tairawhiti dhb annual plan 2015/16 - gisborne hospital€¦ · tairawhiti dhb annual plan 2015/16...

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2015-16 Annual Plan – Tairawhiti DHB 1

Tairawhiti DHB Annual Plan 2015/16

Incorporates the 2015/18 Statement of Intent and 2015/16 Statement of Performance Expectations

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Ta Matou Matakite - Our Vision

Whaia te Hauora I roto I te Kotahitanga

A Healthier Tairawhiti by Working Together

A Matou Uara - Our Values

Whakarangatira Kia Whakarangatira i te oranga o

to tatou hapori

We take responsibility to enrich the

health of our community.

Enrich = increasing the quality

of – Quality Focus)

Awhi Kia Awhi i te turoro We give caring support to our Patients. Patient Care

Kotahitanga Ma te Kotahitanga o a tatou mahi

ka momoho ai

Through our collective effort we

succeed. Employee Synergy

Aroha Kia tuku Aroha ki te Whanau We give compassion to our families. Hearts and minds

This document presents our Annual Plan 2015/16 (referred to as the Plan) and incorporates the 2015/18 Statement of Intent and the 2015/16 Statement of Performance Expectations. Central to understanding this Plan, is our performance story which sets out our key outcomes (what we are trying to achieve), our impacts (our shorter term contribution to an outcome), our outputs (goods and services supplied), and our inputs (resources).

This plan should be read in conjunction with the Tairawhiti District Health Board Māori Health Plan and the Midland DHB Regional Services Plan.

Annual Plan (2015/16), Statement of Intent (2015-18) and Statement of Performance Expectations (2015/16)

Gisborne: Tairawhiti District Health Board

Published in June 2015

by the

Tairawhiti District Health Board

Private Bag 7001, Gisborne, 4010

Acknowledgements for front page photographs, sourced from www.flickr.com/photos/tourismeastland

Main picture - Kutia, Te Aotaihi, My Beautiful Uawa, 2011, Tourist Eastland, Gisborne

Outside Left – Takurua, Hinemaia, A Beautiful Moment, 2010, Tourist Eastland, Gisborne

Middle Left – Ngawhare, Trudi, Kohi Kina, Dats how we roll, 2012, Tourist Eastland, Gisborne

Middle Right – Donnelly, Mikayla, Touching Statues, 2013, Tourist Eastland, Gisborne

Outside Right – Richter, Paige, Aroha, 2013, Tourist Eastland, Gisborne

This document is available on the Tairawhiti District Health Board website:

www.tairawhitidhb.health.nz

http://www.flickr.com/photos/tourismeastland

http://www.tairawhitidhb.health.nz/

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Contents

Ministers Letter of Approval for Annual Plan 2015/16 ......................................................... 7

Karere i to tatou Poari Message from Our Board ........................................................ 9

Signatories - Primary Care..................................................................................................... 12

Module 1 - INTRODUCTION AND STRATEGIC INTENTIONS ............................................ 14

1.1. Context ......................................................................................................................................................... 16

1.1.1. Performance Story ........................................................................................................................................................ 17

1.2. National Operating Environment ............................................................................................................. 19

1.2.1. The Treaty of Waitangi ................................................................................................................................................. 19

1.2.2. Health Sector Challenges and Pressures.................................................................................................................. 19

1.3. Regional Operating Environment............................................................................................................ 20

1.4. Local Operating Environment .................................................................................................................. 21

1.4.2. Our Geography and Population .................................................................................................................................. 21

1.4.3. Health Profile ................................................................................................................................................................. 23

1.5. Nature and Scope of Functions ............................................................................................................... 24

1.6. Koronga rautaki / Strategic Intentions ................................................................................................... 24

1.6.1. Tatou kite / Our vision .................................................................................................................................................. 24

1.6.2. National Strategic Intentions ....................................................................................................................................... 28

1.6.3. Regional Context ........................................................................................................................................................... 31

1.6.4. Local Context ................................................................................................................................................................. 32

1.7. Key Risks and Opportunities ................................................................................................................... 33

1.7.1. Health Inequalities ........................................................................................................................................................ 33

1.7.2. Living Within Our Means .............................................................................................................................................. 33

1.7.3. Health System Workforce Shortages ......................................................................................................................... 33

1.7.4. System Integration ........................................................................................................................................................ 34

1.7.5. Regional Integration...................................................................................................................................................... 34

1.8. Key Measures of Performance ................................................................................................................ 34

Outcome 1 – People are supported to take greater responsibility for their health ........................................................... 34

1.8.1. Fewer People Smoke ................................................................................................................................................... 35

1.8.2. Reduction in vaccine preventable diseases .............................................................................................................. 36

1.8.3. Improving health behaviours ....................................................................................................................................... 36

Outcome 2 - People stay well in their homes and communities ......................................................................................... 37

1.8.4. Children and adolescents have better oral health .................................................................................................... 38

1.8.5. Long-term conditions are detected early and managed well .................................................................................. 38

1.8.6. Fewer people are admitted to hospital for avoidable conditions ............................................................................ 39

1.8.7. People maintain functional independence ................................................................................................................. 40

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Outcome 3 - People receive timely and appropriate specialist care .................................................................................. 41

1.8.8. People receive prompt and appropriate acute care ................................................................................................. 41

1.8.9. People have appropriate access to elective services .............................................................................................. 42

1.8.10. Improved access to mental health services .............................................................................................................. 43

1.8.11. More people with end-stage conditions are appropriately supported .................................................................... 44

Module 2 – Huarahi Rautaki / Strategic Direction ............................................................... 46

2.1 Taumata Hauora / Health Targets............................................................................................................ 47

2.1.1. Shorter Stays in Emergency Departments ................................................................................................................ 47

2.1.2. Improved Access to Elective Services ....................................................................................................................... 49

2.1.3. Increased Immunisation ............................................................................................................................................... 55

2.1.4. Better Help for Smokers to Quit .................................................................................................................................. 58

2.1.5. More Heart and Diabetes Checks .............................................................................................................................. 63

2.2 He pai Hauora Ratonga Public / Better Public Health Services ......................................................... 65

2.2.1. Reducing Rheumatic Fever ......................................................................................................................................... 65

2.2.2. Prime Minister’s Youth Mental Health Project........................................................................................................... 66

2.2.3. Children’s Action Plan .................................................................................................................................................. 69

2.2.4. Whanau Ora .................................................................................................................................................................. 71

2.2.5. Social Sector Trails ....................................................................................................................................................... 73

2.2.6. He Oranga Whānau (Healthy Families New Zealand) ........................................................................................ 74

2.2.7. Reduce the prevalence of obesity .......................................................................................................................... 75

2.3 Integration pūnaha / System Integration ............................................................................................... 76

2.3.1. Integration pūnaha / System Integration .................................................................................................................... 76

2.3.2. Diabetes Care Improvement Packages & Long Term Conditions ........................................................................ 82

2.3.3. Stroke Services ............................................................................................................................................................. 86

2.3.4. Acute Coronary Syndrome .......................................................................................................................................... 88

2.3.5. Improved Access to Diagnostics ................................................................................................................................. 89

2.3.6. Cardiac – Secondary Services .................................................................................................................................... 91

2.3.7. Primary Care .................................................................................................................................................................. 91

2.3.8. Health of Older People ................................................................................................................................................. 96

2.3.9. Mental Health Service Development Plan ................................................................................................................. 99

2.3.10. Maternal and Child Health ......................................................................................................................................... 102

2.4. Improving Quality .................................................................................................................................... 106

2.5. Living Within Our Means ........................................................................................................................ 109

2.6. Supporting Delivery of Regional Priorities.......................................................................................... 110

2.7. National Entity Priority Initiatives ......................................................................................................... 112

2.8. Supporting Delivery of Regional Priorities.......................................................................................... 120

Module 3 – Statement of Performance Expectations ....................................................... 123

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3.1 Output Classes ......................................................................................................................................... 123

3.2 Guide to reading the statement of service performance .................................................................. 124

3.3 People are supported to take greater responsibility for their health ............................................. 124

3.3.1 Fewer People Smoke ................................................................................................................................................. 125

3.3.2 Reduction in Vaccine Preventable Diseases .......................................................................................................... 125

3.3.3 Improving Health Behaviours .................................................................................................................................... 126

3.4 People Stay Well in Their Homes and Communities ......................................................................... 126

3.4.1 An improvement in childhood oral health ................................................................................................................ 127

3.4.2 Long-Term Conditions are Detected Early and Managed Well ............................................................................ 127

3.4.3 Fewer People are admitted to Hospital for Avoidable Conditions ........................................................................ 128

3.4.4 More People Maintain their Functional Independence .......................................................................................... 128

3.5 People Receive Timely and Appropriate Specialist Care ................................................................. 129

3.5.1 People Receive Prompt and Appropriate Acute and Arranged Care .................................................................. 129

3.5.2 People Have Appropriate Access to Elective Services ......................................................................................... 130

3.5.3 Improved Health Status for those with Severe Mental Illness and/or addictions ............................................... 130

3.5.4 More People with End Stage Conditions are Supported Appropriately ............................................................... 131

3.6 Support Services...................................................................................................................................... 131

Module 4 – Financial Performance ..................................................................................... 133

4.1 Financial Performance ............................................................................................................................ 133

Module 5 – Kōwae Tuarima/Stewardship .......................................................................... 152

5.1 Te whakahaere i to tatou Pakihi / Managing our Business .............................................................. 152

5.1.1 To tatou iwi / Our people ............................................................................................................................................ 152

5.1.2 Organisational Performance Management .............................................................................................................. 153

5.1.3 Pūtea me te Whakahaere Pūtea / Funding and Financial Management ........................................................... 154

5.1.4 National Rängai Hauora tari / National Health Sector Agencies ......................................................................... 155

5.1.5 Risk Management ....................................................................................................................................................... 155

5.1.6 Performance and Management of Assets ............................................................................................................... 155

5.1.7 Shared Decision-Making ............................................................................................................................................ 156

5.2 Te Kaha Building / Building Capability ................................................................................................ 159

5.2.1 HealthShare Limited ................................................................................................................................................... 159

5.2.2 Information Communications Technology ............................................................................................................... 161

5.2.3 Integrated Contracting ................................................................................................................................................ 161

5.2.4 Capital and Infrastructure Development .................................................................................................................. 162

5.2.5 Cooperation ................................................................................................................................................................. 162

5.2.6 Long Term Demand Forecasting .............................................................................................................................. 164

5.3 Kaimahi / Workforce ................................................................................................................................ 165

5.3.1 Managing Our Workforce within Fiscal Restraints ................................................................................................. 165

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5.3.2 Strengthening our workforce ..................................................................................................................................... 165

5.3.3 Safe and Competent Workforce................................................................................................................................ 168

5.3.4 Child Protection Policies ............................................................................................................................................ 169

5.3.5 Children’s Worker Safety Checking .......................................................................................................................... 170

5.4 Whakahaere Hauora / Organisational Health ...................................................................................... 170

5.4.1 Kāwanatanga / Governance ...................................................................................................................................... 170

5.4.2 Ratonga whakamāherehere me te Pūtea Hauora me te Hauātanga / Planning and Funding Health and

Disability services .................................................................................................................................................................... 171

5.4.3 Te whakarato Hauora me te Ratonga Hauātanga / Providing Health and Disability Services ........................ 172

5.5 Pūrongo Na Whakawhiti / Reporting And Consultation .................................................................... 173

5.5.1 Consultation with the Minister and the Ministry of Health ..................................................................................... 173

5.5.2 External Reporting ...................................................................................................................................................... 174

Module 6 – Whirihoranga Ratonga / Service Configuration ........................................... 176

6.1 Ratonga Rohe / Service Coverage ........................................................................................................ 176

6.2 Huri Ratonga / Service Change ............................................................................................................ 177

6.3 Take Ratonga / Service Issues .............................................................................................................. 178

Module 7 - 2015/16 Performance Measures....................................................................... 180

Module 8 – Appendices ........................................................................................................ 186

8.1 Glossary of Terms ................................................................................................................................... 186

8.2 Output Class Definitions ........................................................................................................................ 190

8.3 Output Class Revenue and Expenditure ............................................................................................. 191

8.4 Output Measure Rationale ...................................................................................................................... 192

8.5 Organisational Structure ........................................................................................................................ 198

8.6 Services funded but not provided by the DHB ................................................................................... 199

8.7 Māori Health Plan ..................................................................................................................................... 200

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Karere i to tatou Poari Message from Our Board

This document expresses our continued commitment to our local strategic action of Whaia te Hauora I

roto I te Kotahitanga/ A Healthier Tairawhiti by Working Together. It also articulates our commitment to

meeting the Minister’s expectations, including the Health Targets, and how we will achieve this, as well as

how we will work with our Midland DHB, Primary Health Organisation, local provider and iwi partners to

deliver on continual improvement services for our local people.

TDH’s key focus areas can be summarised across five core areas:

Care Closer to Home

Increased patient Quality and Safety

Health of Older People

Regional and National Cooperation

Living within our means.

TDH is also guided by the following 4 key strategic outcomes to achieve its vision.

• Prevent ill health

• Reduce health inequalities between population groups

• Support people to stay well in the community

• Ensure people receive timely and appropriate complex care

These areas are reflected in TDH’s work-plans for improved older persons’ services, child and youth

services, mental health services, improved performance from the primary and secondary care sector

(including addressing the Minister’s core Health Targets and expectations), reduced health inequalities

across Māori and non-Māori, and further improving the quality and safety of the health system for the

people of Tairawhiti.

The 2015/16 financial year represents another challenge to TDH. The current economic and fiscal

environment in the country remains a significant planning consideration, with continuing pressure on

Vote Health for the foreseeable future meaning a continued lower funding growth path for TDH. TDH

has some key cost pressures in 2015/16. These include:

Salary settlements for staff;

Increased investment in regional and national service solutions;

Implementation of the regional Home Care Support Services model;

Growth in demand for some services at a higher rate than the funding increase e.g. aged

residential care, cancer treatment;

Significant cost increases in air transport services through clinically driven changes in practice;

Expectations around waiting times targets that will increase costs as we meet higher demand

expectations.

The Minister of Health (the “Minister”) set out his expectations in his letter of 17 December 2014. This

year, the Minister has identified the following priorities:

Fiscal Discipline/Management of the Health Portfolio

Leadership

Integration between Primary and Secondary Care

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National Health Targets

Tackling Key Drivers of Morbidity

Refreshing New Zealand Health Strategy

To be able to afford new investments and government expectations, TDH will deliver additional

efficiencies in its operations, as well as in its funding arrangements, on top of the significant efficiencies

we have driven over the last 3 years. Meeting the 2015/16 budget against year on year savings initiatives

will not be an easy task, and we have assumed that a number of national savings will be delivered on

(including HBL developed business cases and the national Community Pharmacy Agreement) for us to

reach our break-even budget.

2014/15 has been a successful year for TDH. Already we have seen improvements in TDH’s performance

against the Health Targets, and this will remain a continued focus for 2015/16. We are working in

partnership with the Midlands Health Network, Ngati Porou Hauora and the National Hauora Coalition to

achieve improved performance across smoking cessation, Cardio-Vascular Risk Assessment and

immunisation targets.

E Tipu E Rea will be a key project in 2015/16 that will drive significant changes in the delivery of health

services for children from conception to 5 years in the district, and will be the means for health services

across Tairawhiti to ensure that all tamariki get the best start in life. A new impetus will be given to

reaching a Smokefree Tairawhiti by 2025. Along with the continuation of projects which discourage the

uptake of smoking and assist smokers going smokefree, we intend to challenge people who smoke in

public view and increase the social unacceptability of smoking across our community.

We will also maintain and accelerate our focus on productivity and quality, which will support TDH’s dual

objectives of improving health outcomes for our population, and a break-even budget. Implementation of

our patient quality and safety projects within the Provider Arm will be led through the dissemination of

our patient quality and safety culture to create better outcomes with better utilisation of resources by

elimination of waste.

There is a transformational set of activities accelerating system integration as part of the Government’s

Care Closer to Home platform. We are committed to ensuring that our population gets maximum benefit

from the system changes currently underway. However we also intend to significantly up-scale our

integration programme across a series of new initiatives in conjunction with our primary care partners

through the device of the Tairawhiti Integration Forum.

TDH is committed to regionalisation with the Midland region where this will deliver benefits to the

Tairawhiti population in terms of service effectiveness and sustainability. This is evidenced in our active

participation in, and funding of the implementation of the Midland Regional Services Plan. Information

systems are key to supporting improved clinical outcomes, and these priorities are acknowledged within

regional planning, with TDH setting aside the necessary capital investment for these to be addressed

regionally.

Clinical leadership development in our DHB and across the sector in Tairawhiti is delivering results in

improving outcomes for patients and raising quality of service provision. The clinical leadership structure

now revised and linked to clinicians working in the community setting, partnered with management, is

driving change to ensure service demand is managed, indicators of quality are improved and new service

developments come to fruition.

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In summary, first and foremost our focus is on improving outcomes for people in Tairawhiti through

increased quality and safety of services. We will achieve this by further strengthening clinical leadership

and integration across the whole care spectrum. We will do this while prudently using the resources we

have available, eliminating waste and living within our means. The commitment of all our partners and

the staff of TDH to these causes mean achievement against our challenging work programme is assured.

David Scott

Board Chairperson

Barbara Clarke

Deputy Chair

Jim Green

Chief Executive

Hon Bill English

Minister of Finance

Hon Jonathan Coleman

Minister of Health

http://beehive.govt.nz/gallery/hon-bill-english

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Signatories - Primary Care

The 2015/16 Annual Plan for Tairawhiti has been approved by the Tairawhiti Integration Forum. This

alliancing body governs the integration of services across the primary/community and secondary interface

and is made up of the Chief Executives of the district’s three PHOs and Chief Executive of Tairawhiti DHB.

The following identified sections have been developed and agreed with our Primary Care partners:

2.1.4. Increased Immunisation

2.1.5. Better help for Smokers to Quit

2.1.6. More Heart and Diabetes Checks

2.2.1. Reducing Rheumatic Fever

2.2.2. Prime Minister’s Youth Mental Health

2.2.3. Children’s Action Plan

2.3.1. Service integration

2.3.2. Diabetes Care Improvement Packages and Long Term Conditions

2.3.5. Improved Access to the Diagnostics

2.3.7. Primary Care

2.3.8. Health of Older People

2.3.9. Mental Health Service Development

2.3.10. Maternal and Child Health

_____________________ ___________________________ ___________________________

John Macaskill-Smith Rose Kahaki Simon Royal

Midland Health Network Ngati Porou Hauora National Hauora Coalition

Date: Date: Date:

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Module 1 - INTRODUCTION AND STRATEGIC INTENTIONS

As we enter the 2015/16 planning round, we see a New Zealand public health system that continues to face

challenges. With challenges, however, come opportunities, and this plan details many of the opportunities

and interventions we believe will have positive impacts on the health status of our population. The challenges

that affect us all are both global and local.

The burden of disease is unfairly distributed in our society; long term conditions and risk factors such as

smoking, obesity and diabetes contribute to serious health disparity. The health of Māori remains an area in

which we must do better, and more detail is to be found in Te Tairawhiti - He Urupare Rangapu Hauora

Maori, DHB Māori Health Plan. The physical health of people with serious mental health problems is another

area for concern, with a life expectancy in this group of 25 years less than for other New Zealanders. Already

we are seeing the impacts of an aging population – in 2011 there were four people in the workforce for every

person 65 years and over – by 2031 there will be just half that number with two people in workforce for every

over-65 year old. Whilst increasing numbers of people are electing to work past the age of 65 increasing

numbers of people are reaching the old/old category of 85 plus – often with a high degree of frailty and high

complex health need.

The funding environment remains constrained as health consumes an ever increasing portion of total

government expenditure. Rapid advances in technology continue to fuel ‘tertiary creep’ and the public has

high expectations of its health system.

Resistance to common antibiotics and new infections such as Ebola are ever-threatening. DHBs are

continually looking for ways to increase allocative efficiency by investing in preventative care. Targeting of

vulnerable populations is essential if we are to realise more equitable health outcomes. There is a general

acceptance that if we are to prepare well for a healthy health and disability sector we must focus on four

areas:

1. Better integration of services within health and across the social sector: Strengthening

integration within health and across government to support the most vulnerable, reduce

inequities and address issues outside the health and disability

system that impact on health.

2. Improving the way services are purchased and provided: Ensuring

funding models support change, building and supporting the key

enablers and drivers of change: workforce, health information and

capital.

3. Continuing to lift quality and performance: Driving performance

through measuring and rewarding the right things to improve

quality.

4. Supporting leadership and capability for change: Supporting strong governance, clinical and

executive leadership and capability across the health sector.

Planning involves using a range of information, (demographic, long-term demand projections and

epidemiological information) to help us determine the needs of our population over the next 10 years and

beyond, and to inform the planning and development of the services that will best meet those needs. A

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driving priority for Tairawhiti DHB remains the health of Māori. We must improve health outcomes and

reduce disparity by addressing priority needs first.

While there are a number of key areas that the DHB intends focusing on over the next year, especially on

meeting the Minister’s expectations, there are nevertheless two stand out areas of focus that we believe are

critical to achieving more equitable health outcomes for our population. The first is maternal, child and youth

health, through our E Tipu E Rea project. The second is rigorous management of long term conditions to both

reduce the burden of ill health endured by so many in our population (particularly Māori and those who are

economically disadvantaged), but also to reduce the burden of caring for those with long term conditions on

the health system as a whole. Again curbing tobacco use features strongly in this area, as does the physical

health of those with severe mental health conditions. Management of long term conditions is an area in

which we will work closely with our primary care partners.

