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‘Aakina to ora, hei oranga mauroa’ – Mahaki Albert, Tumu Tikanga CM Health Look after yourself to preserve health and wellbeing

Counties Manukau District Health Board – Community & Public Health Advisory Committee

COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE (CPHAC)

Wednesday, 27 January 2021

Venue: Room 103, Ko Awatea, Middlemore Hospital; 100 Hospital Road, Otahuhu; Auckland Time: 9.00am

Committee Members Colleen Brown – Committee Co-Chair Pierre Tohe – Committee Co-Chair Barry Bublitz – Mana Whenua Dianne Glenn – CMDHB Board Member Katrina Bungard – CMDHB Board Member Lana Perese – CMDHB Board Member Paul Young – CMDHB Board Member Apulu Reece Autagavaia – CMDHB Board Member Robert Clark – Mana Whenua Tipa Mahuta – CMDHB Board Member

CMDHB Management Fepulea’i Margie Apa – Chief Executive Aroha Haggie – Director, Funding & Health Equity Dr Gary Jackson – Director, Population Health Dr Campbell Brebner – Chief Medical Advisor, Primary & Integrated Care) Jessica Ibrahim –Executive Advisor to the CE Vicky Tafau – Secretariat Board Observers Brittany Stanley-Wishart Tori Ngataki

AGENDA: PART I – Items to be considered in this public meeting

1. AGENDA ORDER AND TIMING Page No.

2. GOVERNANCE

9.00am

2.1 Apologies 2.2 Register of Interests

2.2.1 Does any member have an interest they have not previously disclosed? 2.2.2 Does any member have an interest that may give rise to a conflict of interest with

a matter on the agenda? 2.3 Confirmation of Public Minutes of the Community & Public Health Advisory Committee

Meeting – 16 December 2020 2.4 Action Items Register 2.5 CPHAC Draft Workplan 2021

002

003 005

006

016 018

3. UPDATES

9.30am 10.00am 10.30am

10.50am

11.05am

11.35am

3.1 Asian Health Status & Population Growth (Kitty Ko, Asian Health Gain Advisor, Population Health)

3.2 Localities Update (Penny Magud, General Manager Locality Services) 3.3 Faster Cancer Treatment Reporting Data (Aroha Haggie, Director Funding & Health

Equity) Morning Tea 3.4 South Auckland Social Wellbeing Board; 5-Year Strategy (2020 – 2025) and 2-Year Action

Plan (Ann Wilkie, Programme Director) 3.5 Metrics that Matter; 6 Month Summary to December 2020 (Paul Hewitt, Senior Planning

Advisor; Zizi Jasim, Planning Advisor) – to be included

019

041 045

048

4. INFORMATION PAPER

4.1 Action Item from ARF: Implications of Covid-19 on Primary Care 070

11.50am 5. RESOLUTION TO EXCLUDE THE PUBLIC 080

Counties Manukau District Health Board – Community & Public Health Advisory Committee 27 January 2021

CPHAC BOARD MEMBER ATTENDANCE SCHEDULE 2021

Name 27 Jan Feb 10 Mar 21 April May 2 June 14 July 25 Aug Sept 6 Oct 17 Nov

Colleen Brown (Co-Chair)

No

Mee

tin

g

No

Mee

tin

g

No

Mee

tin

g

Pierre Tohe (Co-Chair)

Barry Bublitz

Dianne Glenn

Katrina Bungard

Lana Perese

Paul Young

Apulu Reece Autagavaia

Robert Clark

Tipa Mahuta

Brittany Stanley-Wishart

Tori Ngataki

002


CPHAC MEMBERS

DISCLOSURE OF INTERESTS

16 December 2020

Member Disclosure of Interest

Colleen Brown

(CPHAC Co-Chair)

Chair, Disability Connect (Auckland Metropolitan Area)

Member, Advisory Committee for Disability Programme Manukau Institute of Technology

Member, NZ Down Syndrome Association

Husband, Determination Referee for Department of Building and Housing

Chair, Rawiri Residents Association

Director and Shareholder, Travers Brown Trustee Limited

Board Member, NZ Neighbourhood Support

District Representative, Neighbourhood Support NZ Board

Pierre Tohe

(CPHAC Co-Chair)

Senior Executive, Tainui Group Holdings

Trustee, Taniwha Marae

Barry Bublitz Director, International Indigenous Council for Healing Our Spirits Worldwide

Patron - Management Team, Te Mauri Pimatisiwin (A Journal of Aboriginal and Indigenous Community Health)

Chair - Māori Research Review Committee

Chair, Wikitoria King Whānau Trust

Chair, Eva Newa Wallace Whānau Trust

Secretary, Mataitai Farm Trust

Turuki Health Care – Employee

Co – Chair Mana Whenua Kei Tamaki Makaurau Board

Co-Chair Kaitiaki Roopu: Whakangako te Mauri o te Tangata

Dianne Glenn Member, NZ Institute of Directors

Life Member, Business and Professional Women Franklin

Member, UN Women Aotearoa/NZ

Life Member, Friends of Auckland Botanic Gardens and Chair of the Friends Trust

Life Member, Ambury Park Centre for Riding Therapy Inc.

Member, National Council of Women of New Zealand

Justice of the Peace

Member, Pacific Women’s Watch (NZ)

Member, Auckland Disabled Women’s Group

Life Member of Business and Professional Women NZ

Interviewer, The Donald Beasley Research Institute for the monitoring of the United Nations Convention on the Rights of Persons with Disabilities.

Member, Lottery Individuals with Disabilities Committee

Member, Expert Advisory Group to the Retirement Commissioner working on retirement income

Katrina Bungard Deputy Chairperson MECOSS – Manukau East Council of Social Services.

Elected Member, Howick Local Board

Deputy Chair, Amputee Society Auckland/Northland

003


Member of Parafed Disability Sports

Member of NZ National Party

Lana Perese Director & Shareholder, Malatest International & Consulting

Director, Emerge Aotearoa Limited Trust

Trustee, Emerge Aotearoa Housing Trust

Director, Vaka Tautua

Director, Malologa Trust

Director & Shareholder, Perese Wood Investments Limited

Paul Young Councillor, Auckland Council

Director, Paul Young International Ltd

Apulu Reece Autagavaia Member, Pacific Lawyers’ Association

Member, Labour Party

Trustee, Epiphany Pacific Trust

Trustee, The Good The Bad Trust

Member, Otara-Papatoetoe Local Board

Member, Pacific Advisory Group for Mapu Maia – Problem Gambling Foundation

Board of Trustees Member, Holy Cross School

Member of the Cadastral Surveyors Board

Assessor of the Creative Communities Scheme South & East Auckland

Robert Clark Chair Manawhenua I Tamaki Makaurau Health Board

Member of Te Whakakitenga (Waikato/Tainui Tribal Parliament)

Depty Chair Waikato Tainui Appointments Committee

Depty Chair Huakina Marae Forum

Ngati Tiipa Lands/ Te Kotahitanga Marae Trustee

Chair Counties Maori Rugby

Crown appointed Tangata Kaitiaki for Waikato Awa and West Coast Harbours

Cultural Advisor for Counties Manukau Police

Deputy Chair of Te Hiku O te Ika

Tipa Mahuta Deputy Chair, Te Whakakitenga o Waikato

Councillor, Waikato Regional Council

Brittany Stanley-Wishart Deputy Chair, Pasifika Students in Health in NZ (charity that receives funding from CM Health for its biennial conference)

Tori Ngataki Board member, Ngāti Tamaoho Trust 2016 to 2020 (restanding) Board member, Second Natures Trust 2016 to 2021

Marae Rep, Te Whakakitenga o Waikato Inc 2017 to 2021 (restanding)

Director, Keep it Māori Ltd (social enterprise) 2019

004

Counties Manukau District Health Board –Community & Public Health Advisory Committee 27 January 2021

COMMUNITY and PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 16 November 2020

Director having interest Interest in Particulars of interest Disclosure date Board Action Pierre Tohe Public Excluded Agenda of 8

April 2020 Mr Tohe does work for Waikato/Tainui.

