda pages 70-79)

Robert Paine (Chief Financial Officer and Head of Corporate Services) summarised this item. Morris Pita acknowledged the work of the Provider and the positive performance shown. The Board Chair also acknowledged and was appreciative of the focus on financial performance. The report was noted.

5 COMMITTEE REPORTS

5.1 Minutes from the Hospital Advisory Committee (14/02/18) (agenda page 80-87)

The minutes of the Hospital Advisory Committee were noted.

6. INFORMATION PAPERS

6.1 Health and Safety Marker Report - Update (agenda pages 88 - 107)

Fiona McCarthy (Director of Human Resources) summarised this item. She noted in particular work undertaken with healthAlliance about accessing sites and sign-off for completed projects; combined forms and processes will be developed for this work and shared across the region. In response to a question about the reported summary of compliance with the Health and Safety Work Act, Fiona advised that the progress of many of those categorised as ‘low’ will soon be classified as ‘good’. The Board Chair noted the work undertaken around inductions. A link will be provided to Board members for the DHB’s online induction programme. The report was received.

6.2 System Level Measures Quarterly Report (agenda page 108 - 137)

Apologies were received from Karen Bartholomew (Acting Director Health Outcomes – Auckland and Waitemata DHBs). Debbie Holdsworth (Director Funding) summarised the report. Matters covered in discussion and response to questions included:

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Morris Pita referred to the update provided on skin infections (page 114 of the agenda) and noted the normalisation of hakihaki (skin disease) there are, however, complications associated with this condition that should be addressed.

It was also noted that there is research underway around linking school sores to rheumatic heart disease, demonstrating that the infection may be more serious than originally thought.

The report was noted.

6.3 Statement of Performance Expectations Performance Report – 2017/18 Quarter 2 (agenda page 138 - 145)

Debbie Holdsworth (Director, Funding) noted the report provided a view as to how measures in the Annual Plan were tracking.


6.4 Discontinuation of the Health-Led Better Public Services Programme (verbal update)

Debbie Holdsworth (Director Funding) provided a verbal update on this matter, advising that two targets set ‘healthy mums and babies’ and ‘keeping kids healthy’ have now been disestablished. It was noted that both areas align well with a number of the DHB’s programmes and will continue to be reported on in those work programme. The report was noted.

7 GENERAL BUSINESS

Northern Region Health Plan 2017/18

A copy of the signed Northern Region Health Plan 2017/18 was tabled and will be made available to the Board members on Diligent Boardbooks. It was noted that the preliminary plan was submitted to the Board in April 2017 where the board received and endorsed it subject to minor amendments. The Board noted the signed Plan and acknowledged that it would be made publically available on the Waitemata DHB website.

8 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 146-148) Resolution (Moved Sandra Coney/Seconded Matire Harwood)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Minutes of Meeting of the Board - Public

That the public conduct of the whole or the relevant part of the

Confirmation of Minutes

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Excluded (07/03/18)

proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.

[NZPH&D Act 2000 Schedule 3, S.32 (a)]

As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Minutes from the Audit and Finance Committee – Public Excluded (14/02/18)

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)]

Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

3. Recommendations from the Audit and Finance Committee – Public Excluded (28/03/18)






4. Minutes from the Hospital Advisory

That the public conduct of the whole or the relevant part of the


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Committee with public excluded (14/03/18)

proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.



5. Facilities Update That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.



6. Software – Request for RFP




7. Deed Renewal and Rent Review



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or

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disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)]

8. Facilities update



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:

i) would disclose a trade secret; or ii) would be likely to unreasonably

prejudice the commercial position of any person who supplied, or who is the subject of, such information.

[Official Information Act 1982 S.9 (2) (b)]

GENERAL BUSINESS There were no items of general business. The open meeting concluded at 11.15am. SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 18 APRIL 2018 CHAIR

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Actions Arising and Carried Forward from Previous Board Meetings as at 24 May 2018

Meeting Date

Agenda Ref

Topic Person Responsible

Expected Report back

Comment

07/03/18 7.4 Values Programme Update

The Board requested a quarterly or six-monthly update on the progress of the Values Programme.

Jarrard O’Brien Noted for six-monthly reporting, commencing August 2018.

18/04/18 3.1 Maori Cultural Intelligence Application (App)

To be made available to Board members once developed.

Naida Glavish/ Riki Nia Nia

Noted for action on release.

18/04/18 3.2 Health and Safety Update

Provide information on the top three incident types that cause harm

Fiona McCarthy

Actioned – see item 3.2 of this agenda.

18/04/18 6.1 Online induction programme

Provide board members with access to the DHB’s online induction programme.

Fiona McCarthy

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2.2 Approval of the Draft 2018/19 Statement of Performance Expectations

Resolution passed: That the Board: a) Notes that the Waitemata DHB has not yet received funding or planning advice for the 2018/19

year, resulting in a delay to development of its Annual Plan including the Statement of Performance Expectations.

b) Notes the legislative requirement under the Crown Entities Act to submit a draft Statement of

Performance Expectations to the Minister of Health for review no later than two months before the start of the financial year to which they apply.

c) Notes that the Manager Planning and Health Intelligence (Waitemata DHB) has advised the

Ministry of Health under separate cover that the DHB is not submitting financial or Annual Plan information at this time.

d) Approves submission to the Ministry of Health of the Draft Waitemata DHB 2018/19 Statement

of Performance Expectations (with caveats around the need to update information once advice is received from the Ministry of Health) to meet legislative requirements under the Crown Entities Act.

Prepared by: Peta Molloy (Board Secretary)

The Board was requested (on 26th April 2018) to consider and approve by urgent circular resolution submission of the Waitemata DHB draft 2018/19 Statement of Performance Expectations to the Minister of Health by 30th April 2018 to meet legislative requirements. There were no scheduled meetings of the Board to urgently receive this item and the matter was considered and unanimously supported via circular resolution. The resolution is being submitted to the Board for endorsement.

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3.1 Chief Executive’s Report Recommendation:

That the Chief Executive’s Report be received. Prepared by: Dr Dale Bramley (Chief Executive Officer)

1. News and events summary

A number of events of significance took place across the DHB over the past six weeks

It was a great honour for our DHB to host an official visit by the Prime Minister, Rt Hon Jacinda Ardern, and the Minister of Health, Hon Dr David Clark, to North Shore Hospital on Friday 18 May. Our special guests received a very warm Waitemata welcome, beginning with a cultural ceremony featuring our Maori and Pacific teams in a packed Whenua Pupuke auditorium. A special highlight was a powerful kapa haka performance by our neighbours at Rosmini College Catholic boys’ school, whom we were delighted to include as a demonstration of the DHB’s tight links with our community. The Prime Minister and Minister also met a group of our highly valued, long-serving volunteers in Whenua Pupuke’s Waitemata Room – several of whom have selflessly given their time to our community for many years. Our guests also met recent Health Hero Award winners from the ranks of our staff and then took the opportunity to visit the Lakeview Cardiology Ward to meet some patients and have a demonstration of how e-health initiatives such as eVitals and ePrescribing are supporting our staff to deliver the very best care. We look forward to hosting further official visits across our sites that will allow us to showcase the excellent work our teams perform every day.

Prime Minister Jacinda Ardern meets patient Ann Hein, of Te Atatu South, on Lakeview Cardiology ward.

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The Prime Minister and Minister of Health David Clark meet some of Waitemata DHB’s recent Health Hero Award winners, with Chief Executive Officer Dr Dale Bramley (bottom left).

On 29 April, Minister Clark announced the appointment of the incoming Waitemata DHB Chair, Judy McGregor. I have contacted Judy to congratulate her on her appointment and to make arrangements for her transition into the Chair role. Judy has indicated that she is very much looking forward to working with the Board and our wider workforce from the start of her term on 10 June. Judy has led a distinguished academic career and is currently head of the School of Social Sciences and Public Policy and Associate Dean Postgraduate in the Faculty of Culture and Society at Auckland University of Technology. She is also Patron of the Auckland Women’s Centre and a former Human Rights Commissioner. We will host an official welcoming event and create opportunities for Judy to quickly meet our most precious asset, our people. The appointment follows the completion of Dr Lester Levy’s term as Chair in late January. Deputy Chair Kylie Clegg has been our interim Chair since that time. Kylie’s leadership has been greatly appreciated over recent months and we thank her for her ongoing work and commitment.

Our annual Health Excellence Awards were held on 10 May and I would like to extend my congratulations to all those whose entries were successful, as well as those who put their projects forward for judging. The standard of entries was very high once again and the winners can be satisfied that their projects were judged against worthy competition. The overall winner of the oral presentation category was Georgina McPherson (on behalf of Waitakere and ESC colposcopy clinics) for her presentation 'Improving laboratory testing utilisation in colposcopy clinics'. Georgina also won the Excellence in Leadership Award and is this year's recipient of the Margaret Gadsdon Memorial Endowment.

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Georgina McPherson with Chief Medical Officer and Deputy Chief Executive Officer Dr Andrew Brant

The other prize winners at the Health Excellence Awards were:

- Overall Winner Poster Presentation: Innovative patient-centred approach to prevent surgical site infection in orthopaedic arthroplasty surgery Submitted by Mr Simon Young, Dr Hasan Bhally, Dr Nick Gow, Jeanette Crighton, Nicola Davies, Graham Upton and Alynne Ledesma (On behalf of Orthopaedics, Infectious Diseases, Pharmacy, Infection Prevention and Control, Ward 9, Ward 7 and ESC)

- Excellence in Clinical Care (Poster): The 3G Programme: Get up, Get dressed, Get moving Submitted by Elaine Docherty, Sharon Russell and Renee Kong (On behalf of Medicine and Health of Older People Services)

- Excellence in Clinical Care (Oral): Click, wait… Click, wait… Reducing clinician frustration with fast access to an integrated patient summary by David Ryan (On behalf of Health Information Group)

- Excellence in Integrated Care (Poster): Improving Patient Safety in General Practice Submitted by Dr Neil Houston, Angela Lambie, Dr Lisa Eskildsen, Tim Denison, Dr Eleri Clissold and Kelly Fraher (On behalf of Planning, Funding and Outcomes, i3 and Auckland DHB)

- Excellence in Integrated Care (Oral): E-clinics. A hidden gem behind your doctor’s referral by Dr Peter van de Weijer (On behalf of Obstetrics and Gynaecology Services)

- Excellence in Patient Experience (Poster): Growing Stronger Together ─ Improving Children’s Journey Submitted by Grace Ryu, Dr Ailke Botha, Hannah Lee, Eliene Zhu and William Shong (On

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behalf of Maternal Mental Health, Asian Mental Health, Asian Patient Support Team and University of Auckland)

- Excellence in Patient Experience (Oral): TextMATCH: Text Messaging for MATernal and Child Health by Dr Robyn Whittaker (On behalf of NIHI, University of Auckland, Healthy Babies Healthy Future, Waitemata DHB and Auckland DHB Māori Health and Pacific Health, The Fono, HealthWEST, The Asian Network Incorporated (TANI), Chinese New Settlers Services Trust)

- Excellence in Leadership: Improving laboratory testing utilisation in colposcopy clinics by Georgina McPherson (On behalf of Waitakere and ESC Colposcopy Clinics)

- Excellence in Leadership (Highly Commended): The sooner the better: The impact of acute day medicines reconciliation by an ADU pharmacist by Dean Croft (On behalf of Pharmacy, ADU and General Medicine)

- Excellence in Research and Innovation: Can a novel technology overcome barriers to cervical screening for Māori, Pacific and Asian women? by Dr Karen Bartholomew and Aroha Haggie (On behalf of Planning, Funding and Outcomes)

- Excellence in Health Literacy: Consumer-led development of a head and neck cancer support network Submitted by Diana Ayling, Maureen Jansen, Jarrard O’Brien and David Grayson (On behalf of Head and Neck Cancer Support Group, i3 and ORL Department)

- Margaret Gadsdon Memorial Endowment: Georgina McPherson, Nurse Practitioner, Colposcopy Services

- CEO Publication Prize: Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy Head and Neck, 39 (9) pp. 1869 - 1875. Authors: Dr Jacqui Allen, Dr Dora Blair and Dr Anna Miles

- People’s Choice Poster: iTui – an App improving paediatric assessments Submitted by Dr Maneesh Deva, Dr Tim Jelleyman and Dr Stephen Howie (On behalf of Paediatric Services)

Our staff flu vaccination drive had seen around 2,800 members of the Waitemata DHB workforce immunised at the time of writing this report – around 37% of our workforce. With three weeks of the campaign to go, this had the DHB positioned favourably to meet our target of 60%. More than 100 staff had been trained to administer the vaccinations and we had a group of nurses running static community and hospital clinics and roving vaccinator duties throughout late April and May. In-team vaccinators will continue through until the end of August to extend the programme this year. The Communications Department used all available channels to encourage staff to take up the opportunity for free flu vaccination, including the use of organisation-wide screensavers and via Facebook and StaffNet.

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Dr Sudesh Dixit receives the flu vaccination from Dr Jocelyn Peach

A major storm that hit Auckland overnight on 10 April resulted in widespread disruption to power supplies across the city. Many of the areas still without power after several days were concentrated in West Auckland and, as the outages continued, there was increasing concern about how the lack of heating and the inability to safely store food and cook would be impacting on people. There was particular concern for the vulnerable within our communities, such as those living alone, the elderly and the very young. Our Emergency Planner, Dr Jocelyn Peach, worked tirelessly with our Civil Defence colleagues and other key agencies day and night to identify and assist those at-risk and to make interventions that would assist people to have a level of self-sufficiency until power was restored. I thank her for her care and commitment – it was a great example of our values at work. The storm response effort also created one of the first major opportunities to test the effectiveness of the Medinz primary care communications platform, developed by Waitemata DHB and now in use across the entire metro Auckland area. Via Medinz, the DHB was able to reach out to hundreds of primary care practitioners such as GPs, urgent care clinic staff and community pharmacists to provide real-time information and to seek their help to urgently identify people in need of help. The system worked exactly as we had hoped and it is very reassuring to know that in times of real need, we now have a mechanism for reaching this critical audience and for hearing their feedback. I would also like to pay tribute to the resilience of our staff, many of whom continued to turn up to work as usual, even after days without power at their own homes. They genuinely did put others before themselves, even in very trying personal circumstances.

Improved patient safety, experience and outcomes sit at the heart of a newly launched electronic referral system at Waitemata DHB. eReferrals replaces the old paper forms that were time-consuming to fill out and easy to lose track of. The system ensures that patients referred by doctors to specialist services get prompt care and advice from the right people via an online system that leaves no room for error. Hospital-based clinicians and GPs all have on-

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the-spot visibility, giving them the immediate ability to confirm referrals have taken place, make new ones, document any changes in therapy, find alternative plans to help or get an instant picture of an individual’s referral history. This means valuable time is not wasted with a patient having to retell their story again and again at each consultation. The system provides quicker and more comprehensive communication between health professionals associated with individual cases. Auckland and Counties Manukau DHBs will also soon start using eReferrals.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2018/Electronic-patient-referrals-put-safety-first-at-Waitemata-DHB.pdf https://i.stuff.co.nz/auckland/103452740/electronic-referrals-set-to-be-more-reliable-than-paper-versions-at-waitemata-dhb

An innovative new version of an app designed to steer potentially problematic drinkers away from addiction is about to be put through its paces in Auckland. Researchers from Waitemata DHB, the University of Auckland and the University of Alaska Anchorage are looking for 200 volunteers to help in a six-month trial of a New Zealand adaption of Step Away – an app currently used in the US to encourage a more moderate approach to drinking. Our Director of Specialist Mental Health and Addictions Services, Dr Susanna Galea-Singer, is among those overseeing the clinical trial. The app is tailored to provide local information and support as well as offering coping strategies and weekly progress reports for drinkers who are trying to kick or curb old habits. The ground-breaking opportunity provided through this app is its ability to link hazardous drinkers with local service provision if required.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2018/MG-Step-Away-Clinical-trial-press-release.pdf

Waitemata DHB has partnered with Auckland DHB to create a new role to help build on Sudden Unexpected Death in Infancy (SUDI) work among Māori. Multiple initiatives have contributed to a 63% drop in Māori infant mortality across the Waitemata DHB catchment since 2001. We aim to drive even further improvements with the appointment of Jennifer Fletcher to the new role of SUDI Prevention Programme Manager for Waitemata and Auckland DHBs. Smoking is a leading factor behind SUDI rates, which are still disproportionately higher nationwide among Māori and Jennifer will be looking forward to supporting Māori communities in their efforts to quit. I welcome her to this exciting new role and look forward to seeing further improvements in Māori health outcomes.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2018/Media-release-new-role-to-tackle-SUDI-among-Maori.pdf

On 3 May, ACC released its second annual report on treatment injury resulting from care in hospitals across New Zealand. The new report, covering the 2016/17 year, again shows Waitemata DHB at the lower end of the national data on patient discharges accepted as treatment injury claims. Our rate of 0.31% was equal-lowest with Hawkes Bay DHB but it should be noted that our DHB completed 126,466 discharges during 2016/17, as opposed to 41,317 at Hawkes Bay. While comparisons between DHBs are not meaningful due to differences in case-mix and services provided, the report again demonstrates that our ongoing focus on improvement patient safety is having a positive effect on the lives of those we treat.

www.acc.co.nz/treatmentsafety

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http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2018/Electronic-patient-referrals-put-safety-first-at-Waitemata-DHB.pdf

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2018/Electronic-patient-referrals-put-safety-first-at-Waitemata-DHB.pdf

https://i.stuff.co.nz/auckland/103452740/electronic-referrals-set-to-be-more-reliable-than-paper-versions-at-waitemata-dhb






http://www.acc.co.nz/treatmentsafety


Creating a culture of appreciation

A further 57 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member whose nomination is considered worthy of acknowledgement receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting include:

• Carol Hamon - Ward Clerk, Ward 8. Nominated by Wendy Matthew.

"Carol has been so helpful over the past few weeks with regards to discharging palliative patients. She has been so patient with my requests and is always so pleasant."

• Frances Scheirlinck - Charge Nurse Manager, Ward 8. Nominated by Wendy Matthew. "Frances is such a compassionate charge nurse and always goes the extra mile for any of her palliative patients. Nothing is too much trouble for her and she always does what is best for the patient and the family."

• Robin Tanenui - ARMHIT Trainer, HCC Team, Mental Health Services. Nominated by Kate Doswell. “Robin is great to work with in terms of supporting the team. He is always willing to listen and help and comes up with innovative ways to improve our service data collection.”

• Karla Powell - Programme Manager, Funding, Health of Older People. Nominated by Vicki Scott.

"No matter what the issues we are trying to solve, Karla always keeps the patient central to any decisions made and regularly reminds others to do the same. No matter how complex the challenges are, Karla is always ready to provide clear-minded leadership, compassion and humour in her approach."

• Kirsten Turnbull - Social Worker, Inpatient North Therapies, Specialty Medicine and HoA. Nominated by Ashleigh Share. "Kirsten recently dealt with a difficult social situation and was instrumental in bringing two vulnerable patients (a father and a son) into the care of the hospital. Kirsten co-ordinated the care of both patients and since the son passed away, Kirsten has supported the father through his grief whilst still admitted. Kirsten advocated greatly for both patients and handled the situation with care and empathy."

• Edgar Menchavez – NASC, NASC Rodney, Specialty Medicine and HoA. Nominated by Liz Munt. "Edgar has been working as a NASC within our LTC patient cohort. He models patient centred care and has adapted to the younger patient cohort extremely well."

• Dr Alana Vaai - House Officer, He Puna Waiora, Mental Health Services. Nominated by Mimoza Trenceva. "Dr Vaai went out of her way to review the clients at He Puna Waiora with depth showing diligence, intelligence and empathy. Her people skills are of a highest standard."

• Tanya Arnesen - Registered Nurse, Marinoto Child and Youth North, Mental Health Services. Nominated by Yulia Dudova. "Tanya is always approachable, empathetic and caring with staff and clients alike. Her positivity, gentleness and compassion make a big difference."

• Amelda Wilson - Social Worker, Child and Family North, Mental Health Services. Nominated by Megan Lyell. "Amelda shows great compassion towards her patients, and colleagues, especially when working with complex families. She communicates in a respectful and non-judgmental way and constantly ensures her team are well-supported. She is a wonderful team member to work with."

• Shanti Budhubhai – Orderly, Clinical Support Services, Hospital Operations. Nominated by Sia Uili.

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"Shanti exhibited how ‘connected’ he is to the team, willing to assist and prove that ‘everyone matters’ by coming to my aid without hesitation. He is always friendly, approachable and willing to assist."

• Peter Smith – Cleaner, Clinical Support Services, Hospital Operations. Nominated by Alison Bowman. "Peter covers a huge area, working hard and always executing his tasks with perfection. He has taken his job seriously and has enjoyed his position, showing admirable dedication. You are a true marvel, Peter, and I wish you all the very best for your retirement and many enjoyable days to come."

• Dr Vicki Macfarlane - Lead Clinician, Methadone Services, Mental Health Services. Nominated by Natalie Scollay. "Dr Macfarlane is not only a tremendous colleague who is extremely generous with her time and expertise; she also has a leading clinical role in the implementation of the new SACAT Act in Auckland. Her wealth of knowledge, dedication to clients and focus on person-centred care is front and centre in the challenging work she undertakes."

• Melissa Roberts and Isaac Claffey - Clinical Supervisors, CADs, Mental Health Services. Nominated by Natalie Scollay. "Melissa and Isaac are highly skilled colleagues who epitomise teamwork and person-centred care. They often go above and beyond to ensure clients receive the best support possible, including navigating the connections and links with others services outside of CADS when needed. I have no doubt that their work and advocacy has led to better outcomes, particularly for clients who may be in crisis."

• Man Mohan Lal - Clinical Nurse Specialist, Takanga A Fohe, Mental Health Services. Nominated by Dikrukshi De Silva. "For his dedication to service and his compassion not only for clients , but also for the staff. Mohan is a registered nurse who has been with Takanga A Fohe over 10 years. He is trustworthy and genuine and deserves the recognition."

• Debbie Jensen - ACC Administrator, Occupational Health and Safety. Nominated by Astrid Smith. "Debbie was very supportive and went beyond the call of duty to support me following an accident at work; regularly checking in to ensure I had all the information and support I needed. Debbie is truly a lovely lady whose support has meant I have not had to take time off work and my health has been well taken care of."

• Stefanie Smith - Registered Nurse, SCBU Waitakere, Child, Women and Family. Nominated by Debbie Daniel. "Stefanie lives the values of ‘connected’ in her everyday work. She co-ordinates the unit and manages very busy day shifts by being very organised, has excellent communication skills and works closely with others."

• Melanie Bergh - Registered Nurse, SCBU Waitakere, Child, Women and Family. Nominated by Debbie Daniel. "Melanie is an excellent neonatal nurse who is very caring. She has a kind and gentle way with the families, excellent communication skills and gains trust and respect from them immediately."

• Vicki Savage - Registered Nurse, SCBU Waitakere, Child, Women and Family. Nominated by Debbie Daniel. "Vicki is a passionate neonatal nurse. She works with compassion at all times and this shows in her care for others. She communicates well with families and shows genuine concern for their best interests."

• Jackie Church - Registered Nurse, SCBU Waitakere, Child, Women and Family. Nominated by Debbie Daniel.

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"Jackie strives to ensure families are informed and equipped for their neonatal journey and their transition to discharge. She undertakes a lot of the discharge teaching including safe sleep, shaken baby and infant CPR and does this with energy and enthusiasm."

• Erin Mandeno - Lactation Consultant, SCBU Waitakere, Child, Women and Family. Nominated by Debbie Daniel. "Erin is a fantastic LC who is so passionate about her job and aligns with the DHB value – ‘Better, Best, Brilliant’. She works with our infants and families with such dedication and expertise and gets excellent feedback from them."

Vicki Rolfe-Vyson, Clinical Nurse Specialist - Haematology, nominated by Val Rowland "Vicki is quietly industrious and makes sure that the patients receive the highest level of care and that the service maintains its high standards."

Kirsten Turnball, Social Worker - Inpatient North Therapies, nominated by Kirsten Ter Braak

Deidre Slaney-Heath, Social Worker - Inpatient North Therapies, nominated by Kirsten Ter Braak

Dianne Cooke, Needs Assessor - NASC North, nominated by Kirsten Ter Braak "Kirsten, Deidre and Dianne have displayed kindness, compassion, care and advocacy for two very frail vulnerable older adults during their rehabilitation journeys with us. They have all made very positive contributions to these patients' lives; promoting their dignity as well as helping them achieve their goals of discharge. I feel very privileged to be working alongside these experienced and knowledgeable health professionals."

Liz Pitney, Charge Nurse Manager - NSH Short Stay Ward, nominated by Akisi Hide "For always understanding her staff and being a good charge nurse."

El Mann El, Registered Nurse - Child and Family North, nominated by Hilary McCluskey "El excels in best care for everyone; she offers wise, empathetic and inclusive counsel to children, young people and their families, aiding health literacy to support their health understanding and choices made."

Rikus Vermaak, Security Supervisor - Security, nominated by Raj Jitendra "Riku shows great compassion to all staff - he is approachable, empathetic and an honest worker. He is a highly skilled supervisor and is very compassionate person."

Christine Wall, Team Administrator - Auckland Opioid Treatment Service, nominated by Isaac Sayal "Chris is the glue that holds together multiple aspects of a service dealing with people who have complex needs. She has worked here for over two decades and has a long memory and a wealth of knowledge about this service."

Leone Johnson, Registered Nurse - Ward 6, nominated by Wendy Matthew "Leone is one of the most compassionate nurses that I work with in the DHB. Nothing is ever too much for her palliative patients. She is a wonderful role model and an absolute pleasure to work with."

Janet Guirey, Duty Nurse Manager - Duty Nurse WTH, nominated by Denise Smith "Janet is a very supportive and caring team member, always willing to go the extra mile. She strives to make the hospital an environment that provides the best possible care and steps in when the need arises to support and empathise in distressing situations."

Lei Wang, Phlebotomy Technician - General Labs, nominated by Nicky Graham "Lei sat the QPT examination in November 2017 and passed with flying colours, achieving the top mark in New Zealand.”

Maine Andrew, Social Worker - Takanga A Fohe, nominated by Dilrukshi De Silva "For her dedication and stepping up to the role of acting clinical coordinator and carrying out the work without hesitation."

Hannah Borman, Registered Nurse - Ward 6, nominated by Helen Walsh

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"Hannah was extremely helpful making sure her patient got to an urgent test by bringing the patient in herself. She showed compassion to her patient and was a great role model to the student nurse she was with, using the experience as a teaching example."

Raynaud Forsyth, Health Care Assistant - Emergency Care Centre NSH, nominated by Helen Walsh “Raynaud took time to help us move a patient to CCU and stayed to help us transfer the patient when there were no staff available in CCU to assist.”

Ling Xu, Student Nurse - Ward 6, nominated by Helen Walsh "Stayed on to help with a patient and took advantage of the teaching experience."

Darren Welch, Jon Atkinson and Mary Grantham, medical laboratory scientists. Nominated by Graham Upton. "Darren Welch, Jon Atkinson and Mary Grantham significantly supported the implementation of the ICNET software system. They conducted extensive laboratory tests to ensure the accuracy of the system. They performed this work on top of their existing duties. I would like to thank them for the accuracy and generosity of their contribution.”

Muniappa Goundar, cleaner, Clinical Support Services. Nominated by Wendy Casey. "Muniappa cleans our theatre area every day. He has a brilliant smile and is friendly everyday no matter what. He has compassion towards us working in a busy area where hygiene is critical. Muniappa lives our values and shows that Everyone Matters."

Tania Van Reenen, Chris Biltcliff and Karin McCullough, business analyst professionals, Workforce Central. Nominated by Gale Robinson. “For their passion, dedication and can do attitude during the WFC upgrade, whilst ensuring support to our users were the main priority.”

Sharon Lee, helpdesk and support coordinator, Workforce Central. Nominated by Gale Robinson. “For her passion, dedication and can-do attitude during the WFC upgrade, whilst ensuring support to our users were the main priority.”

Phillip Tarrant, house officer, Gynaecology Services. Nominated by Lara Hopley. “Phillip took time out of his clinical life to talk about our various computer systems with a group of clinicians from Waikato. The passion, insight and commitment they demonstrated was amazing. They represented our DHB with pride and compassion."

Anya Yanke, house officer, General Medical. Nominated by Lara Hopley. “Anya took time out of his clinical life to talk about our various computer systems with a group of clinicians from Waikato. The passion, insight and commitment they demonstrated was amazing. They represented our DHB with pride and compassion.”

Sophia Sherwood, house officer, Ward 14. Nominated by Dr Katherine Bloomfield. “Despite an extremely busy and stressful time on the ward, Sophia has remained composed and level-headed at all times, working without complaint. Ward 14 charge nurse, Kirsten Ter Braak, and I have been very impressed with both her professional and personal skills.”

Charlie Aitken, technical support coordinator, Learning and Development. Nominated by Eleanor Gates. “What a nice man to work with! Even when stressed, Charlie fixed the IT issue and had a dry sense of humour about it, too. My recent encounter of live streaming to 27 DHBs/PHOs was technically challenging but Charlie sorted it.”

Anish Koppikar, physiotherapist, Allied Health. Nominated by Eleanor Gates. “I have struggled with an injury for the past three years and have made incredible progress since being referred to Anish. He is quiet and confident that improvements can be made.”

Sam Ballantine, physiotherapy assistant, Allied Health. Nominated by Eleanor Gates. “Sam is such a pleasant person assisting with hydrotherapy. She makes sure we drink plenty, mops up water to keep us safe and chats away to take your mind off the exercises! She always has a smile and a kind word for everyone.”

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Rebekah Nicholson and Rhonda Tito, registered nurses, Child Development West. Nominated by Richelle Timmins. “Rebekah and Rhonda worked tirelessly assisting a very young baby with highly complex medical needs. They supported this family above and beyond the call of ordinary care. I am very proud of how Rhonda and Rebekah held themselves as expert nurses at a very difficult time; they have lived and breathed our Waitemata DHB values, been role models to the other staff in our team and the wider MDT.

Taulanga Kupu, cultural advisor, Malaga A Le Pasifika, Mental Health and Addictions. Nominated by Asena Lameko. “Taulanga is diligent at helping and working with our Pacifica community. He strives to make a difference and encourages others to do so also.”

Dwaine Faletanoa'i, AOD Youth Clinician, Tupu Services - Takanga A Fohe, Mental Health and Addictions. Nominated by Asena Lameko. “Dwaine is very supportive and compassionate about his work. He is a great role model to the team and has a heart of gold, always willing to lift others where he stands and to lead from the front.”

Lynda Mance, occupational therapist, Child Development North. Nominated by Jane Hamer. “Lynda truly epitomises the Waitemata DHB value ‘with compassion’. She always wants to make a difference in the lives of the children and families she works with, walking alongside them to help in such a professional way, even in difficult situations.”

Dr Jye Ru Lu, senior medical officer, Gynaecology Services. Nomainted by Dr Prem Gill. “Dr Lu is a wonderful SMO who is always supportive and encouraging of her junior staff. She is keen to teach, is always smiling, positive and, overall, a superwoman. She remains tough under pressure, never crumbles and is nurturing and protective. Thank you for showing us all how to keep calm and carry on!"

Kylie Parry, registered nurse, Psychiatric Liaison Team. Nominated by Michelle Dawson. “For her dedication and recent exemplary DAO re-warrant submission, providing exemplars completed to an exceptional level, demonstrating expertise and compassionate care and allowing other staff to use them to further their training.”

Seema Vinish, clinical nurse specialist, Department of Anaesthesia. Nominated by Ümit Holland. “Seema has recently handled a difficult situation advocating for and protecting her patient’s rights. She has provided the care they expect and deserve with the highest integrity demonstrating all of our DHB values. It is a pleasure working alongside her.”

Annie Hooker, administration manager, Quality and Training. Nominated by Dikrukshi De Silva. “For her outstanding contribution to Takanga A Fohe. Annie assisted our team during our audit, credentialing and has been a role model for us. We wish her all the very best in her new role within Waitemata DHB.”

2. Upcoming events Looking toward the upcoming months, we can expect to see:

Incoming Waitemata DHB Chair Judy McGregor’s term begins on 10 June.

Launch of our newly developed ‘Online Pregnancy Smokefree Training Programme’ on World Smokefree Day on 31 May.

2018 CEO Lecture Series addresses.

Further progress on the replacement of CT scanners at Waitakere Hospital, with installation of the second new scanner scheduled for late 2018.

Progress on a new CT scanner for North Shore Hospital.

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3. Future Focus

The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be.

The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience.

The intended benefits are to move these projects along at a faster pace with top-level support for the significant changes required, giving greater visibility and attention to those projects identified as being important in achieving the DHB’s priorities and purpose as well as instilling the culture of improvement and innovation.