This document expresses our continued commitment to our local strategic action of Healthy Tairawhiti –

working together. It also articulates our commitment to meeting the Minister’s expectations, including the

Health Targets, and how we will achieve this, as well as how we will work with our Midland DHB partners to

deliver on Better, Sooner, More Convenient services for our local people.

Healthy Tairawhiti – working together

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1.1. Context

Tairawhiti DHB was established on 1 January 2001 by the New Zealand

Public Health and Disability Act 2000 (NZPHD) and is one of 20 DHBs in

New Zealand. DHBs were established as vehicles for the public funding

and provision of personal health services, public health services and

disability support services for a geographically defined population1.

Tairawhiti DHB is a Crown Entity and is accountable to the Minister of

Health.

This Plan sets out the activities we will undertake in terms of national,

regional and local priorities. It describes to Parliament and to the New

Zealand public what we intend to achieve in 2015/16, to improve the

health of the Tairawhiti DHB population and to reduce or eliminate health

inequalities.

We are part of the Midland DHBs region, and have worked together to

improve regional consistency across our plans. This cooperation is

reflected throughout this Plan.

We receive funding from Government to undertake our functions2. The amount of funding is determined by

the size of our population, as well as the population’s age, gender, ethnicity and socio-economic status

characteristics. We are both a funder and provider of health services. In 2015/16 we will receive $160

million3 in funding from the Government for most personal health (services to improve the health of

individuals), mental health and addictions, Māori health and health of older people services for the Tairawhiti

DHB population.

Our provider arm will receive approximately 65 per cent of the service funding with the remaining 35 per cent

being utilised to fund services including those provided by non-government organisations (NGOs), primary

care, pharmacy and laboratories4.

The Ministry of Health and National Health Board also have a role in the planning and funding of some

services. Some services are funded and contracted nationally, for example public health services, breast and

cervical screening as well as the provision of disability support services for people aged less than 65 years.

We are socially responsible and uphold the ethical and quality standards commonly expected of providers of

services and public sector organisations. We are responsible for monitoring and evaluating service delivery,

including audits of the services we fund.

The costs of providing services to people living outside of our district are met by the DHB of the patient and

are referred to as ‘inter-district’ services or Inter-District Flows (IDFs). Likewise, where we do not provide the

service, we have funding arrangements in place enabling our district residents to travel outside the district.

1 See 1.5.2 for a map of our DHB 2 See 1.5.1 for information on our functions 3 In addition to this Tairawhiti DHB will receive a net inflow of $2.0 million to provide services for other populations giving a combined budget of $162.245 million. 4 See appendix one for more detail on services funded but not provided by DHBs

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We also deliver against service delivery contracts with external funders, such as ACC. We closely monitor IDFs

and ACC volumes to ensure our ability to provide for our own population is not adversely affected by demand

from outside the district.

In order to achieve the planned outputs, impacts and outcomes as outlined in this Annual Plan, we may,

pursuant to section 25 of the New Zealand Public Health and Disability Act 2000, negotiate and enter into, or

vary any current agreement for the provision or procurement of any health and disability support service.

These agreements (or variations) may contain any terms or conditions acceptable to the DHB.

Tairawhiti DHB has a role to play in shifting our health system to a wellness model, and we will continue to

improve how we work with our partners across the system to deliver on the expectations, outcomes, goals,

objectives and strategic priorities we are charged with contributing to each year.

1.1.1. Performance Story

The diagrams presented on the following pages provide a high level summary of our performance story and

demonstrate the link between our outcomes and our stewardship areas. The right hand column of the

diagram indicates the relevant module of this Plan for further details.

National Outcomes

The Midland DHB’s Performance Story

He

alth

&

Dis

abili

ty

Syst

em

Ou

tco

mes

All New Zealanders lead longer, healthier and

more independent lives

New Zealand’s economic growth is

supported

Mo

du

le O

ne

Min

istr

y o

f

He

alth

’s

Hig

h-l

eve

l

Ou

tco

mes

New Zealanders are

healthier and more

independent

High-quality health and disability

services are delivered in a timely and

accessible way

The future of the health and

disability system is assured

Ove

rarc

hin

g

he

alth

se

cto

r

goal

Better, Sooner, More Convenient Health Services for all New Zealanders

Mid

lan

d

Vis

ion

All residents of Midlands DHBs lead longer, healthier and more independent lives

“Healthy Communities – Integrated Healthcare”

Mid

land

RSP

– Mo

du

le On

e

Re

gio

nal

Stra

tegi

c

Ou

tco

mes

To improve the health of the our population To eliminate health inequalities

Re

gio

nal

Stra

tegi

c

Ob

ject

ive

s

Improve Māori

health

outcomes

Integrate across

continuums of

care

Improve quality

across all

regional

services

Improve clinical

information

systems

Build the

workforce

Efficiently

allocate public

health system

resources

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TDH’s Performance Story

Ou

r

Vis

ion



Mo

du

le on

e

Ou

r

Ou

tco

me

s

To improve the health of our population To reduce or eliminate health inequalities

Ou

r St

rate

gic

Pri

ori

tie

s5 JoiniT

(Patient, family/ whanua centred

care)

KnowiT (Excellent Iwi/ Community,

family/ whanua knowledge and engagement)

ShapeiT (working with

community relationships)

VisioniT (Building a “will

do” culture))

ConnectiT (Enabling good

health and well-being through

technology)

Service performance

5 Full details of Tairawhiti’s Strategic Priorities are included in 1.6 Koronga rautaki / Strategic Intentions

6 Only examples of the outputs are presented here. For the full set of measures see module three

Lon

g-

term

Imp

acts

People take greater responsibility for their health

People stay well in their homes and communities

People receive timely and appropriate specialist care

Mo

du

le th

ree

3-5

Ye

ar Im

pac

ts

Fewer people smoke Reduction in vaccine

preventable diseases

Improving health behaviours

Children and adolescents have better oral health

Early detection of treatable conditions

More people are managing their long term conditions well

Fewer people are admitted to hospital for avoidable conditions

People maintain functional independence

People are seen promptly for acute care

People have appropriate access to ambulatory, elective and arranged services

Improved health status for people with a severe mental illness

More people with end stage conditions are supported

Ou

tpu

ts6 Percentage of patients who

smoke and are seen by a health practitioner who are provided with advice on smoking

• Percentage of children (0-4) enrolled in DHB funded dental services

Acute re-admission rate

Kō

wae

Tuar

ima

People Performance Management

Clinical Integration/ Collaboration/ Partnerships

Information

Mo

du

le five

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The outputs part of the service performance section of our performance story diagram contains examples of

measures contained in the statement of performance expectations. There are more than 30 output measures

in total that we will be monitoring.

1.2. National Operating Environment

The Minister of Health, with Cabinet and the Government, develops policy for the health and disability sector.

The Minister is supported by the Ministry of Health and its business units and, advised by the Ministry, the

National Health Board, Health Workforce New Zealand, the National Health Committee and other ministerial

advisory committees. Accident services are funded by the Accident Compensation Corporation (ACC). Health

and disability services in New Zealand are delivered by a complex network of organisations and people. Each

has their role in working with others across the system to achieve better, sooner, more convenient services

for all New Zealanders. The network of organisations is linked through a series of funding and accountability

arrangements to ensure performance and service delivery across the health and disability system.

1.2.1. The Treaty of Waitangi

The Treaty of Waitangi (Te Tiriti o Waitangi) is New Zealand’s founding constitutional document and is often

referred to in overarching strategies and plans throughout all sectors. Tairawhiti DHB is one of many

organisations that value the importance of the Treaty. Central to the Treaty relationship and implementation

of Treaty principles is a shared understanding that health is a ‘taonga’ (treasure).

1.2.2. Health Sector Challenges and Pressures

Major, long-term systematic pressures are shaping the way health services will be delivered in the future.

These pressures not only impact on New Zealand, but on a majority of health systems across the world.

These challenges and pressures include:

• There are substantial variations in outcomes for different populations, particularly for Māori and

Pacific peoples, and those living in more socioeconomically deprived areas;

• With increasing diversity in our population, the health system needs to be flexible to meet

changing needs and expectations of services;

• Changing population health needs and patterns of health and ill-health (e.g. the growing impact of

long-term conditions such as diabetes and risk factors such as high body mass index, multiple

comorbidities that increase with age, population growth and ageing);

• An ageing and unevenly distributed workforce, which does not currently match the anticipated

future demand for health and disability services;

• More expensive treatments and increasing costs, and changing public expectations of services and

treatments; and

• Providing excellent health care whilst ensuring the cost of the health system is sustainable

(historically health spending has grown faster than Gross Domestic Product).

Tairawhiti DHB faces a situation of being tasked with continuing to fund and provide high quality services

within the context of tight financial constraints. To achieve this we must continue to work with our

contracted providers, our communities and other key stakeholders to develop new and better ways of

delivering services and providing models of care that meet the changing needs of our population.

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1.3. Regional Operating Environment

Tairawhiti DHB is one of five DHBs7 that make up the Midland Region. In 2015/16 all five Midland DHBs will continue to progress activities towards regional cooperation in a planned manner. . Collectively the Midland DHBs have agreed a strategic response to assist the region to move forward in the same direction. This direction is articulated in the Midland DHB Regional Services Plan (RSP). Midland region is made up as follows:

The health sector challenges and pressures also have implications at the regional level. Some distinguishing

features of our region include:

High proportion of population identifying as Māori;

Low proportion of the population identifying as Asian or Pacific peoples;

Higher number of people living in rural areas;

Higher proportion of people living in areas identified as higher deprivation quintiles 4 and 5;

Lower life expectancy than the New Zealand average;

Higher smoking rates than the New Zealand average.

There is great need and desire to improve the health outcomes of our most vulnerable populations, in

particular Māori; older people; and our children and youths.

7 Bay of Plenty, Lakes, Tairawhiti, Taranaki and Waikato

Logo Midland DHB Website Forecast Population

2015/16

Bay of Plenty www.bopdhb.govt.nz 223,500

Lakes www.lakesdhb.govt.nz 104,000

Tairawhiti www.tdh.org.nz 47,700

Taranaki www.tdhb.org.nz 119,200

Waikato www.waikatodhb.govt.nz 394,200

http://www.bopdhb.govt.nz/

http://www.lakesdhb.govt.nz/

http://www.tdh.org.nz/

http://www.tdhb.org.nz/

http://www.waikatodhb.govt.nz/

http://www.waikatodhb.govt.nz/index.aspx

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1.4. Local Operating Environment

We are responsible for the provision or funding the majority of health services in our district. These services in our district include:

2 hospital sites 1 mental health inpatient facility 2 community bases 2 maternity units 8 aged related residential care facilities

(rest homes)

6 pharmacies 6 primary care facilities 3 Māori providers 3 Primary Health Organisations (PHOs)

As a DHB we will:

plan in partnership with key stakeholders, the strategic direction for health and disability services plan regional and national work in cooperation with the National Health Board and other DHBs fund the provision of the majority of the public health and disability services in our district, through

the agreements we have with providers provide hospital and specialist services primarily for our population, and also for people referred

from other DHBs, promote, protect and improve our population’s health and wellbeing through health promotion, health protection, health education and the provision of evidence-based public health initiatives.

1.4.2. Our Geography and Population

Our DHB serves a population of 47,075 and covers 8,351 square kilometres, roughly 3% of New Zealand’s land area, Tairawhiti is the most sparsely populated North Island area, with a population density of 5.6 people per square kilometre.

The region’s tallest mountain is Mt Hikurangi (1,752 metres), which is the first point on the mainland that the emerging sun shines on. Māori legend states that the mountain is the resting place of Maui’s canoe after he hauled up the North Island.

The principal iwi tribal groups of the Tairawhiti district are Ngati Porou of the East Coast, and Te Aitanga-a-Mahaki, Rongowhakaata and Ngai Tamanuhiri whose tribal boundaries are situated within the Turanganui-a-Kiwa/Poverty Bay area. While each Iwi values its own identity and independence, strong kinship links exist across all the Iwi groupings within Tairawhiti. TDH recognises the interest of Iwi in terms of their aspirations to improve the health and wellbeing of their people. A detailed breakdown of our population is presented in the following table.

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Table: Tairawhiti DHB projected population by age and ethnicity for 2015/16

Age Group Ethnicity

Māori Pacific Asian Other Total

00 – 24 11,390 518 320 5,680 17,908

25 – 44 5,330 340 283 4,952 10,905

45 – 64 4,625 233 190 6,870 11,918

65 – 74 1,178 40 48 2,652 3,918

75+ 600 13 28 2,064 2,705

Total 23,155 1,143 868 22,187 47,353

A large proportion of our population live outside the main urban areas (approximately 27% per cent)8. Our large rural population presents diverse challenges in service delivery and accessing health services. Significant points of interest in terms our population include:

The Tairawhiti district has an average deprivation score of 7, where 1 indicates least deprived and 10, most deprived.

Deprivation scores in our district range from 2 (in the suburb of Wainui) to 10 in Ruatoria and Te Karaka9.

67% of Māori and 30% of non-Māori in our district are considered to live in the most deprived areas; this is living in areas with deprivation decile’s 9 or 10.

52% of children, 0-14 years, live in these most deprived areas.

Health, Education, Agriculture, Horticulture, Forestry and Fishing are the largest employers of the workforce in our district.

40% of Māori and 50% of non-Māori are employed full time. 35% of Māori in our district (30% nationally) have no

education qualifications10. For Non Māori the rate is 27%

(23% nationally).

28% of families in the Gisborne district are single parent families as compared to 18% nationally.

49% of Non Māori women aged 15 years and over in our district have had two or three children. For

Māori this rate is 33%. 14% of Māori women, 15 years and older have had five or six children. For Non

Māori the figure is 7%11.

54% of households in the Gisborne district live in their own home and 38% rent.

Though Māori make up over 45% of our district population they account for over 70% of those on

welfare benefits12.

8 MoH PHO Enrolment Demographics 2014Q4 (Oct- Dec 2014) 9 http://www.health.govt.nz/publication/dhb-maps-and-background-information-atlas-socioeconomic-deprivation-new-zealand-nzdep2006 10http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?pdf=1&id=1000005&type=region&ParentID=1000005 11 http://www.health.govt.nz/publication/dhb-maps-and-background-information-atlas-socioeconomic-deprivation-new-zealand-nzdep2006

http://www.health.govt.nz/publication/dhb-maps-and-background-information-atlas-socioeconomic-deprivation-new-zealand-nzdep2006

http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?pdf=1&id=1000005&type=region&ParentID=1000005

http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?pdf=1&id=1000005&type=region&ParentID=1000005

http://www.health.govt.nz/publication/dhb-maps-and-background-information-atlas-socioeconomic-deprivation-new-zealand-nzdep2006

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1.4.3. Health Profile

Understanding our health profile plays an important part in our decision making processes. This information helps us focus on where we can make the greatest gains in terms of our strategic outcomes, as well as for planning and prioritisation of programmes at an operational level. Key points of interest in terms of the health profile of the population are:

Immunisation rates for Māori in Tairawhiti are in line with the national average.

Communicable disease volumes have been decreasing significantly over the last few years, especially for Campylobacteriosis.

Māori rates of suicide in Tairawhiti are above that for non Māori.

Smoking rates in Tairawhiti are higher than the national average for both Māori and non Māori, with Māori rates being higher than that for non Māori.

Daily vegetable intake in Tairawhiti is similar to the national average, but our fruit intake for both Māori and non Māori is below the national average.

Māori and non Māori in Tairawhiti are considerably more sedentary than the national average.

Rates of obesity are significant for Māori in Tairawhiti.

Our 4 year old children have the highest rate of obesity nationally (as measured through the B4 School programme)

Māori oral health rates for 5 year olds and year 8s for caries free and decayed, missing filled teeth (dmft/DMFT) are worse than that for non Māori.

The largest injury type by number and cost for ACC in the Gisborne region is for work related injuries.

Plunket data shows Māori breastfeeding rates (exclusive, full) are less than non Māori for the 6 week, 3 month and 6 month age groups.

Teenage births at Gisborne hospital are more than 4 times more likely to be from Māori mothers than non Māori.

Tairawhiti has 214 registered doctors per 100,000 per population compared to a national rate of 271 per 100,00013.

There are 62 FTE GPs per 100,000 people in Tairawhiti, compared to a national rate of 84 FTE per 100,000.

Analysis of the health needs of people of the Tairawhiti has indicated the following features: Ambulatory sensitive hospitalisations are well above the national average Higher rates of avoidable hospitalisation Circulatory system diseases, including ischaemic heart disease and cerebrovascular disease,

accounted for over 40% of deaths Cancer is the second most common cause of death in Tairawhiti, accounting for 25% of all deaths,

with cancer of the digestive system and lung being the most common. There is a significant burden on Māori from deaths related to cancer than non Māori

There is a large and disproportionate burden of disease related to diabetes (including diabetes renal failure) and its long term complications for Māori

Disease of the respiratory system, bronchitis and asthma amongst infants and young children, adults and older people

Cellulitis is a significant issue for children under 5 years Mental Illness impacts significantly on this community, with the burden of disease higher for Māori

than non Māori.

12 MSD TLA Benefit Factsheet – Dec 2012 -http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/statistics/benefit/tla-factsheets.html 13

The New Zealand Medical Workforce in 2012, https://www.mcnz.org.nz/assets/News-and-Publications/Workforce-Surveys/2012.pdf

https://www.mcnz.org.nz/assets/News-and-Publications/Workforce-Surveys/2012.pdf

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Most of the issues related to the mortality and morbidity of Tairawhiti residents are related to preventable lifestyle factors – in particular tobacco use and obesity rates. It should also be acknowledged that with the significant economic burden borne by this community, socioeconomic factors have a bearing on the health needs of this community.

1.5. Nature and Scope of Functions

We collaborate with other health and disability organisations (such as our primary care alliance partners), key stakeholders and our community to identify what health and disability services are needed and how best to use the funding we receive from Government. Through this collaboration, we aim to ensure that health and disability services are well coordinated and cover the full continuum of care, with the patient at the centre. We expect these collaborative partnerships to also allow the sharing of resources, reduction in duplication, variation and waste across the health system to achieve the best outcomes for our community. As a DHB we:

Plan in partnership with key stakeholders, the strategic direction for health and disability services

Plan regional and national work in collaboration with the National Health Board and other DHBs

Fund the provision of the majority of the public health and disability services in our district, through the agreements we have with providers

Provide hospital and specialist services primarily for our population and also for people referred from other DHBs

Promote, protect and improve our population’s health and wellbeing through health promotion, health protection, health education and the provision of evidence-based public health initiatives

1.6. Koronga rautaki / Strategic Intentions

1.6.1. Tatou kite / Our vision

Whaia te Hauora I roto I te Kotahitanga / A Healthier Tairawhiti by Working Together

Tatou uara / Our values

Whakarangatira Kia Whakarangatira i te oranga o to tatou hapori

We take responsibility to enrich the health of our community.

Enrich = increasing the quality of – Quality Focus

Awhi Kia Awhi i te turoro We give caring support to our Patients.

Patient Care

Kotahitanga Ma te Kotahitanga o a tatou mahi ka momoho ai

Through our collective effort we succeed.

Employee Synergy

Aroha Kia tuku Aroha ki te Whanau

We give compassion to our families.

Hearts and minds

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Value What is means at TDH Outcomes Behaviours that show you are demonstrating this

value

Behaviours that are not acceptable when

you are demonstrating this value

Whakarangatira Enrich

Enriching the health of

our community by doing

our very best

We take responsibility for our

results

We excel in all we do

We are proud to be part of TDH

We keep people safe

We treat people fairly and equally

I take pride in my work

I work to the highest standard

I treat everyone with respect

I speak up when I see quality and safety

compromised

I celebrate and recognise success in myself and

others

I admit when I make mistakes and I learn from

them

I look for opportunities to improve

Substandard work

Not admitting or hiding mistakes

Having a negative attitude

Demeaning people

Awhi/ Manaaki Support

Supporting our patients

and whanau

We listen to patients and whanau.

We involve patients and whanau in

decision making

People recover faster and feel

better

I put patients and whanau at the centre when I

make decisions

I make transparent decisions

I encourage personal and professional

development

Not greeting people

Not being respectful of peoples’ time

Not communicating effectively

Not identifying or being informed of the

patients requested needs

Kotahitanga Togetherness

Together we can achieve

more

We work as a team

Together we perform and achieve

at higher levels

We take responsibility together

Together we are resilient

Through collective thought we are

more innovative

I respect others opinions

I communicate effectively

I am willing to engage

I actively participate and speak up

I stick by a decision that is made

I recognise we are different and am considerate of

others

I support my colleagues and have their back

Putting people down and demeaning

others

Sabotage and being manipulative

Responding negatively

Not attending and using this to stop the

process

Personal attacks

Avoiding work

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Aroha Compassion

Compassion and

empathy

We care for people

People want to be cared for by us

We enjoy working for TDH and are

passionate about what we do

I enjoy my work

I go the extra mile

I keep learning

I have a can do attitude

Bullying and harassment

Patient abuse

Consistent open displays of negativity

towards other staff and the workplace

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Care closer to home

“I expect DHBs to move services

closer to home in 2015/2016,

and DHBs need to have clear

evidence of how they are going

to do this”

Minister of Health -

Jonathan Coleman

1.6.2. National Strategic Intentions

The Government has set a clear goal for the health system to make care better, sooner and more convenient. Tairawhiti DHB is one of the agencies charged with giving effect to this overarching goal. There are two identified health system outcomes for New Zealand as detailed in our performance story diagram. Further detail relating to these outcomes can be found in the Ministry of Health Statement of Intent 2014 to 2017. The outcomes are:

1. New Zealanders live longer, healthier, more independent lives 2. The health system is cost effective and supports a productive economy

These health system outcomes support the achievement of wider Government priorities and are not expected to change significantly over the medium term. Tairawhiti DHB contributes to these system outcomes as well as the Ministry of Health’s outcomes of:

1. New Zealanders are healthier and more independent

2. High-quality health and disability services are delivered in a timely and accessible way

3. The future of the health and disability system is assured

Positive health outcomes are a consequence of activities across the social sectors, not just the health sector. Initiatives such as Better Public Services, Children’s Action Teams and Social Sector Trials are examples of where the health sector and the social sectors are working together to deliver a collective impact.