8 April 2020 That PierreTohe’s specific interest is noted and the Committee agreed that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

Lana Perese Integrated Primary Mental Health & Addiction Services (IPMHAS)

Malatest International, the company Ms Perese is a Director and Shareholder for, are evaluating IPMHAS. Also, Ms Perese is a Board Director for Vaka Tautua which is one of the providers in the Pacific Collaborative and potentially one of the Awhi Ora providers

9 September 2020 That Lana Perese’s specific interest is noted and the Committee agreed that she may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

005


Minutes of Counties Manukau District Health Board Community and Public Health Advisory Committee

Held on Wednesday, 4 November, 2020 at 9.00am – 11.30pm Room 101, Ko Awatea, 100 Hospital Road, Middlemore Hospital, Otahuhu, Auckland

PART I – Items considered in Public Meeting

BOARD MEMBERS PRESENT

Colleen Brown (Co-Chair) Dianne Glenn Katrina Bungard Lana Perese Paul Young Apulu Reece Autagavaia Robert Clark (Mana Whenua) Brittany Stanley-Wishart (Board Observer)

ALSO PRESENT

Fepulea’i Margie Apa (CEO, CM Health) Dr Gary Jackson (Director, Population Health) Aroha Haggie (Director, Funding & Health Equity) Dr Christine McIntosh (acting Chief Medical Officer, Primary & Integrated Care), standing in for the seconded Dr Campbell Brebner) Jessica Ibrahim (Executive Advisor to the CE) Vicky Tafau (Secretariat) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

No media representatives were in attendance.

WELCOME

The meeting commenced at 9.00am with a welcome from Colleen Brown.

1. AGENDA ORDER AND TIMING

Items were taken as per the agenda.

006


2. GOVERNANCE

2.1 Apologies

Apologies were received from Pierre Tohe, Barry Bublitz and Tori Ngataki and Robert Clark, Margie Apa and Aroha Haggie for lateness.

2.2 Register of Interests

Disclosure of Interests – no amendments to note. Disclosure of Specific Interests – no disclosures to note.

2.3 Confirmation of the Minutes of the joint Hospital Advisory Committee/Community and Public Health Advisory Committee/Disability Advisory Committee meeting held on 4 November 2020. Resolution (Moved: Colleen Brown/Seconded: Dianne Glenn) That the minutes of the Community and Public Health Advisory Committee meeting held on 4 November 2020 be approved. Carried

2.4 Action Items Register/Response to Action Items Ms Tafau to put all provider presentations into the Resource Centre. CPHAC were happy with Action Item progress. The Kootuitui response was noted.

2.5 CPHAC Work Plan 2021 CPHAC asked for regular Oral Health updates to be added to the work plan. Conversation ensued around Oral Health service delivery in practices around Counties Manukau and peoples’ negative experiences and how that might follow that up. In terms of what is happening in the Prevention space, Dr Jackson suggested asking ARDS and CADS to present to the committee around explaining their customer feedback process. Auditing of contracts to also be put on the work plan.

3. UPDATES 3.1 Mana Kidz Update to CPHAC (Phil Light, acting General Manager-Integrated Child Youth; Dr Philippa

Anderson, Public Health Physician and Claudelle Pillay, Immunisation Nurse Leader) Mana Kidz is a comprehensive school based, nurse-led child health programme delivered in 88 schools across the Counties Manukau region. There are approximately 34,000 tamariki consented onto the programme. 59 schools have a nurse and whaanau support worker in school each day and 29 schools have a nurse in school once a week. To supplement schools, Mana Kidz run an 0800 line where schools and whaanau can ring if they have any child health concerns, the aim of this line is to connect whaanau with the appropriate team or service where applicable. The comprehensive child health programme has three arms; rheumatic fever prevention through sore throat management, skin infection management and child health assessment and management. Dr Anderson gave a broad overview of the information provided in the report and note the following points:

007


Mana Kidz has established more rigorous follow ups for patients.

Nurse practitioners are working with the teams to assist in increasing access for whaanau.

A lot of work has gone into providing training for nasal pharyngeal swabbing.

Asked CPHAC to note the amount of research that is underway with the programme. Looking at piloting COVID testing within schools, potentially for the entire whaanau.

Mana Kidz is a valuable workforce in terms of past responses, eg Measles in 2019, COVID in 2020.

RH Fever – in the May 2019 budget $12M was allocated for 4 years. The bulk of that funding was for a co-design piece. This has now been contracted. ThinkPlace are partnering with local Maaori & Pacific re innovative approaches to Rh Fever prevention and treatment.

CPHAC advised that they would like to receive a copy of the ThinkPlace report to the Ministry of Health. Dr Anderson told CPHAC that the hope is that the information will flow both ways; CM Health influencing ThinkPlace and ThinkPlace sharing data and information with CM Health. The budget will also be divided between the region to support programmes that are being implemented. Annie Ualesi has been engaged by Think Place and a Maori contractor from the Heart Foundation. Apulu Reece Autagavaia is hoping that the funding will assist in resolving the racism issues that were raised within the Rh Fever programmes dealing with whaanau. CPHAC was advised that work is being done in KidzFirst around implicit racism within the service. ThinkPlace have been clear that they wish to work with CM Health. Action Invite MoH to provide their big picture thinking around Rh Fever in Counties Manukau and regionally. CPHAC would like Think Place to present around the ideas they have been coming up with and how they’ll be implemented. June 2021. Colleen is interested in how whaanau manage the purchasing of medication. Dr Anderson advised that the medication is free. The premise of the programme is that if we can deal with the Strep throats it will prevent the Rh Fever. The focus of the programme is on the Group A Strep Throats and Dr Anderson is pleased with the way this is working. There is recognition that there is more work needed locally in the health promotion space around Group A Strep Throat and Rh Fever. Alliance Health+ has been funded to undertake this work. In regard to the Impetigo Programme; if a child has impetigo then comprehensive hygiene information is provided to the whaanau. Clean, Cut, Cover is the information provided. Packs are given to take home. Various programmes are working with whaanau to ensure that homes either have washing machines or have access to washing machines. Laundromat use is quite common for many homes. Ms Pillay advised that there has been much improvement with impetigo over the years and this has been corroborated by CM Health nursing staff. It was reiterated to CPHAC that Ms Haggie will be bringing an Immunisations Review to CPHAC in 2021.

008


3.2 Women’s Health in the Community Update (Dr Christine McIntosh, acting Chief Medical Advisor, Primary & Integrated Care) Dr McIntosh took CPHAC through the presentation, highlighting the benefits of various forms of contraception. Hormonal contraception has very low amounts of side-effects. It is essential that providers in the community have the correct information to provide to women in order for them to make fully informed decisions around contraception. Contraception also assists women with unplanned pregnancies; health issues, alcohol consumption, etc. A planned pregnancy ensures that the woman can be in the best health possible when planning to get pregnant. Through POAC women can be referred to a practice that does provide contraception services. CM Health offers free LARC free for women who are Maaori or Pacific, quintile 5, CSC holders or are engaged in secondary mental health services or CADS. Unintended birth is associated with poor health and social outcomes for women. Reduced birth interval and >5 births carry increased risks for mama and pepe. 48.6% of post-natal women reported having no antenatal discussion about contraception. Removing financial barriers is key for women who are Maaori or Pacific, Quintile 5, CSC holders or women involved with secondary mental health services or CADS. Dr McIntosh noted that access to the morning after pill has also improved. Primary Care and midwives take responsibility for providing contraception information antenataly so that women can be prepared. Best Start Pregnancy Tool has the dissemination of this information built in. Birthing Hubs will also be included in discussions around contraception information dissemination. Apulu Reece Autagavaia noted that if all women are well, all of the time, unintended pregnancies wouldn’t be such an issue. Social and cultural norms associated with whaanau, includes the value of whaanau. The tension about cultural norms and well being can be difficult to navigate. Dr McIntosh advised CPHAC that abnormal uterine bleeding is a prevalent problem in our community (leads to anaemia) which can lead to uterine cancers. This is compounded by obesity, so high rates for Pacific particularly and also Maaori. GPs need to understand the issue, get good background information and potentially take a biopsy. Treatment offered is likely to be the mirena. This treatment reduces periods almost totally, reduces anaemia and reduces the risk of cells turning cancerous. So, communication/information is crucial. Additional funding has been received to ensure more work can be done in the community to assist women with Abnormal Uterine Bleeding. The funding provided will go a long way to addressing the equity gap. Action Dr McIntosh is to return to CPHAC in 2021 to provide detailed information in regard to HPV in CM Health and a presentation regarding the Best Start Pregnancy Tool.

5. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved: Paul Young /Seconded: Robert Clark)

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000:

009


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

2.1 Confirmation of Public Excluded Minutes 4 November 2020.

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(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes As per the resolution from the public section of the minutes, as per the NZPH&D Act.

3.1 Strategic Discussion 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(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

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 S9(2)(i)]

Carried This first part of the meeting concluded at 10.30am.

SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING OF 16 DECEMBER 2020.

__________________________________ Colleen Brown Committee Co-Chair

010


Minutes of Counties Manukau District Health Board Community and Public Health Advisory Committee

Held on Wednesday, 4 November, 2020 at 9.00am – 11.30pm Room 101, Ko Awatea, 100 Hospital Road, Middlemore Hospital, Otahuhu, Auckland

PART I – Items considered in Public Meeting

BOARD MEMBERS PRESENT

Colleen Brown (Co-Chair) Dianne Glenn Katrina Bungard Lana Perese Paul Young Apulu Reece Autagavaia Robert Clark (Mana Whenua) Brittany Stanley-Wishart (Board Observer)

ALSO PRESENT

Fepulea’i Margie Apa (CEO, CM Health) Dr Gary Jackson (Director, Population Health) Aroha Haggie (Director, Funding & Health Equity) Dr Christine McIntosh (acting Chief Medical Officer, Primary & Integrated Care), standing in for the seconded Dr Campbell Brebner) Jessica Ibrahim (Executive Advisor to the CE) Vicky Tafau (Secretariat) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

No media representatives were in attendance.

WELCOME

The meeting commenced at 9.00am with a welcome from Colleen Brown.

1. AGENDA ORDER AND TIMING

Items were taken as per the agenda.

011


2. GOVERNANCE

2.1 Apologies

Apologies were received from Pierre Tohe, Barry Bublitz and Tori Ngataki and Robert Clark, Margie Apa and Aroha Haggie for lateness.

2.2 Register of Interests

Disclosure of Interests – no amendments to note. Disclosure of Specific Interests – no disclosures to note.

2.3 Confirmation of the Minutes of the joint Hospital Advisory Committee/Community and Public Health Advisory Committee/Disability Advisory Committee meeting held on 4 November 2020. Resolution (Moved: Colleen Brown/Seconded: Dianne Glenn) That the minutes of the Community and Public Health Advisory Committee meeting held on 4 November 2020 be approved. Carried

2.4 Action Items Register/Response to Action Items Ms Tafau to put all provider presentations into the Resource Centre. CPHAC were happy with Action Item progress. The Kootuitui response was noted.

2.5 CPHAC Work Plan 2021 CPHAC asked for regular Oral Health updates to be added to the work plan. Conversation ensued around Oral Health service delivery in practices around Counties Manukau and peoples’ negative experiences and how that might follow that up. In terms of what is happening in the Prevention space, Dr Jackson suggested asking ARDS and CADS to present to the committee around explaining their customer feedback process. Auditing of contracts to also be put on the work plan.

3. UPDATES 3.1 Mana Kidz Update to CPHAC (Phil Light, acting General Manager-Integrated Child Youth; Dr Philippa

Anderson, Public Health Physician and Claudelle Pillay, Immunisation Nurse Leader) Mana Kidz is a comprehensive school based, nurse-led child health programme delivered in 88 schools across the Counties Manukau region. There are approximately 34,000 tamariki consented onto the programme. 59 schools have a nurse and whaanau support worker in school each day and 29 schools have a nurse in school once a week. To supplement schools, Mana Kidz run an 0800 line where schools and whaanau can ring if they have any child health concerns, the aim of this line is to connect whaanau with the appropriate team or service where applicable. The comprehensive child health programme has three arms; rheumatic fever prevention through sore throat management, skin infection management and child health assessment and management. Dr Anderson gave a broad overview of the information provided in the report and note the following points:

012


Mana Kidz has established more rigorous follow ups for patients.

Nurse practitioners are working with the teams to assist in increasing access for whaanau.

A lot of work has gone into providing training for nasal pharyngeal swabbing.

Asked CPHAC to note the amount of research that is underway with the programme. Looking at piloting COVID testing within schools, potentially for the entire whaanau.

Mana Kidz is a valuable workforce in terms of past responses, eg Measles in 2019, COVID in 2020.

RH Fever – in the May 2019 budget $12M was allocated for 4 years. The bulk of that funding was for a co-design piece. This has now been contracted. ThinkPlace are partnering with local Maaori & Pacific re innovative approaches to Rh Fever prevention and treatment.

CPHAC advised that they would like to receive a copy of the ThinkPlace report to the Ministry of Health. Dr Anderson told CPHAC that the hope is that the information will flow both ways; CM Health influencing ThinkPlace and ThinkPlace sharing data and information with CM Health. The budget will also be divided between the region to support programmes that are being implemented. Annie Ualesi has been engaged by Think Place and a Maori contractor from the Heart Foundation. Apulu Reece Autagavaia is hoping that the funding will assist in resolving the racism issues that were raised within the Rh Fever programmes dealing with whaanau. CPHAC was advised that work is being done in KidzFirst around implicit racism within the service. ThinkPlace have been clear that they wish to work with CM Health. Action Invite MoH to provide their big picture thinking around Rh Fever in Counties Manukau and regionally. CPHAC would like Think Place to present around the ideas they have been coming up with and how they’ll be implemented. June 2021. Colleen is interested in how whaanau manage the purchasing of medication. Dr Anderson advised that the medication is free. The premise of the programme is that if we can deal with the Strep throats it will prevent the Rh Fever. The focus of the programme is on the Group A Strep Throats and Dr Anderson is pleased with the way this is working. There is recognition that there is more work needed locally in the health promotion space around Group A Strep Throat and Rh Fever. Alliance Health+ has been funded to undertake this work. In regard to the Impetigo Programme; if a child has impetigo then comprehensive hygiene information is provided to the whaanau. Clean, Cut, Cover is the information provided. Packs are given to take home. Various programmes are working with whaanau to ensure that homes either have washing machines or have access to washing machines. Laundromat use is quite common for many homes. Ms Pillay advised that there has been much improvement with impetigo over the years and this has been corroborated by CM Health nursing staff. It was reiterated to CPHAC that Ms Haggie will be bringing an Immunisations Review to CPHAC in 2021.

013


3.2 Women’s Health in the Community Update (Dr Christine McIntosh, acting Chief Medical Advisor, Primary & Integrated Care) Dr McIntosh took CPHAC through the presentation, highlighting the benefits of various forms of contraception. Hormonal contraception has very low amounts of side-effects. It is essential that providers in the community have the correct information to provide to women in order for them to make fully informed decisions around contraception. Contraception also assists women with unplanned pregnancies; health issues, alcohol consumption, etc. A planned pregnancy ensures that the woman can be in the best health possible when planning to get pregnant. Through POAC women can be referred to a practice that does provide contraception services. CM Health offers free LARC free for women who are Maaori or Pacific, quintile 5, CSC holders or are engaged in secondary mental health services or CADS. Unintended birth is associated with poor health and social outcomes for women. Reduced birth interval and >5 births carry increased risks for mama and pepe. 48.6% of post-natal women reported having no antenatal discussion about contraception. Removing financial barriers is key for women who are Maaori or Pacific, Quintile 5, CSC holders or women involved with secondary mental health services or CADS. Dr McIntosh noted that access to the morning after pill has also improved. Primary Care and midwives take responsibility for providing contraception information antenataly so that women can be prepared. Best Start Pregnancy Tool has the dissemination of this information built in. Birthing Hubs will also be included in discussions around contraception information dissemination. Apulu Reece Autagavaia noted that if all women are well, all of the time, unintended pregnancies wouldn’t be such an issue. Social and cultural norms associated with whaanau, includes the value of whaanau. The tension about cultural norms and well being can be difficult to navigate. Dr McIntosh advised CPHAC that abnormal uterine bleeding is a prevalent problem in our community (leads to anaemia) which can lead to uterine cancers. This is compounded by obesity, so high rates for Pacific particularly and also Maaori. GPs need to understand the issue, get good background information and potentially take a biopsy. Treatment offered is likely to be the mirena. This treatment reduces periods almost totally, reduces anaemia and reduces the risk of cells turning cancerous. So, communication/information is crucial. Additional funding has been received to ensure more work can be done in the community to assist women with Abnormal Uterine Bleeding. The funding provided will go a long way to addressing the equity gap. Action Dr McIntosh is to return to CPHAC in 2021 to provide detailed information in regard to HPV in CM Health and a presentation regarding the Best Start Pregnancy Tool.

5. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved: Paul Young /Seconded: Robert Clark)

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000:

014


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

2.1 Confirmation of Public Excluded Minutes 4 November 2020.

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(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes As per the resolution from the public section of the minutes, as per the NZPH&D Act.

3.1 Strategic Discussion 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(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

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 S9(2)(i)]

Carried This first part of the meeting concluded at 10.30am.

SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING OF 16 DECEMBER 2020.

__________________________________ Colleen Brown Committee Co-Chair

015

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


Community & Public Health Advisory Committee Meeting – Action Items/Resolution Register – 16 December 2020

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

Standing Items

Locality Updates: Provide updates for Locality Hubs in general until established enough to provide individual deep dives.

27 January 2021

Penny Magud

ARPHS – six-monthly update. 2 June and

17 November 2021

Doone Winnard

Quarterly Non-Financial Summary: Quarterly report. 27 January 2021

Paul Hewitt Agenda Item 3.5 Metrics that Matter

20/21 Metro Auckland SLM Improvement Plan – quarterly report.

10 March 2021 Robin van Ausdall

26.9.2018 3.1 4.3 Healthy Families New Zealand: Update to CPHAC in 6 months’ time. HFNZ have issued an invitation to host CPHAC at Amersham Way, Manukau.

TBC Phil Light Have not been able to confirm for December. Will try for early 2021.

1.7.2020 4.1 Utilisation of Auckland Regional HealthPathways: CPHAC asked Auckland Regional HealthPathways to return in a years’ time. CPHAC would like to be updated on how well has equity been ‘baked in’ and include progress on links to Disability.

2 June 2021 Catherine Turner

9.9.2020 4.1 Mental Health: The team were asked to report back to CPHAC in three months’ time providing strategic analysis on how the work we do works in with the rest of the country. Include information around future demand.

10 March Charles Tutagalevao, Ian Soosay, Pam Hewlett

4.11.2020 3.1 Covid Testing Strategy: CM Health Board wish to be kept up to date with where this strategy is at, due to workforce at places like hotels and Americold type workplaces, are likely to be South Auckland residents.

TBC TBC

4.11.2020 3.2 Faster Cancer Treatment: reporting data to be provided to CPHAC.

27 January Aroha Haggie

016

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

4.11.2020 3.2 Immunisation Rates Early 2021 Aroha Haggie ELT’s work programme has a deep dive on Immunisations to pick apart what is happening there. Ms Haggie will come back to the committee as soon as they can with the plan of where they need to focus

16.12.2020 3.1 Rheumatic Fever Funding: Invite MoH to provide their big picture thinking around Rh Fever in Counties Manukau and regionally. CPHAC would like Think Place to present around the ideas they have been coming up with and how they’ll be implemented. June 2021.

2 June

16.12.2020 3.2 Women’s Health in the Community: Dr McIntosh is to return to CPHAC in 2021 to provide detailed information in regard to HPV in CM Health and a presentation regarding the Best Start Pregnancy Tool.

017


DRAFT CPHAC Committee Work Plan 2021

Meeting Date Strategic Deep Dive Operational Deep Dive Standing Items External / Regional Presentations Public Excluded

27 January Intesectoral Collaboration

SWB – 5 Yr Strategy & 2 Yr Action Plan (Ann Wilkie)

Asian Health: Health Status & Population Growth (Kitty Ko)

Localities Update (Penny Magud)

Metrics that Matter

(Paul Hewitt & Zizi Jasim)

10 March

Primary & Integrated Care Community Workforce & Capacity

(Matt Hannant & Campbell Brebner)

Te Ranga Ora Update (Matt Hannant)

Mental Health - Provide analysis on how the work we do works in with the rest of the

country. Include information around future demand.

(Charles Tutagalevao, Ian Soosay, Pam Hewlett)

SLM Improvement Plan Quarterly Report (Kate Dowson

National Hauora Coalition – Current State & Future Planning

(Dr Rawiri Jansen, Simon Royal)

Funder Report/Dashboard (Timing TBC) (Fran Voykovich)

21 April Treaty of Waitangi Audit Results (TBC)

(Sharon McCook)

Pacific Health – Fanau Ola Update incl Nurses presenting Patient Stories

(Doana Fatuleai)

Winter Plan – Focus on Vaccinations (Fran Voykovich)

Q3 Non-Financial Summary Report TBC

(Paul Hewitt & Zizi Jasim)

Mental Health & Addiction: Suicide Prevention/Postvention

progress report

2 June Provider Development

(Aroha Haggie/Funder GMs)

Health Pathways – Innovations & Learnings from 2020 and how well has equity been ‘baked in’. Include progress on links to

Disability. (Campbell Brebner, Catherine Turner)

ARPHS 6-Monthly Update to CPHAC

Jane McEntee


Budget 21/22 Funder Discussion

(Aroha Haggie, Steve Murray)

14 July

What is happening in the Prevention space? ARDS & CADS re their customer feedback

process. (Gary Jackson)

Consumer Council re Engagement in the Community

Renee Greaves

Te Ranga Ora Progress Update (Earnest Pidakala, Matt Hannant)

Localities Update (Penny Magud)

SLM Improvement Plan Quarterly Report

(Kate Dowson)

Contract Auditing

(?)

25 August Weight Reduction Service

(Gary Jackson)

Alcohol Harm Minimisation – Strategy Refresh (Gary Jackson)

Women’s Health: Best Start Pregnancy Tool

(Dr McIntosh)

Annual Report (Paul Hewitt & Zizi Jasim)

Q4 Non-Financial Summary Report

TBC (Paul Hewitt & Zizi Jasim)

Funder Report/Dashboard (Timing TBC)

(Fran Voykovich)

6 October Update on Women’s Health

Primary Birthing Units (Mary Burr/Sarah Tout)

Southern Corridor Progress (Alan Greenslade)

Startwell Nurses – How has 2021 been for

vulnerable mothers/whaanau?

Funding Arrangements to ensure Improved Health Outcomes for Vulnerable Whaanau

(Aroha Haggie)

17 November Smokefree 2021/Vaping Area Update

(Basil Fernandes)

SLM Improvement Plan Quarterly Report (Kate Dowson

Q1 Non-Financial Summary Report

TBC (Paul Hewitt & Zizi Jasim)

ARPHS 6-Monthly Update to CPHAC Jane McEntee


018

Date:

Asian Health Asian Health Status & Population Growth

January 2021

Kitty KoAsian Health Gain Advisor

Directorate of Population Health

Hello, Kia Ora, Talofa Lava, Namaste, Nǐ hǎo, Pagbati, An-young-ha-se-yo, Jom reab suar, Xin Chao

019

Asian population in Counties Manukau & Who are Asian people?

The New Zealand health and disability sectorclassifies ethnicity data according to theMinistry of Health protocols. The term ‘Asian’used in the New Zealand Census and relateddata sets, refers to people with origins in theAsian continent, from China in the north toIndonesia in the south and from Afghanistanin the West to Japan in the East. This differsfrom the definition used in other countriessuch as the United Kingdom or the USA.

Reference: Counties Manukau Health (2020). Annual Plan 2020/21. Auckland. Counties Manukau Health. Retrieved from https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2020-21-CM-Health-Annual-Plan-incorporating-2020-21-Statement-of-Perform....pdf

020

https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2020-21-CM-Health-Annual-Plan-incorporating-2020-21-Statement-of-Perform....pdf

Asian populations in Counties Manukau

The largest Asian sub-groups in Counties Manukau in 2018 were Indian (~half) and Chinese (~a third). The highest numbers resided in Eastern locality (Howick, Pakuranga) and Manukau locality (Papatoetoe, Manurewa, Papakura)

Reference: Lees J., Lee M. & Winnard D .(2021) Demographic Profile: 2018 Census, Population of Counties Manukau. Auckland: Counties Manukau Health. In publication.