A new Leapfrog Programme Manager will be starting with the team in mid-June. As per the News and Events summary, our own Lara Hopley recently featured in the media for the inter/intra-DHB eReferrals project that has been successfully launched in Waitemata DHB. This has generated national interest, with Capital and Coast, Hutt Valley and Wairarapa DHBs requesting further information. Further media stories are likely following a visit to our DHB by the new eHealthNews.nz newsletter editor to view some of the recent Leapfrog projects. https://i.stuff.co.nz/auckland/103452740/electronic-referrals-set-to-be-more-reliable-than-paper-versions-at-waitemata-dhb The MyPatientList revised version is out for use by staff. This has addressed performance issues and additional features are being scoped. In the Outpatients FollowUp project, 218 eOutcomes forms have now been completed by rheumatology where the form has now replaced the paper form (83% were for re-appointment, 15% discharged and 2% transferred care). In ORL, orthopaedics and general surgery, 26 SOS cards have been issued (for re-appointment only if requested by patient within a defined period). Our interim telehealth licenses were about to be issued at the time of writing this report, with a focus on clinicians wishing to offer remote consultations via video to their patients. This is likely to commence in ORL and CADS. Outpatient Flow Tools have commenced, with the planning for patient email address validation now underway collaboratively with Auckland DHB. The team have been reviewing options for digital postage solutions that will automate the email and post processes across the DHB. A procurement process will start shortly, with invitations to the region DHBs to participate. Work is underway to standardise outpatient clinic profiles that is critical prior to the introduction of a new system. The Data Discovery team achieved third place at a poster competition at the Qlik Qonnections conference, earning a data literacy workshop for staff. Development continues on dashboards and apps. A proof of concept is planned for ED of ‘tap on/ tap off’ identity authentication – the vendor was to visit Waitemata DHB in May, with set-up complete in June.

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4. Outcomes discussion This month, I have asked Alex Boersma, General Manager Acute and Emergency Medicine, to provide an overview of the achievements of our TransforMED project…

The Acute and Specialist Medicine Patient Flow initiative known as TransforMED is improving patient outcomes and experiences by providing timely care to General Medicine patients through daily consultant-led ward rounds and the creation of ward-based medical teams. These teams work closely with the ward-based multi-disciplinary teams as well as working collegially with each other. Key principles:

Consultant-led, ward-based teams with two teams on the ward at any one time and two or three SMOs per team rotating on and off the ward. Each team is responsible for half the ward, approximately 15 patients.

‘Mornings are for Medicine’ - an apprentice model with early senior decision-making through daily morning consultant-led ward rounds involving registrars, house officers and senior nurses.

Each ward has new patients each day and there are manageable patient numbers on the daily post-acute ward round, with an average of five new patients per team, per ward/day.

Ward rounds are supported through the daily discussion of patient progress at a daily multidisciplinary board round. The board round takes 30 minutes per ward, is attended by both teams and is a catch-up on where the patient is at, what needs to happen today and who is accountable for making sure it happens.

The ward-based teams provide a collaborative multidisciplinary service that make decisions together with the SMO as the lead and have a shared understanding of the agreed Expected Date of Discharge (EDD) and Clinical Criteria for Discharge (CCD).

Delays in patient care are identified, escalated and minimised.

Ward-based teams will spend sequential periods of time (between two and five weeks) on the ward and, during this time, every morning is spent ‘on the ward’. ‘Time on the ward’ for the SMO is balanced by ‘time off the ward’ where the focus is on the SMO’s sub-specialty.

As well as their subspecialty commitments, all SMOs rotate through the ADU on a sessional basis.

The aim is that Waitemata DHB will become a first choice for medical professionals (trainees, nurses and allied health).

While maintaining a general medicine model of care with all patients admitted under general medicine, the new model has ‘themed wards’, allowing for the concentration of skills and expertise relating to a specific subspecialty, e.g. respiratory medicine, gastroenterology on a general medicine ward.

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Structure of ‘home ward’ teams on a daily basis.

The Ward 3 team: SMO Steve Miller, Registrar Tina Chang, two house officers Sheila Kaur, Indi Wickramasinghe and the ward co-ordinator, Kurt Navarro. TransforMED Headlines Since the introduction of Home-Based Wards at North Shore Hospital (NSH), there has been:

9,772 patient bed days saved resulting from shorter average length of stay for general medicine patients through NSH;

11% few beds (19 per night) occupied since November 2017;

8% reduction in stranded patients since August 2017;

Readmissions are running at the normal rate;

17% reduction (16 hours) in average length-of-stay since August 2017 (see graph 1 below).

Team One

SMO x 1 (covered by 2-3

SMOs rotating over the

year)

1 x Registrar

2 x House Officers

Ward Charge Nurse

Team Two

SMO x 1 (covered by

2-3 SMOs rotating

over the year)

1 x Registrar

2 x House Officers

Nurse Co-ordinator

Physio / OT / NASC / Social worker ward based and shared across both teams

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Graph 1 – 17% (16 hours) reduction in ALOS since Aug 2017

NSH ADU model of care The ADU is the focus of Phase 4 of the TransforMED programme and the aim is to increase the number of same-day and next-day discharges, improving patient-seen-by times and outcomes and reducing the number of patients admitted to the inpatient wards. Like the inpatient wards, the model of care is designed for early senior input. There will be an increased SMO presence in the ADU, with SMOs in the morning, rounding on the patients and providing early senior review and decision-making. In the afternoons, SMOs will hold the General Practitioner referral phone, providing advice and assisting with the streaming of patients as appropriate. They will be available to assist and support the registrars and house officers in the assessment and treatment of patients, reviewing patients as appropriate and helping to facilitate discharge where possible. There will be an afternoon board round where patients who are appropriate for discharge will be identified. In addition, there will be an evening SMO facilitating early senior review, managing flow and supporting same-day discharges. Waitakere Hospital The implementation of Home-Based Warding at Waitakere Hospital has been delayed until later in 2018. This is due to the intensity of resource required to support North Shore Hospital to embed and sustain the improvement achieved to date. Waitakere is adapting many TransforMED principles into their daily work patterns while waiting for the formal roll out, such as the daily multidisciplinary board rounds, and increased rounding in the ADU.

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5. Board performance priorities The following provides a summary of the work underway to deliver on the DHB’s priorities: Relief of suffering Progress:

Patient Experience

National Inpatient Survey

The most-recent National Patient Experience Inpatient survey round closed on 7 April and included patients discharged between 5-18 February. A total of 397 patients were invited to complete the survey, with 139 (35%) completed responses.

Year and Quarter

Total Surveys

Communication Partnership Coordination Needs

Jan – Mar 2018

139 8.3 8.3 8.1 8.5

Overall 2017 8.4 8.4 8.3 8.6

*Oct - Dec 2017

- n/a n/a n/a n/a

Jul – Sep 2017

127 8.5 8.4 8.5 8.8

Apr – Jun 2017

120 8.2 8.4 8.2 8.3

Jan - Mar 2017

147 8.3 8.3 8.3 8.7

National Survey Results *Anomaly with survey methodology

Friends and Family Test

In April, the response rate for the Friends and Family Test (FFT) improved further, with feedback from 1,405 people (compared to 1,255 in March and 938 in February). The Net Promoter Score (NPS) was 72. The NPS score continues to track well above the DHB target of 65. Friends and Family Test Overall Results:

Waitemata DHB overall NPS

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Waitemata DHB overall FFT results

Waitemata DHB FFT results (each question)

Total Responses and NPS to Friends and Family Test by ethnicity

April 2018 Māori Overall Asian

Overall Pacific

Other

Responses 115 95 91 295

NPS 80 68 70 74

NPS by ethnicity All ethnicities identified have met the Waitemata DHB NPS target and scored above the target of 65. The response rate and score has improved for Maori from 72 last month to 80 this month. The NPS score for Asian is down four points from the previous month. Volunteer Recruitment Update

Green Coats Volunteers (Front of House)

(A)

Other allocated Volunteers

(B)

Volunteers on boarded awaiting

allocation (C)

Total volunteers available (D)

(A) + (B) + (C) =(D) 62 110 8 180

Volunteers Recruitment The recent focus of volunteer recruitment has been for wards, outpatients and gardening. Volunteers from Countdown and ANZ Bank completed some gardening at Waitakere Hospital in early May. Fortnightly volunteer wheelchair maintenance checks have also commenced at each hospital.

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Facilities Major capital projects need strong regional support and alignment. The Northern Region has developed a Long-Term Investment Plan (LTIP) to guide all significant future capital investments in the region. The Board will be regularly updated on this work. The Waitemata DHB capital projects programme has been reviewed to identify projects that can be delivered under the DHB’s funding, with the remainder forming part of a programme of projects requiring Government funding. Ministerial Program Business Cases are being developed and are anticipated to be; ECIB, Sustainable Inpatient Services (North Shore), Sustainable Outpatient Services, Infrastructure, Waitakere Hospital Development and Mason Clinic. Projects that cannot be delivered under DHB funding have been placed on-hold pending review for inclusion in the Ministerial Programme Business Cases. The Board will be regularly updated on this work going forward. Waitakere Hospital radiology replacement and additional CT scanner Construction of stage two started in February as planned and is progressing as scheduled, with the sluice room, ultrasound room and equipment room now complete. North Shore Hospital third CT scanner The business case for this project was approved by Audit and Finance Committee on 28 March. The project has two streams: the construction and installation of the third CT and the placement of a digital x-ray in NSH Emergency Department. The Digital X-ray in ED is expected to go live in November. The programme for this has construction starting in September to avoid the winter peak. The third CT is expected to go live in April 2019. Surgical pathology upgrade Stage one of the surgical pathology refurbishment was completed on 12 April. Construction of stage two is currently underway, with a scheduled go live date of 23 May at the time of writing. This work is required to maintain ION accreditation. Special Care Baby Unit (SCBU) Waitakere Hospital and North Shore Hospital The project is under cost and timing review. Both the Well foundation and ELT are considering funding options. Diagnostic Breast Service ELT is currently considering a business case for this development. Elective Capacity and Inpatient Beds (ECIB) business case to Capital Investment Committee (CIC) The business case for four additional theatres, four endoscopy rooms and 60 beds adjacent and connected to ESC was submitted to CIC for approval. In response to a CIC request, high-level re-scoping has taken place looking into providing an additional eight theatres and 150 beds. A further response from CIC is awaited. Sustainable Inpatient Services (replacement facilities project) The strategic assessment was submitted to CIC in December 2017. This project links closely with the infrastructure projects and is listed as a key project to address the regional shortfall of beds within the Northern Regional Long Term Investment Plan. A response from CIC is awaited.

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Infrastructure and building services projects These projects are being initiated to respond to urgent infrastructure upgrades that will be required into the future to plan for growth and campus development as well as to ensure high levels of resilience. It is anticipated that a programme Business Case will be developed for submission to Treasury for funding. Urgent projects to resolve immediate risks will progress via Waitemata DHB capital prioritisation process.

Better Outcomes Progress: On track Achieving the health targets – March 2018

Shorter waits in Emergency Departments – 97% (target 95%)

Improved Access to Elective Surgery – 108% (target 100%)

Increased immunisation (eight-month-old) – 92% (target 95%)

Better help for smokers to quit - Maternity – 93% (target 90%)

Raising healthy kids – 99% (target 95%)

Faster Cancer Treatment (62 days) – 91% (target 90%)

Health Quality and Safety Markers – April 2018 Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, Acute and Emergency Medicine completed 90% of falls risk assessments, Specialist Medicine and Health of Older People completed 100% and Surgical and Ambulatory completed 92% on admission. Of those, Acute and Emergency Medicine completed 75%, Specialist Medicine and Health of Older People completed 64% and Surgical and Ambulatory completed 83% within eight hours of admission (against a target of 90%). Hand Hygiene Waitemata DHB’s Hand Hygiene Compliance Audit result for April 2018 was 90%. This exceeds the national target of 80% compliance. Healthcare-Associated Infections The CLAB insertion bundle was used in ICU on 100% of occasions in April 2018. The insertion bundle compliance also exceeds the national target of 90%.

Māori Health Wai 2575 Health Services and Outcomes Kaupapa Inquiry A Health Services and Outcomes kaupapa inquiry was initiated in November 2016. There are 180 claims that cover a range of topics and issues, such as health inequities, primary care, mental health and system issues. The inquiry has three stages:

1. Priority areas that demonstrate system issues 2. Nationally significant system issues and themes that emerge 3. Remaining themes of national significance, including eligible historical claims

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Primary care will be heard in stage one. The proposed priority areas for stage two are: mental health (including suicide and self-harm); Māori with disabilities and alcohol and substance abuse. The Ministry is currently funding a background historical report, Māori health trends (statistical report) and Māori disability statistical status report. The Ministry is also funding the round-table discussions and other Hui related to this inquiry. A joint collaborative response from the Ministry and the DHBs is required to respond to this inquiry well. DHB Chief Executive Officers have agreed to the collaborative approach with the Ministry and DHBs working together to respond. To support the systems response to this claim, Chief Executive Officers have also agreed for key DHB staff to assist the Ministry of Health. Quarterly updates will be provided to the DHB Chief Executive Officer meetings. The reality is we could do a lot better in Māori health. We should see the inquiry as an opportunity for Māori health improvement. Matāriki Awards A call for submissions for this year’s Matāriki Awards has gone out. These awards will take place during the Matāriki Week celebrations across Waitematā and Auckland DHBs in the first week of July. The awards will primarily be to reinforce and promote:

1. The importance of our DHBs’ organisational values. 2. The importance of our Māori health aspirations. 3. The link between our values and our Māori health aspirations. 4. Excellent examples that demonstrate the effective application of our values to achieve one

or more of our Māori health aspirations. Applications were scheduled to close on 30 May at Waitemata DHB, with the award ceremony to be held on 4 July. More information is available at: www.waitematadhb.govt.nz/news/posts/matariki-awards Update on Māori Alliance Leadership Team (MALT) Work Safe Kids appointments I was delighted to see the proactive equity approach taken by the new Director of Safe Kids Aotearoa (a national injury prevention service overseen by Starship Hospital at Auckland DHB) with appointments to newly developed strategic roles with the service. As a result of this approach, 66% of new appointments to the service were either capable Māori or Pacific appointments. This is great leadership, in my view, as it strongly aligns to the work we are promoting as part of our MALT activities and, given the high number of Māori and Pacific children that die from unintentional injury each year, I think these appointments are timely. This is a great example of recruitment consistent with our organisational objectives, values and at the achievement of our MALT aspirations and goals.

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http://www.waitematadhb.govt.nz/news/posts/matariki-awards


CEO Scorecard

Actual Target Trend Patient Experience Actual Target TrendBetter help for smokers to quit - maternity 93% 90% p Complaint Average Response Time 10 days <14 days q

Better help for smokers to quit - primary care 87% 90% p Net Promoter Score FFT 74 65 q

Improved Access to Elective Surgery - WDHB 108% 100% p

Shorter Waits in ED 97% 95% p HQSC Quality and Safety Markers - Quarterly Trend

Faster cancer treatment (62 days) 91% 90% q Older patients assessed for falling risk 96% 90% q

Increased immunisation (8-month old) 92% 95% Older patients assessed as significant fall risk with care plan 95% 90%

Raising Healthy kids 99% 95% Good hand hygiene practice 89% 80% p

Occasions insertion bundle used - ICU 99% 90% q

Occasions maintenance bundle used - ICU 95% 90% q

e. Surgical site infection rate per 100 procedures 0.9 <0.8 q

Waiting Times Actual Target Trend b. Antibiotic in the right time 97% 100% p

ESPI

ESPI 1 - 90% OP Referrals processed w/n 10 days Compliant Improving outcomes

ESPI 2 - % patients waiting > 4 months for FSA Compliant Better help for smokers to quit - hospitalised 99% 95% p

ESPI 5 - % patients not treated within 4 months Compliant a. Ambulatory Sensitive Hospitalisation rate (ASH) 0-4 5425.7 5643 q

Diagnostics f. Annual amenable mortality rate (per 100 000) 70.1 72.4 q

% of CT scans done within 6 weeks 86% 95% p Population coverage/Access Trend

% of MRI scans done within 6 weeks 69% 90% p Cervical Screening 73% 80% q

Urgent diagnostic colonoscopy (14 days) 96% 90% q Breast screening 66% 70%

Diagnostic colonoscopy (42 days) 66% 70% pc. Bowel Screening Participation

Surveillance colonoscopy (84 days) 74% 70% p - Round 3 48% 60% q

Treatment

Patient Flow a. HSMR (Source: Health Round Tables) 0.89 <1.07 p

Elective Surgical Discharges (YTD) a. Surgical intervention rates (per 10,000 pop)

Elective Discharges - Total 15,394 15,458 p - Angioplasty 16.1 12.5 q

Elective Discharges - Provider Arm 10,702 10,641 p - Angiography 42.3 34.7 p

Elective Discharges - IDF Outflow 4,692 4,817 q - Major joints 27.6 21 p

Efficiency - Cataract 45.9 27 p

Outpatient DNA rate (FSA + FUs) 8% <10% g. # NOF patients to theatre (48 hours) 84% 85% q

a. Average Length of Stay - Electives 1.51 days <1.51 days q ST elevation MI receiving PCI (120 mins) 84% 80% q

a. Average Length of Stay - Acutes 2.78 days <2.48 days q AT&R referrals assessed (2 working days) 96% 90% q

Staff Experience Actual Target Trend g. Major Capital Programmes Time Budget QualitySick leave rate 3.3% <3.6% Elective Capacity and Inpatient beds (TBC)

d. Turnover rate - external 13% 8-12% CT scanner Waitakere - Stage 1

Lost time injury frequency rate (per 100 00 hours worked) 4 <2 p CT scanner Waitakere - Stage 2

Mason Clinic Tanekaha replacement

Financial Result Trend Ward 6/7 renovation (Dec/Jan 2018)

Expense/Revenue (YTD Total) 1,288,005 k 1,289,396 k q

Performance indicators: Trend indicators:

Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month

Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month

Performance was maintained

Waitemata DHB Monthly Performance Scorecard

Contact: Victoria Child - [email protected] - Reporting Analyst, Planning & Health Intelligence, Planning, Funding and Health Outcomes, Waitemata & Auckland DHBs Team

CEO ScorecardMarch 2018

2017/18

1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header).

2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed.

3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations

perceived to be large.

e. Prelim data Mar Q3 201718

f. Annual data - latest available 2014

g. Feb 2018

a. Reported quarterly - Dec Q2 17/18

b. Sep Q1 2017/18 (latest HQSC data available).

c. Bowel Screening Round 3 data Dec Q2 201718 (participation rate for invites Jan - Dec 2017).

d. Employees taking positions outside of the hospital/DHB

Health Targets

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

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3.2 Health and Safety Performance Report

Recommendation:

That the Board receives the report.

Prepared by: Michael Field (Group Manager, Occupational Health and Safety Service) Endorsed by: Fiona McCarthy (Director, Human Resources)

1. Purpose of report

The purpose of the Health and Safety report is to provide quarterly reporting of health, safety and wellbeing performance including compliance, indicators, issues and risks to the Waitemata DHB.

2. Strategic Alignment

Community, whanau and patient centred model of care

This report comments on issues and risks that impact on patient care and organisational culture.

Emphasis and investment on both treatment and keeping people health

This report comments on organisational health information via incidents, health monitoring and leave information.

Intelligence and insight The report provides information and insight into workplace incidents and what Waitemata DHB is doing to respond to these and other workplace risks.

Evidence informed decision making and practice

The leading and lagging indicator dashboard is based on current best practise indicators and targets.

Outward focus and flexible, service orientation

Health, safety and wellbeing risks and programmes are inherently focused on staff, patients, visitors, students and contractors. All strategic and operational work programmes and policy decisions are discussed with relevant services such as site visits and approaches to reduce risks.

Operational and financial sustainability

As appropriate, programmes of work will outline how services will ensure operational or financial sustainability, how measures of success are set and value and return on investment is monitored.

3. Board Health and Safety Charter Feedback has been received from Board members with no changes recommended, so the Interim Board Health and Safety Charter will be published as part of our Health, Safety and Wellbeing policy. The Charter will be formally reviewed during the first Board Health and Safety Workshop.

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4. Overview of current health, safety and wellbeing activity for April 2018

4.1 Key highlights

4.1.1 Influenza vaccinations – 2018

The influenza vaccination campaign has begun and as at 16 May around 2,600 staff have been vaccinated

or 33%, with three weeks of the campaign to go. We would expect 30% to have been vaccinated by now to

meet our target of 60%.

Actions undertaken to promote influenza vaccinations include:

1. In-team vaccinations – over 100 staff are trained to administer the influenza vaccination. 2. Several nurses are undertaking static community and hospital clinics and roving vaccinator duties

throughout late April and May. 3. Influenza vaccinations are being promoted on screen savers, our intranet, through newsletter and a

video has been posted to Facebook and U-tube on ‘flu myth busters’. 4. Influenza vaccination statistics down to team level are available on the intranet and updated each

Friday so we can see where we need to promote vaccination. 5. Community influenza vaccination clinics will finish in two weeks’ time allowing us to reallocate

vaccinators where there may be a specific service need.

4.1.2 Update on the health and safety request for proposal Arrangements to write and submit the Request for Proposal (RFP) with healthAlliance are underway.

Regional agreement has now been reached regarding the upcoming RFP with healthAlliance likely to join us

on the initial RFP process and contract provision made for other DHBs to join in due course. The Health and

Safety Managers from all Auckland Region DHBs and healthAlliance are participating in the development of

the technical requirements, as well as key stakeholders from Waitemata DHB, to ensure that all

functionality is clearly specified.

It is estimated that the RFP will now be released by the end of June and the resulting responses assessed by

the end of August.

4.1.3 Workplace aggression – actions underway The following key work is underway to respond to workplace aggression at the DHB: 1. Security and safety education Online training: Two online education modules are underway with CALM communication released and being completed by clinical teams; and a policy foundation module. Face to face training: Mental health and security teams have existing training planned, with specific training for ED staff in development (as noted below) and two courses on emotional management of challenging situations and an internationally endorsed course called MAPA (Management of Actual or Potential Aggression). 2. A workplace safety programme for the Emergency Departments (ED) was established in March, with three major work streams now underway; ED systems, processes and policies; ED staff training; and the Security Services. 3. A data deep dive to check actions underway will be effective and targeted.

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4.2 Performance Scorecard

* The target at end of flu campaign is 60%

Indicators in red Comment

Forty four Injury Claims (target of thirty five or

less).

Fifteen Lost Time Incidents (target of five or

less).

Of the 15 claims lodged in April 2018, 3 had less

than seven days of lost time and have returned to

full duties.

5. Work related injury Claim Data for April 2018

Outlined below is our injury claim data for April. Work injury claim data is for all work injuries currently managed by the DHB including injuries that may have been incurred in previous years, up to and including injuries for April 2018. High accident events account for approximately 76% of the claims as follows:

manual handling – 43%

aggression - 21%

slips, trips and falls - 13%

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INJURY CLAIM DATA

Total: Injury Claim Report for April 2018

Lost days Treatment cost Weekly compensation

costs (80% of salary) Staff cover cost Total

Number of lost

days for month

$ total for

month $ total for month

$total cover cost for

month

Total $ cost for

month

174 $ 52,858.13 $ 35,516.84 $44,396.05 $132,771.02

6. Key Health and Safety Risks

The table below outlines our key health and safety risks together with commentary on the current status/issues related to that risk, our performance level and any actions to address issues.

Key

Risk is well managed –all significant actions complete

Risk is well managed - some minor actions to be completed

Risk is being managed and has some significant actions underway

Risk is being managed and has some significant actions yet to progress

Risk: Aggression-physical and verbal Previous Report Action Current Action Community Worker Alarm Project: Pilot evaluation has commenced and on target to meet May due date. Complete: 75% An indepth study has been commissioned to review aggression data in new ways to better understand where else we may put in place initiatives to improve. Due end April 2018. Resulting workstreams will be reported through this section. Complete: 10% On line security and safety training in development. Due May 2018. Complete: 40% Complete pilot course to help staff thrive in challenging work situations. Due June 2018 Complete: 50%

Community Worker Alarm Project: Pilot evaluation has been completed and a recommendations paper is being drafted. Complete: 100%

In depth data study has commenced and will now complete in June. Complete: 20%

On line security and safety training in development. Due May 2018. Complete: 60%

No change: pilot course to be redeveloped before being run again. Due June 2018 Complete: 50%

New ED workplace safety workstreams: Complete: 10%

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Risk: Blood and Body Fluid Incidents (BBFA)

Previous Report Action Current Action Needleless Systems: Data reviewed on areas with Blood and Body Fluid Events (BBFE) and needless systems. Two areas identified for follow up via the OH&SS team. Any work streams identified will be reported through this section. Complete 80%

Needleless Systems: Data reviewed on areas with Blood and Body Fluid Events (BBFE) and needless systems. Two areas identified for follow up via the OH&SS team. Work has commenced with BD, our supplier of sharps bins and needleless systems, to audit high incident areas. Any work streams identified will be reported through this section. Complete 85%

Risk: Hazardous Substances and New Organisms (HSNO)

Previous Report Action Current Action HSNO audits: Focus has shifted onto newly released legislation and the resulting changes to policies and procedures. HSNO audits will recommence once all policy changes have been finalised. Audits completed: 43% Dangerous goods store: The business case for the Dangerous Goods store will be presented to the Board in July 2018. An interim process has been developed, as outlined below. Complete: 25% Temporary hazardous goods Store: Procedures have been finalised and Dangerous Goods Cabinets have been purchased and installed. Meetings being scheduled with Clinical Support Services to understand resource limitations/requirements to implement system. Complete: 97%

No change as on hold to ensure we have completed all policy changes to align with the new HSNO regulations. Audits will resume by the end of July 2018. Audits completed: 43% The business case for the Dangerous Goods store will be presented to the Board in 2021. An interim facility is due for installation in 2019, and management process has been developed, as outlined below. Complete: 25% Interim internal processes are in place: At present the work is being done via our Hazardous Substances and District Compliance Co-ordinators. Complete: 100% New The DHB is discussing how best to transfer internal hazardous waste to the dangerous goods store (North Shore Hospital) and the dangerous goods cabinets (at Waitakere Hospital). Paper to pilot an internal transfer system is due to the senior management team in May. Complete: 20%

Risk: Manual and Patient Handling

On-going actions Meetings with managers will continue to be held to discuss moving and handling requirements including training, to provide support to services. Additionally, where services are unable to release resources, due to workload, special training sessions are being scheduled via OH & SS.

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Risk: Health and Wellbeing (stress, fatigue, depression)

Previous Report Action Current Action

Healthy Workplaces: Resource has been assigned to complete a new toolkit on bullying and harassment Complete: 15% Work on safe and healthy rostering is in progress for 15 Resident Doctor rosters to comply with the MECA; and centralisation of ward Nursing rosters: Centralisation of nursing rosters: Complete: 50% (Due 2019) RMO rosters: Complete 60% (Due December 2018) Mindfulness Discussion on scoping an integrated and multimedia approach to mindfulness training is underway. Complete 30% Shift work, sleep and fatigue Work on introduction of general guidance for managing sleep and fatigue is in draft. Meetings with professions are planned throughout March to understand what shift work and afterhours materials would be of value to staff. Complete: 10%

Healthy Workplaces: The review of the new toolkit on bullying has been complete and we are due to add these to templates and circulate for review by June. Complete: 70% Centralisation of nursing rosters: Complete: 70% (Due 2019) RMO rosters: Complete 73% (Due December 2018) No change: A stocktake on current resources and internal training opportunities is underway. Complete: 30% Work on introducing general guidance for good sleep is complete. Complete: 100% Meetings with professions are planned to understand what shift work and afterhours materials would be of value to staff. Due date extended to May 2018. Complete: 30%

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Risk: Physical environment (ventilation, lighting, equipment)

Previous Report Action Current Action

Helipad: No change. Hazard signage has been arranged and installed by OH&SS to fencing surrounding the helipad and separate signage placed outside of the doors facing the helipad from Whenua Pupuke. Final enhancement of helipad is being prioritised alongside other capital projects. Complete: 80% Loading Docks: CAPEX has been approved to finalise the design and tender stage. A Business Case will go the Executive Leadership Team in May. The construction has an estimated start date of July/August subject to building consent. Planning complete: 75% Pedestrian Crossings: Designs are complete. The painting of the pedestrian crossings will take 2-3 months (July/August) weather depending. The Waitakere roading /pathway design tender due in June/July for an estimated commencement in August subject to consent. Planning complete: 65%

The helipad improvements: CAPEX is approved. Work commences in late June to replace lighting and helipad painting. Installation imminent. Complete: 80% Loading Docks: In progress: CAPEX has been approved to finalise the design and tender stage. A Business Case will go the Executive Leadership Team in May. The construction has an estimated start date of July/August subject to building consent. Planning complete: 85% Pedestrian Crossings: No Change: Designs are complete. The painting of the pedestrian crossings will take 2-3 months (July/August) weather depending. The Waitakere roading/pathway design tender due in June/July for an estimated commencement in August subject to consent. Planning complete: 65% Additional Security Door Access, North Shore Hospital: A CAPEX has been approved and an order for the new door completed. Estimated completion of the project is September/October 2018. The timeframe has been extended because the door required is specially imported and the lead time is 12 weeks. Where we can we will seek to reduce this timeframe. Planning complete: 100% Installation complete: 10%

Risk: Contractor and Procurement Management

Previous Report Action Current Action Asbestos Register: This project has one stage to complete:

Stage 2: A volunteer is due to commence the transfer of information into the database this month. Due by May 2018 Complete: 35% BIEMS Upgrade: Upgrade progressing with final delivery expected in June/July 2018. Procurement Complete: 100% Delivery Complete: 5%

Asbestos Register: This project has one stage to complete:

Stage 2: A volunteer is due to commence the transfer of information into the database this month. Due by May 2018. Complete: 35% BIEMS Upgrade: Upgrade progressing with final delivery expected in June/July 2018. A mobile app is being developed to enable submission of BEIMS away from the office. This is due to roll out end 2018.

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Contractor management process alignment. This work has now been fully scoped and a resource assigned to progress alignment of current contractor procurement policies, processes and project management and performance practises, which will be implemented between May and July 2018. Processes will be re-assessed in every six months to ensure continuous quality improvement. The processes will be embedded over the following 12 months with the first audit planned for 2019/20. Complete: 55%

Procurement Complete: 100% Delivery Complete: 15% No Change: This work has now been fully scoped and a resource assigned to progress alignment of current contractor procurement policies, processes and project management and performance practises, which will be implemented between May and July 2018. Processes will be re-assessed in every six months to ensure continuous quality improvement. The processes will be embedded over the following 12 months with the first audit planned for 2019/20. Complete: 65%

Risk: Slips trips and Falls

On-going actions Communications continue to be developed and released regarding Slips, Trips and Falls hazards, focussed heavily on staff rushing to complete tasks. Ongoing. Each incident of this type is followed up by OH&SS, with any corrective actions tracked to completion. Ongoing.

7. Stakeholder feedback

7.1 healthAlliance Collaboration We are currently working to ensure that processes are in place and in use, including Waitemata DHB specific inductions, for all healthAlliance contractors carrying out work on our sites. We are working closely with the healthAlliance Health and Safety Manager to align our systems to ensure that this is successfully implemented by end June.

7.2 Facilities and Development Related Contractor Incident Reporting – February 2018 In February 2018, Facilities and Development related contractor incidents included four near miss events, all of which were minor in nature. In all four instances, the contractors completed investigations and ensured all corrective actions and opportunities for improvement were actioned. Records of this close out process are recorded by Facilities and Development for future auditing and record purposes and included as Health and Safety meeting agenda items for the wider Facilities and Development group to ensure visibility and learnings are shared.

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Outlined below is information on key Faciliies and Development health and safety key performance

indicators for major construction projects:

1. Safety inspections completed KPI >100%.

2. Toolbox meetings during construction projects – KPI >100%.

0

1

2

3

4

5

6

7

8

9

10

Lost TimeInjuries

Serious HarmAccidents

AccidentsRequiringMedical

Attention

AccidentsRequiring First

Aid

Near MissIncidents for

Period

Incidents and Accidents this Period

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8. Health and Safety Events April 2018 Rolling year-on-year monthly average comparison:

Previous 12 months – 133 (average) Current 12 months – 160 (average) Current Period:

The number of reported events during the month of April was 291. Rolling 12 month analysis:

In March we became aware of a new category of security incident which has now been made available to include in our event reporting. This has resulted in the overall number of events and near misses being made visible. Incidents at a low level are followed up by managers and incidents at a medium and high level are followed up with Occupational Health and Safety.

The graphs below note all event types, including environmental and people related events.