Minister’s Letter of Expectations

The Minister of Health has outlined his expectations for the 2015/16 year. The expectations reinforce the

Government’s ongoing commitment to protecting and growing New Zealand’s public health services. The key

areas highlighted in the letter of expectations are:

DHBs need to budget and operate within allocated funding and have detailed plans to improve year-on-year financial performance. This includes improvements through national, regional and sub-regional initiatives.

Strong clinical leadership and engagement utilised in all aspects of DHBs’ core business. DHB governance, senior management and clinical leaders working together to ensure we are heading in the same direction.

Integrating primary care with other parts of the health system is vital for better management of long-term conditions, mental health and addictions, an ageing population and patients in general. A key to better health is earlier intervention and population based initiatives delivered in the community.

DHBs must remain focused on achieving and improving performance against the health targets, particularly the primary care targets. DHBs will work directly with primary health organisations to drive performance against the relevant health targets.

Strengthening the link between physical activity and keeping New Zealanders healthy. All DHBs are expected to be considering what they can do to help reduce the incidence of obesity in New Zealand.

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National Health Targets

Improving performance across the sector is fundamental to the Government's goal of Better, Sooner, More

Convenient health services for all New Zealanders. One of the mechanisms used to monitor our performance

is the nationwide Health Targets. The following table outlines our target levels for each of the six health

targets.

Table: Tairawhiti DHB Health Targets 2015/16

Health Target Indicator and National Target Tairawhiti DHB Target

95 per cent of patients will be admitted, discharged, or transferred

from an Emergency Department (ED) within six hours. 95%

Nationally, the volume of elective surgery will be increased by an

average of 4,000 discharges per year. 2,55214

At least 85 per cent of patients referred with a high suspicion of

cancer wait 62 days or less to receive their first treatment (or

other management) to be achieved by July 2016, increasing to 90

per cent by June 2017.

85%

95 per cent of eight months olds will have their primary course of

immunisation (six weeks, three months and five months

immunisation events) on time. 95%

95 per cent of hospitalised patients who smoke and are seen by a

health practitioner in public hospitals 95% 90 per cent of enrolled patients who smoke and are seen by a

health practitioner in General Practice are offered brief advice and

support to quit smoking 90%

Progress towards 90 per cent of pregnant women who identify as smokers at the time of confirmation

of pregnancy in general practice or booking with Lead Maternity Carer, being offered advice and

support to quit.

90 per cent of the eligible population will have had their

cardiovascular risk assessed in the last five years 90%

Having a specific focus on these targets will not only impact the chosen areas, but is expected to bring

broader benefits such as relieving pressure and lifting performance across the sector.

14 total elective surgical discharges

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Better Public Services

The Government has set ten challenging results for the public sector to achieve over the next five years15.

Tairawhiti DHB is committed to focusing our inputs and outputs as appropriate to contribute to achieving the

results. The results that health is taking a major role in are:

Result 2: Increase participation in quality early childhood education

o In 2016, 98 per cent of children starting school will have participated in quality early childhood

education.

Results 3: Increase infant immunisation rates and reduce the incidence of rheumatic fever

o Increase infant immunisation rates so that 95 per cent of eight-month-olds are fully immunised

by December 2014 and this is maintained through to 30 June 2017

o Reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June

2017.

Result 4: Reduce the number of assaults on children

o By 2017, halt the rise in children experiencing physical abuse and reduce current numbers by 5

percent.

Social Sector Trials

There is one Social Sector Trial in our district in Gisborne City, and the current focus is on improving educational outcomes for rangatahi, by increasing participation in education training and employment while also reducing

Truancy

Youth offending

Alcohol and drug use One area in which health has been involved has been in the area of improving the quality of drug and alcohol

programmes and counselling for at risk rangatahi.

Whānau Ora

Whānau ora is an approach that supports whānau to identify and achieve their own aspirations. It is a key

cross-government work programme jointly implemented by a number of sectors, particularly health,

education and social services.

Policy Drivers

Four important policy drivers have been identified through which the health sector may best utilise resources

to achieve better sooner more convenient health care. They are:

Better Public Services (including Social Sector Trials): DHBs must work more effectively with other parts of the social sector. The Government’s Better Public Services targets and the Social Sector Trials will help drive this integrated approach that puts the patient and user at the centre of service delivery. DHBs are expected to work closely with other sectors such as education and housing specifically.

Regional collaboration: means DHBs working together more effectively, whether regionally or sub-regionally.

15 For more information see http://www.ssc.govt.nz/bps-results-for-nzers

http://www.ssc.govt.nz/bps-results-for-nzers

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Integrated care: includes both clinical and service integration to bring organisations and clinical professionals together, to improve outcomes for patients and service users through the delivery of integrated care. Integration is a key component of placing patients at the centre of the system, increasing the focus on prevention, avoidance of unplanned acute care and redesigning services closer to home.

Value for Money: is the assessment of benefits (better health outcomes) relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.

1.6.3. Regional Context

The Midland DHBs have produced an RSP, which describes the strategic intent for the Midland DHBs region.

The strategic outcomes and objectives for the region are outlined in our performance story diagram and

further information is provided in the Midland DHBs’ Regional Services Plan 2015/18.

Our DHB is committed to being an active participant in our regional planning process. This is evidenced by

both clinical and management representatives from our DHB being part of the various forums and networks

that have been established to guide RSP implementation activities as well as directly funding regional work

and positions. HealthShare is tasked with co-ordinating the delivery of regional planning and implementation

on behalf of the Midland DHB region.

Regional Vision

All residents of Midlands DHBs lead longer, healthier and more independent lives.

“Healthy Communities – Integrated Healthcare”

Regional Strategic Outcomes

Strategic Outcome 1: Improve the health of the Midland populations

Health and wellbeing is everyone’s responsibility. A core function of DHBs is to promote, protect and improve

our population’s health and wellbeing through health promotion, health protection, health education and the

provision of evidence-based public health initiatives.

Strategic Outcome 2: Eliminate health inequalities

The DHBs in the Midland Region remain committed to working to eliminate health inequalities in its

populations. This occurs in partnership with key stakeholders and our community (i.e. clinical leaders, Iwi,

Primary Health Organisations and non-Government organisations) and in collaboration with other DHBs and

the Ministry of Health regional and national work.

Regional Objectives

The region has agreed six regional objectives, which are:

• Regional Objective 1: Improve Māori health outcomes • Regional Objective 2: Integrate across continuums of care • Regional Objective 3: Improve quality across all regional services • Regional Objective 4: Improve clinical information systems • Regional Objective 5: Build the workforce • Regional Objective 6: Efficiently allocate public health system resources

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1.6.4. Local Context

To contribute to achieving the outcomes at a national and regional level, we have identified our local strategic

intent for 2015/16. Our strategic intent represents a continuation from previous years, as they are not short

term issues easily resolved within a 12 month period. There is strong alignment between the strategic intent

at the regional and local levels.

Many factors influence outcomes. In contributing to these outcomes we will have a real impact on the lives

of our populations. Many of the activities we plan to implement in 2015/16 will contribute across a number

of our outcomes, priorities and impacts.

Table: Our 2015/16 priorities

Strategic Priority Description

E Tipu E Rea

This is a focus on the first five years of life including the conception to birth period, which encompasses eliminating maternal smoking, particularly in the third trimester and all mothers and children have access to universal services.

Integration People get the care they need, when they need it, in ways that are

user-friendly16

Organisational and workforce

development Our workforce is our biggest asset.

Quality improvement Constantly seeking opportunities to get better at how we function and

improve effectiveness

Addressing chronic conditions

These conditions are the leading cause of ill health and premature

death in New Zealand. They disproportionately affect low income

earners, Māori and Pacific people.

Regional cooperation Improving clinical services quality and viability across the Midland

region and reducing duplication of effort and bureaucracy

Financials Ensuring delivery on agreed financial forecasts and the ability to live

within our means

The local priorities have been included in our overall performance story to ensure priorities important to us

that are not explicitly covered in the regional strategic intent are included within this Annual Plan. An

example of such a priority is the integration of primary and secondary services.

16 World Health Organisation Technical Brief No.1, May 2008

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1.7. Key Risks and Opportunities

By its nature, the health sector is complex and challenging. We have identified the following risks and

opportunities as being particularly relevant for 2015/16.

1.7.1. Health Inequalities

We are committed to reducing or eliminating the effects of health disparities through, firstly, identifying them

and, secondly, through funding and providing universal programmes which include a focus on reducing

disparities as well as specific programmes that target disparities and improve access to services. It should be

noted that long term conditions, particularly those that are exacerbated by tobacco use, and maternal

smoking (particularly in the third trimester) are significant contributors to health disparity. The approach we

take includes:

• Implementing Te Tairawhiti - He Urupare Rangapu Hauora Maori 2015/16 (our Māori Health Plan) • Promoting screening services to hard to reach groups to increase early detection of disease • Implementing services that target communities with identified health inequalities • Setting targets by ethnicity or by high needs • Support kaupapa Māori services and ‘for Pacific by Pacific’ services • Increasing the capability of the Māori and Pacific workforce across our district • Using an equity lens as part of decision-making processes (e.g. the Health Equity Assessment Tool) • Engaging with our Aged and Disability Support Advisory Committee to provide advice and inform

decision making • Engaging with Iwi governance bodies to provide advice and inform decision making • Engaging with Community and Public Health Advisory Committee to provide and receive advice

A challenge for DHBs in this region is to configure health service delivery in a way that takes account of the complex relationships between the key social determinants of health inequalities (e.g. housing quality and employment), while recognising that a number of public and private agencies influence health outcomes.

1.7.2. Living Within Our Means

The ongoing pressure of the financial environment is one of the factors driving the need for the health system to transform. This means seeking efficiency gains and improvements in purchasing, productivity and the quality of our operation and service delivery.

1.7.3. Health System Workforce Shortages

The health workforce is made up of a wide variety of occupational groups employed by a number of different

organisations. Workforce shortages, particularly in rural and provincial areas, are a key threat to the health

system’s ability to provide a full range of accessible, high-quality health services.

Work is occurring at a national, regional and local level to mitigate the impact of workforce shortages. Detail

on a number of the strategies in place to mitigate the impact of this challenge is set out in module 5.3.

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1.7.4. System Integration

A growing commitment to the achievement of more effective system integration in partnership with primary care and other appropriate stakeholders is fundamental to strengthening our healthcare system. As in previous years, we have engaged with our primary care partners and clinical leaders to jointly develop the primary care sections of this Annual Plan.

Evidence shows that integrating primary care with other parts of the health system is vital for better management of long term conditions, responding to the pressure of an ageing population and in managing acute demand. Hospital demand is growing at a rapid rate, and as more hospital admissions occur due to preventable causes, we need to examine what could be improved in regard to how we deliver our services.

1.7.5. Regional Integration

Integration between regional DHBs is important for both financial and clinical reasons. Clinical networks

provide a platform from which to deliver clinically-led innovation and best practice approaches, and these are

supported by integration initiatives in other areas (pharmacy, home-based support services, Information

Systems and so on). The over-arching driver for such developments is improved service quality, and

ultimately better health outcomes.

1.8. Key Measures of Performance

The diagram below sets out the Midland DHB regional approach to the impacts we expect to occur in

response to the outputs delivered. Local actions in relation to our services are recorded, along with

deliverables and timing, in Modules 2 (priorities and targets), 3 (Statement of Performance Expectations) and

5 (Stewardship) of this Plan.

Outcome 1 – People are supported to take greater responsibility for their

health

Expectation

Population health and prevention programmes ensure people are better protected from harm, more

informed of the signs and symptoms of ill health and supported to reduce risk behaviours and modify

lifestyles in order to maintain good health. These programmes create health-promoting physical and social

environments which support people to take more responsibility for their own health and make healthier

choices.

Why is this outcome a priority?

New Zealand is experiencing a growing prevalence of long-term conditions such as diabetes and

cardiovascular disease, which are major causes of poor health and account for a significant number of

presentations in primary care and admissions to hospital and specialist services. We are more likely to

develop long-term conditions as we age, and with an ageing population, the burden of long-term conditions

will increase. The World Health Organisation (WHO) estimates more than 70% of all health funding is spent on

long-term conditions.

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Tobacco smoking, inactivity, poor nutrition and rising obesity rates are major and common contributors to a

number of the most prevalent long-term conditions. These are avoidable risk factors, preventable through a

supportive environment, improved awareness and personal responsibility for health and wellbeing.

Supporting people to make healthy choices will enable our population to attain a higher quality of life and to

avoid, delay or reduce the impact of long-term conditions.

1.8.1. Fewer People Smoke

Why is this important?

Smoking is a major contributor to

preventable illness and long term conditions,

such as cancer, respiratory disease, heart

disease and strokes. Cancer is the leading

cause of death in New Zealand (29.8%), and

is a major cause of hospitalisation and driver

of cost. Cancer also highlights continuing

inequalities, with Māori experiencing a higher

incidence (20%+), higher mortality and higher

stage at presentation. In some communities,

a sizeable portion of household income is

spent on tobacco, resulting in less money

being available for necessities such as

nutrition, education and health. Supporting

our population to say “no” to tobacco

smoking is our foremost opportunity to target improvements in the health of our population and to reduce

health inequalities for Māori.

Key findings from the 2012 NZ Health Survey identify that one in five adults aged 18 years and over (18.0%)

and around one in ten (10.0%) youth aged 15-19 years are current smokers. While, nationally, we are seeing

a decline in smoking rates, we want to reduce the incidence even further. Notably, in the 2009 Tobacco Use

Survey 80.0% of current smokers aged 15-64 years said “they would not smoke if they had their life over

again”.

How will we know we are succeeding?

In order to have the greatest impact, we will prevent people from taking up smoking in the first place (Year 10 students), working our way through the continuum from prevention, to detection (identifying adults who smoke and offering them cessation advice – see Health Targets), and ultimately reducing the number of people who smoke.

Fewer People Smoke Actual Target Target Target

2013 2014 2015 2016

Percentage of Year 10 Students who have

never smoked 59.6 60 Improve

Figure 1 - Percentage of year 10 high school students how have indicated they have

never smoked, not even a puff in the annual ASH survey. ASH New Zealand. 2013.

National Year 10 ASH Snapshot Survey. Report for the Ministry of Health, Health

Sponsorship Council and Action on Smoking and Health: Auckland, New Zealand.

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1.8.2. Reduction in vaccine preventable diseases


Immunisation can prevent a number of diseases and is a very

cost-effective health intervention. Immunisation provides

protection not only for individuals, but for the whole

population by reducing the incidence of diseases and

preventing them from spreading to vulnerable people or

population groups.

Population benefits only arise with high immunisation rates,

and New Zealand’s current rates are low by international

standards and insufficient to prevent or reduce the impact of

preventable diseases such as measles or pertussis (whooping

cough). These diseases are entirely preventable. See Health

Targets.


We will know we have succeed by reducing our admissions for

vaccine preventable diseases

Reduction in vaccine preventable diseases Actual Target Target Target

10/11 to

12/13

12/13 to

14/15

13/14 to

15/16

14/15 to

16/17

3 Year average Crude Rate per 100,000 of vaccine

preventable diseases in hospitalised 0-14 year old 52.4 <40 Decrease

1.8.3. Improving health behaviours


Good nutrition is fundamental to health and to

the prevention of disease and disability.

Nutrition-related risk factors (such as high

cholesterol, high blood pressure and obesity)

jointly contribute to two out of every five deaths

in New Zealand each year.


By seeing a reduction in obesity, a proxy measure

of successful health promotion and engagement,

and a change in the social and environmental

factors that influence people to make healthier

choices.

Figure 3 - 2013/14 New Zealand Health Survey.

Note - Obesity is defined as a body mass index (BMI) of 30 or more (calculated

by dividing a person’s weight in kilograms by the square of their height in

metres). Survey interviewers measured respondents’ height and weight, from

which BMI could be calculated.

Figure 2 - 3 Year average Crude Rate per 100,000 of vaccine

preventable diseases in hospitalised 0-14 year old

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Outcome 2 - People stay well in their homes and communities

Expectation

Primary and community services support people to stay well by providing earlier intervention, diagnostics and

treatment and better managing their illness or long-term conditions. These services assist people to detect

health conditions and risk factors earlier, making treatment and interventions easier and reducing the

complications of injury and illness. They also support people to regain their functionality after illness and to

remain healthy and independent.


For most people, their general practice team is their first point of contact with health services. Primary care

can deliver services sooner and closer to home and prevent disease through education, screening, early

detection and timely provision of treatment. Primary care is also vital as a point of continuity and effective

coordination across the continuum of care, particularly in improving the management of care for people with

long-term conditions.

Supporting primary care are a range of other health professionals including midwives, community nurses,

social workers, aged residential care providers, personal health providers and pharmacists. These providers

have prevention and early intervention perspectives that link people with other health and social services and

support them to stay well. Studies show countries with strong primary and community care systems have

lower rates of death from heart disease, cancer and stroke, and achieve better health outcomes for lower

cost than countries with systems that focus on specialist level care.

With an ageing population, the Midland Region will require a strong base of primary care and community

support, including residential care, respite and home-based support. If long-term conditions are managed

effectively, crises and deterioration can be reduced and health outcomes improved. Even where returning to

full health is not possible, access to responsive, needs-based services helps people to maximise function with

the least restriction and dependence.

If people are well they need fewer hospital-level or long-stay interventions and, those who do, have a greater

chance of returning to a state of good health or slowing the progression of disease. This is not only a better

health outcome for our population, but it reduces the rate of acute and unplanned hospital admissions and

frees up health resources.

Improving health behaviours Actual Target

13/14 2016/17

% Obese of New Zealand 5 -14 years population 10.1 reduce rate of increase

% Obese of New Zealand 15+ years population 29.9 reduce rate of increase

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Figure 4 – Diseased, Missing and Filled Teeth (DMFT) for year 8 students in Tairawhiti

DHB, Midland Region and New Zealand. Data Source: planning for 2013/14 District Health

Boards' Oral Health Performance Measures

1.8.4. Children and adolescents have better oral health


Good oral health demonstrates early contact with health promotion and prevention services and reduced risk

factors, such as poor diet, which has

lasting benefits in terms of improved

nutrition and healthier body weights. Oral

health is also an integral component of

lifelong health and impacts a person’s

comfort in eating (and ability to maintain

good nutrition in old age), self-esteem and

quality of life.

Māori children are three times more likely

to have decayed, missing or filled teeth,

and improved oral health is a proxy

measure of equity of access and the

effectiveness of mainstream services in

targeting those most in need.


With the continued decrease in the DMFT score of year 8 children Mean Diseased, Missing or Filled Teeth

(DMFT) for permanent teeth. DMFT is a count of Diseased, Missing or Filled Teeth in permanent dentition

(permanent teeth) in a person’s mouth. By Year 8, children’s teeth should be their permanent teeth and any

damage at this stage is life long, so the lower a child’s DMFT, the more likely that their teeth will last a life

time.

Children and

adolescents have

better oral health

Actual Target Target Target

2013 2015 2016 2017

Mean DFMT Year 8 1.02 <1.0 reduce

1.8.5. Long-term conditions are detected early and managed well


If we are to empower people to take greater responsibility for their health, to improve the health of our

population and if we are to “contain costs” we have a significant opportunity by detecting conditions early.

Early detection will lead to either successful treatment, or delaying or reducing the need for secondary and

specialist care, enabling more people to stay well in their homes and communities for longer. Our greatest

opportunity to do this is to manage Cardiovascular Disease (CVD or heart disease). It is one of the largest

causes of death in New Zealand, and disproportionately higher for Māori. Often by the time heart problems

are detected, the underlying cause of atherosclerosis (arterial disease) is usually well advanced. Our aim is

to either prevent the disease by modifying risk factors such as healthy eating, exercise and avoiding smoking,

or early detection and management. See also Health Targets.

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Screening is one of the most effective

methods to reduce the incidence and impact

of some cancers. By catching cancers when

they are small screening programmes offer

the best chance of success. Also by increasing

the proportion of people with well managed

diabetes, we will reduce avoidable

complications that require hospital-level

intervention, such as amputation, kidney

failure and blindness, and will improve

people’s quality of life, allowing more people

to stay well in their homes and communities

for longer.

Cervical Cancer mortality in New

Zealand


2011 2015 2016 2017

Aged Standardised rate for NZ 1.7 Decrease

1.8.6. Fewer people are admitted to hospital for avoidable conditions


There are a number of admissions to

hospital for conditions which are seen as

avoidable through appropriate early

intervention and a reduction in risk

factors. As such, these admissions

provide an indication of the effectiveness

of screening, early intervention and

community-based care.

A reduction in these admissions will

reflect better management and treatment

of people across the whole system, will

free up hospital resources for more

complex and urgent cases and deliver on

the Government’s priority of “better, sooner, more convenient” healthcare.