CM Health localities by prioritised ethnic groups, ER population 2018

Maaori Pacific AsianNZ Euro/

OtherTotal

Eastern 9,300 6,700 68,200 71,200 155,700

Franklin 14,600 3,400 6,800 55,900 82,500

Manukau 48,400 50,000 63,300 49,600 210,300

Maangere/Ootara 19,600 65,200 18,600 10,000 112,300

Total 92,360 125,440 158,040 191,170 567,010

Maaori Pacific AsianNZ Euro/

OtherTotal

Eastern 6% 4% 44% 46% 100%

Franklin 18% 4% 8% 68% 100%

Manukau 23% 24% 30% 24% 100%

M/O 17% 58% 17% 9% 100%

Total 16% 22% 28% 34% 100%

Chinese Filipino Indian Korean Other Asian

TotalAsian

% of CM HealthAsian pop

32% 6% 48% 3% 11% 100%

% of CM population

9% 2% 13% 1% 3% 28%

Estimated ER count

51,030 11,340 73,710 5,670 17,010 158,040

CM Health Asian subgroups, 2018

021

Life expectancy

• Life expectancy of Asian people is consistently greater than both the overall life expectancy and the average life expectancy of NZ European/Other ethnic groups.

• When we look deeper into the drivers of life expectancy, we see diversity of health status within the many Asian ethnicity subgroups.

• As the ‘healthy migrant effect’ typically reduces over 5-7 years of New Zealand residency, to sustain this relatively high life expectancy, we are focused on early ill-health prevention and effective management of long term conditions in our Indian and Chinese communities.

Reference: Counties Manukau Health (2020). Annual Report 2019. Auckland. Counties Manukau Health. Retrieved from https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2019_CM_Health_Annual_Report.pdf

022

https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2019_CM_Health_Annual_Report.pdf

Diabetes prevalence by ethnicity in Auckland metro in 2018

• Pacific, Indian and Māori populations have the highest diabetes prevalence in the Auckland metro region. Based on longitudinal laboratory results, the crude diabetes prevalences for people aged 15 and over were 15.1%, 12.0% and 8.6% for Pacific, Indian and Māori populations in metro Auckland in 2018.

• By age 70, 19% of the adult population of metro Auckland in 2018 had developed laboratory-confirmed diabetes. This varied significantly by ethnicity, with European/Other at 12% compared with Indian at 44% and Pacific at 50%. Reference:

Chan, W. C., Lee, M. (AW) & Papaconstantinou, D. (2020). Understanding the heterogeneity of the diabetes population in Metro Auckland in 2018. Auckland: Counties Manukau Health. Retrieved from https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf

023

https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf

Diabetes prevalence by ethnicity and NZDep2013 quintile in metro Auckland in 2018

• Pacific people living in the most socioeconomic deprived areas have the highest diabetes prevalence.

• Pacific and Indian people living in the least socioeconomic deprived areas in Auckland metro still have almost twice the age standardised diabetes prevalence than the New Zealand European and Other group living in the most socioeconomic deprived areas.

Reference: Chan, W. C., Lee, M. (AW) & Papaconstantinou, D. (2020). Understanding the heterogeneity of the diabetes population in Metro Auckland in 2018. Auckland: Counties Manukau Health. Retrieved from https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf

024

https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf

Number of poorly controlled diabetes by ethnicity and by DHB in 2019

Reference: Chan, W. C. & Lee, M. (AW) (2020). Update on Diabetes prevalence in 2019 based on laboratory results in the Auckland Metropolitan Region (from TestSafe). Auckland: Counties Manukau Health. Retrieved from https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020-09-Updates_on_diabetes_prevalence_in_2019.pdf

There are over 6,000 Indian people with diabetes living in CM Health. While more likely to have controlled diabetes than Maaori and Pacific people with diabetes there are still ~16% with very poorly controlled diabetes

025

https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020-09-Updates_on_diabetes_prevalence_in_2019.pdf

Access to prevention services by ethnicity

Reference: Draft Counties Manukau Health Annual Report 2020.

026

Access to prevention services by ethnicity


Asian data is not reported here?

027

Access to early detection and management services by ethnicity


Asian data is not reported here?

028

Barriers to access services

Practical barriers

Lack of English languageproficiency

Inadequate knowledge andawareness of existinghealth services

Cultural barriers

Intense stigmatisation aroundmental illness that exists amongmany Asian cultures

Religious beliefs, and culturaldifferences in the presentationas well as treatment of mentalillness

Systemic barriers

Lack of interpreter services orculturally / linguistically appropriatehealth information

Lack of bilingual health professionals,incompatible Western healthtreatment models

Lack of cultural competence in healthcare

Reference: Ko, S. W. K. (2013). A Review of Asian Mental Health Service Development in Auckland, New Zealand (Unpublished master’s dissertation). University of Auckland, Auckland, New Zealand.

029

Barriers to access services

Reference: Cen, D. (2017). Project report for preventing barriers to Immunisation for Asian population in the Counties Manukau region. Auckland: Counties Manukau Health.

030

Making health decisions by ethnicity and age group

Reference: Azhaara, A. (2017). POPULATION HEALTH 302 ORGANISATION PROJECT REPORT - Oral Health in Young People. Auckland: Counties Manukau Health.

Half of the young participants stated their parents made health decisions for them instead of them making own health decisions even these young people were already in their early 20s.

A Chinese elderly also said family member made health decisions for him/her; again this is very common among Asian cultures for adult children make decision for their elderly parents.

The above show the cultural differences when accessing, approaching and utilising health services; thus, a specific approach to engage with Asian communities is needed in health promotion and delivering health services.

031

Factors affecting health decisions by ethnicity and age group

Reference: Azhaara, A. (2017). POPULATION HEALTH 302 ORGANISATION PROJECT REPORT - Oral Health in Young People. Auckland: Counties Manukau Health.

Cost was a major factor affecting health decisions for young participants; while language and transport were barriers for elderly Chinese.

For adults who were parents, time, priority and cost were the factors affecting health decisions as they needed to work and look after their families; they often put their own health to the last on their priority list.

The above shows different age groups within Asian communities need different approaches when accessing, approaching and utilising health services.

032

Asian Health Gain Advisor role

Build RelationshipsTo establish & grow collaborative and

positive relationships

LeadershipProvide advice, promote and facilitate Asian health gain by influencing local

ownership and commitment to integrated & collaborative approaches

Local Strategic & Annual Planning

Provide advice, encouragement & support to Locality Leadership Groups in development of Asian health gain

activities

Evaluation, Reporting & Communication

Support the Planning Team in building planning & performance reporting in a

manner that enhances visibility at executive & service delivery levels

across the district

Regional Planning Liaison & Networking

Be a visible advocate for the health & wellbeing of the diverse Asian communities living in Counties

Manukau

Service Development Advice & Support

Work closely with subject matter experts to build their understanding of Asian health needs and challenge CM

Health’s performance and opportunities to improve

Asian Health Gain Advisor

033


CM Health Asian Health & Wellbeing Community Network currently has over 230 members; across DHBs, PHOs, NGOs and community organisations including students and individuals who are interested in Asian Health.

Members include Chinese, Indian, Filipino, Korean, Vietnamese, Cambodian, Japanese, South Asian, and others, etc.

034


Asian cultural celebrations

& Asian Health

Action Roadmap

035


Cultural advice needed

Asian speaking support

Asian speaking

therapists

Asian info and resources for cancer patients and families

Chinese and Vietnamese

lawyers

Cultural input for diagnosing and

developing treatment plan for Asian mental health service users

Cultural input into updating CM

Health’s policies & procedures

Queries for accessing services

in CM Health

Share learning and influencing&

Requests from frontline clinicians

036

Communities in Action (Community Flu Fighters Programme in Asian communities)

Korean Positive Ageing Charitable Trust Takanini School Road Gurdwara Sri Kalgidhar Sahib Temple

Wat Khemaraphirataram Cambodian TempleBotany and Flat Bush Ethnic Association

• A total of 945 individuals received the vaccines in 2020.

• 568 from Chinese organisations, 85 from Indian, 148 from Korean, 9 from Cambodian, and 135 from ethnically diverse organisations.

Transport, language, time, priorities, mistrust, and lack of support are barriers to the elderly Asian population accessing influenza vaccinations via the traditional access points of G.P practices or community pharmacies.

Influenza immunisation rates can be improved by offering vaccinations where elderly Asian people socialise as social connectedness is fundamental to Asian culture and

“community is where the heart is”. 037

Communities in Action (Community Flu Fighters Programme in Asian communities)

038

Well-done Asian Communities!