119 122

165 144 155

169

133 151

125 97 102

119 115 143

169 164 137 130 129

158 151

199 171

258

291

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

De

c-1

7

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

24 Months of Reported Incidents

1 2 2

24

31

38

53 55

85

CorporateServices

CEO HumanResources

Child, Women& Family

SpecialityMedicine &

Health ofOlder People

Surgical &Ambulatory

HospitalOperations

Acute &EmergencyMedicine

SpecialistMental Health

& AddictionServices

Number of Events per Division April 2018

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9. Notifiable Events for April 2018

Month Reported to WSNZ Type of Incident

Injury Sustained

Outcome Recommendations

Controls

Nil

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10. Top three Incident types that cause harm

Physical Assaults; Slips, Trips and Falls; and Moving and Handling The main types of incidents that cause harm to our staff and the management of these hazards and risks

are outlined in the following tables:

10.1 Aggression

Rolling year-on-year monthly average comparison:

Previous 12 months – 41 Current 12 months – 59 April 2018 – 95 Rolling 12 month trend analysis

Aggression related incidents remain of high concern, with an increase in incidents due to an additional category of security incidents made visible. We continue to encourage staff to report incident and near misses.

Actions

Significant actions are in place to better understand and manage aggression incidents including ongoing review and improvement of clinical triage, assessment and treatment processes; new security and safety training; An specific Emergency Department workstreams; review of data to better understand areas to focus workstreams; investigation of all incidents; introduction of new risk assessment templates for aggression risks and hazards; completion of reviews of all public reception areas; completion of key deep dive audits and implementation of findings. OH&SS continue to meet regularly with both the PSA and NZNO and collaborate on areas of high incidents/risks.

28 34

39 46

42

54 52 44 41 41

34 31 40 38 36

45

58 58

43 42

60

46

81

48

98 95

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

De

c-1

7

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8Aggression Incidents 24 Months

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6 7 9

12

22

39

Child, Women &Family


HospitalOperations


Health of OlderPeople

Acute &EmergencyMedicine

Specialist MentalHealth &AddictionServices

Aggression Incidents by Division April 2018

Cuts, Abrasions or Bruises, 4

Dizziness, 1 Effect Caused by

Biological Agent, 1

Laceration, Severing Injury or Puncture

Wound, 1

Musculoskeletal Injury (Soft Tissue),

11

Nil, 20

Psychological Effect, 25

Stress or Anxiety, 14

Aggression Incident Outcomes April 2018

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The following tables show the number of physical and verbal assaults directed at staff and how many are generated by patients, visitors or other staff. The information below tells us that almost 100% of aggression incidents were generated by patients or visitors. This information should be viewed in the context that over 60% of these incidents are clinically derived and are likely due to the effects of the patient illness, or their treatment pathway.

32 42

57 63

58

39 36

59

33

58

36

74 74 4

9

9 5 11

12

1

8

12

15

7

14 11

6

2 4 2

2

3

7

4

4

7 10

1 1

1

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18

Community Member 1

Contractor 1

Student 1

Employee 6 2 4 2 2 3 7 4 4 7 10

Visitor 4 9 9 5 11 12 1 8 12 15 7 14 11

Patient 32 42 57 63 58 39 36 59 33 58 36 74 74

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10.2 Slips, Trips and Falls

Rolling year-on-year monthly average comparison

Previous 12 months – 13 Current 12 months – 14.5 April 2018 - 16

21

17 17

15

10

14

12

17

13

11 10 10

11

21

17

13

11 11 12

10

13

21

16

13

16

24 month Slips Trips Falls

1 1 1

2

3

4 4

CorporateServices


CEO Child, Women &Family


Health of OlderPeople

HospitalOperations

Specialist MentalHealth &

Addiction Services

Slips Trips Falls by Division April 2018

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10.3 Moving and Handling

Rolling year-on-year monthly average comparison

Previous 12 months – 6.4 Current 12 months – 9 April 2018 – 9

7 6

10

16

6 6

4

6

8

4

2

4 5

7

10 11

6 7

11 12

6

11 10

8 9

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

Dec

-17

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

24 Months Patient Handling Injuries

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Appendix 1 Glossary for Monthly Performance Scorecard and Report

Lost time incidents Any injury claim resulting in lost time.

Lost time injury Frequency Rate Number of lost time injuries, divided by total hours worked, multiplied by 1,000,000 hours.

Injury Severity Rate Mathematical calculation that describes the number of lost days experienced as compared to the number of incidents experienced.

Lost Time Injury Rate Mathematical calculation that describes the number of lost time injuries per 100 fulltime employees at any given time frame.

Notifiable Injury/illness (a) Amputation of body part, serious head injury, serious eye injury, serious burn, separation of skin from underlying tissue, a spinal injury, loss of bodily function, serious lacerations. (b) any admission to hospital for immediate treatment. (c) any injury /illness that requires medical treatment within 48 hours of exposure to a substance. (d) any serious infection (including occupational zoonoses) to which carrying out of work is a significant factor, including any infection attributable to carrying out work with micro-organisms, that involves providing treatment or care to a person, that involves contact with human blood or bodily substances, involves contact with animals, that involves handling or contact with fish or marine mammals. (e) any other injury/illness declared by regulations to be notifiable.

Notifiable Incident An unplanned or uncontrolled incident in relation to a workplace that exposes a worker or any other person to a serious risk to that person’s health or safety arising from an immediate or imminent exposure to an escape, spillage or leakage of a substance; an implosion explosion or fire; an escape of gas or steam; an escape of a pressurised substance; an electric shock; a fall or release from height of any plant or substance; collapse or partial collapse of a structure; interruption of the main system of ventilation in an underground excavation or tunnel; collision between two vessels or capsize; or any other incident declared by regulations to be a notifiable incident.

Notifiable Event Death of a person, notifiable injury or illness or a notifiable incident.

Pre- Employment Health screening for new employees.

Significant Hazard (Instead of a definition all hazards are risk rated to determine how serious they are under the new legislation)

A hazard with the potential to cause serious harm.

Psychosocial Risk Aspects of the design and management of work, and its social and organisational contexts, which have the potential for causing psychological or physical harm.

Patients who are away without leave (AWOLs)

Patients under the Mental Health (compulsory Assessment and Treatment) Act 1992, who leave Waitemata DHB premises without prescribed or approved leave.

PCBU Person Conducting Business or Undertaking.

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Officer Person occupying the position of a director of a company or includes any other person occupying a position in relation to the business or undertaking that allows the person to exercise significant influence over the management of the business or undertaking.

Worker An individual who carries out work in any capacity for the PCBU e.g. employee, contractor or sub-contractor, employee of the sub-contractor, employee of labour hire company, outworker, apprentice or trainee, person gaining work experience, volunteer.

Reasonably Practicable Means that which is or was at a particular time reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters, e.g. the likelihood of the hazard/risk occurring; the degree of harm resulting; what the person knows about hazard/risk and how to eliminate/ minimise the risk; and the cost associated with elimination of the hazard/risk.

HSNO Hazardous Substances and New Organisms.

OH&SS Occupational Health and Safety Service.

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3.3 Communications Report

Recommendation:

That the report be received.

Prepared by: Matthew Rogers (Director – Communications)

Communications support The communications team provided advice and support to the following projects/campaigns/issues/ events over the last six weeks:

Coordination of visit by Prime Minister and Minister of Health on 18 May.

2018 Health Excellence Awards.

Bowel screening programme promotion.

Nursing Awards.

Privacy Week.

Launch of new StaffNet homepage.

Launch of eReferrals.

Staff flu vaccination programme.

Immunisation Awareness Week.

Concerto Upgrade.

Workforce Central system upgrade.

Hand Hygiene Awareness Day.

End PJ Paralysis campaign.

Nutrition and hydration awareness promotion.

Pharmacy Action Plan.

Rodney Shuttle Service.

Matariki Awards promotion.

Health literacy symposium.

Onboarding experience for new employees.

Promotion of organisational values.

Ongoing publication of messages via the Medinz primary care communications platform.

Health Heroes.

Safety in Practice campaign promotion.

Comms support for Herceptin celebration event.

2018 CEO Lecture Series coordination.

Coordination of responses to ‘Dear Dale’ emails to the CEO from DHB staff.

Review of content for submission to health sector publications.

Ongoing weekly internal communication via StaffNet and Waitemata Weekly.

Ongoing management of Official Information Act responses.

Liaison with Well Foundation Marketing and Communications.

Ongoing liaison with Metro Auckland DHB communications leads.

Ongoing after-hours and weekend media line cover and senior management communications support.

Proof-read leaflets, booklets and brochures for various departments.

Ongoing compilation and distribution of proactive media material.

Ongoing social media strategy, activity and issues management.

Event photography.

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Drafting of correspondence from the corporate office.

CEO Board Report.

Review of copy for DHB website.

Management of DHB general all-user screen saver content.

Approval for all-user staff emails.

Weekly Board briefing.

Fortnightly A Note From the CEO email to all staff.

Weekly National Health Targets and clinically led metrics updated and communicated.

Your Stay at Hospital booklet.

Values campaign.

Waitemata DHB website – Google Analytics Statistics Waitemata DHB website Number of visits

April 2018

April 2017

Total visits to this site 59,614 (+30.3%) 45,758 New Zealand 55,769 43,205 USA Australia

1,244 664

325 817

United Kingdom 249 309 Top areas April 2018 April 2017

21,761 13,390 5,809 2,213 2,167

Waitemata DHB staff page 31,039 Home page 14,097 North Shore Hospital Waitakere Hospital Contact us

5,881 2,726 2,284

Traffic sources

April 2018

April 2017 74% 21% 5% -

Search traffic 67% Direct traffic 26% Referral traffic Social Media traffic

5% 2%

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Social media Facebook

Waitemata DHB Facebook page likes have increased by 49.2% since May 2017, with 3,735* current likes (2,503 likes - May 2017). Waitemata DHB Facebook review numbers have increased by 13.1% since May 2017. Waitemata DHB Facebook star rating - 4.4/5 from 224 reviews* (4.3/5 from 198 reviews May 2017). Total audience reach between 31 March 2018 and 1 May 2018 was 65,700. Top three posts between 31 March 2018 and 1 May 2018:

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1. National Immunisation Week (Audience reach: 6,180 video views: 2,818)

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2. Matariki Awards (Audience reach: 3,630 video views: 1,676)

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3. Vaiola Hospital’s Matron visits Waitemata DHB (Audience reach: 3,245)

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Twitter

Waitemata DHB Twitter followers have grown by 18% since May 2017, with 2,187 current followers* (1,850 followers as at May 2017). Total audience reach between 31 March 2018 and 1 May 2018 was 35,900. Top tweet between 31 March 2018 and 1 May 2018: Healthy food options for families

*As at 14 May 2018

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OIAs received A total of 28 new OIA requests were received between 6 April and 14 May 2018:

J. Schofield - Details of care provided by CADS to Counties Manukau patients in 2016 and 2017.

K. Ruddock (TVNZ) - Information regarding breast reconstruction surgery for breast cancer patients.

C. Meier (Fairfax) - Children wait times to get specialist care including ear, nose and throat, dental and mental health services.

P. Barltrop - Statistics on instances of staff assault.

D. Henry (NZ Herald) - Details of building remediation issues and reporting to the Minister of Health.

N. Jones (NZ Herald) - Copies of correspondence regarding concerns about and/or the effectiveness of cervical and breast screening programmes since 2016.

P. Hobbs (TVNZ) - Assaults on staff and patients at mental health facilities since 2008.

M. Dobbyn (NZRDA) - Orthopaedic workforce data for 2016 and 2017.

K. Brown (Radio NZ) - Copy of Waitemata DHB’s 2016 Long Term Investment Plan.

N. Barratt (NZ Herald) - Details of stolen items from hospital and estimated cost from 2015-18.

M. Shaw (Ministry of Justice) - Copies of various documents regarding Forensic Court Liaison Services in relation to the Christie Marceau coroner's report.

M. Bull (APEX) - Outsourcing of MRI examinations and related workforce data.

S. Stack - Amount of money spent on procuring the services of Acurity Health Group Ltd each year from 2012.

A. Wiggins (NZ Herald) - Information on perineal tear operations following childbirth, including wait times.

M. McCann (Newshub) - Information on an any buildings with weather tightness issues including reports, reviews etc and estimated cost for any repair work.

J. Nam - Query on whether the DHB is looking to locate services to a particular address.

A. Cropp (Stuff) - Details of transportation of patients via dedicated medical flights as opposed to scheduled passenger services.

E. Jolliff (Mediaworks) - Details of spending with a named private provider, transferred from the Ministry of Health.

T. Lorck (NZ Taxpayers' Union) - Number and cost of staff redundancies for 2017/18.

A. Leask (NZ Herald) - Details of entertainment provided to Mason Clinic patients, including movies and video games.

C. Montague - Prevalence and incidence of gender dysphoria, prescription of puberty blockers and administration of opposite-sex hormones among people aged under-18.

C. Whitlock (FYI website) - Follow-up request concerning teen parenting and pregnancy funding and where participants reside.

M. Enoka (The Wireless) - Number of bullying complaints made by staff against management / co-workers since 2016.

G. Jarvis (Medicines NZ) - Total value of budget invested in Schedule H medicines for last financial year.

J. Milne / A. Mau (Fairfax) - Various questions regarding sexual harassment in the workplace including number of complaints, victims and outcomes.

D. Clent (Stuff) - Documentation relating to staff disciplinary matters outlined in a previous OIA response.

M. Sharpe (Stuff) - Average length of stay of people residing in aged care facilities and copy of results and reports on recent Staff Engagement Survey.

Name withheld for privacy reasons - Names of Visionwest employees who, under contract to Waitemata DHB, have entered the home of the requester’s mother.

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Media Clippings – 4 April – 11 May 2018

Positive +

Neutral 0

Negative -

Page no. Channel

1 Generous support secures new transport incubator +

2 Walking the walk to reduce carbon footprint 0

39 Toni’s heartfelt thank you: new cancer day lounge +

Page no. Dominion Post

20 Private hospital project literally a joint venture 0

34 Government monitor to watch over troubled Counties Manukau DHB

0

41 Clark: No politics in DHB appointments 0

Page no. Listener

5 Plot twist 0

Page no. Nor West News

27 Rescue mission 0

44 Immunisation +

Page no. North Shore Times

11 New orthopaedic surgery on way 0

21 Milestones: Longest serving volunteer +

25 Newborn baby left bawling -

31 Get your flu jab +

38 Electronic referrals introduced to DHB +

55 Immunisations encouraged +

59 Meds missed, feeds late -

Page no. NZ Doctor

13 Letter: Auckland PHOs respond to criticisms 0

30 New private hospital to meet growing demand for orthopaedic surgery

0

56 An unabashed plug for PHOs +

57 Most urgent care consults during normal working hours: Study 0

Page no. NZ Herald / Weekend Herald

8 Departing MP leaves a big hole to fill +

14 Aged suffer ‘postcode care’ 0

18 Young guns in frame for byelection 0

28 Auckland nurses push for better pay, staffing 0

33 Waitakere misses out -

37 Labour delays cheaper GP visits 0

46 Patients ‘at risk’ -

49 Unhealthy operation -

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Page no. Rodney Times

4 Online chatter 0

Page no. Sunday Star Times

32 Care gaps -

Page no. The Press Christchurch


0

42 Clark: No politics in DHB appointments 0

Page no. Waikato Times

12 Hospital literally a joint venture 0


0

Page no. Western Leader

10 DHBs fund bariatric surgeries +

15 What’s On: Craft market 0

23 Nurses demand better pay and ‘proper funding’ -

43 Clark denies politics in DHBs 0

45 Reminder to immunise +

61 New mum: Medications missed -

TOTAL:

Positive + 11

Neutral 0 21

Negative - 8

Total items 40

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4.1 Integrating Governance, Leadership and Planning Arrangements for Māori Health

Recommendation:

That the Board:

1. Note that, because of changes in Board leadership, there have been delays in implementing decisions taken by the Boards of the Auckland, Counties Manukau and Waitemata DHBs at their meetings on 1 November 2017, 6 December 2017 and 8 November 2017 respectively in respect of the governance, leadership and planning arrangements for Maori health across the metro Auckland DHBs.

2. Note that the interim Chairs of Auckland and Waitemata DHBs, together with the Chief Executives of the metro Auckland DHBs, recently met to discuss best ways forward in the light of Recommendation 1 above and agreed that:

a) As soon as all three new Board Chairs are in place (by 10 June), the Chairs will be asked to appoint members of the new MHAC, in accordance with decisions 2-3 of the Waitemata DHB Board resolution 08 November 2017. A first meeting of MHAC will then be able to be scheduled.

b) The extension of the role of the Chief Advisor Tikanga for both Auckland and Waitemata DHBs to include Counties Manukau DHB should be placed on hold for the time-being until Counties Manukau DHB and Manawhenua signal they are ready for this extension.

c) Dr Bramley, as lead Chief Executive Officer for Maori health across the metro Auckland DHBs, will consult with Maori Health Advisory Committee (MHAC), once established, on a suitable process for the recruitment and appointment of a Director, Maori Health Services. Assuming MHAC favours a single Director of Maori Health Services across the metro Auckland DHBs, Dr Bramley will lead the appointment panel for the position and invite the other metro Auckland Chief Executives to join the panel, should they wish to do so.

d) As an interim measure, and recognising that the process contemplated in 3 (see the ‘comment’ section of the report) may take a number of months, Counties Manukau DHB should immediately move to fill its vacant position of General Manager Maori Health on a fixed term basis of 12-18 months.

e) A further update should be provided to all three metro Auckland DHB Boards once tangible progress has been made with steps 1-4 outlined in the ‘comment’ section of the report.

3. Note that, as provided by the New Zealand Public Health and Disability Act 2000, appointments to staff positions, as contemplated in Recommendation 2 (c) above, are the preserve of a Chief Executive not a Board or Board Committee

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4. Endorse the actions set out in Recommendation 2 above, subject to the Minister of Health first being advised of the intention to create a combined MHAC and the Boards of the metro Auckland DHBs considering any feedback that he may have.

Prepared by: Gwen Tepania-Palmer (Chair Auckland DHB and Lead Chair, Maori Health for the metro Auckland DHBs)

Purpose This paper provides an update on the implementation of decisions of the Boards of the Auckland, Counties Manukau and Waitemata DHBs (metro Auckland DHBs) in respect of the above subject on 1 November 2017, 6 December 2017 and 8 November 2017 respectively.

Background Late last year, the Boards of the metro Auckland DHBs considered proposals for changing governance, leadership and planning arrangements for Maori health across the metro Auckland DHBs. In separate meetings, the Boards of Auckland, Counties Manukau and Waitemata DHBs each:

Resolution of the Waitemata DHB Board 08 November 2017:

1. Agreed to the creation of a combined Maori Health Advisory Committee (MHAC) across the metro Auckland DHBs with the terms of reference set out in an attached paper.

2. Invited the Chairman of the metro Auckland DHBs, in consultation with the current Chairs of the Maori Health Advisory Committees, to make initial appointments to MHAC and designate its Chair.

3. Noted that, in respect of external appointments, the Chairman will first consult in accordance with memorandum of understanding (MoU) between the metro Auckland DHBs and Manawhenua or Maori organisations.

4. Invited MHAC to recommend to the Boards of the metro Auckland DHBs terms of reference for, and composition of, a Kaumatua Council to provide advice and guidance on efforts to improve health outcomes for Maori across metropolitan Auckland.

5. Invited Dr Dale Bramley, Chief Executive of Waitemata DHB, to assume a leadership role, including full managerial oversight and delegated authority, for Maori health for the metro Auckland DHBs.

6. Invited Dr Bramley to develop options for improving the leadership, management and planning of Maori health issues across the metro Auckland DHBs, including the:

a) creation of a single Maori health team across the metro Auckland DHBs, with one or more senior executive positions to lead and manage the team and clear definition of what functions should be regionalised as opposed to operated locally.

b) extension of the role of the Chief Advisor Tikanga for both Auckland and Waitemata DHBs to include Counties Manukau, subject to consultation with Manawhenua by Counties Manukau DHB.

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c) rationalisation of existing plans and approaches for Maori health across the metro Auckland DHBs.

d) alignment of processes across the metro Auckland DHBs for the review of research proposals from the perspective of Maori ethics and tikanga.

7. Noted that Dr Bramley will engage with MHAC on the proposed plan to give effect to the above

Recommendation and that he will also liaise with the Chief Executives of Auckland and Counties Manukau DHBs, as well as other stakeholders as appropriate, before finalising his proposed plan.

Comment Since these decisions were taken, a number of changes have occurred, the most significant of which has been the retirement of Dr Lester Levy as Chair of the metro Auckland DHBs and his replacement by separate Chairs for each DHB. Deputy Board Chairs have served or are serving as Chairs on an interim basis. New Chairs to lead the metro Auckland DHBs on an ongoing basis have recently been announced by the Minister of Health and either have or will shortly commence their terms. The effect of these changes has been to delay the formation of MHAC, the extension of the role of the Chief Advisor Tikanga for both Auckland and Waitemata DHBs to include Counties Manukau DHB and an appointments process for a Director of Maori Health Services to lead a single Maori health team across the metro Auckland DHBs. This delay has particularly affected Counties Manukau DHB which, unlike Auckland and Waitemata DHBs, has not already had a General Manager for Maori Health Services in place. The interim Chairs of Auckland and Waitemata DHBs, together with the Chief Executives of the metro Auckland DHBs, recently met to discuss best ways forward. Recognising the previous decisions taken the Boards of the metro Auckland DHBs, and the distinction between governance and management roles and responsibilities, as reflected in the New Zealand Public Health and Disability Act 2000, they agreed that: 1. As soon as all three new Board Chairs are in place (by 10 June), the Chairs will be asked to appoint

members of the new MHAC, in accordance with decisions 2-3 noted above. A first meeting of MHAC will then be able to be scheduled.

2. The extension of the role of the Chief Advisor Tikanga for both Auckland and Waitemata DHBs to

include Counties Manukau DHB should be placed on hold for the time-being until Counties Manukau DHB and Manawhenua signal they are ready for this extension.

3. Dr Bramley, as lead Chief Executive Officer for Maori health across the metro Auckland DHBs, will

consult with MHAC, once established, on a suitable process for the recruitment and appointment of a Director, Maori Health Services. Assuming MHAC favours a single Director of Maori Health Services across the metro Auckland DHBs, Dr Bramley will lead the appointment panel for the position and invite the other metro Auckland Chief Executives to join the panel, should they wish to do so.

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4. As an interim measure, and recognizing that the process contemplated in 3 above may take a

number of months, Counties Manukau DHB should immediately move to fill its vacant position of General Manager Maori Health on a fixed term basis of 12-18 months.

5. A further update should be provided to all three metro Auckland DHB Boards once tangible progress has been made with steps 1-4 above.

It is recommended that before proceeding to implement the above decisions, the Minister of Health be informed of the intention to create a combined MHAC and invited to give any feedback that he may have. Any such feedback would need to be considered by the Boards of the metro Auckland DHBs.

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4.2 2018/19 Annual Plan Approach

Recommendation:

That the Board:

a) Note the compressed timetable to deliver a first draft of the 2018/19 Annual Plan to the Ministry of Health by 16 July.

b) Approve the approach to annual planning for 2018/19 which will require a compressed process to develop and collate the first draft to be presented to the 11 July Board meeting to review and also to gain approval to submit to the Ministry of Health.

c) Approve delegation of any amendment or last minute changes to the Annual Plan, Statement of Performance Expectations and Statement of Intent be delegated to the Board Chair and the Chief Executive.

d) Note the recently released national planning guidance, including updates and changes a. The Ministry is exploring life course approaches to understand population

performance. b. Increased focus on equity. c. Additional priority sections: Public delivery of health services, Climate change,

Waste disposal, Budget 18 initiatives (once confirmed), Cross-government targets (once confirmed).

d. All of the Health Targets are under review and information as to which will continue in 2018/19 is still to be confirmed.

Prepared by: Wendy Bennett (Planning and Health Intelligence Manager) Endorsed by: Dr Karen Bartholomew (Director of Health Outcomes)

Glossary: SOI - Statement of Intent SPE - Statement of Performance Expectations


Community, whānau and patient centred model of care

Our Annual Plan demonstrates our commitment to our communities, patients and families through providing information on the priorities for the coming year and the associated activities to achieve these through improving health outcomes and enhancing patient experience.

Emphasis and investment on both treatment and keeping people healthy

Activities focused on both treatment and keeping people healthy are identified within the Annual Plan.

Intelligence and insight

A range of indicators associated with the services and activities the DHB leads or is involved in are captured in the SPE and the MoH’s reporting indicator section – along with targets for the coming year. Our Annual Plan demonstrates our commitment to achieving these.


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Operational and financial sustainability

The Financial section of the Annual Plan lays out in detail the budget for the coming financial year. The Annual Plan also contains a variety of operational measures and targets we have committed to which will help us understand if we are delivering value and operating sustainably.

2. Executive Summary DHBs are required to develop an Annual Plan each year, however, this year the Planning Advice and Funding Envelope have been significantly delayed. The Ministry of Health has only recently released the 2018/19 DHB Annual Planning Package, along with the Minister’s Letter of Expectations on 10 May 2018 – this is usually received in December of the preceding year. The Planning Package indicates some changes in terms of content for 2018/19.

A proposed approach and timeframes are included.

3. The Minister’s Letter of Expectations The Minister’s Letter of Expectations was released alongside the 2018/19 Annual Planning Package on 10 May 2018. The Government has committed to an $8 billion investment to meet cost pressures and deliver new initiatives over the next four years, signalling an increased focus on these priority areas:

1. Primary Care 2. Mental health 3. Public delivery of health services 4. Improving equity in health outcomes.

DHBs are expected to continue to focus on long term capital planning, including service planning and asset investment. DHB Chairs, Chief Executives and management will be held tightly accountable for lifting DHB performance, particularly in relation to equity of access to health services and equity of health outcomes. There is an expectation of strong regional accountability and responsibility where appropriate. The Ministry Advisory Group will work with the Ministry of Health to strengthen relationships across the health sector. Sharing of best practice innovation, clinical leadership and strong and proactive relationships with the Ministry, other DHBs and the wider sector are required to increase collaboration and improve equity of access, quality and health outcomes. An increased emphasis on workforce development, including:

Increased emphasis on the use of generalist workforces for less specialised tasks.

Allied health staff, nursing, medical and related fields need to operate at the top of their scope of practice.

Full implementation of Care Capacity Demand Management by 2021.

All DHBs to adhere to the Medical Council’s requirement for Community Based Attachments for interns.

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Other points to note:

From 2018/19 the full budget management responsibility for all remaining hospital medicines will move from DHBs to PHARMAC.

Expectation that DHBs continue working in partnership with the Ministry to improve data submission and quality for the National Patient Flow collection during 2018/19.

DHBs need to work towards increasing the rate of organ donations.

The annual plan needs to identify how the DHB will: o improve the health and wellbeing of infants, children and youth, with a particular

focus on Māori, Pacific and highly deprived. o reduce the burden of long term conditions, particularly diabetes, in partnership with

primary care. o implement a strong response to climate change.

4. Planning guidance – updates and changes The Ministry of Health released the 2018/19 DHB Annual Planning Package on 11 May 2018. While the package largely adheres to the format requirements established in 2017/18, there are some changes in content requirements. These include:

The Ministry is exploring life course approaches as a way of understanding DHB population performance challenges. Therefore, DHBs are expected to identify within their Annual Plan the most significant actions they expect to deliver in the 2018/19 year to address local population challenges for the following life course groupings:

o Pregnancy o Early years and childhood o Adolescence and young adulthood o Adulthood o Older people.

There is an increased emphasis on reflecting health equity in Annual Plans, though following last year’s format, to include at least one – specifically identified – equity action within each planning priority. There is again no requirement for a stand-alone Māori Health Plan.

All of the Health Targets are under review and information as to which will continue in 2018/19 is still to be confirmed.

The Minister is not requiring DHBs to refresh Statements of Intent in 2018/19. We have signalled to the Ministry that we will incorporate some minor updates.

Additional priority sections: Public delivery of health services, Climate change, Waste disposal, Budget 18 initiatives (once confirmed), Cross-government targets (once confirmed).

Priority sections that have changed: o Now a specific Child Health section, incorporating Child Wellbeing, Maternal Mental

Health Services, Supporting Health in Schools, School Based Health Services and Immunisation.

o Mental Health – removal of the Prime Minister’s Youth Mental Health Project. This section now incorporates Population Mental Health, Mental Health and Addictions Improvement Activities and Addictions.

o Primary Health Care section now incorporates Access and Integration, as well as CVD diabetes risk assessment. System Level Measures and Pharmacy Action Plan focus areas retained.

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Regional service plans will need to be focused on the following regional enablers:

Equitable Access and Outcomes

Child Health

Workforce

Technology and Digital Services

Quality

Clinical Leadership

Pathways

The regional priority is identified as Hepatitis C. Some of the guidance is still under development and health targets, some performance measures and targets are still to be released.

5. Proposed approach to Auckland Annual Planning The 2018/19 DHB Annual Planning Package has been disseminated to staff and other stakeholders. The Planning Team will work with authors/contributors to begin the process of developing and collating the required material to prepare the Annual Plan. New requirements, particularly around the increased emphasis on equity and the life course approach to population performance will be considered and format and content adapted and updated as appropriate. There appears to be quite limited scope for feedback within this planning round, given the very tight timeframes, but where necessary we will be providing some feedback to the Ministry of Health. Changes to the Operating Policy Framework and the Service Coverage Schedule for 2018/19 will be reviewed and those accountable informed. Liaison with Ministry as required. The Planning Team will engage other key stakeholders as required to ensure alignment with other Plans, current activity and existing collaborative work while undertaking the Annual Plan development. The timetable of key activities required to complete the plan is extensive and the Ministry of Health timeframes very tight. There will therefore be reduced opportunity for wider consultation on the content of the first draft of the Annual Plan.

6. Financial Information A separate paper will be submitted to the Audit and Finance Committee at its next meeting, outlining the 2018/19 Annual Planning approach for the development of the budgeting process, capital planning alongside a preliminary funding envelope analysis.

7. Sign Off Process and Timelines Draft 1 of the Annual Plan will be presented to the July Board for review and approval sought to submit to the Ministry of Health on 16 July 2018 as required. The final draft will be presented for consideration at September Board/Committee meetings, to be confirmed once final dates for

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submission are released by the Ministry of Health. Endorsement of the Annual Plan will also be sought at these critical stages from our MoU and other partners. The final Annual Plan will require the signatures of the following:

Board Chair

Deputy Chair

Chief Executive Officer

MoU Partners. As in past years, it is proposed that any amendment or last minute changes to the Annual Plan, Statement of Performance Expectations and Statement of Intent be delegated to the Board Chair and the Chief Executive Officer. This provision allows flexibility to accommodate late information and manage to legislated timelines. Regular oversight of the Annual Plan, the Statement of Performance Expectations and Statement of Intent while under development is the responsibility of the Director – Health Outcomes and the Director - Funding. Timeframe

Note this timetable focuses on the non-financial elements of the planning process and does not include the budgeting process deadlines and milestones. Dates for submission of the finalised Annual Plan (draft 2) have not yet been released by the Ministry of Health.

10 May Minister’s Letter of Expectations released

11 May 2018/19 Annual Planning Package released - MoH

18 May Funding Envelope advice due for release

June Annual Plan content development and review

29 June DHBs to provide the final Statement of Performance Expectations

2 July Submit final System Level Measure Improvement Plan

11 July* Waitemata DHB Board meeting to review and approval sought to submit to the Ministry of Health the Waitemata DHB 2018/19 Annual Plan – draft 1

16 July 2018/19 Annual Plans (including minor updates to Statements of Intent) and Northern Region Health Plan submitted to the Ministry of Health as a draft for review

31 July System Level Measure Improvement Plan approved

Week beginning 13 August

Ministry of Health provides informal feedback on draft Annual Plans

Week beginning

3 September

Ministry expects to facilitate formal feedback on DHBs draft Annual Plans, Regional Service Plans and, Public Health Unit Annual Plans.

September - TBC Board/Committee review of second draft and approval sought to submit to MoH

TBC Board-approved 2017/18 Annual Plans (including any updates to Statements of Intent) and Northern Region Health Plan submitted to the Ministry of Health

* extra time may be provided for full consideration and review of Annual Plan content

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8. Risks, Opportunities and Mitigations

Risk area Specifically Mitigation

Very tight timeframes may impact on quality of content

Ensuring the right balance of government and local priority setting will be challenging, within a restricted timeframe for development.

Early engagement with authors and contributors, assistance as required. Timely liaison with MoH.

Active leadership of priority area content development. Adequately engaging with a wide range of stakeholders.

While the restricted timeframes allow for limited scope for input from stakeholders, there is still an expectation for DHBs to engage with relevant stakeholders, including their primary care partners, when developing their 2018/19 Annual Plans.

Early advice to staff and regular communication that keeps everyone up to date with planning expectations for 2018/19 throughout the process.

Clear roles and responsibilities identified early in the process. Responsible authors identified at the start of the process.

Active support and facilitation of engagement opportunities.