The key factor in reducing avoidable hospital admissions is an improved interface between primary and

secondary services. Improving people’s access to, and the effectiveness of primary care will facilitate early

interventions, particularly among Māori and Pacific people, which supports improving our population’s health

outcomes and reducing health inequalities for Māori.

Figure 5 - Female Cervical Cancer mortality in New Zealand 1948 to 2011. Ministry

of Health. Wellington: September 2014

Figure 6 – Rate of Ambulatory Sensitive Hospitalisations, Ministry of Health, Ash

summary by DHB, Q3 2014/15

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When we reduce the ratio of actual to expected avoidable hospital admissions for our population (Total and

Māori).

Fewer people are admitted to

hospital for avoidable conditions


2014 2015 2016 2017

Tairawhiti DHB 0-74 year olds 2,644 2,297 decrease

1.8.7. People maintain functional independence


If we are to deliver on our twin goals of

improving health outcomes, and reducing

or eliminating health inequalities, for our

older population, we aim to support

people to maintain functional

independence. With an increasing and

ageing population, as this cohort increases,

so does demand on our constrained

funding. Aged Residential Care (ARC) is a

specialist, high cost, and scarce resource.

We are looking to manage the expected

growth in demand, through an ageing

population, by improved models of care

that support people to remain

independent for as long as possible.


Ideally, we would like to promote a model

of care that reduces the proportional length of time an older person requires ARC. As we do not currently

capture this information, our best proxy indicator is to increase the average age at which an older person

enters ARC.

Average Age of Entry to Aged

Related Residential Care (age in

years)


14/15 15/16 16/17 17/18

Rest Home 83.3 Increase

Dementia 84.9 Increase

Hospital 85.5 Increase

Figure 7 – Average age at entry to residential care facilities in each of the last 5 years for

people under the Health of Older People funding stream. Data sourced from Client

Claims Processing System (CCPS).

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Outcome 3 - People receive timely and appropriate specialist care

Expectation

Secondary-level hospital and specialist services meet people’s complex health needs, are responsive to

episodic events and support community-based care providers. By providing appropriate and timely access to

high quality complex services, people’s health outcomes and quality of life can be improved.


Clinicians, in cooperation with patients and their families, make decisions with regards to complex treatment

and care. Not all decisions result in interventions to prolong life, but may focus on patient care such as pain

management or palliative services to improve the quality of life. For those who do need a higher level of

intervention, timely access to high quality complex care improves health outcomes by restoring functionality,

slowing the progression of illness and disease and improving the quality of life.

The timeliness and availability of complex treatment and care is crucial in supporting people to recover from

illness and/or maximise their quality of life. Shorter waiting lists and wait times are also indicative of a well-

functioning system that matches capacity with demand by managing the flow of patients through services

and reducing demand by moving the point of intervention earlier in the path of illness.

As providers of hospital and specialist services, DHBs are operating under increasing demand and workforce

pressures, and Government is concerned that patients wait too long for diagnostic tests, cancer treatment

and elective surgery. The expectations around reducing waiting times, coupled with the current fiscal

situation, mean DHBs need to develop innovative ways of treating more people and reducing waiting times

with limited resources.

This goal reflects the importance of ensuring that hospital and specialist services are sustainable and that the

Midland Region has the capacity to provide for the complex needs of its population now and into the future.

1.8.8. People receive prompt and appropriate acute care


Long stays in Emergency Departments (EDs)

are linked to overcrowding of the ED,

negative clinical outcomes and compromised

standards of privacy and dignity for patients.

Less time spent waiting and receiving

treatment in an ED improves the health

services DHBs are able to provide.

The duration of stay in ED is influenced by

services provided in the community to

reduce inappropriate ED presentations, the

effectiveness of services provided in ED and

the hospital and community services

provided following exit from ED. Reduced waiting time in ED is indicative of a coordinated ‘whole of system’

response to the urgent needs of the population.

Figure 8 – Emergency Department Waiting times

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When we see an increase in the percentage of people who visit our ED are admitted, discharged or

transferred within six hours.

Improved performance against this measure will not only improve outcomes for our population, but will

improve the public’s confidence in being able to access services when they need to.

Percentage of patients admitted, discharged or

transferred from emergency departments within 6

hours


14/15 15/16 16/17 17/18

96% >95% >95% >95%

1.8.9. People have appropriate access to elective services


Elective services are an important part of the health

system, as they improve a patient’s quality of life by

reducing pain or discomfort and improving

independence and wellbeing. The Government wants

more New Zealanders to have access to elective

surgical services (see Health Targets). Improved

performance against this measure is also indicative of

improved hospital productivity to ensure the most

effective use of resources so that wait times can be

minimised and year-on-year growth is achieved.


To meet the appropriate level of access, we want to

ensure that our Standard Intervention Rates (SIRs) meet national expectations for the following procedures.

Standardised Discharge Rates per 10,000 for Publicly

funded discharges


14/15 15/16 16/17 17/18

Cardiac Surgery 7.36 ≥6.5 ≥6.5 ≥6.5

major joint replacement 20.21 ≥21.0 ≥21.0 ≥21.0

cataract procedures 34.86 ≥27.0 ≥27.0 ≥27.0

percutaneous revascularization 9.96 ≥12.5 ≥12.5 ≥12.5

coronary angiography services 28.09 ≥34.7 ≥34.7 ≥34.7

Figure 9 – Ministry of Health Year Ended June 2014 Standardised

Discharge Rates per 10,000 for Publicly Funded Cardiac Surgery

Discharges for patients with 95% Confidence Intervals

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1.8.10. Improved access to mental health services


It is estimated that at any one time, 20% of the

New Zealand population will have a mental

illness or addiction, and 3% are severely

affected by mental illness. With high suicide

rates in some of our communities, we are

working to reduce this rate and support our

communities with Whanau Ora initiatives (see

Module 3). There is also a high prevalence of

depression with the economic downturn and

other pressures. The World Health

Organisation (WHO) predicts that depression

will be the second leading cause of disability by

2020. We have an ageing population, which

places increased demand from people over 65

for mental health services appropriate to their

life stage. The prevalence of mental illness in the population increases with age, and older people have

different patterns of mental illness, often accompanied by loneliness, frailty or physical illness


Access is the key to improving health status for people with a severe mental illness. Our goal is to build on

our existing, and well established intersectoral cooperation between primary / community and secondary

services, by offering programmes to individuals and groups from a broad range of ages – children and youth,

adults and older people.

If we improve access, and providing we provide services to people at the right time, and in the right place,

and can expect to see a reduction in our 28 day readmission rate. This will, in turn, assist in reducing pressure

on our hospital services.

28 day acute re-admission rates


14/15 15/16 16/17 17/18

18% ≤15 % Decrease

Figure 10 – Data from PRIMHD showing the percentage of mental health

patient admissions who are readmitted to hospital within 28 days of a previous

discharge

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1.8.11. More people with end-stage conditions are appropriately supported


For people in our population who have end stage conditions, it is important that they, their family and

whanau are supported to cope with the situation. Our focus is on ensuring that the patient is able to live

comfortably, without undue pain or suffering. Early identification and recognition of end-of-life choices

heavily influence the quality of life an individual experiences during the dying process. Rehabilitation and

Support Services contribute to this impact. Programmes include palliative care, aged residential care, respite

care and home based support services.


Palliative care is being accessed, but we want to target those with greatest need. The Palliative Care Council

has identified inequalities of access to palliative care based on diagnosis (evidence of under-utilisation by

those with non-malignant conditions), with a lack of suitable service provision for children and young people.

We would like to see an increase in palliative support for this group.

The Palliative Care Council in its 2010 position statement identified a lack of data on the need for palliative

care for New Zealand and monitoring on the implementation New Zealand Palliative Care Strategy. Over the

next few months we hope to work towards identifying and reporting on an impact measure

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Module 2 – Huarahi Rautaki / Strategic Direction This module presents the actions we are planning to deliver in 2015/16. Implementation of the actions

outlined in this plan is expected to enable us to positively contribute to local, regional and national outcomes

as well as the goal of Better, Sooner, More Convenient Health Services for all New Zealanders. The actions

and measures presented in this module show:

• How we are implementing Government priorities; • How we are contributing to the activities in the Midland Region Service Plan; and • How we plan to improve performance in terms of our local priorities.

Sections of this module have been developed in collaboration with key stakeholders both internal to the

health sector and external. This helps us to ensure service planning is not done in silos. The methods we

utilise include:

• An alliancing approach to service planning with our primary care partners • Active engagement of clinical leaders / champions • Working with other DHBs from the Midland region • A collaborative cross-sector approach to working with vulnerable children and their families

where information, services, resources are coordinated and shared to improve outcomes • Working with NGOs with a view to including them in alliance arrangements in the future • Utilising the expertise of community clinicians working across the service continuum with an

educative and capacity building focus • Expanding implementation of clinical pathways via Map of Medicine across the region to

promote regional clinical collaboration and consistency • Participating in the social sector trials work streams with cross agency partners

The narrative and tables in this module are clustered into the following topics:

Health Targets

Shorter Stays in Emergency Departments

Improved Access to Elective Surgery

Increased Immunisation

More Heart and Diabetes Checks

Faster Cancer Treatment

Better Help for Smokers to Quit

Better Public Health Services (including Social Sector Trials)

Reducing Rheumatic Fever

Prime Minister’s Youth Mental Health Project

Children’s Action Plan

Whanau Ora

System Integration

Diabetes and Long Term Conditions

Stroke

Acute Coronary Syndrome

Improved Access to Diagnostics

Faster Cancer Treatment

Cardiac – Secondary Services

Primary Care


Mental Health Service Development Plan

Maternal and Child Health

National Entity Priority Initiatives

Improving Quality

Actions to Support Regional Delivery of Regional Priorities

Living Within Our Means

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2015-16 Annual Plan – Tairawhiti DHB

47

2.1 Taumata Hauora / Health Targets

2.1.1. Shorter Stays in Emergency Departments

Our Approach

Better, Sooner, More Convenient Health Services for New Zealanders in relation to emergency departments means all New Zealanders can easily access the best services, in a timely way to improve overall health outcomes. A health system that functions well for people with acute care needs is one that:

• Delivers and coordinates acute care services in the hospital and community • Improves the public’s confidence in being able to access services when they need to • Sees less time spent waiting and receiving treatment in the ED • Moves patients efficiently between phases of care • Makes the best use of available resources.

Te Whare Hauora O Tūranganui a Kiwa’s (Gisborne Hospital) Emergency Department continues to see a decrease in lower level of acuity patients; this has been achieved through closer working with primary care in areas such as

Tairawhiti’s Primary Options,

Strengthening links between secondary and primary care clinicians, so that general practitioners have the ability to speak directly to an emergency department or other specialist at the hospital over concerns around a patient

Telehealth linking emergency department clinicians with rural practices and providing advice on the treatment pathway of a patient, and

Continued media publicity enforcing the message that ED is for emergencies.

Te Whare Hauora O Tūranganui a Kiwa’s Emergency Department is committed to quality

improvement and is continuously implementing the New Zealand Emergency Department Quality

framework. This commitment to continuous quality improvement is supported through the newly

established Emergency Department quality committee, who are supported through the hospitals

clinical quality group which has at its heart improvements in the patient journey.

Linkages

Our Performance Story Impact: People receive timely and appropriate specialist care

New Zealand Emergency Departments Suite of Quality Measures

Midland District Health Boards Regional Services Plan 2015/16

Integrated Health Strategy 2020

System Integration expectations and measures

Integrated Performance and Incentive Framework

Action Plan

Objective Actions to deliver improved performance Measure Reporting

Emergency

Departments

Quality

Framework

In addition to the continued implementation and improvement of the mandatory measures to improvement Te Whare Hauora O Tūranganui a Kiwa’s Emergency Department quality, the following three non-mandatory measures will be implemented.

14. Complaint review and response process.

Sept 2015 the three non-mandatory measures will have been implemented and reporting started April 2016 learnings from findings and commence the

Annual Plan 6 monthly reporting Ed Quality framework on going report

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This ‘measure’ is that there will be a process of review and response to complaints which feeds into quality improvement by identifying and addressing any deficiencies of care.

15. Staff experience evaluations. This will involve listening to the views of our ED staff regarding the quality of the department (job satisfaction, and patient care). Existing DHB mechanisms such as staff forums, planning days, staff appraisals, exit interviews, etc. will be used to address this measure.

30. An appropriate orientation to the ED. In addition to confirming that an appropriate orientation is given, the quality of this orientation will be occasional evaluated through staff feedback or other means. Issues addressed through our orientation training will include cultural awareness, especially for overseas staff coming to New Zealand for the first time.

Professional profile of the Emergency Department which will include 57. Participation in hospital committees. Through the establishment of the Emergency department Quality committee and its linkages with the wider hospitals committee the patient’s journey will improvement as will the quality of care provided.

identification of future non-mandatory measures to monitor will be started.

Whole of

System

Tairawhiti DHB, its Board, its leadership team, clinicians and staff maintain a commitment to continue the effort which will see the DHB maintain and improve on the six hour waiting time health target

Diagnostic/analysis work to identify the main factors impacting on ED length of stay

Address the most significant bottlenecks and constraints identified in the Diagnostic/analysis work.

Actions spanning the whole system – pre ED, within the ED, and post-ED

Whole of organisation focus, with demonstrable support from senior managers and clinicians.

Further develop Care planning and patient care plans. This will extend the capacity of trend care to ensure that discharge planning and community supports are considered as early as possible in the patients length of stay

95 per cent of patients will be admitted, discharged, or transferred from an Emergency Department within six hours. Reduced rates of readmission , especially for those over 65 and 75

Performance against the Health Target Progress on specific actions

Primary care Work with primary care to increase availability of

same day appointments

Continue to support general practitioners with

advice on treatment pathways for individual

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patients

Provide telehealth across the district to support

general practitioners in rural practices with advice

and support on patient pathways.

2.1.2. Improved Access to Elective Services

Our Approach

To achieve our objective of improving people’s access to planned care locally, TDH is implementing a

number of productivity initiatives as well as working closely with our primary care partners to

improve access to virtual FSAs and direct access to diagnostics, as well as the implementation of

various clinical pathways – some of which are being worked regionally through the primary care work

stream of the Midland Regional Services Plan.

To achieve our objective of improving access to planned care regionally, we will continue to work

cooperatively with our regional DHB colleagues by formalising clinical arrangements around the

delivery of services (renal and cardiac in particular), as well as developing a regional electives plan

that focuses on regional productivity and efficiencies.

Linkages

Minister’s Letter of Expectation

Health Target – Improved Access to Elective Services

Midland DHBs Regional Services Plan 2015/16


Action Plan

Objective Actions to deliver improved performance Health system success is measured by

Reporting Requirements

Elective Services

Electives funding will be allocated to support required levels of elective surgery, specialist assessment, diagnostics, and alternative models of care.

Delivery against agreed volume schedule, including a minimum of 2,552 elective surgical discharges in 2015/16 towards the Electives Health Target.

Performance against the Health Target Progress on specific actions

Standardised intervention rates will be used to assess areas of need for improved equity of access.

Refer to SI4: Elective services standardised intervention rates.

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Tairawhiti will continue to work at regional and national levels to support the implementation of the national patient flow collection Patient flow management will be improved to achieve further reductions in waiting times for electives. No patient will wait longer than a maximum of four months.

Elective Services Patient Flow Indicators expectations are met, and all patients wait four months or less for first specialist assessment and treatment from January 2015

Patients will be prioritised for treatment using national, or nationally recognised, tools, and treatment will be in accordance with assigned priority and time waiting.

Increased uptake of latest national CPAC tools to improve consistency in prioritisation decisions.

Prepare elective orthopaedic pathway from referral to discharge, this includes

Referral guidelines

Patient preparedness, including readiness and education

Inpatient event

Discharge

Follow-up

Continue with the principles and methods learned from The Productive Operating Theatre across all services to identify bottlenecks in capacity Continue to support surgical teams to improve on benchmarked performance for start times and patient turnaround , thereby further increasing theatre capacity

Guidelines complete with consideration given to direct General Practitioner access were possible Patient level data for referrals for FSA are reporting into new collection. Inpatient length of Stay (OS3) target achieved

Improving Quality Support the Health Quality and Safety Commissions Quality & Safety Makers to achieve

All three parts of the surgical safety checklist are use at least 90 per cent of the time

95 per cent of hip and knee replacement patients receive cephazolin ≥2g as surgical prophylaxis

100 per cent of hip and knee replacement patients have appropriate skin preparation

Performance updates published by HQSC and local quality report Inpatient length of Stay (OS3) target achieved Reduction in readmission after 30 days (OS8)

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2.1.1. Faster Cancer Treatment

Our Approach

Tairawhiti, together with Midland DHBs and other constituent organisations, is a key stakeholder of the Midland Cancer Network supporting the implementation of the prioritised New Zealand Cancer Plan better, faster cancer care 2015-2018 programme of cancer related activities, identified regional priorities and Tairawhiti initiatives.

Key principles are:

partnership approach to service planning in which clinicians and managers jointly agree service priorities along with appropriate funding

using a whole of system view to determine the most efficient model of care and service delivery

active engagement of ‘front-line’ clinical leaders/champions in health services delivery at Tairawhiti and within Midland

integrating/coordinating clinical services to provider greater accessibility and seamless delivery

strengthen clinical and financial sustainability and make better use of available resource Important policy drivers are:

regional collaboration

integrated care

value for money

Tairawhiti DHB looks forward to the release of the Cancer Health Information Strategy in June 2015, which will support that will be used to inform investment in cancer health information-based initiatives. Linkages


New Zealand Cancer Plan better, faster cancer care 2015-2018

Cancer Health Information Strategy

Midland Hei Pā Harakeke Action Plan

National Cancer Work Programme 2015/16

Midland DHBs’ Regional Services Plan 2015/16

Midland Cancer Network Annual Plan 2015/16

Midland MDM Action Plan 2015

Midland Specialist Adult Palliative Care Services Development Plan 2015-2018

Tairawhiti Palliative Care Service Plan

Health Target – Faster Cancer Treatment and other related policy priority indicators




Faster Cancer Treatment (FCT) - Health Target

Deliver against the Midland FCT Implementation Plan (2015/16)

Continue to improve the quality of data and data collection

Continue to implement initiatives to achieve the 15-25% of cancer registration cohort within the 62 day

Faster Cancer Treatment (FCT) Health Target

At least 85 per cent of patients receive their first treatment (or other management) within 62 days of being referred and triaged

Reported quarterly with monthly data submission

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health target

Participate in the Midland FCT and Tairawhiti Work Groups and regional activities to improve patient care

Initiatives that support primary care and/or private provider interface with FCT indicators are identified and implemented

Identify and implement actions to improve FCT data collection systems to identify service improvements along the cancer patient pathway. Where required, identify risks and mitigation strategies.

Continue to work towards integration of FCT data collection as business as usual across all clinical teams

with a high suspicion of cancer and a need to be seen within two weeks by July 2016.

15% of Tairawhiti newly diagnosed cancer patients, moving towards 25%, will be reported in the FCT Health Target Faster Cancer Treatment (FCT) Policy Priority 30 (PP30) 31 day indicator:

Percentage of patients with a diagnosis of cancer who receive their first cancer treatment (or other management) within 31 days of decision-to-treat.

Faster Cancer

Treatment (FCT) –

Improving the

quality of data and

data collection

Implement national tumour standard phase two initiatives:

tumour specific high suspicion of cancer definitions

tumour specific core datasets within available resources

as required participate in national development of tumour specific follow-up guidance, MDM prioritised guidance and high level review of provisional national standards

to be confirmed to be confirmed

To be determined

Faster Cancer

Treatment (FCT) –

Support Budget Bid

2014 initiatives

Support implementation of Government’s Budget Bid initiatives:

Supportive care

Quality Clinical Information for decision making

Note: details to be developed by Ministry of Health and communicated to DHBs

To be determined

To be determined Progress against actions will reported quarterly

Faster Cancer

Treatment (FCT) -

Regional tumour

standard reviews

Work in partnership with Midland Cancer

Network and participate in the Midland

DHBs’ stocktake of sarcoma cancer services

and gap analysis against national sarcoma

tumour standards:

Tairawhiti self-assessment and data

analysis completed by October 2015

Participate in Midland Work Group to

review findings and develop report and

action plan by December 2015

Work in partnership with Midland Cancer

Network and participate in the Midland

DHBs’ stocktake of lymphoma services and

Lead: Midland Cancer Network in partnership with Midland DHBs DHB self-assessments completed Regional review against national tumour standards reports are completed

Quarterly

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gap analysis against national lymphoma

tumour standards:

Tairawhiti self-assessment and data

analysis completed by April 2016

Participate in Midland Work Group to review findings and develop report and action plan by June 2016

Faster Cancer Treatment (FCT) - Service Improvement Note: refer to Improved Access to Diagnostic section regarding endoscopy/ colonoscopy

Identify actions to improve the timeliness and quality of the cancer patient pathway from the time patients are referred into the DHB through treatment to follow-up/palliative care

Ensure sustainable implementation of round one service improvement fund initiatives (local and regional)

Tairawhiti participates in the regional planning and implementation of approved round two service improvement fund initiatives

Continue to implement Tairawhiti service improvement initiatives from the Midland regional reviews against national tumour standards for lung cancer (2013/14) and bowel cancer, gynae-oncology cancer and breast cancer (2014/15)

Implement priorities identified in the Prostate Cancer Quality Improvement Plan

Implement national guidance on the use of active surveillance treatment for men with low grade prostate cancer by June 2016

Midland round two service improvement initiatives approved by Ministry of Health by 1 October 2015 Reported demonstrated service improvements National guidance implemented

Quarterly

Faster Cancer Treatment (FCT) - Improve Multi-Disciplinary Meetings (MDMs)

Deliver against the Midland MDM Action Plan (2015) that works towards

Compliance with the National MDM Guidance and improve functionality and coverage of MDMs

Report through Policy Priority 24 (PP24) for: Progress delivering improved cancer MDMs based on the actions agreed using the funding for MDMs including variance in expenditure against the allocated Tairawhiti DHB MDM funds

Quarterly

Faster Cancer Treatment (FCT) – Support cancer nurse coordinators

Continue support of the cancer nurse CNS/coordinator role including participation in the national CNCI evaluation process. Enable and support cancer nurse coordinator’s attendance at national and regional training/mentoring forums Review role and FTE of Breast Care Nurse

Report cancer nurse coordinator’s

participation in national and

regional CNC training and

evaluation

Quarterly

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Midland Hei Pā Harakeke Action Plan which seeks to reduce the impact and inequalities of cancer on Tairawhiti Māori

Tairawhiti DHB works in partnership with Midland Cancer Network, Tairawhiti Māori health services and stakeholders to

Apply Equity of Health Care for Māori: a framework resource

Deliver Kia ora – E te iwi programmes with Tairawhiti Māori health providers

Participate in Midland Hei Pa Harakeke Work Group

Increase eligible Māori women enter the breast screening programme

Report on: Number of Tairawhiti Māori health providers completed Kia ora - E te iwi programmes Tairawhiti participation in Midland Hei Pa Harakeke work group % of Māori women entering breast screening programme

30 June 2016

Shorter Waits for Cancer Treatment Indicator

Sustain performance against the radiotherapy and chemotherapy wait time targets by more efficient use of existing resources; and investing in workforce, capital and capacity as required

Identify actions to maintain timeliness of access to radiotherapy and chemotherapy

Report through Policy Priority 30 (PP30) for shorter waits for cancer treatment: All patients for treatment wait less than four weeks for radiotherapy or chemotherapy. Tairawhiti with support from Waikato Regional Cancer Centre reports cancer treatment indicator, Tairawhiti DHB to review received reports and investigate if target not met.