039

Questions & Answers

Source: https://elearning.tki.org.nz/Media/Images/Equity-vs-equality

040

https://elearning.tki.org.nz/Media/Images/Equity-vs-equality


Counties Manukau District Health Board Community & Public Health Advisory Committee

Locality Community Health Services - Community Hubs Update

Recommendation It is recommended that the Community & Public Health Advisory Committee: Receive the update on the Locality Community Health Service Community Hubs. Note this report is being simultaneously submitted to the 267 January Executive Leadership Team meeting.

Prepared and submitted by: Penelope Magud General Manager Locality Services on behalf of Margie Apa, CEO, Counties Manukau Health. Executive Summary This paper details the developments that have occurred to date in regards to the utilization of the 4 Community Hubs and details the developments approved to be implemented over the next 6 months. Background Counties Manukau Health (CM Health) has for several years been progressing a programme of work which is progressively integrating and extending the role of Primary Care and Community Health Services within the District’s health and social care system. Grow Community Hubs is a key investment strategy for CM Health, with the intention to deliver more outpatient/ambulatory services closer to patients’ homes in Primary Care and locality based Community Hubs. This is part of a broader health service delivery network connecting general practice, community care, specialist services, Middlemore Hospital and Manukau Health Park. The plan is for Community Hubs to offer a core suite of services, beyond the scope of general practice, as well as specific services appropriate to the needs of the locality population. The hubs will provide the necessary community infrastructure to enable provision of extended services in the locality community areas and enable an expanded range of services to be delivered in the community from a ‘neutral space’ where a range of professionals can work from, and patients can be referred to, in a model that complements established GP-patient relationships and enhances CM Health provision of more accessible ambulatory care. Locality Community Health Service manages 4 Community Hubs in Mangere, Otara, Botany and Pukekohe as well as the integrated Mental Health and Community Health facility at Awhinatia in Takinini. The service is still currently delivering District Nursing Services from Building 38 Western Campus, Middlemore, however plans are being developed to ensure that these clinics transfer to the hubs at Mangere and Otara. Services can be and are delivered directly or coordinated virtually from these 5 community sites. As Community Hubs are primarily about services, rather than facilities, they are located and organised differently in each locality taking into account pre-existing local services, service mobility needs, operating models and optimal service location.

041


As Community Hubs are further developed they will be an integral part of an integrated continuum connecting health and social services across home, community, NGOs, general practice and hospital settings. They will be supported by an effective information and communication system. Community Hub Developments to date: Mangere Hub Mangere Hub is in Waddon Place; it currently has 7 clinic rooms which over quarter 1 & 2 of the 20/21 financial year has had in excess of 4,500 clinic attendances at the following clinics:

Acute Allied Health Clinics

Cardiology

Child Development

Contraception clinic

Diabetes

Endocrinology

Gastroenterology

General Medicine

Neurology

Ophthalmology Diabetes

Pediatric Medicine

Podiatry

Psychological Medicine

Renal Medicine

Respiratory Medicine

Rheumatology

Stroke Otara Hub Otara Hub is located at 112 Braids Road, Otara. This is a property which is owned by Ngati Tamahoo and until November 2020 CM Health held a license to occupy 6 clinic rooms. The hub currently operates out of 6 Clinic rooms which over quarter 1 & 2 if the 20/21 financial year has provided 1301 allied health or nurse led clinics for Otara domiciled patients in the following clinical areas:

Cardiology

District Nursing clinics (DN clinic volumes are not included in the figure above)

Diabetes

Allied Health clinics

Maternity

Child development

Retinal Screening

Outreach Cervical Screening Ngati Tamaoho own the building and CM Health has recently negotiated a 5-year lease of the whole property. This will enable CM Health to expand clinic space from 6 to 11 clinics, as well as create a staffing hub for community health staff & space to provide virtual telehealth. Eastern Hub (Botany Superclinic) 14 clinic rooms providing in excess of 13,000 clinic attendances. Currently functioning at 94% utilization Monday to Friday 8.30 – 4.30, this is an increase from 23% in February 2017 22% of all patients attending clinics in the Eastern Hub are not Eastern Locality domiciled. District Nursing clinics 7 days per week Retinal Screening Clinics 6 days per week Primary Care provide evening cervical screening clinics Integrated care model being developed,

042


The locality Community Health, Mental Health and Primary Health staff are aware of the range of clinics that are run from the hub and identify the opportunity for consultation or joint visits for their patients.

The Nurse Clinic Coordinator has aligned clinics for patients to reduce the need for patients to come to the hub multiple times in a week.

Clinic Coordinator and Hub Nurses have spent time with clinicians providing education on how the hub staff can support the clinics in the provision of patient education and health care. This has led to clinicians involving the hub nurse’s consultations to enable patients’ needs to be better supported within the community system e.g. referral to complex care, DN referral or additional health education.

The hub has introduced a more comprehensive review of those patients who DNA to help identify barriers to attendance rather than just focusing on the process.

CM Health own the Unit Title for Unit A, with Care Group (Formerly East Care owning the unit titles for B & C), Care group have submitted a formal letter of interest to the Board to purchase Unit A Pukekohe Hospital – Outpatients

Infusion clinic provided in partnership with Medicine has commenced 1 day per week, providing blood transfusion and venous sections to 4 local patients that would normally be admitted to Middlemore Medical Assessment Unit weekly

Clinic Coordinator Registered Nurse has been recruited to, to oversee the coordination of the clinics, ensure clinicians are appropriately supported in line with the other hubs & Manukau Health Park Modules

Locality Leadership Group submitted a report to Board Chair & CEO in regards to local needs & short, medium & long term recommendations of what needs to be delivered & developed locally

Pukekohe Hospital Outpatients has the capacity to provide 6000 outpatient clinics per annum Monday to Friday. The current facilities are 99% utilized providing 5,986 outpatient clinic appointments per annum. This includes private Local Midwife Clinics, as well as regional services such as Wheelchair Services, Starship Diabetes services, CADS services

5% of patients attending clinics at Pukekohe Hospital are not domiciled in the Franklin Locality. These patients are domiciled in Manukau locality, typically in the Karaka, Drury region.

Approved Developments to occur in the next 6 months Locality Community Health Services are working with all divisions to confirm the clinics that should be delivered within each of the hubs as well as the staffing level, competency and equipment that is required to support new locality based community hub services/clinics. Mangere

10 additional clinic rooms – 100 additional clinics per week Monday to Friday with the opportunity to look at providing further evening and weekend clinics, particularly with District Nursing clinics relocating to Mangere hub and being required to operate 7 days per week with some evening clinics too.

District Nursing clinics to move from Building 38 to Mangere Hub

Establishment of a community base for staff – Including Community Health multidisciplinary nursing & allied health teams as well as children’s services

Otara

5 additional clinic rooms; group therapy area – 60 additional clinics or group sessions per week Monday to Friday. Like Mangere there is the opportunity to look at providing further evening & weekend clinics, particularly as all District Nursing clinics will be provided in the hubs and away from western Campus. These clinics will be operational 7 days per week with some evening clinics too.

Re-establish District Nursing clinics across the week and extend to cover evenings & weekends

Establishment of a community base for staff – including Community Health multidisciplinary nursing & allied health teams and Public Health Nursing

043


Franklin

12 additional clinic and procedure rooms (e.g. physician and nurse provider outpatient clinics; patient tele-health rooms; infusions & minor surgical procedure rooms; nurse support/preparation area; patient toileting facilities).

Ongoing development of the Community Ward to provide a medical pathway to support admission avoidance & earlier transitions of care from Middlemore Hospital

Awhinatia (Manukau)

As a CM Health community based multi service site the plan is to ensure retinal screening has the ability to provide clinics from this site. The service is currently working through contractual issues with the clinic where screening is currently provided from.

Opportunity to review what clinics could also be provided from the Awhinatia site as part of an integrated model of care with Mental Health and Locality Community Health Services.

044

Counties Manukau District Health Board- Community & Public Health Advisory Committee 27 January 2021

Counties Manukau District Health Board Community and Public Health Advisory Committee

Faster Cancer Treatment Reporting Data

Recommendation It is recommended that the Community and Public Health Advisory Committee: Receive the Faster Cancer Treatment Reporting Data paper. Note this paper was endorsed by the Executive Leadership Team on 15 December to go forward to the Community & Public Health Advisory Committee for their information. Note that the information provides an update of FCT performance and related activity noting that the focus of FCT is predominantly at the hospital for diagnosis and treatment. Note that FCT performance for October 2020 is 88% in terms of the hospital based specialist treatment being delivered within 62 days. Note that since May 2020, the monthly performance remains at or above 85%. Covid19 contingency plans are in place to maintain cancer services across various levels of alert status. Note that there is potential benefit from further work to address joint Primary Care and Hospital actions to ensure that Equity considerations are adequately incorporated, and FCT can sustainably meet the target of 90%. Note the actions identified in the paper in relation to continued development of FCT performance.