9. Conclusion 2018/19 will present some challenges as we develop Annual Plans, update the Statements of Intent and Statements of Performance Expectations in line with the Ministry’s significant condensed timelines. Key to our success is gaining endorsement from the Board for the proposed planning process. We will also need to make sure content development is appropriately assigned and led and that key stakeholders are informed about the approach and, where practicable, have an opportunity to provide input into the planning process.

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4.3 Amendment to Official Information Act Policy – Charging

Recommendation:

That the Board:

a) Notes the Ombudsman’s decision in relation to complaints by the NZ Herald and the Wireless.

b) Approves the amendment of the sections of the Official Information Act policy dealing with charging for substantial collation or research and in particular, the deletion of the provision for charging if more than five hours collation or research.

Prepared by: Amanda Mark (General Counsel) and Matt Rogers (Director of Communications) Endorsed by: Dale Bramley (Chief Executive Officer) and Robert Paine (Chief Financial Officer and Head Corporate Services)

Glossary

OIA - Official Information Act 1982 Policy - Official Information Act Requests (General) policy

1. Executive Summary

Waitemata DHB’s Official Information Act Requests (General) policy (Policy) currently provides for the DHB to fix a charge for the release of information where a significant volume of information is requested and it appears that it will take more than 5 hours to collate the information. The Ombudsman has recently advised that our approach to charging where substantial collation or research is required does not fulfil the requirement that the decision to charge must be reasonable and take into account the public interest in the information. The Ombudsman recommends that we amend our Policy. The Policy has therefore been amended to align with the Ombudsman’s advice. Key amendments include:

The presumption of charging for more than five hours collation will be deleted

If substantial collation or research is required the following factors will be considered: - whether consulting with the requester would assist them to make the request in a form

which would not involve substantial collation or research and remove the need to refuse the request

- whether extending the time to respond to the request, would enable the DHB to respond - the reasonableness of charging - the public interest in the release of the information - the ability of the requester to pay a charge - whether the public interest means that the information should be provided at no charge

or a reduced charge will be considered

In some cases, the public interest in disclosure may mean that the DHB will be required to provide information without charge even where substantial collation or research is provided.

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Community, whānau and patient centred model of care

Amending the policy will ensure that the DHB position on charging for information is clear and complies with the Official Information Act 1982.


Amending the policy will ensure that staff dealing with Official Information Act requests are able to access appropriate guidance on the application of the Act.

Outward focus and flexible, service orientation

Amending the policy will also ensure that the expectations of individuals requesting information can be managed in accordance with the Official Information Act 1982.

3. Introduction Waitemata DHB’s Official Information Act Requests (General) policy (the Policy) currently provides (at paragraph 4.10) for the DHB to fix a charge for the release of information where a significant volume of information is requested and it appears that it will take more than 5 hours to collate the information. The current policy requires consideration to be given to the circumstances of the request including the ability of the requester to pay the charge and the public interest in the release of the information. In a recent decision, the Ombudsman criticised the charging provisions in the Policy and recommended that it be amended. The amended Policy requires consideration of the public interest in the information requested and the ability of the requester to pay a charge.

4. Approach

4.1 Charging

Section 15 of the Official Information Act 1982 (OIA) allows us to charge for supply of official information. 1 Charges must be reasonable and regard must be had to the cost of the labour and materials involved in making the information available and any costs incurred to a request for information to be provided urgently2. We may require the whole or part of a charge to be paid in advance.3 The relevant sections of the OIA are attached as Appendix A.

1 Section 15(1A) Official Information Act 1982

2 Section 15(2) Official Information Act 1982

3 Section 15(3) Official Information Act 1982

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4.2 Current policy on charging

The current policy on charging provides for Charges to be fixed if more than five hours work will be required to provide the information requested. The section from the policy is set out below.

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4.3 The Ombudsman’s recommendations on the charging provisions in the policy

The Ombudsman made a number of recommendations for amendment of the sections of the policy dealing with substantial collation or research and charging. The relevant section from the Ombudsman’s opinion is below:

A full copy of the Ombudsman’s opinion is attached as Appendix B. 4.4 Key amendments

As a result of the Ombudsman’s opinion, the sections of the policy dealing with charging (Section 4.10) and substantial collation or research (Section 4.13) have been amended to make it clear that:

charges must be reasonable

the public interest in release of the information must be considered

the means of the requester to pay the charge must also be considered. The amended policy requires staff to consider a series of questions before deciding that a fee should be charged for release of information. The questions are set out in section 4.10 of the amended policy.

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In summary, if substantial collation or research will be required to respond to a request, the DHB must ask:

would consultation with the requester assist them to make the request in a form which would remove the need to refuse the request? If yes, then consultation with the requester is required

if the consultation does not result in the request being reformulated in a manner which would avoid the need for substantial collation or research, then the request may be refused but any information that can reasonably be provided should be provided

if substantial collation or research is not required because the requester has reformulated the request, then is there a public interest in making the information available must be considered?

is a sufficient public interest in making the information available for the DHB to absorb the cost or reduce the fee?

if there is insufficient public interest for the DHB to absorb the cost or reduce the fee, is a charge reasonable in the circumstances?

Section 15 does not require consideration of public interest factors when making a decision to charge for the provision of official information. Guidance issued by the Ombudsman’s office indicates:

It is not generally reasonable to charge for complying with simple requests.

It may be reasonable to recover some of the costs if supplying information requires considerable labour and materials.

What amounts to “considerable labour and materials” will depend on the circumstances of the case including the resources available to respond to the request

It may be reasonable to charge if responding to a request will have a significant impact on our ability to carry out our other operations.

4.5 Substantial collation and research

Under section 18(f) requests may be refused if the information requested cannot be made available without substantial collation or research. Before a decision is made to refuse a request on the grounds that substantial collation or research will be required, we are required, under section 18A, to consider whether either fixing a charge or extending the time for providing a response would enable us to grant the request. The amended Policy is attached as Appendix C. 4.6 Amount of charges

Ombudsmen have generally accepted that the charges set out in the Ministry of Justice’s Charging Guidelines4are reasonable provided any circumstances warranting remission have been considered.5 The Ministry of Justice Charging Guidelines prescribe standard charges of:

$38 per half hour of staff time in excess of one hour

$0.20 per page for photocopying in excess of 20 pages.

4 Ministry of Justice, Charging Guidelines

5 Office of the Ombudsman Guide on Charging June 2017, page 7

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4.7 Circumstances warranting remission of charges

The guidance on charging issued by the Ombudsman states that the requirement in section 15 to set a “reasonable” charge requires consideration of any circumstances which might warrant reducing or cancelling charges.6 The Ombudsman’s Guideline on Charging7 suggests that remission may be warranted where:

charging would be likely cause hardship to the requester; or

there is a compelling public interest in making the information available.

5. Impact of changes

Since the introduction of the policy of charging where more than 5 hours collation or research is required, Waitemata DHB has not in fact charged any requestor and it has refused very few requests on the ground that substantial collation or research was required.

Generally, we have worked with requesters to refine their requests so that less collation is required. It is unlikely that the change to the policy will have a significant impact on requesters. The changes are however likely to increase the administrative burden associated with managing responses given the more complex decision-making process now required.

6. Conclusion

It is recommended that the Board approves the amendment of the Policy.

6 Supra, at note 5, page 8

7 Supra, at note 5, at page 8

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Management Communications

Official Information Act Requests (General)

Issued by Legal Advisor Issued Date July 2015 Classification 01001-07-004

Authorised by Chief Executive Review Period 36 months Page 1 of 21

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Contents

1. Overview ................................................................................................................................... 1

2. Key Information ........................................................................................................................ 1 2.1 What Is the Official Information Act? ..................................................................................... 1 2.2 What is Official Information? ................................................................................................. 2 2.3 Principle Of Availability .......................................................................................................... 2 2.4 What Is An Official Information Act Request?........................................................................ 2 2.5 Who Can Make An Official Information Act Request? ........................................................... 3 2.6 Duty Of Assistance.................................................................................................................. 3 2.7 Time Limit for responding to Requests .................................................................................. 3

3. Summary of Steps in Processing an OIA Request ..................................................................... 4 3.1 These steps should be undertaken in the next 12 days: ........................................................ 4

4. Process ...................................................................................................................................... 5 4.1 Register Request .................................................................................................................... 5 4.2 Copy Request to Chair and Minister’s Office ......................................................................... 5 4.3 Allocate To Appropriate Person To Process ........................................................................... 5 4.4 Confirm It Is An OIA Request .................................................................................................. 6 4.5 Consult Where Necessary ...................................................................................................... 6 4.6 Transfer Of A Request within 10 Working Days of Receipt .................................................... 6 4.7 Acknowledgement Letter ....................................................................................................... 6 4.8 Check whether Same Request Made to Other DHB’s ............................................................ 7 4.9 Clarify Scope And Content of The Request ............................................................................ 7 4.10 Charging For Release of Information...................................................................................... 7 4.11 Assessment of Request Against The Acts Criteria .................................................................. 9 4.12 Withholding Information ........................................................................................................ 9 4.13 Draft response ...................................................................................................................... 11 4.14 Prepare OIA Approval Sheet................................................................................................. 15 4.15 General/Group Manager Approval of Draft response ......................................................... 15 4.16 Legal Approval of Draft Response ........................................................................................ 15 4.17 Final response ...................................................................................................................... 16 4.18 Forward OIA request and documents to the Requester ...................................................... 16

5. Ombudsmen ........................................................................................................................... 16

6. Associated Documents ........................................................................................................... 17

7. Appendix One – Other reasons for withholding official information ..................................... 18

8. Appendix Two – OIA Approval Sheet...................................................................................... 19

9. Appendix Three – Process Map .............................................................................................. 20

1. Overview

This document sets out the expected process when dealing with an Official Information request,request; it applies to all services across WDHB. Waitemata District Health Board is subject to requests under the Official Information Act 1982. This policy provides guidance on how to address a request for official information.

2. Key Information

2.1 What Is the Official Information Act?

The Official Information Act (OIA) ensures that government activities are open and transparent and that official information is available to the people of NZ in order:

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to enable their more effective participation in the making and administration of laws and policies; and

to promote the accountability of Ministers and their officials. The OIA, however, recognises that not all official information should be made available and allows information to be withheld in certain specified circumstances. Waitemata District Health Board is subject to the OIA.

2.2 What is Official Information?

Official information is defined as any information held by a Department, Minister of the Crown or government organisation and includes any information held outside New Zealand by any branch or post of a Department or organisation. All information the DHB creates or holds or which is held on our behalf is official information. This includes paper and electronic records. Information covered by the OIA may be contained in: letters emails reports notes or minutes of meetings(formal or informal)/ interviews draft documents media logs mobile phone texts computers CD/ Disks information held by a contractor/ consultant doing work on our behalf recollections of meetings for which minutes were not taken information provided to the DHB by others oral advice

data from which information can be derived

2.3 Principle Of Availability

The OIA is based on the overriding principle that information must be made available unless there is good reason for withholding it. This is referred to as the principle of availability. All decisions on whether to release information must be made with this overriding principle in mind.

2.4 What Is An Official Information Act Request?

A request can be made orally or in writing. It is not necessary for the request to state that it is made under the OIA. Where the original request is made orally, the requesteor may be asked to put the request in writing, if written clarification is reasonably necessary. If the person declines to do so or is unable to, the agency must record its understanding of the request and provide a copy to the requesteor. Requesteors do not need to mention the OIA in their request. It is enough for an individual simply to ask for information. The official information requested should be specified with sufficient particularity that it is clear what information is being sought.

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2.5 Who Can Make An Official Information Act Request?

An official information request can be made by: a New Zealand citizen (whether in NZ or not) a New Zealand permanent resident (whether in NZ or not) any other person who is actually in New Zealand any body corporate (e.g. a company or a trust or incorporated society) that is incorporated in NZ

or that has a place of business in NZ. If a person making a request does not fall within any of these categories then they are not entitled to make a request under the OIA and the DHB has no obligation to provide information under the OIA. Such requests should always be acknowledged and consideration should be given to whether the information should be released or the request addressed in some other way.

2.6 Duty Of Assistance

Under section 13 of the Act the DHB has a duty to give reasonable assistance to anyone who: • is entitled to make a request under the OIA; and • wants to make a request under the OIA; and • has failed to make a request with “due particularity”; or • has not made a request to the appropriate agency. The “due particularity” provision requires the DHB to clarify a request which is unclear or appears too general/broad in scope, rather than simply refusing the request or trying to guess what the request is seeking. Requesters should be asked to confirm any conversation clarifying the request in writing, or written confirmation should be provided to them so the request is not misunderstood.

2.7 Time Limit for responding to Requests

A response must be provided as soon as reasonably practicable and no later than 20 working days. Time runs from the first working day after the day on which the request was received. If a request has been transferred from another agency the 20 working days runs from the day after the request was received from that agency. A failure to make and communicate a decision on a request for official information as soon as reasonably practicable will be deemed a refusal of the request, and may be investigated by the Ombudsman.

Extensions of Time Limit

The time limit may be extended for a reasonable period if:

(a) the request is for a large quantity of information or necessitates a search through a large quantity of information and meeting the original time limit would unreasonably interfere with Waitemata District Health Board’s operations; or

(b) consultation is necessary to make a decision on the request are such that a proper response to the request cannot reasonably be made within the original time limit.

The requester must be notified, within the 20 working day period, that an extension of time is necessary. The notification must advise the requester of:

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the date by which a response will be provided the reasons for the extension their right to complain to an Ombudsman about the extension any other necessary information

Urgent requests

If the request is urgent the requester must provide supporting reasons for the urgency. Those reasons need to be assessed on a case by case basis remembering that the obligation is to answer the request as soon as reasonably practicable

OIA Requests Are A Priority

OIA requests must be given priority to ensure that the time limits specified in the OIA are met.

Media Requests

Generally media requests for information should be dealt with quickly but requests should be discussed with the Communications Manager if:

a significant quantity of information is requested

analysis of a substantial quantity of information is required

the request is one of a number received in quick succession seeking information on a single topic

and a decision made as to whether the request should be treated as an OIA request and processed in accordance with this policy.

3. Summary of Steps in Processing an OIA Request

These steps should be undertaken in the first three days of receiving an Official Information request:

registration of request with Communications Director

notification to Chair and Minister Ministry of Health’s Office by Communications Director or delegate

allocation to appropriate person to process

decision made as to whether substantial collation or research is required and whether requester should be charged

acknowledgement of request in writing within 3 working days

assessment of whether request falls within Official Information Act request

consultation where necessary

transfer of request where appropriate

check if request made to other DHB’s

engagement with requester to clarify scope or content if necessary

assessment of timing requirements - is an extension of time necessary?

where appropriate advise requester of need to extend time

3.1 Consider charging and advise requester in the first 3 days:

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If substantial research and collation is required to respond to an OIA and it is necessary to charge for providing the information, the requester must be notified within the first three days of receiving the request. Note that if we do not advise the requester that we intend to charge for providing the information within the first three days, we cannot charge. See section 4.10 below for more information about charging.

3.23.1 These steps should be undertaken in the first 12

days:

collection of all relevant information

assessment of whether any information may be withheld

consultation where appropriate to clarify scope of request or to assist requester to reformulate request so that charging not required

confirmation of charge to requester if charging because substantial collation or research required. (See sections 4.10 and 4.13 for more detail).

drafting of response

obtain legal review

finalisation of response

ensure copy of response forwarded to Chair via Chair’s personal assistant

response forwarded to GM/Group Manager for signing and sending to Communications Director

response forwarded to Chief Executive Officer, Board Secretary and Ministry Minister of Health’s Office by Communications Director

response saved to Official Information Act Request folder in G drive

4. Process

4.1 Register Request

All OIA requests must be sent directly to the Director of Communications where they will be recorded in the OIA register. Individual services within the DHB may also have their own OIA database. Check and, if required, record the request in that database also.

4.2 Copy Request to Chair and Minister’s OfficeMinistry of Health

Director of Communications (or delegate) to forward copy of request to Chief Executive Officer, Chair Board Secretary and Minister of Health’s OfficeMinistry of Health

4.3 Allocate To Appropriate Person to Process

Once the request has been registered, an appropriate person(s) to respond to the request should be identified.

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4.4 Confirm It Is an OIA Request

When a request is received, it is necessary to assess whether the request is an official information request or a privacy request. The difference is important as different rules will apply: • the OIA deals only with requests for official information • the Privacy Act deals with requests for personal information about any natural person, other

than a deceased natural person. An OIA request can be made in relation to personal information where the request is for information about a decision made about a person. If the request is a privacy request, it should be dealt with in accordance with the relevant WDHB Health Information/Privacy policy.

4.5 Consult Where Necessary

If there is uncertainty about the request or the process for responding to it, staff should consult with their manager, the Director of Communications or one of the DHB legal advisors.

4.6 Transfer Of A Request within 10 Working Days of Receipt

Consider whether the request, or part of the request, should be transferred to another agency. Section 14 of the Act provides that requests (or parts of requests) may be transferred where the information requested is either: not held by the DHB but is believed to be held by another Minister, government agency, local

authority or organisation; or believed by the person dealing with the request to be more closely connected with the

functions of another Minister, government agency or local authority or organisation. This provision, together with the duty of assistance means the DHB should always transfer requests (or parts of requests) where the information is believed to be held by, or more closely connected to the functions of, another government agency. A letter advising that the request has been transferred must be sent to the requester and the relevant agency. The decision to transfer a request (or part thereof) should be made, where possible, within three working days of receipt of the request and in all cases, within 10 working days. Where a request is transferred to another agency, the DHB’s responsibilities in respect of the request will generally cease.

4.7 Acknowledgement Letter

A brief letter acknowledging receipt of a request must be sent to the requester within 3 working days of receipt of the request. This is also an opportunity to :

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advise of any decision to transfer the request to another agency advise that it will be necessary to charge for the provision of the information and seek

confirmation the requester is willing to incur those charges clarify a request which is unclear or too general.

4.8 Check whether Same Request Made to Other DHB’s

Sometimes the nature of the request will suggest that it might be a standard request made to more than one DHB and a national response may be required. It is important in such cases to ensure that answers are coordinated and consistent, where that is appropriate. Consultation with relevant staff within the DHB or other DHBs or support agencies should be undertaken to see if there are similar requests. Likewise if a number of similar or related requests have been received by the DHB, one coordinated response may be given with one staff/ manager taking lead responsibility

4.9 Clarify Scope And Content of The Request

Ensure the scope and content of the request is understood. If the request is unclear or too general/broad it should be clarified with the requester. The requester may need assistance to determine exactly what official information they are seeking. Consultation with a requesteor will often result in an amended or clarified request. An amended or clarified request will be treated as a new request replacing the original request except:

Where the amendment or clarification was sought by the agency; and

The agency did not seek that amendment or clarification within 7 working days of receiving the original request.

4.10 Charging For Release of Information

The Act allows the DHB to fix a charge for the release of official information. Any charge must be reasonable having regard to the cost of labour and materials involved in making the information available, the public interest in the information being made available and the means of the requester to pay a charge. Costs incurred in order to provide information requested urgently can also be recovered. The issues set out below must be considered in order before deciding to charge are:

1. Are there any administrative difficulties in providing information requested e.g. need for

substantial collation and research?

2. If substantial collation or research is required, would consulting with the requester assist

requester to make the request in a form which would remove the need to refuse the

request? If yes, then consultation with the requester is required.

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3. If consultation with the requester does not result in the requester making the request in a

way which would avoid the need for substantial collation or research, then the request may

be refused under section 18(f) of the Act but any information that can reasonably be

provided should be provided.

4. If substantial collation or research not required (either because the request as originally

made does not require this or because discussions with the requester have resulted in the

request being made in a form which does not require substantial collation or research) ,

collate the information and the consider whether

a) any of the withholding grounds in s9 apply and

b) the public interest in making info available greater than need to protect interest

protected by a withholding ground?

5 If there is no good reason to refuse request, is charging reasonable in the

circumstances?

6 Is there sufficient public interest in making the information available that the agency

should absorb or reduce the cost of providing it? If yes, then do not charge. Note: it

may be necessary to ask the requester to comment on the public interest in making the

information available. If the requester is asked to comment but refuses to do so, the

question of public interest should be considered based on what the DHB knows about

the information.

7 If there is insufficient public interest in the information to warrant the DHB making it

available without charge or at a reduced charge and no other reason warranting waiver

or reduction of the charge, only then consider what would be a reasonable charge in the

circumstances of the particular request. Calculate how many hours’ work is likely to be

required and seek the requester’s agreement to pay the costs before proceeding to

collate the information.

Where it is clear a request will take more than five hours, consideration will be given to charging the person or organisation requesting the information. In deciding whether to chargecharging is reasonable in the circumstances, each request must be considered individually on its merits and all the circumstances relevant to the request must be consideredtaken into account, including:

theany public interest in the release of the information being made available either free of charge or at a reduced charge.

the ability of the requestorrequester to pay the charge.,

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When considering the public interest in the information being made available:

the requester must be advised that the DHB is considering charging for the information and asked to clarify what they see as the public interest

if the requester is not willing to clarify what they see as the public interest in the information, then the public interest should be assessed without the requester’s input and on the basis of what is known to the DHB about the issue the request appears to relate to

and the public interest in the release of the information.

Payment of all or part of the charges will be required in advance. . Although charging will be considered if more than 5 hours of work are likely to be required to collate information The amount to be charged each case will be considered set individually on its merits. No charge may be made for time spent deciding whether or not to release the information., and what extent to release. A decision to charge requires approval from the relevant Group Manager or General Manager and the Chief Financial Officer/Head of Corporate Affairs must be informed when charges are proposed so that he may consider whether, in the circumstances of the particular case, , the charges or the the charges or the requirement to pay in advance should be waived, in whole or in part. A decision to charge must be notified to the requester within 3 working days of receiving the request. The requester’s confirmation that they are willing to pay the charge must be obtained before proceeding to collate the information requested. Collection of information can only be charged for where if the DHB has decided to release information because the legal authority to charge under the OIA is limited to actual and reasonable costs of making information available. If required refer to the Director Communications or one of the DHB’s Legal Advisors for the rates charged.

4.11 Assessment of Request against the Act’s Criteria

The OIA’s focus is on availability of and access to information, but the need for protection of information in the public interest or for privacy reasons is also recognised. Staff handling a request should approach all requests on the presumption that information will be released unless one of the grounds for withholding information specified in the OIA applies.

4.12 Withholding Information

Consideration should be given to whether there are grounds to withhold information at an early stage. Information may only be withheld if one of the withholding grounds specified in the OIA is satisfied.

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Good reason for withholding information will exist in the circumstances specified in section 9 unless the withholding of that information is outweighed by other considerations which make it desirable in the public interest to make the information available. The full text of section 9 is set out in Appendix One. However the grounds on which WDHB is most likely to have justification to withhold information are the following:

(a) Protection of the privacy of natural persons, including that of deceased natural persons; or

(b) Protection information where the making available of the information—

(i) Would disclose a trade secret; or

(ii) Would be likely unreasonably to prejudice the commercial position of the person who supplied or who is the subject of the information; or]

(ba) Protection information which is subject to an obligation of confidence or which any person has been or could be compelled to provide under the authority of any enactment, where the making available of the information—

(i) Would be likely to prejudice the supply of similar information, or information from the same source, and it is in the public interest that such information should continue to be supplied; or

(ii) Would be likely otherwise to damage the public interest;

(g) Maintenance of the effective conduct of public affairs through—

(i) The free and frank expression of opinions by or between or to Ministers of the Crown [or members of an organisation] or officers and employees of any Department or organisation in the course of their duty; or

(ii) The protection of such Ministers, members of organisations, officers, and employees from improper pressure or harassment; or

(h) Maintenance of legal professional privilege; or

(i) Enabling a Minister of the Crown or any Department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities; or]

(j) Enabling a Minister of the Crown or any Department or organisation holding the information to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations); or

(k) Prevention of the disclosure or use of official information for improper gain or improper advantage.

(l) If the document alleged to contain the information does not exist, or, despite reasonable efforts to locate it cannot be found.

The focus should be on the information, not the form in which the information is held. In some cases, part of a document may be withheld and part provided.

Legal advice must be sought whenever it is proposed to withhold information.

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4.13 Refusing Requests – Section 18

Requests may be refused only on the grounds set out in section 18 of the Act. Refusal should always be a last resort. The most commonly relied on grounds for refusing are:

The information is or soon will be publicly available

The information does not exist or cannot be found after reasonable efforts to locate it

The information is not held by Waitemata DHB

The information cannot be made available without substantial collation or research. The information is publicly available -available - s18(d) If the information requested is or soon will be publicly available, a request may be refused. The decision to refuse must be reasonable in all the circumstances. Relevant considerations in deciding whether to refuse a request for information that is available include:

Whether the information is accessible to the particular requester. For instance information on the internet will not be accessible to a requester who is known to lack internet access; information held by Archives NZ may not be accessible to someone who cannot travel to inspect it.

Whether it would be administratively burdensome for the DHB to provide the information. If it would take very little effort to provide the information, we should provide it even though it may be publicly available

Information will be publicly available if it is available:

Freely on the internet For purchase In a public library For public inspection e.g. held by Archives NZ

If information is publicly available, we should direct the requester as to where and how the information may be obtained.

Information will soon be publicly available Relevant considerations in deciding whether to refuse a request for information that is soon to be publicly available include:

Whether, on an objective assessment, the requester requires the information before the planned publication date. If there is a legitimate reason for urgency, it may be unreasonable to require the requestorrequester to wait for publication.

Whether there is any reason why the information cannot be made available sooner. If there is no reason why the information couldn’t be made available sooner, it should be released.

Whether there is still work to be done before publication ege.g. quality –assurance, consultation, approval processes. In this case a delay is more likely to be reasonable as long as it is not unreasonably long.

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What amounts to “soon” must be considered on a case by case basis. For example a lengthy and detailed report which has taken more than a year to write and is likely to be published in 3 or 4 months, could be fall within the “soon” to be publicly available class whereas a short report which is likely to be available in 3 months would not. To refuse a request on this ground, there should be some certainty about when the information will be available publicly. The requester should be advised of the date of release or given an explanation of why it is difficult to meet the request immediately. If there is a plan to publish information publicly soon, we should be reasonably certain that the information will be published in the near future to justify refusal. Note that the Ombudsman has indicated that as a general rule of thumb release more than 8 weeks after refusal is unlikely to be considered “soon”. We should advise the requestorrequester of the date or approximate date by which the information will be published if refusing a request on the grounds that the information will soon be publicly available. The information does not exist or cannot be found after reasonable efforts to locate it A request can be refused if the information does not exist. This ground can only be relied on when a particular document has been requested .requested. If that document does not exist orexist or cannot be found after a reasonable search, the request can be refused. The information is not held by Waitemata DHB If Waitemata DHB does not hold the information, it must consider whether:

the information is held by another government agency or local authority

thethe information requested is connected more closely with the functions of another or government agency or local authority.

If neither are is true, the request can be refused. If however, Waitemata DHB does believe that the information is held by, or more closely connected to the functions of, another government agency or local authority, the request must be transferred to that agency or local authority. The information cannot be made available without substantial collation or research – section 18(f) Research means finding the information and collation means bringing it together. The terms encompass:

identifying the requested information

determining whether the requested information is held

searching for the requested information

retrieving or extracting the requested information

assembling or compiling the requested information Collation and research are considered ‘substantial’ if they would have a significant and unreasonable impact on the DHB’s ability to carry out its other operations.

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Multiple requests received simultaneously or in quick succession from the same requester about the same or similar subject matter may be combined for the purposes of considering whether a request may be refused on the grounds of substantial collation. If substantial collation or research is required to make the information available a request can be refused under section 18(f). This ground for refusal should only be relied on as a last resort. Before refusing a request on this ground, consideration must be given to whether :

consulting with the requester would assist him/her to make the request in a form which would remove the need to refuse the request on grounds of substantial collation or research.

charging the requester for the supply of the information would enable the DHB to provide the information. See paragraph 4.10 for information about charging.

extending the timeframe for responding to the request would enable the DHB to provide the information.

Consideration must also be given to whether there are other ways of providing the information requested which would not be so burdensome before a request is refused. The requesteor should be consulted with to see whether other the information could be provided in ways which would reduce the burden for the DHB. Substantial collation can be relied on to refuse a request if:

searching for the information, reviewing and assembling it for release would have a significant and unreasonable impact on the DHB’s ability to carry on its other operations.

Consultations with the requester have not resulted in the requester amending the request in a way which removes the need for significant collation or research

Charging would not make it possible for the DHB to provide the information

Extending the timeframe for responding would not enable the DHB to provide the information.

Note: charging will not assist if:

The work needs to be done by a specific person with expert knowledge whose diversion from core business would have a substantial and unreasonable impact on the agency’s other operations

The requester is not willing or able to pay a charge, or a charge of the magnitude that is likely to be required. The requester should always be asked about their willingness or ability to pay the charge in order to receive the information.

The following factors should be considered:

How much? How much information has been requested? How much information must be gone through to find what has been requested? NB: to answer these questions, you will need to scope the request properly so that you are clear about what information has been requested.

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How long? How long will it take to find the information and collect it together? You may need to carry out a sample exercise to determine how long it will take to collect the information. As a minimum you should estimate how long it will take.

Who will collect the information?

What resources are available to collect the information? Do particular people need to collect the information because of its complexity or because of their familiarity with the information?

What’s the impact? How would diversion of resources to collect the information impact oaffectn the DHB’s ability to carry out its other activities? Consider in conjunction with Communications:

the resources available to process OIA requests the number of other OIA requests the DHB has to respond to the number of people capable of collecting the information the other responsibilities these people hold.

Has the requester been asked whether they are willing to amend their request in a way which avoids the need for substantial collation and research.

Advise the requester that substantial collation and research will be required to respond to their request and it may be necessary to charge. Indicate what information could be provided with less effort and without a charge. Give the requester the opportunity to amend their request in a way which avoids the need for substantial collation and research. Examples of amendments include requesting a subset of the information, reducing the number of years for which information is requested, specifying information held by particular people or services, specifying the particular type of information.

Would extending the timeframe for responding to the request enable the DHB to provide the information?

Would it assist if the DHB had more time to collate or research the information? Note that any extension of time must be reasonable in the circumstances of the request. If the requester requests the information urgently and there are reasonable grounds for urgency, extending the time for responding may not assist

Would providing the information in a different format enable the DHB to provide the information?

Consider whether providing the information in a summary, spreadsheet or other format would assist with the task of collating the information.

Would charging enable the DHB to provide the information?

Consider charging. Refer to section 4.10 for criteria for charging.

Time spent :spent:

deciding whether to withhold or release the information must not be considered as time spent collecting information

drafting covering letters to go out with information obtaining internal sign off

cannot be considered taken into account when considering whether responding to a request requires substantial research or collation.

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If it is thought that substantial research or collation may be required to respond to a request consideration must be given to:

whetherto whether extending the time for responding or charging for the information would enable the DHB to provide the information

consultation with the requester to assist them to make their request in a way which will not require substantial research or collation

Possible solutions may include:

releasing a subset or sample of the information requested releasing other information which is readily accessible releasing the information in an alternative form releasing the information on conditions ege.g. confidentiality helping the requester to refine the request by limiting the search terms, the period

covererdcovered by the request, the type of document or the author providing information about what information the DHB holds andholds and in what format.

For more information refer to the Ombudsman’s Guideline onf Substantial Collation or Research at www.ombudsman.parliament.nz

4.14 Draft response

A response to the request should be drafted. The response must:

answer the questions asked or provides the information requested

note any information which has been withheld and the grounds on which it has been held

4.15 Prepare OIA Approval Sheet

The OIA Approval Sheet which appears at Appendix Two must be prepared. The Background and Issues sections must be fully completed.

4.16 General/Group Manager Approval of Draft response

The draft response and OIA Approval Sheet must be provided to General/Group Manager’s for approval. The General/Group Manager’s sign off on the OIA Approval Sheet of draft response must be obtained.

4.17 Legal Approval of Draft Response

The draft response must be approved by a DHB legal advisor. The following must be forwarded to Legal:

draft response

OIA Approval Sheet

copies of all documents to be released with any information to be withheld tagged

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http://www.ombudsman.parliament.nz/






an explanation of the reasons for withholding information

Obtain Legal Advisor’s sign off on OIA Approval Sheet of draft response Legal Advisor to indicate on OIA Approval Sheet whether final response should be sent to Minister’s Officer.

4.18 Final response

The response should then be finalised and:

Copy to Chair

copied to the Chair via the Chair’s personal assistant at least one day before being sent to CEO forwarded withforwarded with OIA Approval Sheet to the CEO at least five working days

before expiry of time limit for response.

CEO sign off

Once the CEO has signed the response a scanned copy must be forwarded to the Director of Communications who will: save the response in the Official Information Act Requests folder in G drive forward the response to the Minister’s Office where this has been approved by Legal. The person responsible for the response must also: register the response on service database if required keep a hard copy of the request, the response, the OIA Approval Sheet and copies of

information released and withheld.