Quarterly Quarterly

Primary – secondary pathway tools

Participate in Midland Map of Medicine (MoM) initiatives:

Implement national tumour specific high suspicion of cancer definitions by June 2016

Implement national guidance on the use of active surveillance treatment for men with low grade prostate cancer by June 2016

Continue development on the breast cancer MoM pathway

Continue Midland palliative care MoM pathway

Commence development on lymphoma MoM pathway

Commence development on gynae-oncology MoM pathways

Lead: Tairawhiti partner with Leads - Midlands Health Network and Waikato DHB Report on progress of MoM developments

30 June 2016

Improve non-surgical cancer treatment services

Continue to implement the Midland Medical Oncology Service Plan 2013-2018 and the Midland Radiation Oncology Service Plan:

Consider new facilities design in conjunction with ongoing staffing and financial considerations that will need to be sustainable

Support implementation of the national oncology nursing knowledge and skills framework

Yet to be published

Quarterly 30 June 2016

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Tairawhiti palliative care service improvement

Continue to implement the Midland Specialist Adult Palliative Care Service Development Plan 2015-2018 recommendations, by

Participating in review and development of regional MoM palliative care pathways

Participating in regional development of clinical guidelines

Supporting regional Advanced Care Planning within available resources

Continue to implement Tairawhiti Palliative Care Service Plan recommendations:

Plan to implement National Specialist Palliative Care Service Specifications (2015) by 1 July 2016

Utilise technology (telemedicine) to provide palliative advice and support to rural areas

Continue to implement advanced care initiatives and advocate for requirements on advanced care directives

Introduce a yellow envelope system to enable to transition between hospital and aged care. Included as part of this package are advanced care plans

Identify workforce development needs

Implement recommendations from the MoH review of end of life care pathway

Tairawhiti endorses MoM palliative care pathway

Report service improvement initiatives National Service Specifications used to contract services for 2016–17 Telemedicine in place and utilised Yellow envelope system in place End of life care pathway re-introduced to aged care Service improvement initiatives and implementation continues with palliative care service

Quarterly September 2015 30 June 2016 December 2015 30 June 2016 December 2015 December 2015

2.1.3. Increased Immunisation

Our Approach

During 2015/16 we will continue our focus on increasing immunisation in our district and reaching

the immunisation targets. We will focus on a continuum of care from pregnancy test to six years of

age and ensure all universal services including immunisations are delivered on time. Through

registration in pregnancy our system will track children from pregnancy, birth, and up to six years of

age. In a collaborative and cross sector approach that we have developed with our Alliance partners

we will identify and work with high needs and vulnerable children and their families to ensure

immunisation and other universal services are delivered on time. Key to supporting this will be the

introduction of Midland Health Network’s (MHNs) NCHiP that will bring transparency to the delivery

of Well Child services, and milestone based care

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We will be working with our Alliance Partners primary health care, Lead Maternity Carers, Well Child

Tamariki Ora, Ministry of Social Development, Whanau Ora, Social Sector Trial partners to make

progress against this priority.

Linkages

Our Performance Story Impact: People take greater responsibility for their health

Better Public Services: Supporting vulnerable children

Action Plan


Increased Infant Immunisation

• Maintain an immunisation alliance steering group with primary care leadership-include actions to support increased coverage of four year olds

• Introduce NCHiP into the district • Monitor and evaluate immunisation coverage

at 6 months, 8 months, 2 years and four years. at DHB, PHO and practice level, manage identified service delivery gaps and performance through monthly DHB/PHO monitoring meetings

• Maintain monthly multi-disciplinary team (MDT) meetings with primary care, National Immunisation Register (NIR), Outreach Immunisation Service (OIS), Well Child/Tamariki Ora (WCTO), E Tipu E Rea (ETER) and immunisation facilitator to put plans in place for unimmunised and late children from 5 months of age

• Identify immunisation status of children presenting at hospital (inpatients and outpatients), after hours ED and primary health care through NIR look up for all presentations. Implement system for immunising opportunistically those children unimmunised or late.

• Increase the number of providers having access to NIR look up to check on all pre-schoolers immunisation status including; well child providers, B4 Schools, and after hours services before seeing the children and/or referral for immunisation

• B4 School providers to increase the delivery of four year old immunisations at the B4School nurse check

• Continue delivery of outreach immunisation services

• Include pregnancy immunisation, 8 month, 2 year and 4 year immunisation status as an outcome of E Tipu E Rea

• Continue to strengthen and monitor the newborn enrolment process to begin at registration with an LMC , through to booking

Narrative and quantitative report on increasing immunisation rates and interagency activities to support immunisations and immunisation week 85% of 6 week immunisations are completed (measured through the completed events report at 8 weeks) 95% of eight months and two year olds are fully immunised 90% of four year olds are fully immunised by June 2016 Primary care IPIF immunisation targets 98% of newborns enrolled with general practice at 3 months of age in alignment with the WCTO quality indicators

Increased Infant Immunisation

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in at 28 weeks and new born enrolment booking to ensure named GP and WCTO provider

• Monitor and evaluate uptake of HPV on a quarterly basis.

• SBVS continue to promote HPV in schools through education sessions and online tools for staff, students and their families

• Develop a strategy for students not immunised by SBVS to be followed up in Primary Care

• Primary care to develop strategies for promotion of HPV vaccination for women up to the age of 20 years, and not vaccinated in the school programmes.

• • Include immunisation in all Children’s Action

Plans, Gateway assessments and MSD health assessments on vulnerable children: both in the assessment and the implementation plan to ensure all services support immunisation uptake

MHN specific activities

• • The network positions itself as the region’s front door in the community for the co-ordination of community and primary care based health services for children via NCHIP.

• • NCHIP – all community providers of healthcare services to children will be able to access NCHIP.

• • NCHIP Coordination service will ensure that there are no GAPS and all children within Midland will have reached their milestones

• • All information available through multiple systems will be made available to co-ordinate immunisation services

• • Co-location of NIR and integration of NIR and NCHIP functions

• Drawing on the population level data from the locality planning project at risk and children being left behind will be targeted.

By end of June 2016;

70% of 12 year olds girls will

have dose 1 HPV vaccination

65% of 12 year old girls will


65% of 12 year old girls will


Increased Influenza Coverage

• Support Māori health providers to deliver and promote influenza vaccination programmes at Marae and other Kaumātua programmes.

Midland Health Network specific action - Integrated in the network quality plan

75 per cent of the eligible population (65 years and over) completed seasonal influenza immunisation.

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2.1.4. Better Help for Smokers to Quit

Our Approach

Our children and tamariki need to grow up free of the risk of becoming addicted to tobacco and the effects of second-hand smoke. We recognise that actions we take at a regional and local level will link with the actions driven at a national level to contribute to the achievement of the goal of a Smokefree New Zealand by 2025.

A renewed impetus is required in order to achieve the Government’s aspirational goal of a Smokefree New Zealand by 2025. Increased integration into all other aspects of health is critical to achieving Smokefree Aotearoa 2025. Supporting smokers to quit needs to be integrated into all primary, secondary and maternity health services and DHBs have a leading role.

We are active participants in the regional smokefree network and will be implementing the actions from our revised tobacco control plan. This plan will have a focus on achieving the national Health Targets. We will continue to engage regularly with our primary care partners and share information about the Health Target as well as monitoring actual performance against planned performance.

Our focus on smoking during pregnancy is part of our Maternity Quality and Safety (MQSP) programme.

We will be working with our Primary Care Alliance Partners to make progress against the primary care portion of this priority.

Linkages

Health Target – Better Help for Smokers to Quit


Our Performance Story Impact: People stay well in their homes and communities

Our Performance Story Impact: People receive timely and appropriate specialist care Action Plan



Tairawhiti DHB will work towards the goals of Smokefree Aotearoa 2025 and Smokefree Midland 2025 by ensuring that:

All patients (who smoke and are seen by a health practitioner in primary, secondary and maternity care settings) are asked about their smoking status, given brief advice to stop smoking, and are offered/given effective smoking cessation support (i.e. ABC), as part of their routine clinical care;

Each patient’s ABC information is documented accurately within their patient record, accuracy of records will be maintained through regular practice level audits by PHO teams of smoking status and followed up with session with practice staff to reinforce correct documentation process.

Primary, secondary and maternity services undertaking ABC processes with patients who smoke and refer to national and district

95 per cent of patients who smoke and are seen by a health practitioner in public hospitals will be offered brief advice and support to quit smoking 90 per cent of patients who smoke and are seen by a health practitioner in primary care will be offered brief advice and support to quit smoking 90 per cent of pregnant women (who identify as smokers at confirmation of pregnancy in general practice or booking with a Lead Maternity Carer) will be offered advice and support to quit smoking By 2025 Tairawhiti is smokefree.

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providers of cessation services Primary care will continue to provide ongoing audit and training services to the practices within Tairawhiti. Midland Health Network Specific Activities

• Core platform in service and quality coverage for the networks quality framework

• Use of Patient Prompt and Best Practice intelligence reporting tools both within general practice but also in other community settings by NGOs and other providers

• Strategy in place for using text messaging • Practice based smokefree champions • Network based smokefree practitioners • Centralised telephone catch up service • Web-based tool available for third party

providers to record smoking data • Map of Medicine pathway published for

smoking cessation

The prevalence of Māori smokers is reduced to 18% by 2018. 90 per cent of all Primary care enrolled patients who smoke and are seen by a health practitioner in General Practice are offered brief advice and support to quit smoking Map of Medicine pathway identified and published as agreed by Midlands Regional Governance Group by June 2016

Continue to contractually require and support all DHB and non DHB providers to implement smokefree policies including help for all smokers over 15 years within their services (staff, volunteers and clients) and referral pathways


By July 2015 update the Tairawhiti Tobacco Control plan to provide direction for the next 3 years. Continue to support innovation for providers of cessation services focusing on young Māori females

TDH is funding Te Aka Ora to provider smoking cessation advice and support to teenage mothers and female youth. This support is being targeted at these women’s whanau to ensure that quit attempts have the support of the whanua. Incentives to both the individuals and their whanau are available, these include teeth whiting and gym memberships.

Turanga Health has been successful in accessing innovation funding from the Ministry of Health to provide cessation advice and support to workers in agricultural and forestry work gangs. TDH will support individuals identified by Turanga Health with gym and oral health incentives

Reduce the rate of smoking for first time mothers by at least 5% Increase rate of never smoked in annual ASH survey in 2015 Successful work place programme reduces smoking rates within the most deprived areas of the district.

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Progress the TDH ‘Totally Staff Smokefree’ Policy 2014 Annual workforce wellness survey started and support offered to smokers.

Continued reduction in staff employed by the DHB who continue to Smoke Benchmark established of percentage of smokers within TDH workforce.

Gisborne Hospital to continue to monitor and action reviews of missed opportunities for ABCs with clinicians. Continuation of the ABC monitoring by ward/department with exception reporting by relevant managers to CE. We will include attainment and maintenance of this target as a KPI within managers’ YouTime (annual appraisal).

Maintenance of secondary achievement against Health Target throughout 2015/16

Performance against the Health Target.

Primary care to maintain the 90 per cent target

Continue to resource and support primary care coordination of the primary care smoking target at 0.4 FTE (Midlands Health Network). Provide further resource 0.4 FTE from the DHB and primary care smoking cessation service to work in partnership to implement sustainable systems and processes into National Hauora Coalition (NHC) and Ngati Porou Hauora (NPH) practices.

ABC within NHC and NPH practices will be supported through practice and district PHO smokefree champions, use of Map of Medicine pathway for smoking cessation, promotion of the use of prompts within each practice and circulation of practice against PHO/DHB rates.

MHN will provide accelerated performance on health target indicators by:

• Continued support for practices in developing and implementing smoking cessation plans to provide a patient centred practice based ABC service. These will include processes for training of GPs and nurses and identified practice smoke free champions.

• Exploring additional linkages, pathways and feedback for referrals to NGO’s for cessation support.

• The development and implementation of a MHN centralised practice support process for those smokers not contacted in 12 months and hard-to-reach smokers

• The development and implementation of a Map of Medicine pathway for smoking

National Health Target • 90% of MHN practices will have

implemented a smoking cessation plan

• 90% of MHN practices will have an identified smoking champion in their smoking practice plan

• Information of linkages made for referral to NGO cessation support reported via quarterly reporting

• Information relating to support process will be demonstrated via quarterly reporting

• Timeframe for implementing Map of Medicine pathway is demonstrated via quarterly reporting

Performance against the Health Target.

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cessation • Utilisation of practice tools such as Patient

Prompt and BPI reporting to record and report on smoking status

• Monthly feedback to each practice on their health target performance via Network Liaison process

Maternity Continue to support Lead Maternity Carers (LMCs) and primary care practices to provide pregnant women who smoke with active support to quit as early as possible in pregnancy Continue to support dedicated Smokefree midwife to liaise with LMCs and providers of services to pregnant women to implement smokefree ABC in early pregnancy, including training, referral pathways, monitoring and support Continue to attend monthly LMC meetings, college meetings to have smokefree as a routine agenda item Smokefree midwife to continue to facilitate access for all midwives (DHB and LMCs) to pregnancy smokefree training From July 2015, review the local maternal and child health sector WCTO QIF smokefree outcomeh Continue to collect the information of Smokefree ABC status on the DHB booking in form, follow up incomplete documentation Continue to work with LMCs and cessation providers to implement consistent best practice referral pathways and treatment plans. Plans will be developed and implemented and monitored through the smokefree coalition. review the integration of current specialist smokefree services for pregnant women into the maternal, child and youth health community Review providers on their focus, to identify the target group, evidence based interventions, issues, barriers etc. Continue communications to LMCs on the target and the WCTO QIF results for smokefree

• Continue to support sonographers providing prenatal ultrascans at Gisborne hospital radiology to provide brief advice with a view of having smoking cessation support available to provide immediate support.

MHN practices will have monthly feedback on smoking, CVRA and Diabetes via Network Liaison Team and information on this process will be demonstrated via quarterly reporting Hospital sonographers are applying brief advice to pregnant women who smoke and referring them onto smoking cessation services

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Increase provision of interventions by health professionals by trailing ABC programmes within the districts community pharmacies and other allied health professionals

Increase referrals from (Aukati KaiPaipa) AKP providers from allied health professionals

Continuation of the tobacco control working group to look at opportunities within the district for invests opportunities which will see reduction in tobacco consumption in Tairawhiti. Initiatives to be funded in 2015/16 include

• Extend the Smokefree School Ambassador project across the district.

• Continue to work with Te Wananga o Aotearoa who independently promotes Smokefree to ensure consistency of message

Develop local resources which are suitable for all settings to ensure consistent advice and message is delivered

Students become train the trainers and information is taken in to the homes and school community • Reduction of Staff, Students

and whanau who smoke at the wananga

• Community, Primary and Secondary care resources are compatible

Work across the district to increase the number and compliance of the districts smoke free areas. Work alongside Te Ara Ha Ora the National Maori Smokefree Coalition group to promote Auahi Kore/ Tupeka Kore Marae , Kura, Koahangareo, hakinakina and areas where large groups of Maori are most likely to frequent Work alongside Te Ara Ha Ora to promote Haputanga wahine Increase social responsibility and encourage the frequency of smokers being discouraged from smoking in public spaces Increase advocacy for smokefree cars and support for the tobacco plain packaging amendment bill

Promotion of Smokefree Tairawhiti 2025 Debate on new areas to public areas appears at least once on the Gisborne District council agenda Increased awareness of Auahi Kore / Tupeka kore Marae etc Increased awareness of Maori traditional haputanga and the importance of Auahi Kore/ Smokefree High visibility of Tairawhiti DHB’s support

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2.1.5. More Heart and Diabetes Checks

Our Approach

Long term conditions are a significant burden for many of our Tairawhiti whanau. To ensure those

living with conditions like diabetes have the appropriate tools and support to manage them, we will

continue to work closely alongside our primary care Alliances and NGO providers. The establishment

of a Tairawhiti long term conditions service level alliance team (LTC SLAT) mid-2015 will provide the

coordinated forum to appropriately identify need and service gaps, and drive the necessary system

improvements. It will seek to build on the regional Alliance SLAT’s leverage off current gains and

tools.

Early detection of long term conditions will continue to be a key focus area (including More Heart

and Diabetes Checks Health Target) as this gives the patient, with the support of the health system,

the most opportunity to remedy inflammatory lifestyle factors and implement effective

management. The opportunistic checks performed by Turanga Health, mainly in work places,

captures between 1 to 2% of those eligible for a cardiovascular risk assessment per year and links

those how require more active management into primary and community based providers.

Risk stratification is an agreed principle across all service providers in dealing with our whanau with

long term conditions. MHN has developed and been using a stratification tool to target care and

additional services for high need and at risk individuals. Further investigation into individuals who use

secondary and primary care most has shown that those with co morbidities, especially those with

diabetes make up the bulk of these admissions/attendances. Within Tairawhiti, following on from the

successful introduction and development of the service by MHN we have a MHN practice trailing a

clinical pharmacist as part of a multi-disciplinary team approach to support medium to high risk

individuals. Tui Te Ora, Long Term Condition unit, is continuing to support primary care successfully

manage high risk individuals in a community setting.

Linkages


Health Target – More Heart and Diabetes Checks

Section developed and agreed with our primary care partners


System Integration: Long Term Conditions

Action Plan Objective Actions to deliver improved performance Measure Reporting

More heart and diabetes checks

All three Tairawhiti PHO Alliances will use budget 2015 funding to support care to maintain delivery against the health target and ensure its sustainability. This includes the further effective use of patient prompts, decision support tools, recalls and undertaking virtual CVDra checks developed by the Primary Care Alliances to ensure at least 90% of eligible patients are stratified according to their

Health Target – More Heart and Diabetes Checks For all ethnicities 90 per cent of the eligible adult population will have had their cardiovascular disease (CVD) risk assessed in the last five years.

More heart and diabetes checks IPIF

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risk.

Performance against the CVDra Health Target will remain as a key performance indicator within each of our PHOs’ quality programmes and with particular emphasis on “no gaps” between Māori and non Māori.

Turanga Health, Māori health provider, will continue to perform opportunistic CVDra’s in various settings outside of general practice, these included agricultural work places and Marae. Individual participants in these programmes are from the three PHOs and these are captured and passed on to the appropriate primary health care practice.

Clinical Specialists within Tui Te Ora, Gisborne Hospital’s long term conditions unit, will continue to assist practices in managing those patients who require additional support across the district. Clinical Leaders from Medicine Speciality within Gisborne Hospital are becoming increasing visible across primary care, both in supporting the management of high risk patients in the community, but also through increasing skills and knowledge across primary care.

Further development of risk stratified patients will have multi-disciplinary team wrap around services available to them to support the self-management of their condition(s), according to their risk level. This will be supported from secondary care by staff from within Tui Te Ora, pharmacy liaison and physiological support.

Midlands Health Network: The extension of the MHN Long Term Condition Programme including the stratification and management of people at risk of, and living with Diabetes.

Enhanced ability and services through the strengthening and further integration of hospital community based multi-disciplinary teams to be co-ordinated by and supportive of the Health Care Home in managing long term conditions.