Prepared and submitted by: Aroha Haggie Director Funding & Health Equity Glossary ADHB Auckland District Health Board CNC Cancer Nurse Coordinator CTT Cancer Tracking Team DNA Did Not Attend ED Emergency Department FCT Faster Cancer Treatment FSA First Specialist Assessment GP General Practitioner MOH Ministry of Health NCN Northern Cancer Network Purpose

The purpose of this paper is to provide an update on Faster Cancer Treatment (FCT) reporting data in line with action 3.2 from the 4 November 2020 Meeting of the Community and Public Health Advisory Committee. Background FCT has a current target of 90% of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.

045


The current reporting of FCT data is mandated by MOH for 13 tumour streams and the focus is on hospital patient flow performance. Not all cancer care is included in the FCT reporting. Rather FCT reporting is restricted to measuring the timing of care where clear pathways are in place – 62-day pathways. Hospital based cancer treatment The FCT target and current reporting is focused on hospital based cancer patient flows, with performance recorded against all tumour streams. Actual volume of treatment numbers are not reported as part of FCT. One of the key challenges across all the tumour streams is to ensure that FCT is a core priority of all clinical teams and support staff involved in the patient pathway. In the past 12 months services have refocused on the need to meet the FCT target and are ensuring patients are continuously facilitated, predominantly by the CNC and CTT. For the month of October the achieved level of FCT was 88%. In terms of patient numbers this means that 30 of 34 eligible patients were treated within 62 days. If 1 additional patient had passed this would have achieved the 90% target. Of the four patients who breached: two patients were delayed in medical oncology at ADHB and two other patients faced delays due to in-house capacity constraint.

A key component of all FCT activity is developing collegial relationships across all services and also externally with regional NCN colleagues and specifically with ADHB as the tertiary provider of treatment. This includes engagement with regional meetings and data evaluation to establish consistency in application of the business rules to standardise the comparison of performance against the target and monitor the various cancer pathways. Recently senior managers and clinicians from the organisation’s cancer service participated in a regional review of the gynaecological endometrial cancer pathway to improve FCT performance. The cancer service intends to progressively engage in similar regional reviews for other tumour streams. Community/Primary Care Currently, the FCT reporting data excludes any primary care related information. However there are steps being taken to capture information that will allow better monitoring of how patients are being detected and progressed through the system of care. Cancer screening data, such as for Breast and Bowel cancers are also reported separately and do not form part of FCT reporting. From a population health perspective,

046


the Cancer Steering Group does ‘deep dives’ into specific tumour streams (2-3 times a year). This provides an in-depth analysis of cancer registrations, treatments, and mortality for that tumour stream, as well as ethnicity-based volumes so that a reasonable view of equity and outcome for each deep dive can be developed. FCT is largely predicated on the specific grading of each patient by hospital specialists for an FSA appointment. The hospital based grading of patients for FSA is however dependent on the supplied information from the GP. Equity Equity considerations are an important part of the funding of services. Utilisation by ethnicity indicates that in particular tumour streams, there is lower achievement of FCT performance for Maori and Pacific patients. This is difficult to measure on a month by month basis as the volumes in each group are small. In the 12 month period Nov 2019 – Oct 2020 FCT performance has been 85% for both Maori and 85% Pacific patients.

Discussion In the Counties Manukau district, there is a growing and aging population, with an expected increase in incidence for all cancer types. Volumes requiring specialised treatments such as chemotherapy and radiotherapy are also projected to increase. There will be increased capacity constraint, particularly in Breast, Gynaecology and Head & Neck tumour streams. Patients require upfront outpatient and diagnostic services to reach a diagnosis or be excluded from the FCT pathway. This creates the need for additional outpatients, radiological and biopsy procedures. The decline in FCT performance against the target for Maori and Pacific patients is particularly worrying. Delays to treatment impose ill health onto the community and a poorer outcome for individual patients. Reportedly, Maori and Pacific patients have trouble engaging with services, demonstrate significantly higher outpatient DNA rates in existing models of care and frequently have comorbid conditions affecting management. This is not always evident as patients that delay due to comorbidity or patient choice are excluded from the FCT target. In the case of delays caused by patient choice it is important to understand the barriers that prevent individuals from engaging in timely access to services. Hence, while the FCT target focus is predominantly at the hospital for diagnosis and treatment, there are areas that would potentially benefit from further collegial work with Primary Care. A community focus can be taken to assist hospital FCT performance, as follows:

Deeper review of the barriers for patients presenting to GP - current data suggests that a significant number of patients (mainly Maaori & Pacific) present to ED with subsequent diagnosis of late stage cancer. It would be worth exploring what the gaps are, and how these result in patients not being referred earlier or obtaining an earlier diagnosis.

Potential of developing Marae based services and like-opportunities that may improve the experience of Maaori patients with a suspicion / diagnosis of cancer.

89.2% 94.7% 5.5%88.8% 100.0% 88.2% -11.8%376 334Total

84.6% 94.4% 9.8%85.3% 100.0% 83.3% -16.7%68 58Pacif ic Islander

100.0% 100.0% 0.0%100.0% 0.0% 100.0% #DIV/0!6 6Other

81.3% 100.0% 18.8%84.6% 100.0% 100.0% 0.0%65 55Maori

100.0% 100.0% 0.0%100.0% 100.0% 100.0% 0.0%18 18Indian

90.2% 92.1% 1.9%European 186 170 91.4% 100.0% 81.8% -18.2%

-14.3% 100.0% 90.9% -9.1%

Variance

Asian 33 27 81.8% 100.0% 85.7%

Oct 2020 Variance May 2020 - Jul

2020

Aug 2020-Oct

2020

Period 01 Nov 2019 To 31 Oct

2020

Performance Trends last 6 months

62-day target: passes and

capacity breaches

Ethnicity

Patients Passed

62 Days

62 day

compliance

%

62 day

compliance

Trend

Sep 2020

FCT HeatMap Report Includes patients with first treatment period 01 Nov 2019 To 31 Oct 2020

047


Developing information sets for primary care referrals so that the decision making around cancer suspicion could be better prioritised

Exploring the use of basic diagnostic tests in primary care to support referrals (e.g. pipelle procedures undertaken in primary care; to decongest the volume of patients on a suspicion of cancer pathway as patients with a negative pipelle are more likely to not have a cancer).

048

South Auckland Social Wellbeing Board 5-Year Strategy (2020 – 2025) and 2-Year Action Plan

S

Appendix 1. 5-year strategy & 2-year work plan

049

Contents

The South Auckland Social Wellbeing Board 3

Purpose of this document 4

Introduction – the next 5 years 5

What we know 6-8

Our Strategic Aspirations and Success Factors 9

Prevention, crisis and resilience building in an end-to-end system 10

The 5 Year Strategy 11

Why are we doing this 12-13

Executing the Strategy - the 2 Year Action Plan 14

Accountabilities 15

2020/2021 Work Programme 16

Our commitment to innovate and disrupt 17

Infrastructure 18

Appendices – descriptions of new initiatives 19-21

050

Independent Chair Sandra Alofivae

Advisor to the Chair Lewis Holden (State Services Commission)

Accident Compensation Corporation: Neil Phillips

Council: Gael Surgenor

Ministry of Pacific Peoples Sina Aiolupotea- aiono

Ministry of Social

Mark Goldsmith

NZ Police John Tims

Oranga Tamariki Glynis Sandland

Te Puni Kokiri Martin Mariassouce

The South Auckland Social Wellbeing Board (as at June 2020)

Department of Corrections Alistair Riach

Kainga Ora Karen Hitchcock

Ministry of Education Isabel Evans

Ministry of Health Clare Perry

Ministry of Justice Julia Lynch

Counties Manukau DHB Margie Apa

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Our community is diverse and vibrant with

strong cultural values. We need to leverage the strengths and work better together at all levels to achieve sustainable future change

Engage Others in the diversity, equity challenge and

opportunties in our community

We need agency mandate at all levels to

enable our local leaders to do what it takes to make a difference for our communities

Achieve Mandate to do what it takes to make a difference

for our children & whānau

As a Board we are committed to breaking down the barriers and disrupting the

parts of the system that aren‘t working optimally for our community

Ensure Commitment to break down the barriers & disrupt

the system where required

Purpose of this document

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Introduction The next 5 years – building on the work to date The development of this 5 year strategy and 2 year action plan is intended to create a shared medium term

vision, and to identify the actions required to achieve the 5 year goals. There is a deliberate shift to a “next

phase” view for the SASWB, building on the cross-cutting themes from learnings to date. The 2 year action

plan is aligned to the confirmed 2 year funding path, including the Joint Venture for Family Violence and Sexual

Violence (JV) funding for early years family violence initiatives.