4.19 Forward OIA request and documents to the Requesteor

5. Ombudsmen

Review by Ombudsmen Note that requesters have the right to complain to the Ombudsmen about: any refusal to release official information (which may also arise where a response is perceived

by the requester as incomplete) the fact, and amount, of any charge for releasing official information a decision to extend the time available for responding to a request, including the length of the

extension a failure to comply with time limits, which is deemed to be a refusal to release a decision to impose conditions on the use, communication, or publication of information

made available under the Act the form in which information has been released to the requester i.e. if we have not provided

the information in the manner requested (bearing in mind that information may be made available in electronic form, or by electronic means, such as email).

a refusal to release official information because the information cannot be found or is not held.

The Ombudsman may notify the Chief Archivist of refusals on certain administrative grounds, such as:

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the information does not exist or cannot be found;

the information cannot be made available without substantial collation or research;

the information is not held. The DHB is obliged to advise requesters of their right to complain to the Ombudsmen if not satisfied with the DHB’s response.

6. Associated Documents

Legislation Official Information Act 1982 Privacy Act 1993 Health Information Privacy Code

Policy Health Information/ Privacy -3rd Party Requests Official Information Act- OIA requests Planning and Funding

Guidelines Ombudsmen Guide- How the Official Information Legislation Works

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7. Appendix One – Other reasons for withholding official information

Other reasons for withholding official information

(1) Where this section applies, good reason for withholding official information exists, for the purpose of section 5 of this Act, unless, in the circumstances of the particular case, the withholding of that information is outweighed by other considerations which render it desirable, in the public interest, to make that information available.

(2) Subject to sections 6, 7, 10, and 18 of this Act, this section applies if, and only if, the withholding of the information is necessary to—

(a) Protect the privacy of natural persons, including that of deceased natural persons; or

(b) Protect information where the making available of the information -

(i) Would disclose a trade secret; or

(ii) Would be likely unreasonably to prejudice the commercial position of the person who supplied or who is the subject of the information; or

(ba) Protect information which is subject to an obligation of confidence or which any person has been or could be compelled to provide under the authority of any enactment, where the making available of the information—

(i) Would be likely to prejudice the supply of similar information, or information from the same source, and it is in the public interest that such information should continue to be supplied; or

(ii) Would be likely otherwise to damage the public interest; or

(c) Avoid prejudice to measures protecting the health or safety of members of the public; or

(d) Avoid prejudice to the substantial economic interests of New Zealand; or

(e) Avoid prejudice to measures that prevent or mitigate material loss to members of the public; or

(f) Maintain the constitutional conventions for the time being which protect -

(i) The confidentiality of communications by or with the Sovereign or her representative;

(ii) Collective and individual ministerial responsibility;

(iii) The political neutrality of officials;

(iv) The confidentiality of advice tendered by Ministers of the Crown and officials; or

(g) Maintain the effective conduct of public affairs through -

(i) The free and frank expression of opinions by or between or to Ministers of the Crown or members of an organisation or officers and employees of any Department or organisation in the course of their duty; or

(ii) The protection of such Ministers, members of organisations, officers, and employees from improper pressure or harassment; or

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(h) Maintain legal professional privilege; or

(i) Enable a Minister of the Crown or any Department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities; or

(j) Enable a Minister of the Crown or any Department or organisation holding the information to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations); or

(k) Prevent the disclosure or use of official information for improper gain or improper advantage.

8. Appendix Two – OIA Approval Sheet

DETAILS

Date:

Responsible Person Name: Position:

Date Response Due (20 working days after receipt)

BACKGROUND: provide a brief background and attach copies of all relevant information. (Tag documents or highlight sections which are to be withheld)

ISSUES: outline any specific issues to be considered, including whether there are grounds to withhold information and any other areas of concern:

SIGN OFF

Signature Date

General Manager/ Group Manager:

Legal: Response to be forwarded to Minister’s Office: Yes/No

Copied to WDHB Board’s Chair by Chair’s PA:

Copied to Communications Director: (once final approval given )

CEO (once all of above complete):

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Management Health Information





9. Appendix Three – Process Map

Receiver Director Comms Appropriate Person to Process

OIA

Request

1. Allocate to appropriate person for processing

2. Forward to Director Comms to register

3. Register in own service database if required

Copy to Chair & CEO

1. Request extension of time if required 2. Transfer of Request if required

Acknowledgement

Letter

Record in OIA Register

Same Request for other DHBs?

Continue OIA Process

(cntd…)

Coordinated approach required?

RequestorRequester

(Pg 1)

Confirm OIA request?

No

1. Advise Requesteor

2. Take appropriate action

Unsure

Yes

Clarify scope / content: 1. Internally 2. Letter to Requesteor

OIA confirmed?

Yes

No Yes

Identify Lead Person

No

Yes

First 3 working

days End Process

if Transfer required

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Management Health Information





Receiver Director Comms Appropriate Person to Process

Prepare OIA Response: 1. Assemble OIA documents 2. Draft Response and identify documents to be withheld

(if grounds for withholding) 3. Assemble OIA Response and tag documents to be

withheld (if required)

Approved by CEO?

RequestorRequester

(Pg 2)

OIA Response to RequestorRe

quester

Yes

No

Next 12 working days

Charge Required?

No

Yes

Advise Requestoer. Confirm to proceed.

Obtain Approval: 1. Complete OIA Approval Sheet 2. Refer to General / Group Manager for approval 3. Refer to DHB Legal Advisor for approval

Obtain Sign-Off: 1. Finalise Response for sign-off 2. Copy to Chair (through PA) at least 1 working day

before sending to CEO 3. Send to CEO for sign-off at least 5 working days

before expiry time limit

Copies of OIA Response: 1. Keep copy of Request, Response, documents sent and

documents withheld 2. Send scanned copy of Response to Director of Comms 3. Note in service database if required

Save copy in G:/ OIA folder

Send copy to Minister of

Health Office

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4.4 Appointment of Catherine Abel-Pattinson to healthAlliance NZ Limited Board

Recommendation:

That the Board:

a) Note that Lee Mathias’ term as the Counties Manukau DHB Chair concluded in December 2016.

b) Note that Counties Manukau DHB has proposed that Catherine Abel-Pattinson, Counties Manukau DHB Board Member be appointed as a Director of healthAlliance NZ Ltd, to replace Lee Mathias.

c) Approve the appointment of Catherine Abel-Pattinson, Counties Manukau DHB Board Member, as a director of healthAlliance NZ Ltd.

Prepared by: Mark Gosche (Counties Manukau DHB Board Chairman)


The Board is asked to approve the appointment of Catherine Abel-Pattinson, Counties Manukau DHB Board Member as a Director of healthAlliance NZ Limited.

2. Background

Following the conclusion of Lee Mathias’ term as Counties Manukau DHB Board Chair, Counties Manukau DHB is now proposing that Catherine Abel-Pattinson, Counties Manukau DHB Board Member be appointed to replace Lee Mathias as a Director of healthAlliance NZ Ltd. The Constitution of healthAlliance NZ Limited and the Shareholder’s Agreement provides that all shareholder’s appoint Directors.

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5.1 Financial Performance March 2018

Recommendation:

That the Board note the content of this report

Prepared by: Simon Watts (Deputy Chief Financial Officer) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary IDF - Inter District Flow NGO - Non Government Organisation YTD - Year To Date

1. Executive Summary The March 2018 YTD result for the DHB is a surplus of $1.391m, against a budgeted surplus of $1.745m, and therefore is $356k adverse to budget. This adverse variance is slowly reducing, and additional efforts, as outlined in previous meetings, are underway to close this shortfall completely by year end. The DHB result for the month of March 2018 was a deficit of $599k which was $195k favourable to budget. The Provider made a deficit of $2.147m, against a budgeted deficit of $1.377m, and therefore was unfavourable to budget by $771k. The Governance and Funding Administration Arm made a surplus of $127k and the Funder made a surplus of $1.421m, both against a breakeven budget. The Provider Arm YTD result primarily reflects unbudgeted expenditure in non-personnel costs, unrealised expenditure reduction initiatives, and an increase over budgeted growth in acute demand. Non-personnel expenditure consisted of outsourced services and labour (to cover budgeted vacancies), increased clinical supplies (volume demand and pricing) and utility costs. Within the Provider Arm, an actively managed Financial Sustainability Portfolio is being executed. Capital expenditure for the nine months ending March 2018 was $15.517m with a year-end forecast of $26m, against the $30m approved budget. The financial position as at 31 March 2018 indicates a net worth of $615.607m including $46.987m in cash.

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2. Financial Performance - March 2018 The financial result for the DHB for the month ended March 2018 compared to the budget is summarised in the following table:

Comment on Major Variances for the month of March 2018

Revenue Revenue was $955k favourable to budget due primarily to revenue from MoH and IDF. Expenditure Personnel ($1.128m favourable) The favourable variance was driven by vacancies across all service areas.

Other Expenditure ($1.888m unfavourable) The unfavourable variance was driven by unbudgeted expenses and unrealised expenditure reduction initiatives, as follows: Outsourced Services ($726k unfavourable) The unfavourable variance was due to unbudgeted outsourced radiology, gastroscopy and colonoscopy services. These procedures continue to be outsourced to meet MoH targets and population demand. Clinical Supplies ($53k unfavourable) The unfavourable variance was driven by unbudgeted costs for clinical supplies, inpatient pharmaceuticals and unbudgeted repairs and maintenance. Infrastructure & Non-Clinical Supplies ($1.408m unfavourable) The unfavourable variance was driven by unrealised expenditure reduction initiatives. Funder Provider Payments ($299k favourable) Funder Provider payments for March were $299k favourable against budget for the month and $9.234m favourable against budget for the YTD. Funder Provider payments as reported in the Consolidated Statement of Financial Performance represents all Funder expenditure to third party providers and includes payments to NGO Providers as well as payments to other DHBs through IDF expenditure.

($000's)

Actual Budget Variance Actual Budget Variance Budget

REVENUE

Crown 140,892 140,301 591 1,265,694 1,262,460 3,235 1,683,292

Other 3,216 2,852 364 23,701 22,961 741 32,579

Total Revenue 144,108 143,153 955 1,289,396 1,285,420 3,975 1,715,872

EXPENDITURE

Personnel

- Medical 14,507 15,449 942 133,769 136,139 2,370 183,419

- Nursing 20,086 20,171 85 179,222 179,561 338 239,775

- Allied Health 9,985 9,947 (38) 84,355 87,470 3,115 117,043

- Support 1,569 1,630 60 14,221 14,731 510 19,785

- Management / Administration 6,297 6,375 78 57,072 57,443 372 77,360

52,444 53,573 1,128 468,639 475,344 6,705 637,382

Other expenditure

Outsourced Services 6,437 5,710 (726) 55,914 51,258 (4,656) 68,253

Clinical Supplies 10,171 10,118 (53) 92,172 86,385 (5,788) 115,849

Infrastructure & Non-Clinical Supplies 10,138 8,731 (1,408) 88,177 78,352 (9,825) 104,608

Funder Provider Payments 65,516 65,815 299 583,102 592,336 9,234 789,782

92,262 90,374 (1,888) 819,365 808,330 (11,035) 1,078,491

Total Expenditure 144,706 143,947 (760) 1,288,005 1,283,675 (4,330) 1,715,872

NET RESULT (599) (794) 195 1,391 1,745 (355) (0)

FULL YEAR

Waitemata DHB Consolidated Statement of Financial Performance

MONTH YEAR TO DATE

March 20185.1

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Importantly, it does not include payments made to the Waitemata DHB Provider Arm which on inclusion reduces the YTD Funder expenditure position to $5.929m favourable against budget. Commentary on key drivers of the favourable Funder position are summarised under the Funder Financial Performance section that follows later in the report.

3. Financial Performance - DHB Arms (YTD) The financial performance for each of the DHB Arms for the month and the year is summarised in the following table. A detailed Statement of Financial Performance by DHB Arm is provided as Attachment 1.

Comment on Major Variances YTD

Net Result - Consolidated The overall DHB result for the YTD to March 2018 was a surplus of $1.391m which is $356k unfavourable to budget. Provider Arm - Clinical Services The Provider Clinical Services was $10.216m unfavourable YTD. The key drivers of the variance are summarised below: Acute and Emergency Medicine ($2.198m unfavourable YTD) The variance was driven by unbudgeted increased RMO costs due to over allocations, pricing variations and increased allowance costs. The strategies for reducing costs over the balance of the year will focus on optimising the operational efficiency gains being achieved from the TransforMED ‘Home Warding’ initiative through maximising leave consumption and opportunistic bed closures.

Specialty Medicine and HOPS ($3.949m unfavourable YTD) The variance was driven by outsourced gastroscopy and colonoscopy procedures, and increased demand for high level respite care for complex needs patients and a change to the model of care in the Kingsley Mortimer Unit. Surgical and Ambulatory Services ($7.534m unfavourable YTD)

($000's)

Actual Budget Variance Actual Budget Variance Budget

REVENUE

Provider Arm - Clinical Services 2,907 2,794 114 24,656 24,106 550 33,988

Provider Arm - Corporate & Support Services 73,057 72,776 280 657,157 653,071 4,086 870,892

Governance & Funding Admin Arm 1,206 1,184 22 10,451 10,657 (206) 14,209

Funder 137,445 137,097 348 1,236,728 1,233,878 2,850 796,782

Elimination (70,507) (70,699) 192 (639,597) (636,292) (3,305) 0

Consolidated 144,108 143,152 955 1,289,396 1,285,420 3,975 1,715,872

EXPENDITURE

Provider Arm - Clinical Services 63,944 62,914 (1,030) 492,923 482,156 (10,767) 647,008

Provider Arm - Corporate & Support Services 14,168 14,034 (134) 202,519 198,525 (3,994) 264,872

Governance & Funding Administration 1,079 1,184 105 9,460 10,657 1,196 14,209

Funder 136,023 136,514 491 1,222,699 1,228,628 5,929 789,782

Elimination (70,507) (70,699) (192) (639,597) (636,292) 3,305

Consolidated 144,706 143,947 (760) 1,288,004 1,283,674 (4,330) 1,715,872

NET RESULT

Provider Arm - Clinical Services (61,036) (60,120) (918) (468,267) (458,050) (10,216) (613,020)

Provider Arm - Corporate & Support Services 58,889 58,743 147 454,638 454,546 92 606,020

Governance & Funding Admin Arm 127 0 127 991 0 991 0

Funder 1,421 583 839 14,029 5,250 8,779 7,000

Elimination (0) (0) 0 (0) (0) 0 0

Consolidated (599) (792) 195 1,391 1,746 (356) 0

FULL YEARMONTH YEAR TO DATE

Waitemata DHB Statement of Financial Performance By DHB Arm

March 2018

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The variance was driven by increased unbudgeted RMO expenditure due to unbudgeted over allocations and ongoing unbudgeted outsourcing expenditure associated with Radiology. Radiology procedures continue to be outsourced to meet MoH targets and population demand. Increasing clinical supplies costs, unbudgeted repairs and maintenance, other one-off costs and unrealised expenditure reduction initiatives have also had an unfavourable impact. Elective Surgery Centre ($633k favourable YTD) This was driven by lower than planned personnel costs due to vacancies, package of care volumes and clinical supplies as a result of lower than planned volumes and case mix variances. Child, Women and Family Services ($779k favourable YTD) The variance was driven by higher than anticipated vacancies across Allied Health and Management/Administration staffing groups. Partially offsetting this are unmet cost reduction initiatives. The service continues to be faced with recruitment and retention challenges across Dental and Maternity services. Alternative service delivery methods are being utilised to ensure continuity of care. Other costs pressures are evident in Repairs and Maintenance of clinical equipment, treatment disposables driven by service demand and cleaning supplies. Specialist Mental Health and Addiction Services ($2.052m favourable YTD) The favourable variance was due to vacancies in nursing, partially offset by casual staff and overtime cover. There were also vacancies in medical which was partly offset by locum cover. To minimise vacancies, a retention and recruitment committee explore ways of attracting and retaining staff. Provider Arm - Corporate and Support Services Corporate and Support Services were $92k favourable YTD. This is a result of unrealised budgeted financial sustainability initiatives across Corporate and Provider Support and unbudgeted inpatient pharmaceuticals and patient meal contract price increases in Hospital Operations, offset by favourable variances elsewhere.

Governance and Funding Administration Arm The Governance and Funding Administration (GFA) represents the Waitemata DHB share of the Joint Planning Funding and Outcomes Arm and includes the Waitemata DHB share of the Northern Regional Alliance expenditure. The Governance and Funding Administration Core net variance was $127k favourable against budget for the month and $991k favourable against budget YTD. The year-end result is forecast to be $1.3m favourable against budget. Funder The Funder net result for March was $839k favourable against budget for the month and $8.779m favourable against budget for the YTD. This was derived from a favourable Funder YTD revenue position of $2.850m against budget and a favourable Funder YTD expenditure position of $5.929m against budget. This Funder result is for the totality of the Funder Services across all its divisions and is inclusive of Funder Provider Arm, Funder NGO and Funder IDF. Also of note is that a substantive component of the Funder net result is interrelated and compensatory in nature. For example, unbudgeted Funder revenue allocations to the Provider Arm have a favourable impact on the Provider Arm result and are accounted for within the Funder as additional Funder expenditure. The Funder net result is a consequence of contributing factors across both revenue and expenditure and across all of its divisions. The most fundamental of these include adjustments relating to prior years. These adjustments are mostly one off in nature and currently account for most of the upside within the Funder’s favourable YTD result. Other factors influencing the Funder result include the normal expenditure variations across Funder demand services, current year wash-up considerations within IDF services, additional revenue allocations within Provider Arm Services and changes relating to funded initiatives subsequent to budgets having been set. The Funder year end net result forecast remains similar to the current YTD position at circa $8.5m.

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4. Capital Expenditure Capital expenditure for the nine months ending March 2018 was $15.517m with a year-end forecast of $26m. This forecast is $3m favorable against the $30.901m approved budget. Management has improved the scrutiny over capital expenditure with all strategic investment decisions now being made by the Portfolio Investment Committee, comprising of the ELT supported by the Portfolio Support Office.

5. Financial Position/Cash Flow Position The financial position as at March 2018 is given below. This indicates a net worth of $615.607m including $46.987m in cash. The detailed Statement of Financial Position for the DHB is provided as Attachment 2.

Summary of the cash flow statement as at March 2018 is given below. The detailed Cash flow statement is provided as Attachment 3.

The Cash movements and daily cash balance is being monitored on a daily basis. The net operating cash flows are greater than budget due to elective revenue received in the month and supplier and payroll payments being less than anticipated in the budget. Capital expenditure is being incurred at a lower monthly rate than in 2016/17, with a number of major projects concluded.

FULL YEAR

($000's) Budget Actual Budget Variance Actual Budget Variance

Land 0 0 0 0 0 0 0

Buildings & Plant 14,864 845 1,197 352 7,947 11,139 3,192

Clinical Equipment 3,869 216 276 60 5,669 2,939 (2,730)

Other Equipment 1,832 41 153 112 203 1,377 1,174

Information Technology 6,408 160 534 374 1,474 4,806 3,332

Motor Vehicles 160 0 10 10 224 130 (94)

Purchase of Software 3,768 0 314 314 0 2,826 2,826

Total Capital Expenditure 30,901 1,262 2,484 1,222 15,517 23,217 7,700

YEAR TO DATEMONTH

Waitemata DHB Capital Expenditure Budget

March 2018

OPENING FULL YEAR

($000's) 30-Jun-18 Actual Budget Variance Budget

Crown Equity 614,215 615,607 617,333 (1,726) 615,588

Represented by :

Current Assets 85,857 113,299 91,881 21,418 123,754

Current Liabilities 218,353 251,692 220,534 (31,158) 221,674

Net Working Capital (132,496) (138,393) (128,653) (9,740) (97,920)

Fixed Assets 784,389 783,252 796,240 (12,988) 764,011

Term Liabilities 37,678 29,252 50,254 21,002 50,503

Total Employment of Capital 614,215 615,607 617,333 (1,726) 615,588

MONTH

Waitemata DHB Statement of Financial Position

March 2018

($000's) Actual Budget Variance Actual Budget Variance

Opening cash 35,886 19,464 16,422 17,812 17,812 0

Operating 13,038 1,666 11,372 51,820 24,051 27,769

Investing (1,937) (2,484) 547 (22,645) (23,217) 572

Financing 0 0 0 0 0 0

Closing cash 46,987 18,646 28,341 46,987 18,646 28,341

Waitemata DHB Statement of Cash Flows

MONTH YEAR TO DATE

March 2018

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Attachment 1

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance

PROVIDER

Acute & Emerg Medicine 268 308 (40) 13,380 13,220 (159) (13,112) (12,912) (200)

Sub Specialty Med HOPS 659 749 (89) 9,338 8,804 (534) (8,679) (8,055) (624)

Medical Services 927 1,057 (130) 22,718 22,024 (694) (21,790) (20,967) (823)

Surgical Services 923 837 86 16,994 16,393 (601) (16,071) (15,557) (514)

ESC (0) (0) (0) 2,467 2,434 (33) (2,468) (2,434) (33)

Child, Women & Family Services 483 453 30 9,081 9,288 207 (8,599) (8,835) 236

Mental Health 575 447 128 12,683 12,774 90 (12,109) (12,327) 218

Sub Total - Clinical Services 2,907 2,794 114 63,944 62,914 (1,030) (61,036) (60,120) (917)

Director of Hospital Services 783 756 27 1,418 954 (464) (635) (198) (437)

Elective & Outpatient S 15 14 1 371 389 19 (356) (375) 20

Sub Total-Hospital Services 798 770 28 1,789 1,344 (445) (991) (574) (417)

Hospital Operations 74 389 (315) 7,935 7,987 52 (7,860) (7,597) (263)

Facilities 10 5 6 3,082 2,891 (191) (3,072) (2,887) (185)

Provider Management 69,677 69,750 (74) (10,017) (9,391) 627 79,694 79,141 553

Corporate 2,498 1,863 635 11,379 11,203 (177) (8,882) (9,340) 458

Sub Total - Corporate & Support Services 73,057 72,776 280 14,168 14,034 (134) 58,889 58,743 147

Total Provider 75,964 75,570 394 78,111 76,947 (1,164) (2,147) (1,377) (770)

Governance & Funding Administration 1,206 1,184 22 1,079 1,184 105 127 0 127

FUNDER ARM

Funder NGOs 41,691 41,406 285 39,508 40,822 1,314 2,183 584 1,599

Funder Inter District Flows 24,777 24,993 (216) 26,008 24,993 (1,015) (1,231) (0) (1,231)

Funder Governance 1,173 1,166 8 1,173 1,166 (8) 0 0 0

Funder Own Provider 69,803 69,533 270 69,334 69,533 200 469 0 469

Elimination (70,507) (70,699) 192 (70,507) (70,699) (192) (0) 0 (0)

Total Funder Arm 66,938 66,399 539 65,516 65,815 299 1,421 584 838

Consolidated 144,108 143,153 955 144,706 143,947 (760) (599) (793) 195

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance

PROVIDER

Acute & Emerg Medicine 2,818 2,726 92 107,981 105,691 (2,290) (105,164) (102,966) (2,198)

Sub Specialty Med HOPS 6,217 6,615 (399) 70,173 66,622 (3,550) (63,956) (60,007) (3,949)

Medical Services 9,034 9,341 (307) 178,154 172,314 (5,840) (169,119) (162,973) (6,147)

Surgical Services 6,872 6,465 407 129,847 121,907 (7,941) (122,975) (115,442) (7,534)

ESC (0) (0) (0) 20,308 20,942 633 (20,309) (20,942) 633

Child, Women & Family Services 4,025 4,057 (32) 67,277 68,088 812 (63,252) (64,032) 780

Mental Health 4,725 4,243 482 97,337 98,906 1,569 (92,612) (94,663) 2,051

Sub Total - Clinical Services 24,656 24,106 550 492,923 482,156 (10,767) (468,267) (458,050) (10,216)

Director of Hospital Services 6,697 6,370 326 10,296 7,474 (2,822) (3,599) (1,104) (2,496)

Elective & Outpatient S 142 126 16 3,556 3,323 (233) (3,414) (3,197) (217)

Sub Total-Hospital Services 6,839 6,496 343 13,852 10,797 (3,055) (7,013) (4,300) (2,713)

Hospital Operations 3,235 3,503 (268) 64,313 61,583 (2,730) (61,078) (58,079) (2,998)

Facilities 359 271 88 28,068 25,532 (2,536) (27,708) (25,260) (2,448)

Provider Management 629,548 626,516 3,031 3,242 9,149 5,907 626,306 617,368 8,938

Corporate 17,176 16,284 892 93,045 91,466 (1,579) (75,869) (75,182) (687)

Sub Total - Corporate & Support Services 657,157 653,071 4,086 202,519 198,525 (3,994) 454,638 454,546 92

Total Provider 681,813 677,177 4,636 695,442 680,682 (14,761) (13,629) (3,505) (10,125)

Governance & Funding Administration 10,451 10,657 (206) 9,460 10,657 1,196 991 0 991

FUNDER ARM

Funder NGOs 373,312 372,650 662 357,045 367,400 10,355 16,267 5,250 11,017

Funder Inter District Flows 225,190 224,937 253 226,057 224,937 (1,121) (868) (0) (868)

Funder Governance 10,549 10,490 59 10,549 10,490 (59) (0) 0 (0)

Funder Own Provider 627,677 625,801 1,876 629,048 625,801 (3,246) (1,370) 0 (1,370)

Elimination (639,597) (636,292) (3,305) (639,597) (636,292) 3,305 (0) 0 (0)

Total Funder Arm 597,131 597,586 (455) 583,102 592,336 9,234 14,029 5,250 8,779

Consolidated 1,289,396 1,285,420 3,975 1,288,005 1,283,675 (4,330) 1,391 1,745 (355)

Waitemata DHB Statement of Financial Performance By DHB Service Group

Net ResultDirect Revenue Direct Expenditure

Direct Revenue Direct Expenditure Net Result

Waitemata DHB Statement of Financial Performance By DHB Service Group

Month - March 2018

Year to Date- March 2018

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Attachment 2

($000's) 30/06/17 31/03/18 31/03/18 30/06/18Actual Actual Budget Budget

Crown Equity

Crown Equity 379,721 379,721 379,721 379,721 Revaluation Reserve 273,512 273,512 273,512 273,512

Retained Earnings - Prior Years (40,935) (39,018) (37,645) (37,645)Retained Earnings - 2017/18 1,917 1,392 1,745

614,215 615,607 617,333 615,588

Represented by :

Current AssetsBank and Short Term Deposits 17,812 46,987 21,627 19,599

Debtors 55,291 56,194 57,500 58,000 Prepayments 5,201 2,340 5,201 5,201

Inventory 7,553 7,778 7,553 8,053

85,857 113,299 91,881 90,853

Current Liabilities

Bank OverdraftCreditors 108,871 155,454 109,091 106,874

Provisions and Accruals 1,051 1,051 1,051 1,051

Staff Related Liabilities - Current 108,175 94,931 110,136 113,721 Term Debt - Current Portion 256 256 256 28

218,353 251,692 220,534 221,674

Net Working Capital (132,496) (138,393) (128,653) (130,821)

Fixed AssetsLand, Buildings and Plant (net) 641,592 633,444 638,766 637,890

Leasehold Building Works (net) 3,328 3,109 3,329 3,329 Equipment (net) 37,963 34,974 36,594 39,127

Information Technology (net) 140 220 4,822 6,382

Intangible Software (net) 252 157 2,947 3,846 Vehicles (net) 3,474 2,528 2,773 2,522

Work in Progress 55,991 64,551 57,435 54,242 742,740 738,984 746,666 747,338

LT & Investments in Associates 41,649 44,267 49,574 49,574

41,649 44,267 49,574 49,574

Term Liabilities

Staff Related Liabilities- Term 36,988 28,754 37,334 37,334 Trust and Special Funds 348 348 12,578 12,827

Term Debt - External 342 150 342 342 37,678 29,252 50,254 50,503

614,215 615,607 617,333 615,588

Waitemata DHB Statement of Financial Position

31 March 2018

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Attachment 3

Attachment 4

Actual Budget Variance Actual Budget Variance

Cash flows from operating activities:

Inflows

Crown 140,053 139,194 859 1,261,509 1,252,574 8,935

Interest Received 109 234 (125) 1,500 2,107 (607)

Other Revenue 1,653 3,722 (2,069) 21,423 30,743 (9,320)

Outflows

Staff 51,136 53,571 2,435 465,200 475,228 10,028

Suppliers 13,764 18,270 4,506 167,834 159,358 (8,476)

Other Providers 65,516 66,566 1,050 583,102 599,094 15,992

Capital Charge 0 3,077 3,077 18,358 27,693 9,335

GST (net) (1,639) 0 1,639 (1,881) 0 1,881

Net cash from Operations 13,038 1,666 11,372 51,819 24,051 27,768

Cash flows from investing activities:

Inflows

Sale of Fixed Assets 0 0 0 0 0 0

Associates 0 0 0 0 0 0

Outflows

Capital Expenditure 1,937 2,484 547 20,027 23,217 3,190

Investments 0 0 0 2,618 0 (2,618)

Net cash from Investing (1,937) (2,484) 547 (22,645) (23,217) 572

Cash flows from financing activities:

Inflows

Equity Injections 0 0 0 0 0 0

New Debt 0 0 0 0 0 0

Deposits Recovered 0 0 0 0 0 0

Outflows

Interest Paid 0 0 0 0 0 0

Funds to Deposit 0 0 0 0 0 0

Net cash from Financing 0 0 0 0 0 0

Net increase / (decrease) 11,101 (818) 11,919 29,174 834 28,340

Opening cash 35,886 19,464 16,422 17,812 17,812 0

Closing cash 46,987 18,646 28,341 46,986 18,646 28,340 Closing Cash Balance in HBL Sweep account 46,987 46,987

MONTH YEAR TO DATE

Waitemata DHB Statement of Cash Flows

31 March 2018

As % Total Outstanding Current 1 - 30 D 31 - 60 D 61 - 90 D 91 Days + Prior Month

ACC 3.5% 592,201 526,480 (1,326) 25,552 1,773 39,721 344,568 Accredited Employers 0.1% 13,618 3,306 0 0 0 10,312 10,443 Commercial 1.4% 235,922 168,917 87,885 5,030 (4,851) (21,061) 224,044 Crown (excluding MoH) 7.1% 1,183,325 390,850 178,209 194,460 1,822 417,984 1,204,127 DHBS' 44.5% 7,456,079 3,625,576 186,857 812,161 6,528 2,824,956 4,897,496 MOH 19.9% 3,337,175 2,605,674 29,785 228,303 174,225 299,189 2,291,910 Non Residents 23.5% 3,934,514 2,454 577,416 434,122 269,680 2,650,842 3,779,442 Overseas Govt 0.0% 0 0 0 0 0 0 0

Patient 0.1% 16,842 0 11,247 3,503 (720) 2,811 12,461 Staff 0.0% (382) 0 0 0 0 (382) 618 WDHB Total 100% 16,769,294 7,323,258 1,070,074 1,703,132 448,458 6,224,372 12,765,109

44% 6% 10% 3% 37%

Total Less Non- residents 12,834,780 7,320,803 492,658 1,269,010 178,778 3,573,530

57% 4% 10% 1% 28%

Total 30+ 5,021,318

39%

who has been waiting answer/s and outcomes from ACC Case Manager for either good outcome or bad news

61+Days overdue comprised of :$2.8m = $344K Opex cost from 2013-14 waiting for resolution+$471K RMO

leave transfer (both issues with CMDHB); the rest $1.9m are mainly ADHB invoices

ASAP. David Vial has issued a memo to the managers to sort unpaid invoices by 20 Apr.

61+ days $473K - consist of two invoices 585128 & 623255. 585128 waiting approval from

Nicky Mulholland.Have resent invoice to MOH if there is a payment hold or contract variation.

Non Residents $1.7M are on payment plan; while the others are still being actively collected.

Good side: The total current outstanding amount represents approximately 89% of the Total Outstanding.

Waitemata DHB Statement of Accounts Receivable

Down side/ Challenges: The 91 days and over approximately 7% of Total Outstanding of which 70% of the amount has been

under dispute with ACC under our WDHB ACC Hyperbaric service

Have billing issues from Hyperbaric service on no prior approvals last Oct 2017 ACC Invoicing from service, which are not quite

promising

91+ Days overdue consists mainly of MOJ invoices. There has been a reduction in the MOJ debt from $447k to $228k in regards

to the new MOJ process which has translated into payments being processed quickly. There are two MSD invoices totalling

$172k which will be processed against the pending Gateway Agreement which is currently under review

ACC

Crown

DHB's

MOH

March 2018

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6.1 Minutes of the Hospital Advisory Committee Meeting held on 28 March 2018

Recommendation:

That the minutes of the Hospital Advisory Committee meeting held on 28 March 2018 be received.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 28 March 2018

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 1.35pm

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Max Abbott Kylie Clegg Brian Neeson Allison Roe

ALSO PRESENT

Warren Flaunty (Waitemata DHB, Board Member) Dale Bramley (Chief Executive Officer) Fiona McCarthy (Director of Human Resources) Jocelyn Peach (Director of Nursing and Midwifery) Tamzin Brott (Director of Allied Health) Joanne Brown (Funding and Development Manager-Hospitals) Penny Andrew (Clinical Leader Quality) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.)