Further development of a range of electronic tools to support patients in self-management and providers in care support. • Implement cardiovascular disease management

training for general practice. • Multidisciplinary team for cardiovascular disease • Virtual cardiovascular disease risk assessment

project to support general practice activities. See also System Integration: Long Term Conditions

There will be no difference in performance against Health Target – More Heart and Diabetes Checks between Māori and non Māori. As some patients in our higher deprivation areas have extremely high Hb1Ac levels, we will work towards a reporting template which recognises the effort service providers have provided to lower the patients Hb1Ac level by Oct 2015. 90 per cent of high need eligible adult population will have had their cardiovascular disease (CVD) risk assessed in the last five years. Ongoing cardiovascular disease refresher for Network available General practice has access to agreed multidisciplinary team for cardiovascular disease Virtual cardiovascular disease risk assessment part of business as usual

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2.2 He pai Hauora Ratonga Public / Better Public Health Services

2.2.1. Reducing Rheumatic Fever

Our Approach

During 2013/14 we developed the Tairawhiti rheumatic fever prevention plan. This plan is due to

updated by 20 October 2015. Through the actions outlined in the plan we expect to reduce both the

incidence and impact of rheumatic fever across our district.

Our plan includes sections on:

Overarching actions to reduce the incidence of Rheumatic Fever

Investment in reducing Rheumatic Fever

Actions preventing the transmission of Group A Streptococcal throat infections

Actions to treat Group A Streptococcal throat infections quickly and effectively

Actions facilitating the effective follow-up of identified Rheumatic Fever cases

Linkages

Our Performance Story Impact: Fewer people admitted to hospital for avoidable conditions

Better Public Services: Supporting vulnerable children

Tairawhiti rheumatic fever prevention plan

Action Plan

Objective Actions to deliver improved performance

Measure Reporting

Reduce the incidence of rheumatic fever

Implementation of actions identified in the DHB’s rheumatic fever prevention plan

Implements the Rheumatic Fever’s 3 pronged approach of:

Enhancing primary care engagement through the rapid response programme

Supported community development to facilitate community awareness, ownership and management of rheumatic fever prevention at a community level.

Enhancement of the community based kaiawhina role to further support health messaging, referral pathway utilisation to housing insulation.

Treatment of GAS throat infections quickly and effectively by:

Implement the sore throat map of medicine pathway in primary care, youth health and school based health services

Education updates across primary

TDH target for 2015-16 is a 55% reduction from baseline for hospitalisations for Acute RF The 2015/16 targets for have been set by the MoH are included as per MoH requirements.

2015/16 Target:

55% reduction from baseline level

Rate Numbers Tairawhiti 4.2 2

Midland region

1.8 16

• Delivery of the Tairawhiti DHB

Rheumatic Fever prevention plan

• Provide the data from the RCA on Acute RF hospitalisations-template to be provided by the Ministry

• Provide a report on the lessons learned and actions taken following the RCA to the

Quarterly

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Measure Reporting

care to clinicians from the RF champions

Work with primary care to implement rapid response prescribing including dispensing medicines

Community awareness raising sore throats matter and how to access rapid response

Communications programme on completing antibiotics for sore throats

Effective follow up of identified RF cases by:

Referral to the RF nurse

Root cause analysis and review of all new and recurring RF cases, report results to steering group and identify issues and areas for improvement in prevention and system errors

Referral pathway into ongoing monitoring and follow up, including notification and registration on the RF register

Monthly audit of bicillin delivery for all patients receiving bicillin

Transition plans for children to adult services for RF patients

Continue to undertake a root cause analysis of every rheumatic fever case and identify systems failures

Ministry

2.2.2. Prime Minister’s Youth Mental Health Project

Our Approach

We continue to work with our partners to improve access to and uptake of primary mental health

services by young people aged 12 to 19 years. Tairawhiti has established strong cross-sector

leadership around the local Social Sector Trial (SST). This leadership is ensuring a vision is created for

Tairawhiti youth, and that agencies are clear about their contribution so that development of mental

health issues is prevented and access to youth mental health services is improved.

Work with our primary mental healthcare partner, MHN, is underway to increase the level of

interventions delivered directly into schools, alongside the established school based health services

(SBHS), HEEADSSS wellness checks in Year 9, Social Sector Trial alcohol and drug coordinator, and the

other primary mental health and addiction approaches. The Youth Health Team has chosen to focus

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on one high school to evidence quality improvement. This case study will tell the story of the school’s

journey from the introduction of SBHS; there are multiple PDSA examples along the way and this will

be told by narrative and hopefully, in pictures. The narrative will also explore the potential for quality

improvements moving forward.

One priority is the establishment of the Youth-specific Service Level Alliance Team (SLAT) which is

linked to the Gisborne Social Sector Trial. Recent interventions provided through the Social Sector

Trial have included appointment of a youth worker with expertise in alcohol and other drugs to

further investigate the role of alcohol and drugs in stand-downs, suspensions and expulsion from

school; and a series of youth events on Saturday afternoons. This group will also consider the need

for a Youth One-Stop Shop in Tairawhiti. A further consideration is linking into the work of Children’s

Team which will be operational from October 2015.

Key to the sector is support to and from the Child and Adolescent Mental Health Service (CAMHS) for

those young people with serious mental illness and/or addiction. Towards the end of 2014 CAMHS

changed how they responded to referrals, as a result improved access rates are anticipated in

2015/2016. Additionally this year’s plan includes a measure on the provision of care plans to primary

health care providers on discharge from CAMHS to improve the level and quality of support from

primary care.

Overlaying all of this activity is the Suicide Prevention and Postvention Plan, as one of Tairawhiti’s

most vulnerable groups is Maori youth aged 15 to 24 years. Youth are a significant focus within the

Plan.

Linkages

PP25 Prime Minister’s youth mental health project

PP26 Mental health services development plan

Midlands regional services plan


Action Plan


Measure Reporting

Improve the responsiveness of primary care to youth

Work closely with Tairawhiti Social Sector Trials to develop and implements a Youth SLAT by

Develop a work programme to help improve youth health and system integration in Tairawhiti Maintain school based health services (SBHS) in decile 1 to 3 high schools, including the GP in schools programme, to ensure equitable access to early identification of mental health or addiction issues

Youth SLAT in place by September 2015 Work programme identified by December 2015 and completed by June 2016 One quality initiative completed by

PP25 Prime Minister’s youth mental health project Service Development Plan

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Measure Reporting

Undertake a quality initiative under the SBHS Continuous Quality Framework at a Gisborne high school to evidence quality improvement Ensure referral pathway to primary and secondary mental health services is straightforward and well publicised

March 2016 Percentage of young people referred to primary and secondary mental health services

Improve and strengthen youth primary mental health

Increase provision of primary mental health services in schools Enable access to group work within primary mental health services to young people MHN specific Activities • Ensure youth appropriateness is

part of the review of current services that support people with mild to moderate mental health conditions

• Centralised triage process for all referrals to primary mental health service

• Contracting model in place to ensure compatibility and capability or third party providers for delivering youth services

Number of interventions provided in schools Number of group therapy sessions each quarter Review completed by October 2015 Providers able to receive referrals from primary mental health service via electronic system By June 2016 Model in place by June 2016


Review and improve follow-up care

Provide care plans to service users and whanau, and primary care providers for those 12 to 19 year olds discharged from TDH CAMHS to improve follow up in primary care

Percentage of care plans provided to the registered GP and service users and whanau for 12 to 19 years olds discharged from CAMHS


Improve access

Evaluate measures implemented in November 2014 to increase access to CAMHS by December 2015

80% young people access services within three weeks of referral. 95% access services within eight weeks of referral

PP8

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2.2.3. Children’s Action Plan

Our Approach

We are committed to the Government’s White Paper for children work and implementing activities

across our population for getting better outcomes for our most at-risk children. This will include re-

orientating the way we work, to a collaborative cross sector multi agency approach to working with

vulnerable children and their families.

Alongside our participation in this new way of working has been our planning and remodelling of our

maternal and child health services to improve health outcomes for these children. This includes

addressing integration, quality, address gaps in service delivery and capacity of providers to deliver to

the children’s action plans. A collaborative cross-sector approach to working with vulnerable children

and their families where information, services, resources are coordinated and shared to improve

outcomes.

Linkages

E Tipu E Rea action integration plan

Performance Story Impact: People receive timely and appropriate specialist care


Action Plan


Implement E Tipu E Rea

E Tipu E Rea service commencement (phase 1) 1 July 2015.

Completion of review into DHB service disinvestment and reinvestment (so to support ongoing E Tipu E Rea funding) completed by January 2016.

E Tipu E Rea service delivery evaluation (against agreed outcomes and including qualitative reporting from service users and wider stakeholders) completed May 2016.

• E Tipu E Rea Network finalises all identified changes to the E Tipu E Rea service delivery model for 2016/17 by June 2016

Continued progression of the Tairawhiti Well-being: a Collective Impact framework for E Tipu E rea (and other cross sector initiatives). This is phase 3 of E Tipu E Rea, i.e. moving to a cross sector service model

Investigate incorporating Children’s Action Team administrative and support function within the E Tipu E Rea coordination Hub

The targeted 20% service user cohort utilising E Tipu E Rea services. E Tipu E Rea community hub in place. Wider stakeholder and service user evaluation confirms E Tipu E Rea is reaching those most at risk-and applying a “whatever it takes” and whanau driven solution. Service disinvestment and reinvestment completed so that service delivery capacity aligns with service need.

Board Tairawhiti Integration Forum

Reducing the number of assaults on

Children’s Action Plan Full DHB implementation of FVIP through FVIP governance and to provide governance for

TDH reports exceptions and remedial actions to audit scores less than

6 Monthly to the Ministry DHB reports

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children FVIP, National Child Protection Alerts System, Shaken Baby, Child Protection, Gateway, Vulnerable Unborn Babies service and Children’s Team. • Dedicated FTE FVIP coordinator • Dedicated FTE Child Protection Coordinator • Mandatory FVIP Ministry accredited

training for all DHB staff, rolled out across secondary, primary and community services, including NGOs

• Implementation of the requirements of the VCA. Workforce requirements met as per section 5.3.4 and 5.3.5 in the workforce section

• TDH will maintain the National Protection Alerts System and align with other child protection information systems

• Ensure strong linkages between FVIP, Children’s Action Team and the E Tipu E Rea coordination hub.

80/100 for each of the child and partner abuse components of their VIP programme implementation of NCPAS and other child protection information systems by 30 June 2016 Reports actions to reduce deaths and hospitalisations due to assault, neglect or maltreatment co children 0-14. Supports the establishment of Children’s Teams Internal governance/engagement arrangements and with primary and community partners to provide services for: Vulnerable Children and their whanau Pregnant women with complex needs Children referred to Gateway Supports implementation of Raising to the Challenge (eg COPMIA), and Healthy Beginnings: Developing perinatal and infant Mental Health Services in NZ.

exceptions and remedial actions to audit scores less than 80/100 for each of the child and partner abuse components of their VIP programme. NCPAS and CYPAP reports to FVIP quarterly Children’s Action Plan reporting quarterly

Implement the Children’s Action Plan

• TDH to participate in regional Children’s Team governance (DHB and non DHB employed health professionals) • TDH to collaborate with other agencies to plan, test and monitor assessment processes to support early response systems, assessment processes and service coordination for vulnerable children. • TDH to develop effective referral pathways to/from Children’s Teams and primary and secondary health services • TDH service planning and development

Board

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activities work to provide an effective continuum of services across primary and referred health services to meet the needs of: • Pregnant women with complex needs • Vulnerable children and their families • Children in state care • Children with mental health and behavioural problems • Support mental health and addiction service users in their role as parents (see Mental Health Services 2.3.8)

2.2.4. Whanau Ora

Our Approach

The development of Whanau Ora continues in Tairawhiti with Te Runanga o Turanganui a Kiwa

piloting Whanau Direct grants on behalf of the Horouta Collective. Further applications will be made

to Te Pou Matakana (North Island Commissioning Agency) for Whanau Collective Impact funds.

Tairawhiti DHB has been proactive in promoting the concept of Whanau Ora within it’s services and

methodology. Emphasis has been on recognising the importance of the Whanau Collective in Maori

health consumer needs and relationships and where appropriate involving the Whanau in the

decision making processes. For example

the appointment of a Pakeke Whanau Ora in the Provider Arm as a key Whanau Ora

intermediary between clinicians and Maori consumers/Whanau,

the development of the business case for the East Cape Collective for Healthy Families

which has been led and developed by Te Whare Hauora O Te Aitanga A Hauiti, and

the development of the E Tipu E Rea Children’s (ETER) strategy by our Primary Care

Alliances.

With ETER the National Hauora Coalition (NHC) have been contracted by the Alliance and Tairawhiti

DHB to deliver a new approach to improving child health outcomes as part of E Tipu E Rea (ETER)

work programme. ETER, a Primary Care Alliance supported programme, that aims to work with

Maori, primary care and secondary care providers and Whanau in Tairawhiti to ascertain new ways

to approach, design and deliver services to sustainably ensure improved child health outcomes and

to achieve a more integrated higher performing system. This approach was premised on NHC’s

proven experience in developing and delivering a Whanau Ora system and outcomes framework in

other DHBs, Primary Care and Maori Provider Networks, that integrated health and social service

approaches, and reports on the resulting impact on whether Whanau are better off. Further

development will occur in relation to the development of a workforce of Whanau Ora practitioners

and Clinicians able to apply a Whanau Ora approach.

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Linkages




Module 2.2.3 Children’s Action Team

Module 2.2.6 Healthy Families NZ

Module 2.3.9 Maternal and Child Health

Action Plan


Whānau Ora Tairawhiti DHB supports whanau ora providers to develop services which met the needs of the communities they serve. The Boards of Ngati Porou Hauora (NPH), Te Runanga O Ngai Porou and TDH are currently engaged in designing how services are delivered to the district East Coast communities. This redesign has at its core the need for these communities to direct how services engage with them while delivering a high quality service. With the support of Te Runanga O Ngai Porou, NPH and TDH have started a three year approach to moving NPH to an Integrated Contract and increasing the levels of trust around contracting which this requires. The DHB has successfully negotiated two integrated contracts with other crown partners to fund Te Aitanga-a-Hauiti Hauora (HH) and Turanga Health (TH). Both these agreements have a strong outcomes focused basis, and we will continue implementation of integrated contracts where opportunities present themselves. A number of smaller providers who provide the majority of their services to the districts Māori community are being encouraged to further develop whanua ora approaches based on successes with TH and HH. We will work with the Ministry to support those primary care providers, who are part of Whanau Ora collectives, to use their practice management systems to report on Whanau outcomes.

Refer S15: Delivery of Whanau Ora High quality model of care which meets the criteria identified by East Coast communities in 2013/14 consultations. This is expected to be finalised by July 15 and provide a comprehensive redesign of Te Puia Springs Hospital. Outcome framework design agreed by Oct 2015 and individual measures agreed by and reported on by March 2016. Improvement in the outcome measures within each providers integrated contract. Continued development of innovative approach to service delivery.

Annually

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The implementation of the E Tipu E Rea project, will improve outcomes and improve service delivery to the districts children (-9 months to 5 years). The project has focused on changes which will improve universal access but also support the engagement of the most disadvantaged pepi and tamariki to access the best available health care within the district.

Increased number of 2015/16 service agreements reflect an outcomes based approach

2.2.5. Social Sector Trails

Our Approach

By linking to the work initiated under the Prime Minister’s Youth Mental Health project, we will work

with our partners to improve access to and uptake of primary mental health services for young

people aged 12 to 19 years, especially around access to addiction services. Work with our primary

mental healthcare partners is underway to increase the level of interventions delivered directly into

schools, alongside the established school based health services, HEEADSSS wellness checks in Year 9,

and the other primary mental health and addiction approaches. A key strategy to reduce youth

offending (and in particular, offences involving misuse of drugs) is to keep young people positively

engaged in education. Young people who have been stood down from school are at risk of

disengaging from education. There are no formal pathways for schools to access supports for young

people who are stood down from school due to drug related incidents. Establishment of a model of

best practice for supporting reintegration of students to school and continued achievement of

student’s educational goals. This project will identify what support is available for high school

students who have been stood down for drug related issues. Establish a model of best practice to

support students, families, schools and the wider school student population. Build capacity and

capability of schools to case manage AoD stand down cases.

Another priority is the establishment of the Youth-specific Service Level Alliance Team (SLAT) which is

linked to the Gisborne Social Sector Trial. This group will consider the need for a Youth One-Stop

Shop in Tairawhiti. Further consideration is linking into the work of E Tipu e Rea which will be

operational from July and the Children’s team from October onward.

Linkages

• Social Sector Trial Action Plan • Children’s Action Team • Better Public Service Targets

Action Plan


Social Sector Trials support

Provide continued support to the youth social sector trail aimed at reducing rangatahi truancy, youth crime rates, and drug and

Reduction in A0D school suspensions and expulsions

Quarterly

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alcohol consumption. Active engagement of the schools with the initiative to reduce AoD related school suspensions and expulsions. In alignment to Youth Mental Health establish the Youth Service Level Alliance Team (SLAT) by September 2015

School reintegration post AoD suspension/expulsion protocols developed and consistently applied by schools Youth SLAT in place by September 2015

2.2.6. He Oranga Whānau (Healthy Families New Zealand)

Our Approach

The Horouta Whanaunga – East Cape collation includes the Opotiki district as well as Tairawhiti. The

programme is led by Te Whare Hauora o Te Aitanga a Hauiti based in Uawa. DHB representation is

led by Bay of Plenty DHB as a member of the Collations governance group. The governance group will

ensure that linkages are made to existing DHB delivered or funded programmes delivered across the

East Cape such as Health Promoting Schools, Hapu Hauora, smoking cessation and promotion of

smokefree environments, monitoring of liquor licensing, and Green Prescription. In addition the

governance group will contribute to the better coordination of services and development of new

lifestyle programmes in response to community needs as the project consolidates and matures

throughout 15/16.

Linkages



Māori Health plan



Module 2.2.7 Reducing the prevalence of obesity

Module 2.3.1 Integrated Healthcare

Module 2.3.2 Diabetes and Long Term Conditions

Module 2.3.6 Primary Care

Action Plan


He Oranga Whānau (Healthy Families NZ)

Support Horouta Whanaunga projects across East Cape, with improved coordination and enhanced service delivery of DHB delivered or funded programmes.

Tairawhiti DHB health promotion team will work closely with the He Oranga Whanau team. This support will assist the He Oranga Whanau team through workforce development work, key linkages into vulnerable communities and the development of outcomes thinking models to support the Horouta Whanaunga model.

Measures will be worked out by Sept 2015

Six monthly Board report

Quarterly Advisory committee/TIF updates He Oranga Whanau governance group

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2.2.7. Reduce the prevalence of obesity

Our Approach

An increasing focus will be placed on obesity by the Tairawhiti DHB as a measure to reduce the

incidence and impact of long term conditions such as diabetes, cardiovascular disease and some

cancers, as well as on maternal and child health. The DHB will continue to deliver or support

programmes such as Adult Green Prescription, Active Families and the newly established Healthy

Families NZ programme across the East Cape. In addition new activity will begin in 2015/16 to meet

the Minister’s obesity target.

Linkages



Māori Health plan



Module 2.2.6 He Oranga Whānau (Healthy Families New Zealand)

Module 2.3.1 Integrated Healthcare

Module 2.3.2 Diabetes and Long Term Conditions

Module 2.3.6 Primary Care

Action Plan


He Oranga Whānau (Healthy Families NZ)

Support Horouta Whanaunga projects across East Cape, with improved coordination and enhanced service delivery of DHB delivered or funded programmes.

Measures will be worked out by Sept 2015

Quarterly

Green prescription

Deliver Adult Green Prescription services in Tairawhiti based on a target of 1,099 total referrals, including an additional 253 scripts for diabetes and pre-diabetes patients Deliver additional capacity to rural areas of the district, this may not follow prescribed green script service specifications but will aim to incorporate similar values based approach as utilised in E Tipu E Rea and He Oranga Whānau

Maintain current excellent quality performance Service provision to rural population has significantly increased

Quarterly

Active Families Continue to support the active families programme delivered through Sport Gisborne. This programme will develop ways to support He Oranga Whānau

Ensure service provider maintains and fosters links with the He Oranga Whānau collective

Quarterly

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2.3 Integration pūnaha / System Integration

2.3.1. Integration pūnaha / System Integration

System integration encompasses key components of system change and improvement to ensure

patients receive more effective and co-ordinated services closer to home. This priority area

encompasses requirements for the Integrated Performance and Incentive Framework and integrating

services into the community, as well as integration requirements set out under the primary care

section (note: primary care remains a priority of its own).

Focus areas include: ensuring all children get the best start (E Tipu E Rea), supporting people with

long term conditions receiving appropriate services closer to home; implementation of national

criteria for community referred diagnostics; managing long term Mental Health whaiora personal

health needs in primary care; continued adoption and release of clinical pathways that support

integrated care for primary care direct and easy access to specialist nurse/doctor advice. Localised

clinical pathway information will also support extended care in the community setting by primary

care.

Other key system approaches identified to significantly contribute to system integration are: long

term conditions management; diabetes care improvement packages; more heart and diabetes;

primary mental health which referenced in further sections of this plan.

The Tairawhiti Integration Forum (TIF) that draws together in an Alliance Agreement Ngati Porou

Hauora, Midlands Health Network, National Hauora Coalition and TDH has taken the lead for the

identification and progression of wider system oriented improvements to service integration in

regard to the above focus areas and linking to existing broader Alliance work programmes in the

midlands region.

Information sharing is collectively appreciated as critical to support the integrated approach and

information system capacity within systems will be a key enabler for the Alliance partners to

achieve objectives between primary, secondary and social sectors. As such work has begun to

develop a dashboard across the Midland region which provides partners with a view of how their

activity contributes to outcomes for the whole district and as a region.