Factors impacting our community in the next 5 years

The Board has identified a number of factors that will impact our local environment, and therefore the role

and function of the SASWB over the short-medium term, including:

• An increased agency focus on relationships with Iwi and NGOs, and enabling communities to take active

roles

• A strong focus on partnerships, prevention and participation, however, at the same time,

acknowledgement of an increase in intensive support models that are currently operating within single

agency silos

• Agencies’ operating models are evolving, building on learnings from the COVID response, and include

a general shift by the majority of agencies from central to local / regional decision making

• The COVID recovery response. There will be a significant impact in South Auckland, particularly on

unemployment, housing, financial security and the resulting psychological distress and trauma. There is

an exacerbation of existing stressors for already at risk families, but also a population cohort who have

never required support before now accessing support. The Board considers it has a role to play in

supporting South Auckland’s COVID recovery phase

• The social housing building programme (volume and density) will have an impact on the ability of existing

infrastructure and supporting services including schools to meet the needs of a growing and potentially

vulnerable population.

There is a consensus that the impact of these factors in the medium term will benefit from enhanced

collaboration, a specific focus on communities of greatest need, and a wellbeing strength based approach.

Our journey to date and the shift to the next phase

Since its inception in 2016, the SASWB has applied a whānau-centred early support and prevention approach

to improving long term outcomes for children. The original ‘5 intervention settings’ have evolved over time,

to testing initiatives across the spectrum of prevention, crisis and building whānau resilience. We recognise

the unique features of our community, the local nuances and the need to understand the complexities and

growing inequity for our Māori and Pasifika populations. The ongoing refinement of the PBI infrastructure,

governance and management arrangements, and the backbone function over time, has enabled the SASWB

to test and learn rapidly, and therefore respond in a timely way, to community needs as a collective, when

required.

Building resilient communities through greater collective impact

The SASWB’s member agencies have collectively been on a journey of mindset change, contributing to the

design of different ways of working that use evidence and insights to achieve greater collective impact.

There is still more work to do to integrate the culture change throughout the member organisations, and

this will be a key piece of work in the 2 year action plan.

Agencies have achieved a significant shift on the spectrum from networking / co-ordination as a group,

where information was exchanged for mutual benefit, to an advanced level of co-operation and

collaboration where there is now some common planning, formal communication flows and some

resource sharing and concessions. The SASWB is on the cusp of being able to achieve greater collective

impact and an end to end system; a system that will support and enable communities to build social

capital, whānau resilience and long term intergenerational change. The key elements required to achieve

this are highlighted in Figure 1, and work on these elements form the foundation of the Board’s 5 year

strategy.

Figure 1: Key elements to

achieve greater collective

Impact and an end-to-end

system

There is more work to be done to make a long-term difference through evidence-based disruption

Long term sustainability continues to be a key driver of the SASWB’s strategy.

Embedding the collaborative way of working into core business, and formalising iwi and community

partnerships will enhance our ability to respond to the consistent theme across all SASWB prototypes; that

there is a high complexity of underlying stressors for a large proportion of South Auckland families, and

systems are currently disproportionately accessible to those that do not require them the most.

The strategy and action plan will reinforce the test and learn approach but will also incorporate an intent

to act on its mandate to disrupt where necessary to achieve outcomes for whānau. There will be support

for agencies to identify and implement core business improvements that are gained from improved

collaboration; inform system level change; and to break down organisational barriers and silos.

We will continue to support and work in partnership with other PBIs and across Tāmaki Makaurau to

create an environment that supports and enables protective factors in communities; share learnings; and present national themes for system level change.

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What we know: There are many opportunities to make a real difference for children and whānau

• Agency commitment, passion and investment in South Auckland

• Effective collaborative / local infrastructure established through building of

trusted relationships and mindset evolution over time – and a recognition

that this takes time

• Deep understanding of South Auckland community, the complexities of its

unique population groups & challenges

• A willingness to challenge the status quo and tackle what is often considered

as “too hard”

• An Independent Board Chairperson

• Ability to incorporate strategic and operational insights

• Relationships functioning well with proven deliverables

• Diversity across agencies

• An agile backbone function / Implementation Office

• Focus on achieving a whānau-centred approach

• A common purpose driven by shared culture and vision & ability to

influence and challenge each other

• A testing / learning framework underpinning design and delivery

• Funding uncertainty – resulting in lack of staff security / consistency

• Decision making at local level being impacted by centre

• Different governance arrangements across agencies, and a lack of

regional autonomy for some who then cannot fully participate in SASWB

activity and/or local decision making

• National barriers – national policy influencing local ability to exercise

discretion and therefore a tendency to err on the side of caution locally

• Ability to navigate complexity of Manawhenua and Matawaka in South

Auckland

• Ability to respond to the complexity within the Pasifika community

• Currently a government agency focus only with no Iwi / Māori /

community input at governance level

• Shift to a focus on wellbeing rather than deficits

• Embed learnings and performanceimprovement

opportunities into agencies / system

• Systematise established trusted relationships across agencies

• Iwi / community voice at the table

• Build community relationships and partnerships that ‘live’

the Treaty partnership approach

• Better define whānau

• Springboard off COVID-19 operating model enhancements

• Align with other Auckland regional initiatives for impact (APO,

ASSLG, Regional Public Sector Lead)

• Connect and share learnings with other PBIs and NGOs

• Resource investment in Auckland region

• Increase visibility of learnings in Wellington

• Mandate for disruption

• Risk aversion & organisational inertia

• Scale and complexity of South Auckland – risk of being put in

the “too hard” basket

• Reprioritisation of collaborative resources back into agencies

at discretion of individual agencies

• The need to continue to prove ‘legitimacy’ to ensure

longevity

• Pace of change limiting communication / real engagement

with communities

• Limitations on local mandate and flexibility from centre

Our 5 year strategy

builds on our strengths,

and the opportunities

we have identified, that

will continue to

strengthen the

effectiveness of the

SASWB’s collaborative

way of working to

achieve improved

outcomes for children

and whānau.

The 2 year Action Plan

specifically incorporates

mitigation strategies to

address known

weaknesses and threats

that limit our ability to

achieve our goals.

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Strong cultural values and unique needs Access to support is impacted by size and inequity

It is complex, but we need to do better…

1 in 10* adults receive care for a diagnosed

mental health condition

On average, we receive more than 60 Police 111 calls every day relating to family harm

A further 18,500 people receive other income support

Almost 20,000 people in South Auckland receive Job Seeker Income Support (43% of the

total for Auckland)

Almost 70,000 people live with one or more

long term health conditions

1,086 school age children are not attending school

We have the highest number of child protection referrals nationally with over 1,000 per year

What we know: We need to work differently to be able to respond to the diverse and complex needs of our community

* This rate is potentially impacted by lower than expected access rates for some populations

40% of total CM population is born overseas

16% Māori

21% Pasifika

27% Asian

1 in 2 children live in the most socially deprived areas

Māori (36%) and Pacific (32%) populations aged

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different ethnicities

Nearly two-thirds of people in Māngere-Ōtāhuhu identify as Pacific (61%), alongside almost half of the people in Ōtara-Papatoetoe (46%) and one-third of the people in Manurewa (33%)

18% of those who had been born overseas had been living in New Zealand

Our strategic aspirations and success factors

In 5 years time, we will be able to say....

We will know we’ve succeeded when....

1 Children and whānau are leading the development of their own “one plan” and they trust us to support them

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We are working in partnership with Iwi

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Collaboration across government and non-government organisations is the way of working

counties manukau district health board community … · 2 days ago · dr campbell brebner –...

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