PUBLIC AND MEDIA REPRESENTATIVES

There were no members of the public or media representatives present.

WELCOME

The Committee Chair welcomed those present. APOLOGIES

Apologies were received and accepted from Morris Pita, Sandra Coney, Andrew Brant, Cath Cronin and Jacky Bush.


James Le Fevre advised that he was now a member of the Northern Region Clinical Practice Committee.

There were no declarations of interest relating to the open section of the agenda.

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1. AGENDA ORDER AND TIMING Due to timing constraints of reporting officers, the public excluded section of the meeting was held before the open section of the meeting. Item 4.3 of the open meeting was considered before item 3.1 and a presentation held after item 2.1; the remaining items were taken in the same order as listed in the agenda. 1.37pm to 1.54pm - the open meeting adjourned for consideration of the public excluded section of the meeting.

2. COMMITTEE MINUTES

2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 14 February 2018 (agenda pages 5 to 12) Resolution (Moved Kylie Clegg/Seconded Allison Roe) That the Minutes of the Hospital Advisory Committee meeting held on 14 February 2018 be approved. Carried Actions Arising (agenda page 13 )

Noted.

PRESENTATION

Dr Jocelyn Peach (Director of Nursing and Midwifery) presented to the Committee on ‘Patient and Whanau Centred Care Standards and Ward Accreditation Programme.’ The Committee Chair acknowledged the presentation and noted the complexity of the programme. He queried the underlying success factors for the level of uptake. In response Jocelyn advised that a framework was needed and welcomed, which assisted with the level of uptake, coupled with the leadership in place. In addition, matters covered in discussion and response to questions included:

That the programme is frequently reviewed with a view to reduce the number of audits undertaken. It is proposed that audits be undertaken six-monthly for regular monitoring on Wards and to highlight improvements.

Noting that there is potential to partner with the University of Auckland to review and validate the programme.

That the there is a time commitment to undertake the programme, however, it does not impact patient care.

3. PROVIDER ARM PERFORMANCE REPORT 3.1 Provider Arm Performance Report – January 2018 (agenda pages 14 to 74)

The Committee Chair queried the DHB’s influenza planning, in response the Chief Executive advised that the DHB is reviewing its pandemic readiness and escalation

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plans in preparation if there is an influenza outbreak. Fiona McCarthy noted that there are over 100 nurses ready to provide vaccinations within the organisation over a four week period, in both static clinics and on Wards. In addition the Chief Executive noted that TransforMED is assisting with occupancy at the DHB; metro Auckland Chief Operating Officers are working together to develop a winter plan including the provision of assistance from neighbouring DHBs if required. TransforMED is now being implemented at Waitakere Hospital. The volumes through the emergency department in January 2018 were higher than normal, which appears to have been experienced nationwide. Volumes dropped following that, but an increase has been seen in recent weeks. Human Resources (agenda page 32 to 35)

Fiona McCarthy (Director, Human Resources) summarised this section of the report, noting in particular sick leave management and that some reduction in annual leave is expected. In response to a question from the Board Chair about challenges to recruit within the cleaning service, Fiona noted that innovative campaigns are underway and the DHB has recruited in this area. She also noted that there are changes within the DHB with staff undergoing career opportunities and moving to new roles in the organisation.

Acute and Emergency Medicine Division (agenda page 36 to 43)

Alex Boersma, (General Manager, Acute and Emergency Medicine) summarised this section of the report. Matters covered in discussion and response to questions included:

The Board Chair noted the Government’s focus on road safety and improvement, she queried whether the DHB kept data in this area; in response Alex advised that some data is kept, however, Waitemata DHB would not receive high trauma cases as these are bypassed to Auckland DHB and Counties Manukau DHB Emergency Departments.

The Committee Chair noted the reported ‘seen by time for orthopaedic patients at 45% seen within two hours of triage’ and queried whether the service structure needed to be reviewed; in response Alex advised that work is underway with ADU and there is an opportunity to improve patient flow.

Specialty Medicine and Health of Older Persons (agenda page 44 to 49)

Dr John Scott (Head of Division) and Brian Millen (General Manager, Medicine and Health of Older People Services) presented this section of the report. With regard to the Kingsley Mortimer Unit update, it was noted that a further report will be submitted to the Committee on the review of the short, medium and longer term solutions to increase capacity in community to care closer to home and community settings. It was further advised that due to the Government’s Mental Health Inquiry, the deep dive for long term planning in this area will be deferred until the inquiry is completed. With regard to possible impact on patients in delaying the deep dive, Brian noted that the service has acute visibility of people entering the service and that there have not been any adverse events on the waiting list. The

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Kingsley Mortimer Unit is a working high acuity ward that achieved gold in their care standards. In response to a query from the Committee Chair regarding service delivery for diagnostic colonoscopies within 42 days being below target (59% against a target of 70%), Brian advised that the service had received unusually high demand over the December 2017/January 2018 period. It is anticipated that this rate will be improved by April 2018 with near target achievement in May 2018. Child Women and Family (agenda page 50 to 56)

Emma Farmer (Head of Division Midwifery) and Stephanie Doe (General Manager Child, Women and Family Services) were present for this item. An apology from Dr Meia Schmidt-Uili (Division Head) was noted. Stephanie Doe introduced the report noting the highlight of the month ‘Implementation of the Healthy Housing Initiative’; a further update on this initiative and its metrics will be provided to the Committee at its next meeting. Matters covered in discussion and response to questions included:

That with regard to the Auckland Regional Dental Health Services update, an audit of sterilisation processes has been undertaken in ten clinics to identify improvements. Work will be undertaken on an improvement plan including the use of disposable instruments (in liaison with the DHB’s sustainability officer).

Noting the collaborative model between nursing and midwifery reported. Emma Farmer further advised that a cohort of nurses had been recruited to work in maternity and with midwives and will be looking after women and babies; this is intended to be a long term model of care.

That work with vulnerable children happens in variable ways across the DHB’s services, including ‘friends and family’ on the paediatric ward as well as an App being developed where children can draw their experiences. It was noted that privacy/or obtaining a parents permission had not been an issue for the DHB; communication is key with/and for the family and this is managed.

That the delivery of fluoride varnish for pre-schoolers (page 56 of the agenda) is for the prevention of dental disease; it was noted that only 35 per cent of pacific children have no dental caries.

The Committee Chair thanked the team for the update, noting in particular the detailed improvement plan and the positive recruitment in midwifery. Specialist Mental Health and Addiction (agenda page 59 to 65)

Susanna Galea (Head of Department, Mental Health Services) and Alex Craig (Head of Division Nursing, Mental Health) summarised this section of the report. Matters covered in discussion and response to questions included:

Noting that it is possible to achieve a zero seclusion rate; procedures are in place to do this and include learning to identify when a client is becoming agitated and how to manage that for each individual (as one person may need space and another may need people to support them).

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Noting the DHB’s low rate of seclusion for Maori clients, where other DHBs show higher rates. Alex Craig said that this is a reflection of close engagement with Kaumatua and recognising an individual client’s needs.

That the Substance Addiction Compulsory Assessment and Treatment Act (SACAT) came into effect on 21st February 2018. Data to date for enquires and assessments were reported (page 61 of the agenda), with six applications for treatment made and three people now under the Act. It was noted that if data is extrapolated then there is likely to be in the region of 500 enquiries a year with a significant number then under the Act. Susanna noted that there is a concern of the impact on voluntary clients; each enquiry takes between 10 to 20 hours of work.

With regard to numbers of clients being admitting under SACAT to the treatment centre in Christchurch, it was noted that there has been one person admitted from the Christchurch area, another in process under certificate from the Wellington area and the remainder are from the Waitemata district.

That the scorecard details waiting times for clients to be seen in Community, Drug and Alcohol services.

The Committee Chair acknowledged the work around managing the implementation and implementing SACAT. Susanna Galea advised that the DHB has engaged with the mental health enquiry panel, who will be visiting the DHB on 10 May. There is particular interest in understanding how the DHB has a rapidly growing population in its district and continue with high standards of care.

Surgical and Ambulatory Services/Elective Surgical Centre (agenda page 66 to 74)

Debbie Eastwood (General Manager) presented this section of the report. Apologies were received from Dr Michael Rodgers (Chief of Surgery) and Kate Gilmour (Head of Division Nursing). Debbie summarised the report. Matters covered in discussion and response to questions included:

The Committee Chair noted the combination of low theatre utilisation and outsourcing for ORL; in response Debbie advised that this was due to workforce issues.

Querying whether the updated provided on higher than ‘budgeted volumes and more complex case mix driving clinical supplies costs’ were related to incorrect budget assumptions; Debbie advised that clinical supplies in a clinical environment can be challenging when identifying what is required.


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4. CORPORATE REPORTS

4.1 Clinical Leaders’ Report (agenda pages 75 to 80)

Tamzin Brott (Director of Allied Health) presented this item. Apologies were received from Andrew Brant (Deputy Chief Executive and Chief Medical Officer) and Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner). Medical Staff

This section of the report was noted. Nursing and Midwifery

This section of the report was noted. Allied Health, Scientific and Technical Staff

Tamzin Brott summarised this section of the report. The update provided on the new graduate programme was mentioned and it was noted that there are six dental therapists in the pilot. The report was noted.

4.2 Human Resources (agenda pages 81 to 90)

Fiona McCarthy (Director of Human Resources) summarised the report. Allison Roe queried the ‘return to nursing programme,’ information will be provided to Allison on this programme. The report was noted.

4.3 Quality Report (agenda pages 91 to 182)

This item was received before item 3.1. Penny Andrew (Clinical Lead Quality) presented this item. It was noted that the mortality rate is sustaining a downward trend. Penny advised that a mortality workshop has been established that has three key areas: family escalation, national early warning score and goals. Work is underway on establishing a new early warning system. An update will be provided to the Committee on this work. The report was noted.

5. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 183) This item was considered before item 2. Resolution (Moved Allison Roe/Seconded Brian Neeson)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

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The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:




1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 14/02/18

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Quality Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

3. Human Resources Report


Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)]

Carried The meeting concluded at 4.12 pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 28 MARCH 2018 COMMITTEE CHAIR

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6.2 Minutes of the Community and Public Health Advisory Committee Meeting held on 04 April 2018

Recommendation:

That the minutes of the Community and Public Health Advisory Committee meeting held on 04 April 2018 be received.

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122


Minutes of the meeting of the Auckland DHB and Waitemata DHB

Community and Public Health Advisory Committees

Wednesday 04 April 2018

held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.01am

Part I - Items considered in Public Meeting COMMITTEE MEMBERS:

Sharon Shea (Committee Chair - ADHB Board member) Max Abbott (WDHB Board member) Judith Bassett (ADHB Board member) Edward Benson-Cooper (WDHB Board member) (until 12 noon, item 4.1) Zoe Brownlie (ADHB Board member) Sandra Coney (WDHB Board member) (until 12 noon, item 4.1) Warren Flaunty (Committee Deputy Chair - WDHB Board member) Matire Harwood (WDHB Board member) Lee Mathias (ADHB Board member) Robyn Northey (ADHB Board member)

ALSO PRESENT:

Dale Bramley (WDHB Chief Executive Officer) Ailsa Claire (ADHB Chief Executive Officer Debbie Holdsworth (ADHB and WDHB, Director Funding) Karen Bartholomew (ADHB and WDHB Acting Director Health Outcomes) Andrew Old (ADHB Chief Strategy/Participation and Improvement) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

Bill Grieve (Chair, Hibiscus Hospice) Nicolette Bodewes (Chair, North Shore Hospice) Jan Nichols (Chief Executive, North Shore Hospice)

KARAKIA:

The Committee Chair invited Bruce Levi to open the meeting with a prayer. WELCOME:

The Committee Chair welcomed those in attendance at the meeting. APOLOGIES:

An apology was received and accepted from Allison Roe and for early departure from Edward Benson-Cooper.

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There were no declarations of interests relating to the agenda. Sharon Shea advised that she is working with Te Ha Oranga, the provider arm of Te Runanga o Ngati Whatua who is delivering a new programme within the Auckland Women’s Prison in Wiri.

1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed on the agenda.

2. COMMITTEE MINUTES 2.1 Confirmation of Minutes of the Auckland and Waitemata DHBs’ Community and Public

Health Advisory Committees Meeting held on 06/12/17 (agenda pages 7 to 11) Judith Bassett corrected Dame Sister Pauline Engel’s (not Francis) name in the minutes of 06 December 2017; Dame Sister Pauline Engel sadly passed away late 2017. Resolution (Moved Judith Bassett/Seconded Warren Flaunty) That the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 06 December 2017 be approved. Carried The Committee Chair acknowledged Warren Flaunty and his recent retirement from the pharmacy profession. Matters Arising (agenda pages 12)

Debbie Holdsworth summarised the matters arising reported. In response to a question about the recent mumps outbreak Ruth Bijl said that there has been a slight decrease in the number of cases. With regard to immunisation, Waitemata DHB has undertaken a ‘catch-up’ programme in five low decile primary schools. Auckland DHB has also taken the opportunity to engage with the Pacific community through PHOs and tertiary institutes. In response to a question about the age of patients being diagnosed with mumps and whether there was an issue with the vaccine still being effective, Catherine Jackson noted that the primary reason for those diagnoses is that people have not been immunised. In 2001 when the vaccine age was adjusted from 11 years to 4 years of age, this resulted in a cohort that was not vaccinated. The majority of patients diagnosed were not fully immunised due to changes in the health system.

3. STANDARD REPORT 3.1 Planning, Funding and Outcomes Update (agenda pages 13 to 104)

One of the key highlights identified in the update report was the strengthened strategic partnership established between Hibiscus Hospice and the North Shore Hospice Trust. In attendance to present to the Committee were Bill Grieve (Chair, Hibiscus Hospice), Nicolette

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Bodewes (Chair, North Shore Hospice) and Jan Nichols (Chief Executive, North Shore Hospice). The Committee Chair invited the hospice representatives to open the discussion and highlight the work undertaken to form an alliance. The following was noted:

Bill Grieve noted his background as a retired engineer, his role as Chair of Hibiscus Hospice for the past nine years and for a period as Chief Executive of the Hospice. He spoke about the focus of retaining costs and maximising revenue for the hospice as well as the support given and steps taken with Pat Alley as previous Chair of the northern region hospices. Following that, over a three year period a lack of clinical leadership was identified and at the hospice Board’s discretion, Simon Allan came on board and was instrumental in getting things back on track. Bill noted that in stepping into the role of Chief Executive the clear need for a change in style and culture was identified, as well as recognising the needs of a growing population. Radical change was needed and an alliance with North Shore Hospice was developed. A good relationship has been formed and a common Chief Executive, Jan Nichols, appointed.

Jan Nichols spoke about the changes that have taken place to-date, noting the motivation from both Trusts to provide the best service. She said that funding is an issue from all sources, with equity issues in the district. Population growth is a significant issue, with a large number of people expected to die over the next 50 year period. In addition Jan noted that since being appointed as Chief Executive across the North Shore and Hibiscus Hospices, a HR hub has been developed. It is a small team that deserves much credit as no external consultants or resource was utilised in effecting the required changes and setting a single set of values, a single voice for the DHB, a single contract across both Hospices and an attractive employment plan. All clinical services were looked at with restrictions put in place, duplication in clinical management and administration has been streamlined; in particular a staff member, Ree, was noted for the exceptional role in working across services with a focus on supporting the clinical team. Areas of restructure have taken place with others in process or being finalised. Feedback on the proposed changes and those now in place was invited. It was also noted that as these are community hospices, there are also a lot of volunteers helping.

Nicolette Bodewes noted her profession as a lawyer and that she had been on the Board of North Shore Hospice for five years. She advised that consideration is being given to forming a Foundation Trust, this depends on a legal technicality and ensuring that with regards to bequests, those willed to Hibiscus Hospice are used for that Hospice alone (this will also apply to fundraising). In addition it was noted that there is engagement with a PR company to present the Hospices’ story to the community.

As at 1 July 2018, it is hoped both Hospices will be one entity, making required savings and providing a better service to patients and their families.

In response to a question about lessons learnt, it was noted that: it can be done and where there is a will there is a way. There was a strong willingness of both boards to cooperate and work towards one goal, all Board members recognised one goal which was for the best service for patients. The transition has gone smoothly with there now being a combined Board. There is a motivated team to achieve the same goals.

Bill Grieve also noted that often when a merger occurs there often is a dominate player, this has not occurred for the Hospices and both are seen as absolute equals. He acknowledged both Hospice Boards for their support in achieving this.

Warren Flaunty acknowledged the work undertaken and queried if there was any involvement from the West Auckland Hospice; in response Nicolette advised that there was

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no involvement at this stage, but suggestions are welcome. She noted that there is room for growth and reiterated Bill’s comments that there is not a dominant party involved in the new alliance. Bill further noted that the key is common values and purpose. The Committee Chair thanked Bill, Nicolette and Jan for attending and speaking at the meeting. Debbie Holdsworth noted the key highlights in the Funding and Planning report. The following matters were discussed and response to questions included:

Samantha Bennett noted the Asian, Migrant and Refugee Plan and that high level findings show that the Auckland DHB and Waitemata DHB are national leaders in Asian health. However, there were also disparities identified in high risk Asian groups, such as high numbers of Chinese smoking as well as obesity and diabetes for South Asian groups. The Plan is a high level summary and provides an understanding of cultural needs for the high risk groups.

Lee Mathias noted a potential impact for the way in which data is collected, a third of our population is Asian and there is an opportunity to formally request changes via the DHB Boards in time for the next Census to allow better data outcomes. Samantha Bennett advised that Lifeng Zhou works closely with Statistics NZ and there is dialogue about the MELAA (Middle Eastern, Latin American and African populations) category and whether a broader category is needed. The Chair agreed and Samantha should report back to the Committee Lifeng’s progress with Statistics NZ.

Tim Wood advised that the diabetes clinical indicators can now be reported at a more granular level. An understanding is being gained about what is being prescribed and what is being dispensed; however, whilst prescribing data shows an improvement in what is being prescribed, an equivalent improvement is not being show with respect to patients collecting their scripts from the pharmacy. Tim acknowledged the PHOs work in producing the data and starting to use it in a meaningful way to address disparity. In response to a question from Lee Mathias, Tim said that the data was stored by the DHBs and that there is a process across the three metro Auckland DHBs about having a repository in the Cloud on an ongoing basis.

With regard to the diabetes clinical indicator data now available, the Committee Chair queried whether there is work on identifying any ethnic differences when collecting a prescription. Tim advised that the data collection is providing an opportunity to ask questions such as ethnicity differences; the Diabetes Service Level Alliance will start to look at the data and develop a work plan. The work plan will include areas like co-design with general practices, a programme of activity over the next two years and co-design of patients and general practice teams. A piece of work has been undertaken previously around high needs patients with general practices. He also noted two key areas of work that have a strong equity lens, being: a programme around improving podiatry care with GP practice teams and the way community podiatrists provide care; and there is work on improving the retinal screening programme. It is known that there is a high level of DNA rates and not enough screening capacity within the system.

The remainder of the report was taken as read. Additional matters raised and response to questions included:

Warren Flaunty noted the update provided on aged residential care audits (page 31 of the agenda) and that it was not clear whether any spot audits had identified irregularities in the system; he also asked that a breakdown of corrective actions

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between spot audits and normal certification be identified. Debbie Holdsworth advised that this will be responded to.

Matire Harwood noted the ethnicity and inequity data reported in areas such as cervical smears and queried what is being done to change this. Debbie Holdsworth advised that this could be presented to the Committee as a deep dive and this would include cervical screening and breast screening. It was requested that the deep dive also include information on the cost for cervical screening (as it is not a free service) as well as the self-sampling programme and whether that will suit Maori women.

In areas such as dental care and inequity, Ruth Bijl advised that oral health identified that clinic opening hours were not favourable and that Saturday clinics were introduced and are working well.

Warren Flaunty noted the Zero Suicide Framework reported (page 35 of the agenda) and queried whether people who commit suicide are known to the DHBs services. Trish Palmer advised that they may have been known to the DHBs services, but might not be an active client. She also advised that a National Suicide Mortality Group had been established. It was also noted that a programme was in place across hospital presentations to address suicidal thoughts with targeted interventions; this is in the early stages with positive results being seen.

In response to a question from Sandra Coney about programmes in schools to help prevent suicide, Trish Palmer advised that there is investment from the Ministry of Health and a call for resilience and mental health wellbeing programmes funded by the Ministry of Health from within school based programmes. Trish Palmer noted that Tamaki College are piloting a ‘peered up’ programme which is peer youth support; this is a 12 month programme that commenced in January 2018.

Dale Bramley noted that he and Ailsa Claire had recently met with the Alliance Chairs. He acknowledged the practice level data now being provided and the challenge in best utilising that data.

4. DEEP DIVE REPORT 4.1 Equity Focus in System Level Measures Planning Process (agenda pages 105 to 159)

The Chair opened this part of the meeting noting that the two DHB Boards had agreed to focus on Equity, and in particular, improving Equity for Maori, Pacific Peoples’ and other high need groups as an important strategic priority. The purpose of this part of the CPHAC meeting is to give committee members an opportunity to guide DHB management about its expectations for equitable outcomes. Members are also encouraged to offer a future-focused view about ‘what works’, for management consideration. Dr Catherine Jackson presented to the Committee on equity and system level measures. Matters covered in discussion and response to questions included:

Noting that there have been discussions around targeting specific populations to communicate health messages, including digitally targeting those groups.

That there is room for improvement in learning from programmes that have been successfully communicated. The metro-Auckland DHBs could work together to understand what social marketing looks like and utilise that data.

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Noting that PHO data collected is reported back to general practices, but it is anonymised.

In response to a comment and question from Matire Harwood about how workforce development and employment is a determinant of health outcomes and wellbeing, Ailsa Claire noted that it is recognised that the ADHB is the largest employer in the community. The ADHB is looking at how it can support and encourage its low paid workers in career pathways. She spoke about the ADHB programme ‘Thrive’ (which provides a framework of initiatives that may be replicated for employee groups); it was noted that ADHB has had 60 cleaning staff move to a level 3 grading and are now moving to healthcare assistant roles.

In response to a question from Max Abbot about the graph presented for ‘acute bed days – equity,’ it was noted that the data is adjusted for age and not deprivation.

The Committee Chair acknowledged the presentation given and encouraged Committee members to provide feedback directly to Karen Bartholomew on the deep dive. In response to a question about the reporting of system level measures, Karen Bartholomew noted that a quarterly report is submitted to both the Auckland DHB and the Waitemata DHB Boards. There is also reporting to each of the Boards Committees that focus on the each specific Committees purpose.

5. GENERAL BUSINESS

There were no items of general business. The meeting concluded at 12.08pm

SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS’ COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 04 April 2018

CHAIR

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7.1 Health and Safety Marker Report

Recommendation:

That the report be received.

Prepared by: Fiona McCarthy (Director Human Resources)

Purpose of report The purpose of this report is to provide an update on progress towards meeting the expectations of the Health and Safety at Work Act 2015, which came into effect on 4 April 2016.


The new Health and Safety at Work Act 2015 came into force on 4 April 2016. The new legislation and updated regulations is the result of work from the health and safety taskforce established in 2012 to evaluate whether the workplace and safety system in New Zealand was fit for purpose, and to recommend practical strategies for reducing the high rate of workplace fatalities and serious injuries by 2020. From taskforce recommendations made in 2013, WorkSafe NZ was established with one goal – to reduce workplace deaths and injuries by 25% by 2020. The Waitemata DHB has been working on key aspects of the legislation specifically those related to:

Contract and reactive maintenance triage and works management

Incident management

PCBUs, where we share accountability and procurement processes It is pleasing to note the work undertaken in the contractor management space and as a result the indicator had reduced from red to amber. To monitor our compliance, nine dive audits have been completed in 2016-2018 and one is due to complete before June 2018. Comments on the audit outcomes are noted in the summary. The annual safe way of working audit is underway which measures the practical application of health, safety and wellbeing policies and initiatives. A summary of our compliance with the Health and Safety at Work Act is outlined below and details are outlined in Appendix 1.

Key

Complies substantially or fully with legislation

Some actions to be completed

Significant or some key actions to be completed

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Topic Performance Outstanding actions

1. Policy

2. Worker engagement, participation and representation

A national worker participation agreement template is in discussion with the National Bipartite Group.

3. Notifiable events

4. Health, Safety and Wellbeing Committee

5. Orientation

- Staff and Volunteers

- Local orientation for staff and students

New systems for recording local orientation are in development.

- Contractor

6. Risk Management Safe work protocols published and others in development (see section 6 of Appendix).

Funding for dedicated health and safety software will be raised during the year; planned implementation mid-2018/19.

7. Contractors (Facilities, healthAlliance and IT)

Confirmation that tender documentation and contractor performance is aligned.

Fully implement the health and safety framework.

8. Hazardous substances

Audits for high use areas complete with over 400 chemicals registered. Close to 300 DHB site still require audits.

9. Health of workers Comprehensive health monitoring plan in development.

10. Equipment and Maintenance

Processes for reactive maintenance triage and works planning and completion is under review. Interim processes for health and safety works assessment are in place.

Phase 1 resources now approved for recruitment.

11. Training Health and safety training in place, key components being reviewed.

12. Audits

13. Reporting

14. Resources

Work underway to 1. Assess resourcing for incident follow up due to a

significant increase in incidents for monthly review and follow up

2. Convert existing contract resource to Full Time Equivalent (FTE) for additional Occupational Health Physician and work injury administration support.

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2. Glossary HSNO – Hazardous Substances and New Organisms Act 1996. PCBU – person conducting a building or undertaking, and has a primary duty of care to ensure the health and safety of workers. The Waitemata DHB is the PCBU. Officers - Includes Board Directors and the Senior Management team who make governance decisions that significantly affect the business. Officers have a duty of due diligence to ensure their business complies with its health and safety obligations. Officers may be found guilty of an offence under the Act, in addition to the PCBU. Due Diligence – taking steps to acquire and keep up to date knowledge of health and safety matters. Gain an understanding of the business and hazards and risk associated with that business. Ensure PCBU has available and uses appropriate resources and processes to manage risk. Ensure PCBU has appropriate processes for considering incidents, hazard and risks in a timely way. Ensure PCBU implements processes for complying with obligations under the Act, validates the provision and use of resources and processes to comply with obligations under the Act. Workers - Workers have a duty to take reasonable care for their own safety and that their own actions do not adversely affect the safety of others. They need to comply with reasonable health and safety instructions from the PCBU and co-operate with health and safety policies and procedure. Workers are people who work at the Waitemata DHB and include employees, contractors, sub-contractors or their employees, apprentices, trainees, persons gaining work experience, employees of a labour hire company and volunteers. Other people - People who come to the workplace such as visitors or customers also have duties to comply with health and safety processes. Our patients and visitors are in this group. Notifiable injury or illness – an injury or illness that requires immediate treatment (i.e. amputation, serious burn, serious head injury or burn), admission to hospital, serious infection and medical treatment within 48 hours of exposure. All notifiable injuries or illnesses are to be reported to WorkSafe NZ. Notifiable incident - an incident that is an unplanned or uncontrolled incident in a workplace and that exposes a worker or other person to a serious risk to health and safety. Notifiable incidents include events such as: a spillage or leak of a substance; explosion or fire; escape of gas or steam; falls; electric shocks; structural collapses; in rush of water, gas or mud; interruption of underground ventilation. All notifiable instances are to be reported to WorkSafe NZ. Health and Safety Representative - a person elected to represent the workers in relation to health and safety matters. The representative has specific functions and roles under Schedule 2 of the Act.

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Appendix 1 Progress implementing the Health and Safety at Work Act 2015

1. Policy The Waitemata DHB policies have been reviewed and are aligned to the new legislation. Changes and updates to policy will occur over the next few years as new regulations, audits and experiential learnings lead to new processes. Significant policy changes will be endorsed by the Board. 2. Worker engagement, participation, and representation

What the Act says

A PCBU must:

Initiate election of health and safety representatives on request of workers.

Agree the work groups that are represented by a health and safety representative.

Consult about matters related to health and safety.

Provide information as requested with due consideration to the Privacy Act.

Allow a health and safety representative time to discharge their powers under the act.

New regulations on worker engagement, participation and representation were introduced in February 2016 and outline the functions, number, training, powers and participation expectations of health and safety representatives.

How do we comply?

We have 307 health and safety representatives throughout the business, most of whom have baseline health and safety representative training, as endorsed by WorkSafe NZ as well as divisional health and safety committees in place to provide ways to participate in local issues. In addition, the annual update of hazards is reviewed by representatives, and representatives participate in the self-assessed departmental health and safety audit. Representatives also undertake Waitemata DHB wide health and safety activity such as flushing low use water outlets. Seven health and safety representatives sit on our health, safety and wellbeing committee. Transition training for representatives has been provided and foundation health and safety training is available online. Meeting with on-site contractors to establish health and safety representatives and discuss health and safety matters have commenced. New for May We are re-electing our health and safety representation for the health, safety and wellbeing committee. Representation may expand beyond the seven members to include separate hospital and community representation in some of the divisions with large hospital and community services.

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What is outstanding?

The regional employee participation agreement between the Northern Region DHBs and unions has not yet been signed by the Unions. Discussions are progressing nationally with union parties.

On-going training needs (as part of the new Worker Engagement, Participation and Representation Regulations) have been assessed following the completion of a special project led by Margaret Kamphuis (Specialist Health and Safety Advisor). We are currently reviewing our training providers to meet these needs.

Consequences

There are fines for not having appropriate employee participation processes in place.

3. Notifiable events

What the Act says

A PCBU must

Report on notifiable injury, illness and incidents as soon as possible after being made aware of them.

Secure a site if a notifiable event has occurred.

Keep a record of notifiable events.

How do we comply?

We have robust notifiable event reporting and recording processes in place.

What is outstanding? There are no outstanding actions.

Consequences

There are fines for not notifying workplace injury or illness as soon as possible after being made aware of them.

4. Health, Safety and Wellbeing Committee

What the Act says

A PCBU must:

Put in place a health and safety committee if requested by a worker.

Establish a health and safety committee within two months of this request.

Consult about health and safety matters with the committee.

Allow time for members to attend and carry out functions as a member of the committee.

Provide information to the committee.

Within a reasonable time, adopt recommendations made by the committee.

A PCBU can also establish a health and safety committee on its own initiative.

How do we comply? The Waitemata DHB has two organisation-wide Health, Safety and Wellbeing Committees focussing on 1) Executive governance and risk; and 2) Operational and policy matters.

What is outstanding? There are no outstanding actions

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Consequences

There are fines for not setting up a Health and Safety Committee if requested, and if a PCBU does not

allow time for members to attend committee meetings/consider matters raised at the committee; or

if a PCBU does not implement recommendations from the committee.

5. Orientation

What the Act says

Orientation to a workplace is an important part of complying with the duty of care to ensure the provision and maintenance of a workplace that does not give rise to health and safety risks.

How do we comply?

A mandatory pre commencement orientation and ‘safety first’ video was made available to new staff from the end of December 2017. Reporting on completion rates are included in the Scorecard in the Health and Safety Performance report from April and has been consistently reported at 100% completion since then. This online Health and Safety module is also utilised for all new Doctors and volunteers. A departmental health and safety induction checklist (form) is sent to recruiting managers.


We need to put an Officer orientation programme in place however, in the meantime we have run Officer training for both the Senior Management Team and the Waitemata DHB Board. We are currently reviewing orientation processes, including pre-start health screening, for students. The current manual departmental health and safety induction form will be moved onto an electronic platform so we can start to record completed departmental inductions. Due date December 2018.

Consequences

There are fines and criminal punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

6. Risk Management

What the Act says

PCBUs have a duty of care to ensure the health and safety of another person is not put at risk from work carried out as part of the conduct of the business or undertaking. Risks must be eliminated or minimised so that a PCBU can, in so far is reasonably practicable:

Provide a workplace without risk.

Provide and maintain safe systems, plant and structures.

Ensure the safe handling, storage and use of plants, substances and structures.

Provide training or supervise to protect persons from risk.

Maintain accommodation so a worker is not exposed to risk.

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How do we comply?