New models of care and approaches to delivering services in a sustainable manner are going to be

critical to support the population of the district moving forward. The `Health Care Home` as signalled

in the N4 Business Case, (General Practice), `packages of care` and patient self-management and

workforce development is also a critical component for system development including new models

of care such as The Alliances will be required to plan for capacity and a competency requirement as

progress is achieved, including peer support and education.

The Alliance’s work plans reflects the priorities for the district which currently are to

Ensure all children in Tairawhiti have the best start in life

People with long term conditions are supported in the best possible way, and

Seek to achieve an improved Integrated Care system Preliminary SLAT developments will be flagged within the TIF annual plan to ensure priority work areas are acknowledged and planned for.

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Included within system change for integration this year will be the implementation of E Tipu E Rea,

which will see the coordination processes relating to child health services currently located across

community, primary and secondary brought together under one roof. This singular child health hub

coordinated approach to service provision will see an increase in services provided to vulnerable

whanau and ensure that they are connected to, and have the ability to access health care services

which are tailored to their needs.

Tairawhiti has already made progress in many areas around service integration and continues to

work at it and perhaps hasn’t “publicised” enough some of its initiatives. Below are examples of

some initiatives already underway.

Approach to shifting

services What this means Tairawhiti Example

Substituting skills Shifting services so that

care is provided by the

right person

Since 2005 Retinal screening outreach service has sit within the community using local optometrists for screening and ophthalmologists for quality control.

From Jan 2015 Cellulites IV Clinics have shifted from being a service delivered by District nursing/ Emergency Department to being delivered by Primary care, both in and out of working hours

Since 2008 post-acute community based pulmonary and cardiac rehab has been provided by PHO and Iwi provider nurse oversight for exercise programmes for patient’s pre/post cardiac/pulmonary intervention.

In January 2015 Mental Health Medication Support service has been provided by community pharmacy rather than secondary care community support workers

From July 2014 community focused dietetics moved from secondary care to Sport Gisborne

Integration Bringing organisations and

professionals together with

the aim of improving

outcomes for patients

through delivery of

integrated care

Joint work on social sector trials since January 2014 with initiatives based around youth alcohol and drugs

July 2014 Primary Options services have been in place to support short term cares for aged related conditions to residential care, DVTs and Cellulitis management

Since January 2014 there has been a collaborative IS programme in ED allowing access to primary care information

Transfer of mental health clients with specific need from specialist services back to general practice

Simplifying access Providing better access to

services closer to home, by

bringing care to the patient

and/or simplifying referral

mobile retinal screening and cardiology assessment clinics on the coast for a number of years- and community podiatry

Enabling primary care to undertake cardiac

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Approach to shifting

services What this means Tairawhiti Example

pathways from community

based care

holter assessments, which previously was delivered by specialist services

GP direct access to radiology, with the exception of CT and MRI

Professional support Providing support for

primary care to manage a

wider range of patients and

to reduce avoidable

referrals

From July 2014 VideoHealth has been implemented across the district and provides direct specialist support to rural general practice, hospice care and community Mental health workers

Since July 2014 Mental Health integration initiative with Specialist MH Services providing staff to primary care practices to work alongside GPs. This initiative also provides support to NGO sector

From January 2014 Long Term Condition nurse specialists have been working in primary care in educative role

There are numerous examples of Tairawhiti working collaboratively, for example around children’s

team, ETER and so on. However it is important to recognise that for service shifts to be successful

there have to be willing and able partners – in some cases GP practices are severely limited by space

issues and simply cannot take on more personnel.

Objective Actions to deliver improved

performance Measure Reporting

Shifting services

into the

community

Under the governance role of the

Alliances commence the analysis

and investment planning for

Service shifts; to inform DHB and

PHO executive decision making

and leadership and future district

wide devolvement.

Scope and implement services

closer to patients home

completed with TIF; including

integration of nursing roles, child

health coordination and multi-

disciplinary input within the

practice environment.

Process milestones for;

Sept 2015 Identify clinical

governance group with partners

Dec 2015 Establish

Implementation plan for

specific service(s) including

budget and volumes

March 2016 Roll out of plan

June 2016 Complete

implementation

On-going

reporting on

progress to the

Alliances

Six monthly

Board report on

Annual plan

progress

Improved patient

journey

Implementation of National

Access Criteria for community

referred diagnostics. Volume

capacity has had `Right size`

Direct access monitored

through volumes

(monthly/Quarterly) to the

milestone volume capacity

On-going

reporting on

progress to TIF

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analysis based on 5 year

historical/ & actual volume

review. Total RVU`s 46,281

planned providing flexible

application across the Radiology

modalities through clinical

decision. (see also section on

Access to Diagnostics)

planned (PVS) radiology.

Sept 2015 ability to report

different modalities

Six monthly

Board report on

Annual plan

progress

Co-ordinated

services restrict

acute demand

Acute demand strategies planned

including analysis for ASH, include

MHN Primary Options

programmes across the region;

currently two senior medical

physicians are available to assist

primary care decision making on

acute patient needs via

telephone, recognising local

priorities and progressed through

and by the Alliance partnership

framework.

Process milestones for Acute

demand plan implementation;

Sept 2015 Finalise the data

analysis on ASH attendances by

Census Area Unit to investigate

the impact of hydrology and

other environmental conditions

on ASH attendances

Dec 2014 Develop community

based dashboard which

provides service providers and

community groups with the

information they need to

determine their priorities for

improving community health

March 2016 review and

evaluate community dashboard

June 2016 encourage other

social service providers to

participate in the project

On-going

reporting on

progress to the

Alliances

Six monthly

Board report on

Annual plan

progress

Utilisation report

by partners and

other social and

health stake

holders

Clinical pathways

provide local

information for easy

access between

primary and

secondary clinicians,

and extended care

in the community

High demand services are

selected for improvement in

primary/secondary clinician

access, including improved

localisation of information,

through active management by

the Clinical Pathways group

process.

Pathways identified; update of

Cellulitis & DVT; Cancer

Treatment and improved Cardiac

pathways across the primary

Sept 2015 Review the improved

clinical pathways between

secondary and primary care

service for Mental Health and

Specialist Diabetes initiated in

2014/15.

Oct 2015 Clinical Leaders Forum

identify areas where clinical

pathways could be improved

and seek feedback on progress

to date.

Dec 2015 Extend the Medicine

On-going

reporting on

progress to TIF

Six monthly

Board report on

Annual plan

progress

Utilisation report

by partners

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secondary continuum (ref Cardiac

in plan and regional Cardiac

services Plan)

clinical pathway beyond

diabetes to include all General

Medicine specialists.

Dec 2015 Paediatric Specialist’s

clinical pathway established

through E Tipu E Rea to provide

support to General

Practitioners.

June 2016 Surgical Services

clinician will establish a clinical

pathway to support General

Practitioners.

Annual Map of Medicine

pathways reviewed as planned;

At least quarterly progression

for localisation and matched to

parallel release of e Referrals

facilitated as complementary

process for pathway

implementation to improve

integrated approach

(primary/secondary)

Staff are

supported to work

collaboratively

within local

Integrated care

processes

Local staff development on new

models of care, such as patient

self management and working

between specialist, general

practice and community services

Work on the maternity pathway

to identify key points in which

smoking cessation can be

provided to support smoking

Hapu wahine become smoke free

Dec 2015 Assess feedback at

the annual clinical leaders

forum on who successful

integration initiatives have

been.

Sept 2015 Develop pathway for

referrals to ultra-scans for hapu

wahine.

Dec 2015 Evaluate support

offered at ultrascan

appointments and find

opportunities to engage earlier

in the pregnancy

On-going

reporting on

progress to TIF

Six monthly

Board report on

Annual plan

progress

Greater support

for patients to self-

manage their own

health journey;

through more

cohesive

engagement with

Further development of patient

portals are implemented at

practice level with system support

from PHOs; to enhance patient

self-management

Further development/

In cooperation with local PHOs

and MoH the ongoing reporting

of implementation roll-out

progress.

Dec 2016 Non regulated

approach which supports

On-going

reporting on

progress to TIF

Six monthly

Board report on

Annual plan

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primary health and

community

services

investigation of electronic tools,

and models of care, eg Standford

Model to enhance patient self-

management

Health Care Home developed

progress

Reduce system

inequality for

Maori at the local

level through

elimination of

disparity evident in

health targets

Ensure ethnicity data

performance is maximised for

identification and improved

access for Maori.

Ensure governance relationships

and cultural consultation is in

place to assist action plans for

delivery of services.

Audits undertaken to ensure

cultural competence is included

within service delivery

performance.

Percentage of Maori enrolled in PHOs is at least maintained continuously

Consultation is evidenced in reporting

Disparities ASH rates reduced

By June 2016 CVDRA disparity gap reduced by 10%

Cervical screening disparity reduced by 5% by June 2016

Breast screening reduced by 10% by June 2016

On-going

reporting on

progress to TIF

Six monthly

Board report on

Annual plan

progress

IPIF/ national

performance

reporting

Service Shift Model of Care developed to assist

in the management of non-

attendances/failure to deliver

services (previously DNAs)

Consultation Sept 2015

Plan prepared April 2016

Implementation June 2016

On-going

reporting on

progress to TIF

Six monthly

Board report on

Annual plan

progress

Integrated Performance and Incentive Framework

As a measure of progress at the system level Tairawhiti DHB will actively participate in local

management of the national `Integrated Performance and Incentive Framework` (IPIF) and will work

closely with Primary Care to implement key system measures identified:


Achievement

of system

level

measures

Implement the health Quality and Safety

Commission Patient Experience survey

By June 2015 the survey

will be implemented

On-going

reporting on

progress to

TIF

Six monthly

Board report

on Annual

plan progress

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Selection of agreed quarterly milestones with

Alliance and PHO partners to be agreed for key

focus areas, such as baseline qualitative

measures for LTC/DCIP services

Milestones identified and

agreed by Sept 2015 and

updated quarterly, within

context of Alliance work

plans and reported on

quarterly

On-going

reporting on

progress to

TIF

Six monthly

Board report

on Annual

plan progress

Specific actions to meet the following System

Level Measures:

Early registration with an LMC within the first 12 weeks of pregnancy (target TBC)

Early enrolment with a PHO within 4 weeks of birth (target TBC)

95% of newborns receive all scheduled immunisations by 8 months of age

95% of children have received all scheduled immunisations by 2 years of age

More Heart and Diabetes Health Target

Better Help for Smokers to Quit Health Target

PHO enrolled women 25 – 69 years who have received a cervical smear in the past three years

IPIF Targets achieved by

June 2016

On-going

reporting on

progress to

TIF

Six monthly

Board report

on Annual

plan progress

2.3.2. Diabetes Care Improvement Packages & Long Term Conditions

Our Approach

We will maintain our integrated approach to reducing the impact of long term conditions for the

Tairawhiti population. There will be a focus on ensuring the people with long term conditions have

the appropriate tools and support to aid their management of their own conditions effectively and

receive health care in the most appropriate setting (particularly community and primary settings).

Linkages


Performance Story Impact: People stay well in their homes and communities

Health target – More Heart and Diabetes Checks

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Action Plan Objective Actions to deliver improved performance Measure Reporting

Diabetes and Long-term Conditions˟

Long Term Conditions SLAT The Tairawhiti Long Term Conditions Service Level Alliance Team (LTC SLAT) will be established with representation from NGOs, primary and secondary care services and consumer groups. The LTC SLAT will begin with following baseline workplan:

Assess the clinical review of very high users of the health system undertaken in early 2015. Being those who match any two of the three criteria below in any 12 month period

2 or more inpatient attendances

2 or more secondary first attendances

2 or more primary care attendances

Drive the planning and implementation of services to address the gaps identified by the clinical review

Assess current state of services against the 20 Quality Standards of Diabetes Care and Diabetes Atlas of Variation to identify gaps

Identify key outcomes measures to assess overall system performance for patients with long term conditions

Provide ongoing oversight and governance of Long Term Conditions services across the district

Prevention Tairawhiti DHB will continue to support the Healthy Families provider alliance and services. Tairawhiti DHB will continue to maintain the level of green prescriptions at 22% above the MoH funded levels and aim to continue to maintain this level of service. Tairawhiti Maori NGO providers will continue to empower community wellness and prevent or reduce the acuity progression of chronic conditions through whanau ora services. Identification of Risk Tairawhiti PHOs will use common risk stratification guidelines and tools to trigger the appropriate proactive testing and recall for patients, such as community and mobile retinal screening services, foot checks and renal function tests, and subsequent multidisciplinary wrap around services. Tairawhiti DHB will continue to support the

Identification of gaps in current service provision Six monthly data sharing and eligibility identification process agreed. Implementation of service improvements to increase district-wide performance against 20 quality standards Outcomes measures agreed and regular reporting established Reduction in Ambulatory Sensitive Admissions to Hospital (ASH) rates for 45 to 64 year olds Measurement of improved diabetes outcomes using a set of clinical indicators to be developed.

To be defined outcomes reporting framework

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Objective Actions to deliver improved performance Measure Reporting provision of:

Training to primary care staff regarding the appropriate identification of at-risk feet for patients with diabetes to support the suitable management action.

Community and mobile (East Coast) retinal screening services

Community and mobile (East Coast) podiatry comprehensive assessment

Continue to support the mobile cardiology assessment service

See also Health Targets: More Heart and Diabetes Checks section regarding the proactive Primary Care checks for all eligible/at-risk patients. Management Primary care LTC programmes will be person/whānau centred to deliver planned care to improve self-management and programme intervention. Current service provision will be measured against the 20 Quality Standards for Diabetes Care, with the help of the Diabetes Atlas of Variation, to identify gaps and develop a plan to implement changes to address those gaps. The additional funding provided by Budget 2013 for DCIP will continue to be utilised to bolster community and mobile (East Coast) podiatry services for those with most high needs to reduce the progression to secondary level services, and to increase provision of community dietetics and social worker service as part of the diabetes MDT. TeleHealth will continue to be used for Long Term Conditions and Diabetes virtual clinics between Gisborne Hospital specialist services and East Coast general practices. Where appropriate the specialist services, particularly for diabetes, will become available to general practice to support the appropriate clinical management decisions for patients. The DHB will continue to support the monthly mobile dietetic clinics for the East Coast general practices. The community cardiac and pulmonary rehabilitation service will continue to provide intensive programmes to support lifestyle

Implementation of service improvements to increase district-wide performance against 20 quality standards Diabetic lower limb amputations will continue the downward trend from pre-extended service.

DCIP reporting of HbA1c results

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Objective Actions to deliver improved performance Measure Reporting changes in high acuity and post-discharge patients in these areas. Enablers The virtual diabetes register (VDR) information will be shared with PHOs to identify patients who are likely to have diabetes or a condition which will see them develop diabetes unless action is taken. The Long Term Conditions SLAT with the support of the (Clinical) Tairawhiti Integration Committee, the local TIF alliance and Midlands Health Network ALT will provide the clinical governance for long term conditions services in Tairawhiti. This group will also include consumer group representation to provide input into service design. See section on LTC SLAT above. The DHB and PHOs will continue to provide support to and promote Map of Medicine and its development/enhancement of local clinical care pathways for diabetes, stroke, heart failure and other long term conditions. Telehealth will enable the specialist support to East Coast primary care teams. Regular enhanced diabetes, cardiovascular disease and other LTC training will be provided for Tairawhiti general practice workforce. Resources and tools which support identification, clinical and self-management of long term conditions will continue to be developed by the DHB and PHOs. Midland Health Network specific activities

The extension of the MHN Long Term Condition Program including the stratification and management of people at risk of and living with Diabetes.

Enhanced ability and services through the strengthening and further shifting of hospital community based multi-disciplinary teams to be co-ordinated by and support the Health Care Homes in managing long term conditions.

Further development of a range of electronic tools to support patients in self-management and providers in care support.

As soon as VDR is released by MoH TDH will distribute to PHO partners Diabetes level 700 nurse training for Network available and ongoing by June 2016 Steering group established to explore opportunity for a regional diabetes service by July 2015 Roll out of second wave of practices by June 2016 General practice has access to agreed multidisciplinary for diabetes by September 2015

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Objective Actions to deliver improved performance Measure Reporting Implement enhanced diabetes training for

general practice

Regional diabetes service integration project

Integration of quality standards in diabetic care – Ministry of Health

Multidisciplinary team for diabetes extended

Further development and the Promotion of map of medicine and continued pathway development for long term conditions

Development of patient self-management resources for general practice

Introduce new long term conditions programme

Implement cardiovascular disease management training for general practice.

Active review of the long term conditions framework.

Continued development of risk-stratification framework and tools for the Network to support allocation of resources to practices.

Workforce and education plan refreshed

A comprehensive chronic obstructive pulmonary disease (COPD) long term conditions management plan in place across the Network

Map of Medicine pathways completed as per map of medicine Regional Governance Plan by June 2016 Self-management Network training and supporting resources available ongoing development of specific conditions as added Steering group established to prepare annual recommendations Network annually consulted to identify future long term conditions to be included in the framework Ongoing cardiovascular disease refresher for Network available Measures as per locality primary options plans Annual update and review of long term conditions plan Network Risk Stratification tool annual review Plan refreshed Approach in place covering electronic decision support tools, risk stratification, education plan, and multidisciplinary team for COPD

2.3.3. Stroke Services

Our Approach

The Midland Stroke Action Group are leading on regional actions to improve DHBs’ ability to improve

stroke prevention, stroke event survival, and reduce subsequent stroke events and improve access to

organised acute and rehabilitation stroke services

Our organised stroke service has an integrated approach, which has been embraced by the Tairawhiti

sector wide steering group. It brings together nursing, allied health and medical specialist from both

acute and rehabilitation services as well as services offered in the community. The focus of the

service is about prevention and promotion as well as getting the best outcome for each patient who

has had a stroke, bringing all the resources we have to ensure they get the best care.

Linkages

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Action Plan


Stroke Services Management of people with stroke, acute transient attack services and rehabilitation by dedicated virtual team (as recommended in the NZ Clinical Guidelines for Stroke Management)

• All stroke patients admitted and treated in the setting of an organised stroke unit with an interdisciplinary stroke team

• 6% of potential eligible stroke patients thrombolysed

• Improve the number of TIA patients having carotid ultrasound and carotid endarterectomy

• All eligible stroke patients receive appropriate rehabilitation services, supported by an interdisciplinary stroke team

• Participate in national and regional clinical stroke networks to implement actions to improve outcomes for people who have had a stroke.

• Identify the inequity of thrombolysis rates between Māori/Pacific and others

• Review all rehabilitation services in Tairawhiti for people who have had a stroke by March 2016

80 per cent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway. 6 per cent of potentially eligible stroke patients thrombolysed 80 per cent of all eligible stroke patients receive appropriate rehabilitation services, supported by an interdisciplinary stroke team All eligible stroke patients have equitable access to community stroke services, regardless of age, ethnicity or geographic domicile

Performance against the targets. Progress

Develop a more integrative approach to stroke/Tia development

Implement a hospital post discharge checklist

Expand local stroke steering group to include Iwi, community and consumer/whanau by end of July 2015

Promote the use of Map of Medicine stroke/Tia pathway

Functioning integrated stroke steering group Implemented local Map of Medicine TIA pathway


Increase awareness of TIA/stroke and its significance

Work together with community of stroke prevention promotion

• explore option of increasing funding of Gisborne Stroke to have a presence on East coast

Develop a health promotion/communication plan for stroke/TIA

Stroke prevention services linked with existing Cardio-vascular and other health promotion services.

Increase funding of Gisborne Stroke to have a presence on East coast

Work with Gisborne Stroke to promote the use of the FAST message in the Tairawhiti community with an increased emphasis in the East Coast population


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Link stroke with cardiovascular risk assessments and activities through cardiac clinical nurse specialist services

Ongoing Stroke education training and development

Identify actions that the region will take to

develop and implement a regional workforce

plan that supports the delivery and

achievement of sustained, consistent and safe

thrombolysis, and comprehensive evidence

based interdisciplinary acute and rehabilitation

stroke care provision

Regional education programme developed Monthly sessions for hospital staff Annual stroke education session a regional workforce plan Regional collaboration with thrombolysis training All members of the interdisciplinary stroke team participate in ongoing education, training and audit programmes according to the Stroke Guidelines Regional MDT case reviews At least one education session for rural GP’s and practice nurses

Quality assurances process are ongoing

Develop a regional oversight role to support improved information management

Quarterly individual audits of all stroke admissions, number thromoblised, door to needle time and outcomes

Regional MDT case reviews

Continue to Implement the 2010 Stroke Guidelines

2.3.4. Acute Coronary Syndrome

Our Approach

In 2015/16 we will be continuing the work around the acute coronary syndrome (ACS) project, which

is a major focus for our region. We will continue to engage with our primary care partners in the

planning and implementation activities that occur in this area.

Linkages




Action Plan

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Acute

Coronary

Syndrome

• Maintain the Cardiac ANZACS QI and Cardiac Surgical registers and continue to feedback to consultant for quality improvement.

• Maintain the increased Clinical Nurse Specialist FTE implemented to enable the ACS project manager to implement and monitor the following in alignment with the Midlands Cardiac Network Vision and goals

• Continue with the weekly monitoring system of ACS admissions, with statistics sent to MoH which allows timeframes and adherence to best standards of practice across the region

• Continue with the designed and implemented TIMI score sticker system. This is a risk score predictor. TDH’s aim is for 90% of admissions to be TIMI scored within 4 hours.