An online hazard management system is in place where hazards are identified and controls recorded. Hazards are reviewed between monthly and annually as well as after any related incidents, depending on the level of risk and risks are reviewed every 12 months by the divisional lead manager and Health and Safety Representatives. A corporate risk register is in place where service, division and organisation wide health and safety risks are also recorded, controlled and regularly reviewed. A total of thirteen risks are now on the register (legislation, wellbeing, hazardous substances, use of sharps, aggression, community workers, working with machinery, electrical equipment, moving and handling, exposure to blood and body fluids, asbestos, psychosocial stressors, slips/trips and falls and fire safety). Evidence of audit, checks and compliance will be noted where controls prescribe this. Reporting on the register will be via the Executive Health, Safety and Wellbeing Committee, and where risks are elevated to the Corporate Risk Register - to the Risk and Compliance Committee, and the Audit and Finance Committee. Waitemata2025 design and work impact meetings are occurring. Processes to monitor and maintain operational compliance are in place, i.e., fire management plan, training, exercises, maintaining clear egress, etc. Entrance ways have non slip flooring and signage to indicate they may be slippery when wet. On wet days, additional signage is displayed to alert patients, staff, visitors, contractors to potential slip, trip and fall hazards. This expectation is spot audited. CCTVs are active in appropriate places in and around our sites. A reception and aggression hazard and security risk assessment tool has been developed for use in Community and inpatient settings. Asbestos surveys are ongoing for buildings constructed before 2000. An online Asbestos Register is ready to be populated and a volunteer resource will commence this month to load the information. A fixed term resource has been approved to oversee reactive maintenance triage and works management. Facilities staff have had existing Site Safe training which includes hazard identification. Refresher training has been completed for Trade staff. Remaining Facilities and Development staff booked to complete Hazard and Risk Management training beginning of November. 21 Draft Safety Maintenance Procedures (SMP) have been created and reviewed to manage Facilities hazards and risks. An annual Safe Way of Working (SWoW) annual self-assessment audit tool is in place and is completed by all areas in May/June each year, with validation audits undertaken post the audit.

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Updates for May The 2018 SWoW annual audit wend live on 6 April 2018, for completion by all Waitemata DHB staff managers.

What is outstanding? Recent audits have identified a number of Health and Safety Information Technology (IT) systems that are not providing the ability for robust, integrated and systematic analysis across the organisation. A Request for Information has been evaluated in February with a view to go to Request for Proposal in July 2018. In the interim:

A combination of the hazard register and the risk register is being used to store and make visible organisational, divisional and unit hazards (A new organisational risk register has been established as noted above).

A Microsoft Access database has been created to provide a greater ability to automate basic reporting of statistics and carry out limited data mining.

The new instance of the BEIMS system based on Auckland DHB implantation is being implemented to replace the current system version. Procurement confirmed and implementation by July 2018.

A recent deep dive audit has identified a number of Facilities technology, systems and processes where improvements of current processes to better implement good practise is warranted. The first review of this work was completed with the Executive Leadership Team on 3 July 2017. Work to review and mitigate high residual risks is underway and due to be completed in 2018. Tranche 1 of critical resources for Facilities management works have been approved and recruitment is underway.

Electrical Safety Draft Policy for Tagging and Testing is to be tabled at the May 2018 Executive Health and Safety and Well Being committee for approval.

Consequences

There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

7. Contractors (Facilities, Health Alliance and Information Technology)

What the Act says

The PCBU, as well as ensuring the health and safety of its employees (workers), is also required to ensure the health and safety of other workers, as well as ensuring that plant and fixtures and fittings are fit for purpose and without risks to health and safety of any person. There are new asbestos regulations that require a change in how PCBU’s currently manage and remove asbestos.

How do we comply?

Selection of Construction Contractors: The Waitemata DHB has moved to a process of selecting a panel of preferred contractors who can tender for Waitemata DHB construction and refurbishment work as it arises. Each main contractor has to first qualify to be a part of the panel by satisfactorily completing a contractor health and safety questionnaire which allows the organisation to demonstrate their performance against 12 health and safety

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criteria. Complete for incumbent contractors. Any new contractor must complete a requalification questionnaire. Maintenance contractors do not have a supplier panel arrangement in place. All regular contractors have been required to submit prequalification documentation in response to an HS200 questionnaire. Only those that satisfy the prequalification requirements which are safety compliant focused can continue to work for the Waitemata DHB. 1. Supplier Contracts and RFP processes Waitemata DHB contracts provide a standardised health and safety statement for minor or individual contracts. This clause is confirmed as satisfying the Act. The standard terms and conditions applicable to any procurement via an Oracle purchase order are being updated to include conditions relevant to serviced included requirements to meet HSWA 2015. Orientation: The contractor induction documentation and process has been refreshed. A new document, revised presentation and updated requirements for attendance by all contractors. Online contractor inductions have been developed and are now operational. The online induction is required for all contractors, with medium to high risk contractors also needing to attend the Facilities and Development No contractor is now able to receive their security pass without either having completed the online induction (for low risk contractors) and/or the Facilities and Development induction (for medium to high risk contractors). Site access: All building contractors must report to Facilities before commencing their work and all healthAlliance staff (IT) will report to security. In addition,

New projects must be agreed and coordinated with Facilities prior to commencing.

A contractor carrying out an agreed task e.g. for call out that does not need to be reported to Facilities prior – they do need to report to the area supervisor prior to and post work.

All healthAlliance staff and contractors are required to have healthAlliance issued photo identification on them at all times and for it to be visible. Usually if they are based on a particular site on a regular basis (i.e. not just visiting) then we will request a security access card with photo ID for that staff member from the site. 2. Facilities Once inducted, contractors working for Facilities are issued with a Waitemata DHB ID card with a photo. Proof of identification (passport/ drivers licence) is required to obtain this ID. The duration of the ID card can be set to cover the estimated time of the project. Contractors carrying out very urgent works are exempt from the requirement to complete the formal induction course and photo ID but must be provided with an induction and safety briefing suitable for their task prior to starting work.

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On the job: Construction Toolbox meetings occur on a scheduled basis. There is active management and collaboration with architects and designers to meet design expectations and requirements. Work impact meetings to assess risk occur regularly and ensure contractor health and safety plans are implemented. All Project managers, including the Waitemata2025 team are Site Safe certified as they join the team. Asbestos: Asbestos management surveys are completed, and a register of these surveys is in place, by building which notes hazard level. The type, location, condition and personal protective equipment expectations are identified in the survey so staff and contractors are alerted. Staff and contractors need to contact Facilities to seek information from the relevant survey. An online system is being developed to provide easier access to the detailed information. Corrective actions are being implemented to mitigate identified asbestos hazards. Asbestos management plans are being developed and implemented. This work is being led by the Waitemata DHB Asbestos Management Group in consultation with Auckland DHB Asbestos Management Group. Incidents and Accidents: Reporting of incidents and accidents follow the Waitemata DHB process. Contractors experiencing any accident or incident are required to notify the Waitemata DHB, investigate and report back any findings. On site audits: Regular external audits are conducted for construction site work. Project managers also undertake audits of their projects.

Orientation: Induction material is in place. On the job: A pre start safety meeting process is in development for all build projects, as well as ensuring work impact meetings occur regularly during the project. Safety in design guidance is in development. Quarterly meetings with maintenance contractors are now in place with the first meeting held late last year. Investigations Facilities adopted an ICAM concept of investigation that will identify why things went wrong and what actions are required to ensure compliance and keep workers safe. Records gained through incident reviews, audits and investigations are saved as confirmation of active management by the Waitemata DHB in its role as the PCBU.

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IT work review and sign off For IT project work related to moves and new fit-outs, the desktop team work closely with the Waitemata DHB Project Manager who reviews and signs-off that the work is complete. Building project health and safety management and sign off A performance review is done mid-way through each major building project. Health and Safety design sign off and pre-occupation processes are complete. The building sign off process follows the relevant policy. Post Implementation Reviews (PIRs) PIRs are done for each facility build project and results provided to the contractor selection panel.


Selection of contractors: The Waitemata DHB is moving to the same preferred supplier process for maintenance contractors as noted above for large construction contractors. The Waitemata DHB will transition to this process over the next 12 months. The first step of this transition is underway i.e. Waitemata DHB maintenance team requires contractors to provide suitable prequalification material by a certain date. If not met the contractor will be removed from the approved contractor list. All regular and new contractors employed by Facilities and Maintenance are required to undertake pre-qualification. Any emergency contractors must provide relevant works planning details and meet work safe requirements. healthAlliance processes: The Waitemata DHB is working with healthAlliance on site orientation, works planning and safety and procurement processes. These processes will be agreed across the region. healthAlliance works affecting a facility will be approved by Facilities management before commencing. Where induction or works are not adequately planned or completed will be deferred until signoff/ approval has been achieved. Building project health and safety management and sign off: Waitemata DHB needs to put in place a complete implementation of project sign off documentation. Project sign off documentation for building commissioning is structured and comprehensive. PCBU meetings Facilities management are implementing a schedule for contractor

engagement meetings expected to be initially held quarterly through the

year.

Consequences


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8. Hazardous substances

What the Act says

A PCBU has a primary duty of care to provide for staff use, handling and storage of substances. The Waitemata DHB is also required to comply with the Hazardous Substances and New Organisms Act 1996 (HSNO) and related regulations which requires the Waitemata DHB to prevent and manage adverse effects of hazardous substances and new organisms.

How do we comply?

The Waitemata DHB has focused on the 33 areas with high volume and/or exposure risk for the use of hazardous substances, constituting the highest risk areas, with 420 substances identified and added to the online register of substances available on StaffNet. A new and comprehensive HSNO policy has also been developed and published on the intranet, including new legislative updates relating to hazard classifications and tracked substances, with a strong focus on roles and responsibilities. The Intranet HSNO site now contains hot links to information covering:

Policy document.

Full HSNO database of all hazardous substances identified, including constituents, product state, United Nations number, Chemical Abstracts Service number, identified hazards, exposure limits, HSNO class and Personal Protective Equipment specific to each substance.

This database has recently been fully upgraded and allows each area to automatically create their own HSNO registers.

Master Material Safety Data Sheets repository.

Wastewater Disposal Guidelines.

Training resources, including introductory PowerPoint.

List of all Approved Handlers and their locations.

Emergency response requirements.

Specific spill kit contents list.

Managers’ responsibilities.

Key contacts for staff. Approved handler training has been delivered for high risk areas. Work has also concluded with healthAlliance to ensure that Material Safety Data Sheets are supplied for all new chemicals being procured and that these have been assessed by OH&SS prior to introduction. The North Shore Hospital has a dangerous goods store for holding hazardous substances to be used in the hospital and for storing waste prior to collection. The latest HSNO Legislation was released in November 2017 and we are currently reviewing it to understand all material changes required of us. Our existing HSNO Policy has been updated and republished. Of note, HSNO training will now be required under the new legislation, for all workers who use or handle hazardous substances.

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We are currently developing mandatory online training modules for these staff, with more specialised training for those staff that have a higher level of oversight and responsibility (competent persons).


We have another estimated 300 areas to review but a comprehensive audit of the 33 high risk areas is underway. Updates for May Due to the long term facility planning underway at Waitakere Hospital it is not advisable to construct a permanent hazardous substances store until the use of the property is confirmed. The store has been added to the capital planning in 2021. In the interim period, a temporary structure for Waitakere Hospital is being planned with procurement and installation scheduled for 2019. Until then, the DHB is limiting the volumes that areas are able to order at any one time and hold on site and in their own Dangerous Goods Cabinets. The only remaining issue is a lack of holding space for waste chemicals for disposal. At present materials are delivered via Waitakere to the North Shore Dangerous Goods Store, until we can activate an internal hazardous waste process utilising the dangerous goods cabinets at Waitakere Hospital. A pilot is currently underway. At present the waste removal work is being done via our Hazardous Substances and District Compliance Co-ordinators.

Consequences

There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. It is worth noting that hazardous substances are covered under three sets of national legislation, as well as local bylaws (Health and Safety at Work Act 2015, Hazardous Substances and New Organisms (HSNO) Act 1996, Resource Management Act 1991 and Auckland Council’s ‘Water Supply and Wastewater Bylaw’), under all of which fines can be payable.

9. Health of workers

What the Act says

A PCBU must ensure that the health of workers and conditions of the workplace are monitored for the purpose of preventing injury or illness. The PCBU must, as far as reasonably practicable, maintain accommodation so that the worker is not exposed to risks to health and safety.

How do we comply?

Pre-employment screening in place, however a number of staff still commence work pending their results. A pilot has been completed with the Specialist Mental Health and Addictions Services, and pending discussions on future options to implement across the Waitemata DHB, the pilot will continue and staff and managers asked to complete health screening prior to employment.

We undertake occupational health monitoring via our Occupational Physician health clinics and have now extended this to monitoring exposure to noisy areas (facilities), hazardous substances, laser care, and other risk areas. Monitoring for exposure for radiation (Radiology, Cardiac Catheter Lab) occurs externally.

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We provide free influenza and other vaccinations for staff.

We provide and maintain workplace heating, ventilation and cooling.

Areas with friable asbestos are sealed and require additional security clearance to gain access.

Containers for sharps, hazardous materials and substances are provided on each site.

Staff are provided with Personal Protective Equipment (PPE) to wear. PPE requirements are outlined in various policies as well as the hazardous substances register, Infection prevention and control, use of lasers, etc.

Infection prevention and control processes are in place to manage any disease exposure and outbreaks.

Slips, trips and falls posters have also been developed and distributed to the Health and Safety representatives for display within their areas. OH&SS are also displaying these posters in ‘common’ areas, where Health and Safety Representatives are generally not allocated.

Regular communication on hazards is issued.

Staff have access to EAP works, the Employee Assistance Programme for up to three free sessions on work or personal matters.

Wellbeing, resilience and mindfulness training is available as part of the organisation development team offerings as well as on request.

The Staff influenza campaign for 2018 has commenced, including a further increase in the number of in-team vaccinators, as evidence suggests opportunistic access and availability is a factor on decisions to gain a vaccination. Planning for patient responses, e.g. isolation of suspected flu cases, proactive vaccination of vulnerable cohorts is also underway. The latest HSNO Legislation was released in November 2017 and we are currently reviewing it to understand all material changes required of us. Of note is the expectation that we undertake specific area and hazardous substances task analysis and put in place appropriate processes to manage any possible exposure that may impact staff health. We are also developing mandatory online training modules for these staff, with more specialised training for those staff that have a higher level of oversight and responsibility (also called competent persons (was approved handler)). New for May

1. A sharps safety week is planned in November/December 2018 to promote awareness of risks, controls and safe use and disposal of sharps.

2. Staff influenza vaccination is currently at 34%, against a target of 60%. Several weeks of the vaccination campaign is still to go.

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Health monitoring programmes should be in place across all relevant risk areas. An audit on use of personal protective equipment will be planned as part of the health monitoring programme to validate the application of various policies and risk controls – due December 2018.

Consequences


10. Equipment and Maintenance

What the Act says

A PCBU must provide and maintain a work environment that is without risk to health and safety.

How do we comply?

Equipment that is broken is escalated for capital replacement as relevant. A register of capital assets is in place and being added to, to ensure that equipment is budgeted for replacement according to the life span of that equipment. All hospital bio-medical equipment is maintained by the Bio-Engineering team. An escalation process for urgent health and safety works has been agreed by the Chief Financial Officer, Chief Medical Officer and Director Human Resources. The Waitemata DHB is currently collaborating with regular meetings between Waitemata DHB, Counties Manukau Health, Northland DHB and Auckland DHB on contractor management, asbestos management, aggression risk management and other legislative compliance work. Task planning and sign off process for maintenance work, ensuring competent review and management oversight will be shared.

Support for Job Safety Analysis and safety planning is underway with training, monitoring and guidance for staff. Management of Job Safety Analysis is being provided by contracted resource prior to recruitment of permanent staff focused on health and safety and work management.


Maintenance work review and sign off: The Waitemata DHB needs to resource reactive maintenance triage and works planning and a fixed term resource has been engaged while a permanent resource is in recruitment. Trades staff have completed training in risk identification prior to undertaking maintenance works. An interim fast track process to approve maintenance triggered for health and safety reasons is in place but this needs to systematise. The BEIMS system is due for update in May 2018. The security alert systems for community workers working group have completed their Request for Proposal and a pilot is underway. The completed pilot report is due in the next two months.

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Consequences


11. Training

What the Act says

A PCBU must provide any information, training, instruction and supervision necessary to protect all persons from risks to health and safety arising from work carried out by the Waitemata DHB.

How do we comply?

A compulsory online Health and Safety Orientation is provided to staff pre-commencement. Health and Safety representatives are provided with two days of training (Four half day modules) by the Occupational Health and Safety Service covering an introduction to health and safety management, hazard and emergency management, accidents and occupational rehabilitation, safe working procedure, health and wellbeing and the new legislation. All staff are required to complete the mandatory annual health and safety update online. Training is provided on departmental specific instances such as moving and handling in patient areas, crisis intervention in areas where aggressive clients may be experienced, calming and restraint in mental health services, laser care in theatre, handling sharps by infection prevention and control. As already noted, approved handler training is in place for hazardous substances. Training is provided on how to access our incident management, risk register and hazard register systems.

Training for notifiable events is complete. Emergency Response Training occurs regularly.

Fire Response and Evacuation Training occurs for all new staff and annually online and face to face in key areas.

Fire Evacuation drills occurs across all Waitemata DHB areas six monthly which means each week there are activities in order to cover all areas.

Warden Training occurs on all sites annually for all wardens and deputy wardens. This is for all areas so requires multiple sessions annually.

Duty Nurse Manager training occurs for all new duty nurse staff and three times a year.

Incident Management Team training occurs quarterly.

Key staff are required to attend Health CIMS2 training – which is available monthly and is done as a regional programme with the other District Health Boards. This is open to all health settings including PHO’s Accident and Medical centres and Residential Aged Care key staff.

The Waitemata DHB runs particular Health CIMS4 training with a provider twice a year for key areas that have identified a need.

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Training in the due diligence responsibilities as Officers for the Senior Management team was completed on 7 July 2017 and for Board members on 27 September 2017. Training for risk assessment complete for Facilities and Development staff. New online training to manage difficult communications was launched in mid-February and is now available for all staff. The CALM communication the module teaches good communication and de-escalation skills. Also in development is an online module called “Introduction to Staff Safety and Security at WDHB” for all staff to complete as part of Orientation. The module will deliver the foundational requirements to the Staff Safety policy training in the following areas:

S.T.E.P. Matrix for risk assessment

Know-how to call for assistance and respond to calls for help

Security alerts and incident reports

Security and safety tools

Additional modules for community workers include Risk management, preparedness and safety planning. The DHB has also piloted a newly developed programme which will support staff to cope emotionally with challenging work related situations.


Specific service based training to manage aggressive behaviour is being scoped. Development of E-learning for hazardous substances and new organisms is in development.

Consequences


12. Audits

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the Waitemata DHB.

How do we comply?

Since early 2015 we have completed a number of readiness audits to assess compliance with the new health and safety legislation and to assess new or different resources needed. Regular external audits of contractor sites are in place. A governance audit on the Board charter is completed biannually. An audit programme for 2016/17 has been completed with Internal audit and includes deep dive audits on essential service maintenance, investigation processes and feedback loops, contractor management, community safety, governance assurance, efficacy of works to improve our three top accident types, and environmental controls. The 2017 Safe Way of Working audit has been completed; divisional results

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have been validated and distributed. Audits underway for 2017/18 include:

1. Health and safety governance – complete 2. Companion audits for the 2016/17 deep dive audits for community

workers and construction/contractors. These audits are planned to look at contemporary Waitemata DHB practise against industry expectations, as well as understanding what is working well, what we still need to develop and any work we should do regionally in these areas – Complete

3. A follow up audit on the essential services maintenance deep dive audit to check that all critical or immediate steps have reduced overall residual risk- Complete.

For 2018/19 audit topics are as follows:

1. Safety culture 2. Emergency response 3. Control measures for high accident types 4. Safety and security


There are no outstanding actions. Audit findings and actions are reflected in other sections of the report.

Consequences


13. Reporting

What the Act says

An Officer of a PCBU must ensure they acquire and keep up to date on health and safety matters.

How do we comply?

Monthly reports on health and safety matters are provided to the Board meeting, Audit and Finance Committee meeting and the organisational Health, Safety and Wellbeing committee. A new Board Health and Safety Reporting format has been in place since November 2016 and additional information continues to be identified for inclusion, e.g. the recently added work-related injury claims cost data. The Waitemata DHB has commenced commentary on trend drivers in Board reporting to give Board members a view on what impacts our health, safety and wellbeing performance. Board reports now also comment on health and safety impacts on stakeholders including contractors, patients and visitors.

A health and safety annual report is currently in development, commenting on the Waitemata DHB health, safety and wellbeing policies, activities, audits, systems and future plans and challenges in an engaging short report format. Comprehensive health, safety and performance statistics will be attached as appendices.

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What is outstanding? A divisional real time reporting scorecard will be developed alongside the new health and safety IT system. As part of the outcome of the governance audit, an annual assessment of the DHBs risk profile has been suggested. The first annual review will occur in August/September 2018 and measure status as at 30 June 2018.

Consequences


14. Resources

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the Waitemata DHB.

How do we comply?

A resource review was completed in 2016. Recommended actions were tabled to the Board in August 2016. On review of the report we have implemented the following new resource:

0.4 training FTE to an existing Health and Safety Adviser role.

Hazardous substances co-coordinator (1 FTE).

Health monitoring nurse specialist (1FTE fixed term for two years).

Health and Safety advisor (1FTE) so we can spread training across the advisory team and allow advisors to have service portfolios for in service outreach, advice, training and assistance.

Health and Safety Manager has been employed by Facilities and Development (1FTE).

Investigator/auditor (1FTE). An additional Duty Nurse resource has been in place for four months and extended for up to an additional 12 months. Facilities and Development roles are either currently being appointed or in recruitment. The list of the roles are as follows:

Works Manager x1

Works Planner x1

Project Manager for Facilities and Maintenance (small projects – 0.8FTE x1

BEIMS Administrator Position 0.25FTE x1

Carpenters x2

Fitters x2

Plumber x1

Engineers x2

Painter x1

In response to the new Health and Safety at Work (Hazardous Substances) Regulations 2017, we have extended the fixed term role for health monitoring to June 2019. During that time we will review the future needs for ongoing health monitoring resourcing.

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Work underway to 1. Assess resourcing for incident follow up due to a significant increase

in incidents for monthly review and follow up 2. Convert existing contract resource to Full Time Equivalent (FTE) for

additional Occupational Health Physician and work injury administration support.

Consequences


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7.2 Briefing on Waitemata DHB Activity in the Minister of Health’s priority areas

Recommendation:

That the Board receive the report.

Prepared by: Tim Wood (Deputy Director Funding), Ruth Bijl (Manager Child, Women and Youth), Aroha Haggie (Manager, Māori Health Gain), Lita Foliaki (Manager, Pacific Health Gain), Samantha Bennett (Manager, Asian, Migrant and Refugee Health Gain), and Trish Palmer (Manager, Mental Health and Addictions). Endorsed by: Dr Karen Bartholomew (Director Health Outcomes) and Dr Debbie Holdsworth (Director Funding)

Glossary

CNS - Clinical Nurse Specialist FftF - Fit for the Future GP - General Practitioner HNA - Health Needs Analysis PCSP - Primary and community Services Plan PHO - Primary Health Organisation POAC - Primary Options for Acute Care POCT - Point of Care testing LMC - Lead Maternity Carers MALT - Māori Alliance Leadership Team MoU - Memorandum of Understanding NCHIP - National Child Health Information Platform SACAT - Substance Addiction Compulsory Assessment and Treatment SLM - System Level Measures


The government, Prime Minister and Minister of Health have articulated four key priority areas in health: equity, child health, mental health and primary care. This briefing paper outlines current Waitemata DHB key programmes of work, areas of focus and investment proposals in these priority areas.

2. Equity

DHBs have legislative responsibility to uphold the principles of Te Tiriti o Waitangi, improve equity for our population, improve health outcomes for Māori and enable Māori to contribute to decision making and delivery of services. These are the fundamental components of the framework for improving equity of healthcare, which describes the necessity of leadership, knowledge and commitment across three levels: the health system, healthcare organisations and health practitioners. As a health system, we need to clearly understand the drivers of inequity and have multifactorial actions to address and mitigate these, to accelerate health gain and improve equity. This is an ‘and-and’ situation that requires actions within mainstream services as well as targeted approaches, specific services, partnerships and intersectoral working. Accelerating improvements in

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high level Māori health outcomes and reducing health inequity are priorities articulated in Ngā Painga Hauora the Waitemata DHB Outcomes Framework developed with Sir Mason Durie. This framework highlights the contribution of Māori providers to Māori health gain, as well as the need to continue to focus on improving access and quality of mainstream healthcare services. In addition, Auckland’s population is growing and changing incredibly rapidly. In the last 15 years, the greatest increase of any ethnic group has been in those of Asian origin, principally from China, India, Korea and more recently the Philippines. In 1991, 5.5% of Auckland’s population identified themselves as Asian; by 2001, this had risen to 14% and in 2017 it has reached 26%. The Planning, Funding and Outcomes team work closely across the hospital and community portfolios and with partners and providers to lead on equity. Planning, Funding and Outcomes team have three equity managers – Māori Health Gain, Pacific Health Gain and Asian, Migrant and Refugee Health. In addition, the Health Gain team support across the teams to provide expertise and evidence on concrete equity activity, and the Planning and Intelligence team support development and reporting of the equity plans, annual plan indicators by ethnicity and equity reporting more broadly. Leadership is also demonstrated at Board and governance level, through the lead Chief Executive Officer for Māori Health Dr Dale Bramley, and joint Waitemata-Auckland DHB roles for General Manager Tikanga Dame Rangimarie Naida Glavish, General Manager Māori Health and General Manager Pacific Health. Our approach to equity is described below:

a. Strategic approaches; b. National, Regional and DHB Plans.

a. Strategic approaches

Approach Commentary

1. Mainstream services

Provide care for majority of Māori, Pacific and Asian people.

Focus on the reach (access/participation), quality of care and outcomes.

Focus to reduce the disproportionate disease burden for key areas (e.g. diabetes, cardiovascular disease, smoking, child health).

o Reflect commitment to equity in our commissioning and documentation. o Monitoring outcomes by ethnicity: specific equity KPIs and indicators of

performance. o May involve some differential resourcing or targeting of services within current

service delivery.

Patient experience, cultural competency and workforce development are important components. Co-design of services and pathways is becoming a common approach, and we are increasingly incorporating health literacy principals and actions.

2. Targeted approaches

Based on population need (Health Need Analyses (HNAs)) o Identified by health outcomes e.g. top causes of preventable mortality or

hospitalisation. o By population groupings (e.g. Māori, Pacific, refugee migrant, disability, age). o By location (e.g. localities work, health hubs). o By high impact disease groupings (e.g. cardiovascular disease, cancer, diabetes).

Evidence based and/or creating evidence (evaluation of new approaches) eg Abdominal Aortic Aneurysm (AAA) screening for Māori, human papilloma virus (HPV) self-testing for cervical screening for Māori, Pacific and Asian women.

3. Specific Interventions

Key issues or disease groups o High impact on mortality/morbidity outcomes e.g. cardiovascular disease,

cancer, diabetes).

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a. Strategic approaches

Approach Commentary

o Risk factors action to prevent disease (e.g. smokefree activity, cardiovascular disease risk management, obesity).

o New technologies (e.g. as above targeted AAA and HPV screening, proposal for lung cancer screening).

o New models of care (e.g. community cardiac rehab at Whānau House).

Including issues identified by community itself (e.g. Family violence prevention, parenting) in the Pacific Health Action Plan and local priorities by MoU partners in Māori Health Plan (obesity, cardiovascular disease management, workforce development)

4. Partnerships

MoU partnership (see table b below) with identification of key areas of focus – patient and whānau experience, and progression of whanau ora.

Whanau ora commissioning agents.

Enua Ola and Healthy Village Action Zones.

Māori and Pacific Providers. o Evolution of integrated contracting (contracting for outcomes) for both Māori

and Pacific providers. o Community development and engagement. o Workforce development and capacity building.

5. Intersectoral work

Action on the determinants of health (key areas that impact health outside of healthcare) e.g. housing, education, income, urban design, transport – social sector leaders forum.

Action on complex issues that cross sector boundaries (eg obesity, rheumatic fever, alcohol).

DHB leadership role across a number of areas o Healthy Auckland Together (ARPHS coordinate). o WaiAuckland (ARPHS coordinate, DHBs co-fund with Auckland transport). o Healthy Babies Health Futures. o Healthy Families. o Investing for social wellbeing (previously Social Investment e.g. Oranga Mahi

trials to improve employment for people with stroke and serious mental illness and the Tamaki Response), previous work on the social sector trials.

b. National, regional and DHB plans Māori Pacific Asian, refugee, migrant

National plans

New Zealand Public Health and Disability Act, Te Tiriti o Waitangi, He Korowai Oranga

Equity of Health Care for Māori Framework (2014)

Te Ara Whakawaiora - Māori Health Dashboard.

‘Ala Mo’ui: pathways to Pacific Health and Wellbeing (national plan that sets out priorities, outcomes and actions).

NZ Migrant Settlement and Integration Strategy.

NZ Refugee Resettlement Strategy.

NZ International Student Wellbeing Strategy.

Regional plans

Regional Health Plan (regionally agreed WFD and Māori health priorities).

System Level Measures (SLM) plan (metro Auckland SLM Plan 2017/18) with equity focus.

Regional KPI Dashboard.

Regional Health Plan.

SLM Plan

Regional Health Plan

SLM Plan

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https://nsfl.health.govt.nz/system/files/documents/pages/metro_auckland_2017_18_slm_plan_final.pdf

https://nsfl.health.govt.nz/system/files/documents/pages/metro_auckland_2017_18_slm_plan_final.pdf



DHB plans

MoU relationships with Te Runanga o Ngati Whatua and Te Whanau o Waipareira.

Joint Waitemata DHB/Auckland DHB (and aligned to Counties Manukau Health) Māori Health Plan continue despite no longer being a Ministry requirement (WDHB MHP).

Annual Plan (Whanau Ora).

Nga Painga - Māori Health Outcomes Framework.

Māori health providers.

Joint Waitemata DHB/Auckland DHB Pacific Health Action Plan 2016-2020.

Partnership with churches / communities through Enua Ola and Healthy Village Action Zones.

International Benchmarking report 2017 (Asian Benchmarking Report).

Joint Waitemata DHB/Auckland DHB Asian, migrant and refugee health plan 2017-2019 (WDHB Asian Plan, aligned to the Counties Manukau Health plan.

Key areas of focus

Integrated contract review.

Equity focus as highlighted in the Waitemata DHB/Auckland DHB Maori Life Expectancy Report and aligned in the SLM plan (see primary care section) – focus on maternal smoking, pregnancy vaccinations, cardiovascular disease management.

Diabetes management (Diabetes Service Alliance).

Increasing eight month immunisation.

Oral health (metro Auckland Preschool oral health strategy) – improving dental service enrolment and earlier access, kohanga reo fluoride varnish programme.

Obesity (metro Auckland Child Health Weight Action Plan) - Healthy Auckland Together actions, Healthy Babies Healthy Futures Project and Bariatric Service Project (to increase access).

Implementation of the Maori and Pacific Did Not Attend (DNA) reduction strategy (Waitemata DHB/Auckland DHB).

Ethnicity data quality improvement.

Implement Māori Workforce Development Strategy and Kaumata Action Plan.

Integrated contract review.

Eight priorities:

That children are well and safe and that families are free from violence.

Pacific people are smoke free.

Pacific people eat well and stay active.

Pacific people seek medical and other help early.

Pacific people use hospital services when needed.

Pacific families live in warm houses that are not overcrowded.

Pacific people will experience optimal mind health and wellbeing.

Pacific elders are valued and experience optimal health and wellbeing.

Focus:

Further improvement on smokefree churches (currently 71%).

Further development of parish nursing.

Delivery of tailored family violence programme

Parenting education and support.

Continue leading Healthy Babies Healthy Futures.

Preschool oral health, early childhood fluoride varnish

Primary care access via PHO enrolment – through improving awareness and knowledge about the NZ health system to students who are eligible and new migrants and the Metro Auckland DHB funded Refugee Primary Care Wrap Around Service Agreements which provide no or low cost general practice access to former refugee and asylum seeker patients.

Better management of long term conditions.

Smoking cessation for Chinese males.

System Level Measures (see primary care section) – focus on youth mental and sexual and reproductive health.

Breast feeding.

Preschool oral health.

Cervical screening

Influenza immunisations (over

65 years).

Refugee and asylum seeker primary health.

Ethnicity data quality improvement, particularly the introduction of level 4 ethnicity classification for better granularity for sub-groups.

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http://www.waitematadhb.govt.nz/assets/Documents/health-plans/2017-18-Maori-Health-Plan-Auckland-and-Waitemata-DHBs.pdf

http://www.waitematadhb.govt.nz/dhb-planning/health-needs-assessments/international-benchmarking-of-asian-health-outcomes-for-waitemata-and-auckland-dhbs/

http://www.waitematadhb.govt.nz/dhb-planning/health-needs-assessments/international-benchmarking-of-asian-health-outcomes-for-waitemata-and-auckland-dhbs/

http://www.waitematadhb.govt.nz/assets/Documents/health-plans/2017-19-Asian-Migrant-Refugee-Health-Plan-ADHB-WDHB-CPHAC-Final.pdf

http://www.waitematadhb.govt.nz/assets/Documents/health-plans/2017-19-Asian-Migrant-Refugee-Health-Plan-ADHB-WDHB-CPHAC-Final.pdf



Progressing whanau ora centres.

programme.

Implementation of the Maori and Pacific Did Not Attend (DNA) reduction strategy (Waitemata DHB/Auckland DHB).

Business cases or areas for further investment

Maternal smoking cessation incentives programme business case approved – monitoring outcomes.

Waipareira investment cases based on Whānau House HNA (currently for Immunisation and Youth Mental Health).

2.1 Māori Health Advancement Pipeline

A pipeline to accelerate Māori health focused proposal and projects to achieve Māori health gain has been initiated. This pipeline includes priorities identified from a range of work undertaken including the Māori Life Expectancy Report, the Whānau House HNA, the Māori Health Plan, the equity re-focussing of the System Level Measures Plan, the DHB and Nga Painga Hauora outcomes frameworks, the review of the integrated contracting processes, and horizon scanning of evidence and technologies. The pipeline will provide a structure to accelerate progression of key strategic projects in high impact areas, including a lung cancer screening feasibility assessment and alternative models for cardiac and pulmonary rehabilitation.

2.2 Māori Workforce Development

The Māori Alliance Leadership Team (MALT) is a governance group across metro Auckland, chaired by Lead Chief Executive Officer for Māori Health Dr Dale Bramley, which oversees the implementation and monitoring of the co-developed Māori workforce development strategy with Ngati Whatua and Te Whānau o Waipareira. This is a significant piece of work as health is one of the largest employers in the metro Auckland region. The primary purpose of MALT is in improving Māori workforce participation, recruitment, retention and workforce development. Initial MALT work has been focussed on hospital recruitment; a process to describe Māori participation in the primary care workforce is currently underway. MALT has a number of workstreams under its work programme. The Data Working Group is one workstream which is tasked with identifying the issues and improving ethnicity data (and employment coding) in Human Resources systems, to ensure compliance with the Health Information Standards Organisation (HISO) Ethnicity Data Protocols 2017, as well as develop metrics and dashboards for MALT visibility and monitoring of workforce development progress. The Data Working Group has undertaken and have underway a range of audits of specific data quality issues, which has identified a number of Māori staff incorrectly coded in the workforce reporting and corrected this data. The Human Resources system ethnicity data flows have been process mapped, and points of error identified. A proposal for a longer term electronic solution to improve data

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quality is underway, which will be of benefit to the eight other DHB users of the Human Resources IT system. MALT has taken a market-research approach to address the lack of Māori nursing and medical doctor job applicants. Focus groups were held to understand health career choices, what barriers and enablers are important in their career journeys and job application processes. The final report with key findings and recommendations will provide MALT with an additional evidence-base to address Māori recruitment and retention issues. Māori Clinical Nurse Specialist (CNS) roles have been in place for five years, to accelerate Māori health outcomes in reducing patient Did Not Attends (DNAs), enabling workforce development and new models of care. Most recently, the Māori CNS team of three (Diabetes, Gerontology and Respiratory) became four with the appointment of the Māori Cancer Care Coordinator. A focus on sustainability and succession planning has created an accelerated pathway from Level 2 Nurse to Clinical Nurse Specialist, this is a pilot being implemented in the Diabetes service. The Māori Clinical Nurse Director is heavily involved in supporting this work. Kia Ora Hauora is the national Māori health workforce development programme. It is supported by all DHBs and has a major focus on increasing the proportion of Māori in the health workforce. The MALT is leading a complimentary piece of work to review of the recruitment process across the three Metro-Auckland DHBs, focused on ensuring positive outcomes for Māori candidates. Initiatives to increase transparency, reduce barriers and improve Hiring Manager accountability include a policy that all eligible Māori applicants are invited to interview, a new applications data report, and Māori workforce champions. The DHBs also lead local initiatives, including under the Youth Employment Pledge banner, to improve the pipeline into health careers for young people.

3. Child, Youth and Women

3.1 Former Better Public Service (BPS) Targets and Health Targets

The whole of government ‘Better Public Service’ (BPS) key results areas have been disestablished. Some of the key areas remain important areas of focus for the DHB including ‘early engagement with a Lead Maternity Carer’ and ‘Avoidable Hospitalisations 0–12 years,’ as well as ‘Supporting Vulnerable Children.’ Going forward, child poverty and early intervention are expected to be part of the scaffolding for a number of the priorities in child health. The evidence shows that maternal health and well-being (including pre-conception health) is important for both infant and life-long health outcomes. There are significant inequities in maternal and infant health outcomes such as gestational diabetes, low birth weight, sudden unexpected death of an infant (SUDI) and prematurity. This is most pronounced inequities are for Māori and Pacific women and women living in economically deprived communities. A healthy housing service (Kainga Ora, see section 3.3 below) is considered an important programme designed to address determinants associated with poor mental and physical well-being stemming from housing-related poverty. Our aim is to ensure this is delivered early in the life-course. Whether the current Health Targets (including the 8-month immunisation indicator) will remain is unknown. However along with obesity reduction and early intervention from pregnancy, immunisation remains an important area of health gain focus (see 4. below). The joint Auckland DHB and Waitemata DHBs Maternal and Child Service Alliance continue to support and monitor activities related to maternal and child health priorities. The Alliance includes clinical and management representatives from DHB maternal and child health, College of Midwives/Lead Maternity Carers, GP,

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Well Child Tamariki Ora (WCTO), Social Work and mental health. The group routinely monitors performance against a range of metrics such as family violence screening, referrals to maternal smoking cessation services and immunisation.

3.2 Maternity and early infant care

The way the health system is designed around maternity and early infant care is complex. The DHB has few levers they can apply to drive health practitioner behaviour in this area. The Ministry of Health holds maternity funding and Lead Maternity Carers (LMCs – most often midwives) claim funding under the Maternity Services’ Notice, Section 88 of the NZ Public Health and Disability Act. The College of Midwives and the MoH have been in discussion through a co-design process regarding payment and presumably expectations of midwives under the notice. These discussions have excluded DHBs. General Practitioners (GPs) can also make claims under the notice but very few provide LMC care. More often GPs provide first trimester of pregnancy care following confirmation of pregnancy. The system is disjointed and there are recognised issues with engagement, consistency, comprehensiveness and sharing of information. The DHB has a number of projects which seek to address this under the umbrella of the First 1,000 days, including an ambitious programme of work around an ‘all providers’ Maternal and Infant Well-being Assessment (MIWA) which has just completed a test of concept phase. The ‘all providers’ includes LMCs, GP (and practice nurses), DHB employed midwives and maternity services and WCTO providers such as Plunket (there is also a national contract with Plunket). This work is identifying service gaps and barriers which may require additional investment, such as for wrap around social work support and primary mental health services for pregnant women experiencing depression or anxiety. Workforce issues are apparent with shortages of both LMC and DHB employed midwives. This is a particular problem in the metro-Auckland region. Women can choose where they give birth, including in other DHB’s facilities. Waitemata DHB has approved development of a primary maternity unit on the Waitakere Hospital campus.

3.3 Healthy Housing Initiative (HHI) Kainga Ora

Kainga Ora is a wrap-around service which uses markers for poor health as a flag to engage whānau with assertive social work services, using a ‘housing first’ lens. The HHI service is now well established, and has been operating in Waitemata DHB and Auckland DHB for over a year. The original service was contracted through MoH with a Counties Manukau Health focussed provider. This arrangement achieved limited effectiveness for Auckland and Waitemata. Kainga Ora is led by the Funder with an operational arm coordinating activity and contracts with both hospital and community provided social work. Referrals are steady and the service has become well known amongst relevant referrers. To date, from Waitemata DHB there have been:

362 eligible referrals including 1,658 individual family members. Of these, 129 referrals were for pregnant women/new mothers (pregnant women are a particular focus as the programme aims to intervene early, before respiratory illnesses become a chronic condition).

602 interventions have been delivered including 41 families moving into new social housing. The focus now is on ensuring Kainga Ora is receiving all eligible referrals and continuing to improve feedback loops and communication with referrers. Ministry for Social Development and Kainga Ora have worked together to develop a robust reporting process that meets both organisations needs and ensures that no whanau fall through the gaps. Housing New Zealand and Kainga Ora are in the

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process of improving reporting mechanisms so they are fit for purpose while ensuring whanau needs are addressed. Further investment in healthy housing could be anticipated.

3.4 Immunisation

Immunisation protects against a range of serious, life-threatening diseases. In addition to personal health benefits, immunisation protects vulnerable people who cannot be immunised (such as those who are immune compromised or who are too young to have received the full schedule of vaccines). The system is reliant on primary care engaging all the people they can, supported by an outreach system for whānau who are not readily engaged in primary care. There is an unremitting flow of people who require immunisation. In addition to a highly systematised means of identifying and engaging people in a timely manner for their routine immunisations (supported by the National Immunisation Register), there is an on-going anti-vaccination community dialogue. Immunisation starts in pregnancy, to protect both mother and baby. There has been a strong focus on the two year old child and 8 month infant. Waitemata DHB continues to have to work very hard to achieve immunisation health targets and equity for Māori remains an outstanding issue. The Funder’s child health team follows each Māori infant turning 8 months in the quarter and offers supports including an in-home visiting vaccination service. There is also a Māori case review group hosted by Te Whanau o Waipareira which prospectively looks into the information held by a range of DHB and community providers to support making connections with whanau and consider systems changes if required. There are still on-going out-breaks of specific diseases (currently mumps and pertussis). Various approaches to address these are being implemented including a school based catch up programme. In addition to other factors, capacity in primary care may be an issue. Consideration of different models of care such as culturally appropriate, primary care nurse-practitioner led service delivery in high needs communities could be considered for future investment.

3.5 Obesity Health Target – ‘Raising Healthy Kids’

A focus for improving healthy eating and activity has been through the ‘Raising Healthy Kids’ Health target. Auckland DHB had led the country and continues to exceed the Health Target for all ethnicities, maintaining a 100% result. Training for Primary Care providers and a brief intervention service continues following positive evaluations. A Positive Parenting and Active Lifestyle Programme for pre-school children and their families have also just been commissioned. The metro Auckland Child Health Weight Action Plan, agreed in 2017, covering actions across the life-course is a more important population focus. As with so many areas, the determinants lie beyond the health system and are in part about environmental design and community awareness. We consider that the Triple P healthy lifestyle intervention could be a useful tool alongside other behavioural changes such as encouraging people to replace sugary drinks with drinking water and use more active transport options. Health promotion messaging alignment work between the obesity plan and the oral health plan has been undertaken.

3.6 Oral Health

Pacific children followed by Māori and some Asian children have disproportionately poor oral health. As for Healthy Weight, we have agreed a metro Auckland Oral Health Plan. Activities focus on increasing enrolment, including automatic enrolment at birth and updating the Auckland Regional Dental Service (ARDS) registration form. Some ARDS clinics are now open on Saturdays, with plans to expand to more clinics. A Fluoride Varnish programme was implemented in March; it will be evaluated and rolled out to other Early Childhood Centres. Work is also underway to review the

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accuracy of the oral health data collected and reported. Further service development is required in the adolescent space to ensure young people can readily access oral health care. In most cases, adults cannot access oral health care. The exception to this is ‘relief of pain’ which is provided by the DHB and contracted providers in the community. An oral health service for pregnant women living in Tamaki is in the process of being scoped.

3.7 Youth

Most young people are well. However, adolescence is a time of risk-taking and on-going brain development. This, combined with high levels of emotional distress, contributes to high rates of suicide and accidental injury. Again, Māori and Pacific are disproportionately affected. To improve access to primary health care we have an excellent school based health services (SBHS) programme inclusive of a full time, nurse-led clinic supported by a GP in 5 lower decile secondary schools. The interface between health and education continues to throw up challenges such as the quality of facilities and expectations of school leadership. Signals from the new government regarding extending the reach of nurses in schools are awaited. Any extension of the programme needs to ensure nurses are well supported in a professionally isolated environment. Traditionally, funding provided by the MoH has not matched actual service delivery costs. A funding short-fall against expected deliverables could be anticipated.

3.8 Transgender

There is considerable lobbying underway by the transgender community for improved access to gender affirming services, including lower genital surgeries. We have a relatively developed programme of services for transgender peoples. This includes services provided by Centre for Youth Health for young people going through gender identity issues or wishing to transition. Development of services provided by Auckland Regional Sexual health services has also been undertaken to ensure they provide appropriate services, and can work effectively with gender diverse people. Gender diverse people experience extremely high levels of distress and are much more likely to commit suicide than other groups of people. There is currently strong interest from the community in provision within New Zealand of lower genital surgery. This is currently funded and sourced outside New Zealand by the MoH. However, only two people a year are funded to access these relatively high cost services. This creates a long wait list (with wait times in the order of decades).

3.9 National Child Health Information Platform (NCHIP)

Auckland, Waitemata and Northland DHBs’ Boards approved funding to implement the NCHIP over two years, to provide a centralised system to identify children living in the region and report on enrolment and milestone data from providers delivering core universal child health services. This is part of the Northern Region’s aim to ‘Knowing Every Child’ in early childhood. NCHIP will allow a provider to assess whether the child they are seeing has accessed all potential services. It will allow the DHB to develop systems to identify and support access to services for children that are currently missing out on the full range of health care services. As the service is implemented, service gaps may become apparent.

3.10 Cervical Screening

Coverage targets for cervical screening, in particular in Māori, remain below target with unfavourable trends. We continue to provide education, practical support, funding to screen priority women, and encouragement to promote screening, utilise opportunistic screening strategies, and broadening clinic hours. The Cervical Screening Programme is unique in that most women are required to self-fund screening. The small amount of funding for free screens is inadequate to support achievement of national coverage targets, particularly regarding equity. There are advances in screening

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technologies which need to be implemented over the next few years. The focus should be on ensuring developments work for Māori women, as has been developed for the HPV self-testing for cervical screening research programme in Waitemata DHB and Auckland DHB.

4. Mental Health and Addictions

4.1 Government Inquiry into Mental Health and Addiction 2018

The Government Inquiry into Mental Health and Addiction was established by the New Zealand Government in response to widespread concern about mental health and addiction services in the mental health sector and the broader community. The purpose is to identify unmet needs related to mental health and addiction, and develop recommendations for a cohesive approach for Aotearoa, New Zealand. The inquiry must report back to the Government by 31 October 2018 and are committed to making recommendations that are pragmatic and implementable, with a focus on short and long-term solutions at the national and local level. The priority groups identified are Māori, youth, Pacific people, minority, immigrant and refugee groups, LGBTIQA+ communities, prison populations, the elderly and rural/farming communities. The inquiry wants to build on the good work already being done, while looking to system-level change that will improve both promotion of good mental health and support for people with mental health challenges and/or addictions. In short, the inquiry report aims to generate hope and set a clear direction for the next five to ten years that Government, the mental health and addiction sectors, and the broader community can pick up and implement, to make real, positive change. This is divided into phases: Currently the focus is on producing an accurate picture of how well New Zealand’s Current Mental Health and Addiction services are working. Waitemata DHB has compiled and submitted a stocktake report including information about the population served and detail about new initiatives and gaps. An overview of highlights and challenges was presented at the Inquiry panel visit on 9 May. The Inquiry is due to release a consultation document on which they will be seeking sector feedback (via written submissions/at forums or by direct engagement) through to the end of September which will provide the opportunity to build consensus about the way forward.

4.2 Zero Suicide Framework

Waitemata DHB and Auckland DHB supported Dr Kathryn Turner, from Gold Coast Health, who presented two workshops in December 2017 on her organisation’s journey to Zero Suicide. She offered learnings and support to start our own journey to implement a Zero Suicide Framework. The Zero Suicide Framework includes a number of evidence-based interventions that hospital health professionals and GPs/Primary Care providers use to respond to suicidal ideation or attempts, to reduce deliberate further self-harm and mortality. Auckland DHB has agreed to fund 1 FTE for a project manager/clinician for three years to implement the Zero Suicide framework; a business case will be developed for similar funding for Waitemata DHB.

4.3 Substance Addiction Compulsory Assessment and Treatment (SACAT) Act Update

Since the SACAT legislation came into effect on 21 February 2018, at 20 April 2018 38 inquires made to Authorised Officers with 14 applications made for Compulsory Treatment Certificates (CTC), with five CTCs being issued. Based on activity to date service will be processing 500 enquiries a year with potentially 50 achieving SACAT, this is nearly double the amount of activity predicted. Enquiries take significant time as often dealing with very concerned relatives, who in addition to information, they need support and reassurance. Direct negative impact of SACAT demands on other CADS functions and responsiveness Key issue is that the clients often regain capacity within 5-10 days. Judges are reluctant to take off Act due to concerns about repeating behaviour. Salvation Army who worked

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with people under the old Act, states that 90% of clients, who come off the Act and agree to voluntary attendance at treatment, walk out of treatment. Once the patient is detoxed, medically stable and if determined not to have regained cognitive capacity, they will be transferred to the National facility located in Christchurch. Air NZ requires clients to be stable for an additional five days beyond the medical assessment. One patient transferred to Nova (National SACAT Treatment Service in South Island). Patients are staying in Pitman House medical detox services for 10-15 days. Average length of stay for voluntary clients is seven days, so reduced capacity for voluntary clients. The implementation of SACAT has not been cost neutral for Waitemata DHB (metro Community and Alcohol Drug Service provider) with several submissions made to MoH to support the extra costs to meet Act requirements in addition to meeting identified service gaps for this population. We have submitted a business case seeking financial contribution from the Ministry of Health to implement SACAT in addition to an innovative Northern Region initiative to co-locate specialist addictions services with the intent of co-locating social and medical detoxification services within integrated primary and secondary health, housing, and social services. This initiative has the potential to achieve substantial health and social benefits, with provision for future proofing for a Northern Region SACAT facility.

4.4 Equally Well Initiatives

The findings of the 2017 Health Needs Assessment (HNA) by the Health Gain Team on the Physical Health Status of people with chronic serious mental illness in Waitemata DHB have helped drive our ‘Equally Well’ work. A key finding from the first phase of analysis is that people with serious mental illness are enrolled with primary care at similar levels to the rest of the population and are utilising primary care. This led to Health Pathways work to localisation a specific physical health pathway so that primary care could easily reference what should be checked and resources to support management of any issues. Generally the HNA identified areas for improvement across the system (Specialist services, Primary Care and NGO services) this is being progressed as a workstream under Tūhono (forum of mental health and addictions DHB and NGOs services and consumer representatives). Future areas of focus include: better monitoring and collection of data, providing more wrap around support at initiation of antipsychotics to prevent weight gain, sector agreement and clarity about responsibility for metabolic monitoring, doing more to support healthy lifestyles by utilising peer support/health coaches and self-management groups. Primary Health Organisations (PHOs) are working through an initiative to raise a flag for people on antipsychotic drugs to ensure that evidenced based practice is followed with monitoring and linking up with appropriate health support services to address potential metabolic syndrome.

4.5 Infant, Child, Adolescent and Youth Mental Health and Alcohol and Other Drug issues continuum of care review and project plan

Child and Adolescent Mental Health Services are currently under increasing pressure. The closure of the Richmond Youth residential respite service, increased demand for Child and Family Unit beds, increasing levels of acuity and complexity, demand from Child Youth and Family Services, and the need to address multiple co-morbidities has highlighted the need for more cohesive and targeted interventions to meet the needs of children and young people across the developmental spectrum. This project looks to document existing gaps, effectively respond to demand and ultimately ensure the right level of care is provided timely in the right place. The project will:

Establish through community and sector collaboration, a Waitemata DHBs and Auckland DHB coordinated Infant, Child and Adolescent mental health and addictions continuum of care to ensure cohesive, effective and sustainable service responses from primary prevention to acute care.

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Identify existing resources, ascertain if there are gaps in service provision, determine what interventions are most effective and should be up-scaled and conversely those which do not meet the current need and may be rationalised or integrated to make more efficient use of the existing investment.

4.6 Review of Primary Mental Health Initiatives

The implementation and priority actions for 2017/18 are:

Development of a co-designed model of care across both Auckland and Waitemata DHBs.

Alignment of any actions with the Fit for the Future Project (outlined below) and the evaluation framework that is being completed. Work is progressing on developing a meaningful outcomes and data framework, with the appointment of project lead.

Three forums planned for 2018 are occurring in February, May and August across the metro Auckland DHBs and PHOs to share priority areas of focus and key projects and initiatives, and explore the feasibility of a joint ‘Metro’ approach to Primary Mental Health Initiatives service planning, delivery and evaluation, as the majority of providers span the three DHBs.

4.7 Fit for the Future (FftF) Evaluation and Our Health in Mind progress

The Fit for the Future (FftF) funding provided an opportunity for Waitemata DHB and Auckland DHB to build on their work in responding to the needs of people with mild to moderate mental health needs and strengthen the evidence base for their approach. Specifically, Waitemata DHB received funding for the 2017/18 financial year to:

Support community based initiatives that meet the needs of people with moderate mental health issues. This consists of the upscaling and development of existing initiatives and implementation of new initiatives as follows:

o Direct phone access to specialist advice for GPs. o Enhanced specialist support for primary care. o Packages of Care. o Improved navigation resources. o Awhi Ora Supporting Wellbeing.

To evaluate these interventions and support to build an evidence base of effective interventions for people with moderate mental health needs. This is will be achieved by a robust process and outcome evaluation. The Waitemata DHB FftF evaluation is currently in the data collection phase, and is largely on track in terms of MoH deliverables. Accessing quantitative data has taken longer than hoped and we have received an extension enabling more data to be collected. Analysis and interpretation is now happening in August to support a draft and final report in September 2018.

Enhanced specialist support has been delivered via different models of care by two Waitemata DHB psychiatrists; the key intended outcome of this intervention is to develop capability and empower practices to confidently manage patients in primary care. Information from the evaluation will allow a preferred model to emerge.

Direct telephone access to specialist support from a psychiatrist is available to primary care teams across Waitemata DHB. This service provides valuable and timely information exchange. It operates in business hours and continues to be consistently utilised. Interestingly our evaluation shows 65% of the time the calls to the line are about people known to specialist mental health services, so there is complexity around their management and also a lack of

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visibility in our current systems in terms of care previously provided or where a referral might be up to in terms of provision of care. 80% of the time calls are about clinical management and medication queries and the advice back often provides service navigation advice (50% of the time). The psychiatrist is faxing supporting material to the caller for about 25% of calls.

Additional 2017/18 funding for primary mental health initiatives was used by ProCare to develop enhanced practice teams at two practices, by Comprehensive Care to pilot eTherapy for patients not accessing face-to-face therapy sessions (13 week online course that launched last September) and by Hearts and Minds to provide additional Primary Mental Health Initiatives groups.

Awhi Ora Supporting Wellbeing is in its initial stages of implementation at Waitemata DHB. There are four NGO providers that have received additional funding to deliver Awhi Ora with six other providers able to reprioritise 10% of their existing support hours from the 1 October 2017 to deliver to the Awhi Ora model. Additional project management resource has been allocated to Awhi Ora. This role has been filled by someone from Comprehensive Care. It will be useful to understand the value this brings in terms of establishing relationships with primary care to support the implementation and success of Awhi Ora in Waitemata DHB.

The Framework for enhanced integrated practice teams presents key principles and insights to promote enhanced integrated practice teams in Primary Care, is being delivered by ProCare and East Tamaki Health Care. Although primarily an Auckland DHB initiative, there currently are two practices involved in prototyping in Waitemata DHB from which we will have visibility over data and achievements.

4.8 Integrated Employment Services (Oranga Mahi, investing in social wellbeing)

Individual Placement and Support (IPS) is an evidence-based employment model where in employment specialists are co-located within existing Mental Health clinical teams.

The Ministry of Social Development funded nine month prototype offering services to 50 people (Adult and MOKO services) is on track to start on 5 June with implementation well underway. Potentially this will expanded to 500 people in 2019.

A fidelity review (to the IPS model) is an important part of the evaluation at six months and outcomes for Māori along with cultural acceptability are key components.

5. Primary Care

5.1 System Level Measures (SLMs)

The New Zealand Health Strategy outlines the high-level direction for New Zealand’s health system to 2026 to ensure that all New Zealanders live well, stay well, get well. One of the five themes in the Strategy is value and high performance. This theme places greater emphasis on health outcomes, equity and meaningful results. Under this theme, the Ministry of Health (MoH) worked with the sector to develop a suite of System Level Measures (SLM) to provide a system-wide view of performance and a whole-of-system quality improvement programme. The SLM work programme began in 2016/17, replacing the existing primary care performance improvement programme. District Alliances (both Auckland-Waitemata and Counties Manukau District Alliances) generate an annual SLM Improvement Plan. The SLM work programme is evolving and maturing. Confirmation of the indicators for the third planning round (2018/19) have recently been released, with the previous developmental indicators (5 and 6) now becoming incentivised indicators. SLM indicators are:

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1. Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for 0 – 4 year olds. 2. Acute hospital bed days per capita. 3. Patient experience of care. 4. Amenable mortality rates. 5. Babies living in smokefree households at six weeks. 6. Youth are healthy, safe and supported.

Planning includes a high level improvement milestone, which focuses improvement activity for each SLM; SLMs span the life course, chronic disease, acute demand and patient experience. The milestone must be a number that improves performance from the district baseline or reduces variation to achieve equity. Each SLM has a set of contributory measures that show a clear line of sight to the achievement of the improvement milestones, have clear attribution and have been validated locally. The metro Auckland Alliances have encouraged identification and resolution of systems issues, engagement with systems partners (e.g. LMCs and Well Child providers), and target interventions to address inequity. 2018/19 provides further opportunity to increase primary and secondary care integration and engagement with systems partners. Improvement opportunities are enabled by increased visibility of and access to population data, deliverable at practice level. This newly enabled access to data has increased relevance in primary care and improved visibility of population issues for secondary care. In addition, 2018/19 planning includes Maori providers, Pacific providers and consumers, which will led to an increased focus on amelioration of defined equity gaps in the various SLM areas. Link to current plan: WDHB-ADHB SLM plan

5.2 Primary and Community Services Plan (PCSP) 2016

The collaboratively developed WDHB PCSP informed investment decisions and associated work programmes. The Waitemata PCSP outlines a vision to transform our current healthcare system and sets the direction for primary and community services to 2025. The plan signals our collective desire to accelerate progress in primary and community services. Primary and community services will increasingly play a pivotal role in responding to the challenges of a growing and aging population, the need to better manage those with chronic disease and addressing health inequalities. This is against a backdrop of cost and workforce pressures, along with rapid advances in technology. Investment in line with the Waitemata PCSP includes activities summarised below.

5.3 Diabetes

Improving outcomes for people with diabetes is a key priority, in particular those with poorer outcomes in the highest priority work programme. Consequently, this is where the most significant investment in both service development and level of service provision occurs. The Service Level Alliance overseeing the work programme has the following priorities:

a. Use co-design processes to transform the diabetes system of care. b. Repurpose Diabetes Care Improvement Package and PHO flexible funding to improve diabetes

outcomes and reduce inequity. c. Lift the standard of foot care services for people with diabetes. d. Transform the way retinal screening services are provided. e. Implement text reminders to assist the self-management of people living with diabetes.

The programme is supported by a Public Health Physician and project management expertise.

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http://www.waitematadhb.govt.nz/assets/Documents/health-plans/metro-auckland-2017-2018-SLM-Plan.pdf

http://www.waitematadhb.govt.nz/assets/Documents/health-plans/WDHB-Community-Services-Plan.pdf


5.4 Safety in Practice (SiP)

The SiP programme is designed to provide tools and training to primary health care teams to facilitate reduced preventable harm to patients when receiving care in the community. Over $500,000 per annum is invested in this programme, noting that a significant portion has been invested in development and seconding a Clinical Director from Scotland. Increasing the number of general practice teams and community pharmacy teams from the current numbers of 30 and 10 respectively in the programme to all such teams over the coming years is planned subject to funding.

5.5 Coordinated care, Assessment, Rehabilitation, Education (CARE)

The CARE project proposal was approved by the Board in November 2014, with a $1.81m investment over two years. In 2016, the Board agreed to increase and guarantee an investment of $1.07m p.a. for at least 10 years. The CARE Project is a primary care-based trial that aims to improve the care of older people aged 75 years and over (Māori/Pacific aged 65 years and over) living in Waitemata DHB, specifically to reduce hospitalisations and delay aged residential care placements in older adults receiving a comprehensive interventions package, which is expected to deliver improved health outcomes and positive economic benefits. The learnings form this programme will inform further investment decisions related to improved care of the elderly in the primary care setting.

5.6 Primary Options for Acute Care (POAC)

POAC was initially implemented by Waitemata and Counties Manukau DHBs in 2001, followed by Auckland DHB in 2007. $2.7 million in clinical services are funded annually through POAC. The core intent of POAC is to safely and effectively manage more acute demand in the community, with the objective of reducing attendance at EDs and admittance to a hospital bed. POAC provides a payment to any community provider for undertaking actions to avoid an ED attendance, or by paying for and co-ordinating a community-delivered activity, across a range of investigations, care and treatment, that avoids ED attendance. Much of the POAC service is provided in the general practice by the practice team. The opportunity to expand this programme to enable the shift of services, such as infusions, to the primary care setting is a priority. This builds on the recent expansion to include Opioid Substitution Treatment and Hepatitis C treatment.

5.7 Rural Services

The key goal of the Rural Alliance is to promote clinical leadership in the health system, producing aligned clinical and financial accountability and supporting patient-centred clinically led decision making in health services. Two new services have recently been invested in:

a. Point of Care testing (POCT) – Provision of POCT in rural general practices to aid in diagnostics by enabling rapid decision-making from assessment to treatment, avoiding unnecessary ED visits/hospitalisations and facilitating the provision of appropriate care. The cost of this programme is $1.02 million over the first two years, inclusive of capital cost of analysers, plus $70,000 p.a. for reimbursement of practice costs.

b. Ferinject® - rural general practices are funded to provide Ferinject® at no cost to the patient, eliminating the need to attend a hospital outpatient appointment. A $5 patient co-payment to pick the medication from a community pharmacy applies. We proposed to make this available to all patients in the District in due course, when funding is available. Additionally, this model can be expanded to other infusions currently provided in an outpatient setting.

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5.8 Pathways

The regional pathways work programme is jointly funded by all three DHBs and seven PHOs in metropolitan Auckland. The pathways provide a platform to agree regionally consistent standards and care expectations. Pathways are increasingly being accepted by many of the clinical teams as adding value and supporting provision of effective patient care. Ongoing work is needed to ensure that all teams use the pathways consistently.

6. Conclusion

Waitemata DHB has a focus on the government and Minister of Health’s priority areas with a comprehensive range of programmes, activities and cases for investment across the hospital and community. We will respond to further clarification of the Minister’s expectations and planning advice as soon as it becomes available.

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9. Resolution to Exclude the Public

Resolution: That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered



1. Minutes of Meeting of the Board - Public Excluded (18/04/18)




2. Recommendations from the Audit and Finance Committee – Public Excluded (09/05/18)


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


3. Minutes of the Audit and Finance Committee – Public Excluded (28/03/18)


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be

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in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


4. Minutes of the Hospital Advisory Committee – Public Excluded (28/03/18)




5. Minutes from The Three Harbours Health Foundation (08/11/17)




As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act

6. Mason Clinic Site Update



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.

[Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


7. 2018/19 Colonoscopy and Gastroscopy Outsourcing

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the


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Official Information Act 1982.


[Official Information Act 1982 S.9 (2) (i)]

8. Contract Renewal and Value Increases



[Official Information Act 1982 S.9 (2) (i)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:




9. Settlement of Auckland DHB DRG price and non-DRG Ophthalmology IDFs for 2016/17



Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)]

10. Recycling of Capital That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.





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11. 2018/19 Asset Performance Measures




12. 2018/19 Capital Investment Plan






13. New Zealand Health Partnerships Proposed Annual Procurement Plan FY18-19





Obligation of Confidence

The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:




14. New Zealand Health Partnerships Statement of Performance

Commercial Activities The disclosure of information would not be in the public interest because of the

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Expectations 2018/19

greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.







15. Lease Renewal That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.












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Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)]

18. Asset Condition Survey




19. Safe Transfer of Patients from ED - Part A










20. Safe Transfer of Patients from ED - Part A

That the public conduct of the whole or the relevant part of the proceedings

Commercial Activities The disclosure of information would not be

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of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.







21. Hospice Service







23. Compassionate Funding Report



24. Compassionate Funding Decision



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27. Board Decision Implementation Report


As per the resolutions from the open section of minutes of the relevant meetings as they relate to particular items in terms of NZPH&D Act 2000.

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