• Maintain the Exercise Tolerance testing available on public holidays to assist Physicians with early risk stratification

• Continue the electronic referral system implemented across the region which provides early access for ACS patients to angiogram waitlist

• Establish an angiogram worksheet which will be completed prior to patient being transferred to tertiary centre to enable ACS patients to get to the cath lab table sooner

• Maintain cardiac focus group with sole purpose to look at quality improvements to enable best patient outcomes.

• Examine possibility of making echo available for ACS patients when echo technician is not available. Physicians looking at upskilling to enable them to measure Cardiac function for patients presenting with Myocardial Infarctions.

• Maintain Local ACS project steering group to monitor and review targets set and look at next project to improve patient outcomes

• Pre-admitting more cardiac patients locally for Tertiary investigations to enable them to get to their appointment dates safely with all preliminary work up done locally assisting in reduced W\L timeframes.

• Extend the post-Acute Cardiac - pulmonary rehabilitation to rural areas

Tairawhiti DHB is committed to the Acute Chest Pain Pathway and will engage with regional partners to implement this pathway.

70% of high-risk

patients will receive

an angiogram

within 3 days of

admission. (‘Day of

Admission’ being

‘Day 0’)

Over 95% of

patients presenting

with ACS who

undergo coronary

angiography have

completion of

ANZACS-QI ACS and

Cath/PCI registry

data collection

within 30 days

By July 2015 post

acute cardiac-

pulmonary services

extended to rural

areas

Quarterly

2.3.5. Improved Access to Diagnostics

Our Approach

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Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times

for diagnostics can reduce delays to a patient’s episode of care and improve DHB demand and

capacity management.

Currently, the Tairawhiti community has excellent access to most diagnostic services. Continued

monitoring and improvements in waiting times, untangling system bottlenecks, and identification of

other areas of improvement will ensure that this good access will be maintained.

Phase two of the National Patient Flow Collection and the Faster Cancer Treatment programmes will

be drivers along with Elective Service targets and intervention rates. It is planned that these

initiatives will further enable an improvement in waiting times.

Linkages

• Our Performance Story Impact: people receive time and appropriate access to diagnostic services

• Midland DHBs’ Regional Services Plan 2015/16 • Improved Access to Elective Services • National Patient Flow Collection • Faster Cancer Treatment programme

Action Plan


Improved Access to Diagnostics

Work with regional and national clinical groups to contribute to development of improvement programmes. Support and participate implementation as required.

Continued purchasing of higher radiology volumes in PVS 15/16 than actual delivery 13/14, improving access for our demographic need through defined referral criteria.

Continue to ensure internal data collection systems are in place to facilitate accurate reporting. Patients access diagnostic services in accordance with priority.

Increase access to community referred bone density scan focusing on our older population especially those within residential care

Continue to work with primary care to improve effectiveness of Endoscopy programme.

Continue to provide direct access to X-ray, ultra-scan, and CT to primary care.

Map of Medicine utilisation within the health sector, streamlining synergies in our current models of care amongst various the service providers.

Refer PP29: Improving waiting times for diagnostic services:

Coronary angiography – 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days).

CT and MRI • 95% of accepted referrals for CT

scans, and • 85% of accepted referrals for MRI

scans will receive their scan within six weeks (42 days)

Diagnostic colonoscopy

75% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 days), 100% within 30 days

65% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days) 100% within 120 days

Surveillance colonoscopy – 65% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date, 100% within 120 days

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2.3.6. Cardiac – Secondary Services

Our Approach

Tairawhiti residents currently have amongst the highest access rates to cardiac surgical interventions

across the country, this will be maintained. In conjunction with Waikato DHB, our Cardiac Tertiary

provider, we will focus of reducing waiting times to treatment and diagnostic procedures.

Linkages




Action Plan


Health system success is measured by

Reporting

Cardiac Work with Waikato DHB to manage waiting times for cardiac services, so that no patient waits longer than four months for first specialist assessment or treatment. Initiatives we will be working on include

• Improve equity of access to cardiac diagnostics by achieving planned FSA volumes through visiting cardiology outpatient clinics including virtual FSA volumes.

• Early identification of cardiovascular risk and referral through early completion of (<4 hours of admission) TIMI risk scores –audited yearly to enable ACS patients to receive their angiograms within a maximum 3 days of presenting.

Elective Services Patient Flow Indicators: all patients wait four months or less for first specialist assessment and treatment from January 2015.

TDH intends to undertake a number of local initiatives to ensure population access to cardiac services are maintained above the agreed rates. These included-

Continue the early identification of patients with confirmation of new murmurs by allowing general practitioner’s direct access to echo services.

Cardiology Clinical Care Nurses will continue to act as a clinical resource for primary care to support a seamless transfer of cardiology patients across the cardiology care pathway

Cardiology Nurse led follow-up clinics assist in reducing waiting times for patients and act as the pivotal point for patient referrals to other services such as cardiology and medical outpatient clinics, cardiac investigations, cardiac rehabilitation, and support services such as dietetics and social services.

Local Cardiac network aligns and supports work programmes rolled out from the Midland Cardiac Clinical Network.

Refer SI4: Standardised Intervention Rates. Cardiac surgery: 6.5 per 10,000 of population Percutaneous revascularisation: 12.5 per 10,000 of population Coronary angiography: 34.7 per 10,000 of population.

2.3.7. Primary Care

Our Approach

We will work with our primary care partners to drive system and clinical integration, improve service efficiency and sustainability, through capacity development, consolidation and monitoring of performance with our PHOs.

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The Alliances will work to:

Strengthen accountability and align with government priorities

Support delivery of regional and local priorities within our means

Financial incentives

Non-financial incentives

Shifting services closer to home

Collaboration with community NGOs TDH is taking a local approach in developing a more integrated health system through its Alliance

partnerships with primary care (for instance, through its Alliance Leadership Forum (Tairawhiti

Integration Forum (TIF), local clinical leaders forum and clinical integration group (Tairawhiti

Integration Committee (TIC). System integration is also being supported sub-regionally through the

work of the Midland Health Network Trust (MHN) through participation in its Alliance Leadership

Team (ALT), and the various Service Level Alliance Teams (SLAT). Similar work is occurring with the

National Hauora Coalition and in intensive work-out work activity with Ngati Porou Hauora.

Through TIF, Tairawhiti will be implementing Health Care Home (HCH) across the district in the

2015/16 year. HCH is having a single place which will connect the patient with health and social

service systems. This team based approach, lead by primary care clinicians, will provide

comprehensive and continuous health and social care to empower patients to make the most of

health services and will reduce the demand for unplanned and low acuity care on hospital services.

The work of the redevelopment of services to the district’s East Coast population will be finalised

early in the 2015/16, this will offer significant opportunities and challenges to each community on

the East Coast as well as services providers. All these communities have requested more ownership

of how health services interact with them and we look forward to this positive challenge which will

enable the communities’ to take control of their health. Through TIF and TIC we will, using alliancing

principles, develop integrated plans for E Tipu E Rea, Primary Care (including Rural Health), and the

Prime Minister’s Youth Mental Health Project – Youth Services.

Finally, the Midland Regional Plan has a system integration focus in some key areas including renal,

maternity and cardiac services. We intend to maintain our impressive downward track in acute

demand over the last 2 years, working in partnership with primary care.

Linkages




Better, Sooner, More Convenient

Action Plan


Tairawhiti Integration Forum

Tairawhiti Integration Forum will continue its focus on the three priority areas of Child (-9 months to 5 years), high resource patients with chronic conditions, and high acuity patients with limited interaction with health care services. The work programme will include

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oversight of the two service level teams for rural and youth health services and the establishment of a long term conditions service level team, and continue to support the proposals from TIC which would improve the treatment pathways for patients and clinicians. Work streams agreed by the TIF will continue to link with the broader Alliances and where possible make use of the Flexible Funding Pool to meet identified service changes such as the E Tipu E Rea coordination and package of care service. E Tipu E Rea, our child work programme will implement the first phase of developments at the beginning of July 2015 being the new coordination hub, refined service specifications for the wrap around services and additional packages of care for most high needs children and whanau. The Tairawhiti Long Term Conditions Service Level Alliance Team (LTC SLAT) will be established with representation from NGOs, primary and secondary care services and consumer groups. See Also System Integration: Diabetes and Long Term Conditions for LTC SLAT role detail.

Coordination hub and package of care framework implemented July 2015

2015/16 service agreements

reflect outcomes framework

Tairawhiti Integration Committee

Tairawhiti Integration Committee will continue to push forward concepts identified through the clinical leaders’ forum to improve the treatment pathway for patients and clinicians. Initiatives for 2015/16 include • Improving quality of secondary care e-

discharge summaries • Monitor the implementation of Primary

Options –Mental Health and Addictions (POMHA) which supports the re-integration back into primary care of targeted tangata whaiora from specialist services, and supports primary care workforce development to manage this transition.

Monitor the transition of the DHB District Nursing IV service to primary care under the Primary Options umbrella.

Monitor and continue to identify strategies to increase primary care utilisation of Map of Medicine and Primary Options

Continue as vehicle to identify and support initiatives to enhance primary (and community) care interface with DHB

A continued downward trend in the districts acute demand curve The target tangata whaiora transition successfully back to primary care: their personal and mental health are well supported with oversight/intervention by specialist services as clinically required. Primary care workforce is developed District Nurse IV service successfully and sustainably transitioned to primary care. Increased utilisation of Map of Medicine and Primary Options Virtual clinical volumes in

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specialist services, e.g. the implementation of the TDH medical outreach initiative, identification of where and how Primary Options could be further developed to support “care closer to home”

hospital SLA increased to enable increased GP-Specialist communications

Rural East Coast Services

The Rural SLAT, implemented in early 2015 will undertake the role of oversight and service planning of primary care services on the East Coast, including:

Assessment of current rural primary care services and identification of gaps and issues affecting the sustainability of services.

Implementation of agreed work plan including service improvements with the use of the new rural primary care funding.

Community development to improve, within each rural East Coast community, the skill base required to take ownership of their care.

Support the development of the intervention logic model of improved integration and coordination between rural primary care and associated rural health services available on the East Coast

Sustainable rural primary health care services.

Free Under 13s Tairawhiti DHB will work closely with primary

care and pharmacy partners to implement the

free general practice visits and prescription co-

payments for children under 13 years of age.

All Tairawhiti children under

13 have access to free health

care.

Health Care

Home

Midlands Health Network • Further development and roll out of the

Health Care Home model of care to ensure a fit for purpose sustainable primary care environment - create capacity for patient-specific appointments

• Scope the potential for the development of Expert Patient Groups for those with common needs to facilitate self-management of long term conditions.

Other PHO’s,

Through TIF the DHB will encourage the participation of the districts other PHOs to

50% of the MHN networks population will be covered by HCH by 2017 Greater standardisation and increased capacity within primary care by July 2015 Increased capacity within HCH sites by June 2016 Primary options service for acute and non-acute care is accessible Roll out to create capacity for patient-specific appointments – 30 percent of practices by June 2016 Self-management groups established in each locality by June 2016 Localised implementation plan by Oct 2015

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incorporate the development of health care home services into their service improvement plans.

Go live June 2016 Initially review by Dec 2017

Diagnostics Continue to enable direct access to x-ray, ultra scan and CT from primary care, Community Radiology expenditure for the district has increased by 24% to $4.116M, with $20,000 being set aside to fund radiology services based at 3 Rivers Medical centre.

Improvement in annual GP survey results

Primary Options

Primary Options will continue to be refined and promoted to increase the effective management of patients in primary care and the community. Two new services functioning within primary options will be implemented by July 2015. • The Community IV Cellulitis Clinic Service

will ease the burden on ED and the district nursing service.

• The Primary Options for Mental Health and Addictions will shift people with stable and enduring mental health illness or addiction back to primary care management, ensuring specialist resources are used appropriately and that these patients receive appropriate personal health care alongside their ongoing mental health care.

Increased utilisation by primary care of Primary Options and more people manage without need for a secondary care attendance

Integrating Services into the Community

Tairawhiti Integration forum will support the following activities • Co-location and integration of

administration function of NIR, OIS, NCHIP and B4School Check

• District Nursing integration into Community based services

• Specialist Diabetes service integrated as part of primary care network and the Health Care Home

Implementation plan by September 2015 Services colocation by Dec 2015 Implementation plan June 2016

Data Quality Midland Health Network specific activity • As part of the N4 grouping the

establishment of a standard national primary care dataset and data warehouse

• Integration of national and hospital datasets in the MHN data warehouse to support the deployment of active locality profiles

By June 2016

IPIF Support the ongoing evolution of the Integrated Performance and Incentive Framework (IPIF).

Improved performance of the district-wide system.

IPIF

quarterly

reporting

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2.3.8. Health of Older People

Our Approach

During 2015/16 we will continue to work with our primary care partners and regional DHBs to

develop and refine integrated services that will address the needs of older people - from those with

basic needs to those whose needs have a greater complexity where more restorative outcomes can

be expected. We have set up a Health of Older People (HOP) Service Level Alliance Team (SLAT)

project which will identify current gaps and develop sustainable pathways for older people across

primary, secondary and tertiary services.

During 2015/16 we will continue our focus on establishing a regional approach to the purchase and

delivery of Home and Community Support Services. The Midland DHB region will participate in the

development of the national Health of Older People Steering Group’s national framework on cost

implications of quality care. Where applicable we will use the framework to inform decision-making

about the implementation of a Midland DHB regional approach.

Linkages





Action Plan



Home and Community Support Services for Older People (PP23)

Work with HCSS providers to commence implementing in-between travel requirements

Confirm the funding resultant of the in-between travel settlement is transferred from the DHBs to the contracted HCSS providers, to the qualifying employees for qualified travel time and qualified travel costs.

Use of interRAI measures to progress and compare performance with other DHBs.

Work with HCSS providers to implement national complaints process

Use of quality measures for HCSS identified by the DHB HOP Steering group

Work with regional DHBs to complete the regional DHB HCSS model of care change

Implementation of Phase 1– in between travel – paid time and paid mileage for HCSS support workers. Confirmation of transfer of funding from in-between travel settlement. Evidence of DHB using interRAI quality measures to progress and compare performance with other DHBs National HCSS complaints process in place by July 2016 HCSS services move to responsive model of care by July 2016

Quarterly update

Dementia Care Pathways (PP23)

Work with regional Dementia Care Pathway group to implement regional

Evaluate and report progress

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dementia clinical pathway initiatives, including access barriers to driving assessments

Continue development of dementia care pathways, building on previous work to develop further components of the dementia pathway through the HOP SLAT project

Include in the HOP SLAT workstream for EPOA/Dementia, development of processes to monitor impact of Tairawhiti clinical pathway programme, with particular attention given to access to care and support for rural patients with dementia and their whanau

Continue to collect data relating to current support services for people with dementia and their carers

against regional plan

Plan to improve access to driving assessments completed

Provide specific detail of improvements to support and services available following a dementia diagnosis (eg, education, increase funding, information, on-going support).

Report progress of the HOP SLAT EPOA/ Dementia workstream

Report and evaluate referral volumes to NASC, Alzheimers Society and specialist services

Report number of education sessions for health professionals held on identification and management of delirium and dementia

Monitor and report on access to respite services

Record carer participation in Alzheimer Society education programmes

Quarterly update

Fracture Liaison Service (PP23)

Monitoring and measuring the number of people who are seen by the service and the treatment that they receive (i.e., osteoporosis treatment, referral to fall prevention programmes, referral for interRAI assessment).

Establish a fragility fracture register for Tairawhiti

Report through Policy Priority 23 (PP23) for

Show that the DHB has established a Fracture Liaison Service (FLS) and is monitoring its operation, in particular report the number of people who are seen by the service and the treatment they receive (ie, osteoporosis treatment).

Database in place to monitor volumes of fragility fractures, interventions, prevention recommendations and the proportion who have a secondary fracture

interRAI (Comprehensive Clinical Assessment in residential care and in home settings) (PP23)

The number and percentage of older people who have received long-term support services at home in the last three months who have had an interRAI homecare or a contact assessment and

Evidence of the number of older people who received long-term support services for home and community supports. Percentage of older people in aged residential care by facility who have a second interRAI

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completed care plan.

The percentage of older people in aged residential care by facility who have a second InterRAI LTCF assessment completed 230 days after admission.

Older people referred for an interRAI assessment to access publicly funded care services will undergo the assessment and have a service allocated/declined in a timely manner.

Work with primary care partners to find opportunity to extend read only access of InterRai for primary care

LTCF assessment completed 230 days after admission. Show time taken from referral from any source to complete (not triage) an interRAI assessment (ie, Contact, MDS-HC, assessment) and complete service allocation. Read only access to interRAI for primary care has been accepted as a good initiative by PHO partners but an opportune time for implementation has yet to be decided. A regional PHO network approach needs to be developed

Health of Older People Service

Through the recently set up HOP SLAT, develop an integrated pathway for older people to access health services through primary, secondary and tertiary services, including a single point of entry to Gisborne Hospital

Ensure DHB specialist Health of Older People Services (geriatricians, gerontology nurse specialists) advise and train health professionals in primary care and aged residential care to ensure quality outcomes for older people.

Progress reports on this workstream

The DHB provides data to evidence type of specialist support, number of hours or consultations that specialist HOP services consult with health professionals in primary care and aged residential care.

(Please note there is no IT system being developed as referenced in the MoH feedback

Psychogeriatric Care

Develop clear criteria and pathway for patients requiring psychogeriatric residential care Increase availability of support services for older persons with mental health and addiction issues in aged residential care facilities. Increase community mental health and addiction providers involvement with clients within ARRC

Criteria and pathway developed 2 information sessions delivered to ARRC facilities within Tairawhiti

HOPS Nurse Practitioner

Support aged care staff in their knowledge and skill set around falls reduction.

Number of education sessions for aged care staff

Elder Abuse Support consistent policies and procedures across service providers for elder abuse Stocktake of support currently in place and gaps identified

Progress reports on this HOP SLAT workstream

Advanced Directives and enduring powers of attorney

Support implementation of Advanced Directives in aged care including “Yellow Envelope” transition between hospital and aged care. Establish local guidelines between ARRC,

Yellow envelope system in place December 2015 Progress reports on this HOP

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Department of Justice, Ministry of Social Developments and TDH on enduring power of attorney to reduce timeframes for issues to be resolved.

SLAT workstream

Supporting providers

Continue to support and increase the availability to local providers with DHB organised training opportunities

2.3.9. Mental Health Service Development Plan

Our Approach

TDH is working towards a more integrated continuum of care as articulated in “Rising to the

Challenge”. We will see more integrated and responsive services which demonstrate a consumer-

focused, whatever-it-takes approach of creativity and innovation leading to excellence. The links to

primary care providers have been established with greater emphasis to be placed on addressing the

physical health needs of people with serious mental illness and/or addiction. The Service

Development Group which meets monthly underpins the continuum of care within the sector.

The single point of entry into adult mental health and addiction services is now in place with further

work planned to ease access for people who have previously been cared for by specialist services.

Determining how to best support people with high and complex needs related to serious mental

illness and/or addiction in Tairawhiti continues, with Midland Mental Health and Addiction Regional

Network also working on a regional approach.

Other key areas of activity include Tairawhiti’s suicide prevention and postvention plan, perinatal and

infant mental health, adult alcohol and other drug services and respite for young people with serious

mental illness and/or addiction.

The action plan is based around the four objectives of “Rising to the Challenge” –

1. Use current resources more effectively

2. Improve integration between primary and specialist services

3. Cement and build on gains in resilience and recovery

4. Deliver increased access for all age groups

Considering current information, four actions may remain outstanding at the end of June 2016; these

include the following.

Employment specialists

Sustained reduction in seclusion rates for Māori

Other population-specific interventions

Enhance responsiveness and flexibility of specialist mental health services for older people

Funding decisions will reflect the terms and conditions of the ring fence for mental health services.

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Linkages


PP25 Prime Minister’s youth mental health project

PP26 Mental health services development plan

Midlands regional services plan



Action Plan



Reporting

Improve specialist service performance using national performance indicators and service user feedback

TDH will actively participate in the national KPI forums (Adult, and Child and Youth)

Improvement against KPIs each year

Service Development Plan

Maximise the percentage of staff time spent in direct service delivery

Fully implement single point of entry in adult mental health and addiction services by September 2015 Implement fast-track process for people to re-enter specialist mental health and addiction services by June 2016

Access rates to adult specialist adult mental health services Stakeholder feedback (using Real Time if implemented in TDH)


Support fit-for-purpose service configuration

Review provision of primary health care (physical health) to people with serious mental illness and/or addiction by March 2016 (if approved by TDH Advisory Committee in February 2015) Make any changes as the result of the review by June 2016 Work with providers in the mental health and addictions sector to implement three yearly agreements and service evaluations to improve sustainability

Resulting review report to TDH Advisory Committee Changes implemented by June 2016 Three yearly agreements with NGOs signed by 30 July 2015

Service Development Plan Review report Service Development Plan

Support service users in the role as parents

Work with the Ministry of Health and the local sector to implement stages of the COPMIA guidance

Measures to be confirmed in COPMIA guidance


Work to prevent suicide among people known to mental health and addiction services

Implement the cross-sector Tairawhiti Suicide Prevention and Postvention Plan (due to Ministry of Health by 20 April 2015) including workforce development and a coordinated, cross sector response to suicide)

Reduction in rate of suicides for Māori aged 15 to 24 years of age Support for individuals and whanau post-suicide


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Reporting

Work collectively to improve coordination

Strengthen coordination of care for those with Eating Disorders in Tairawhiti by April 2016 Contribute to Midlands representation on the supra-regional clinical governance and implementation groups to accurately reflect Midlands’ needs (date to be agreed)

Agree transition process to adult mental health services by April 2016


Employment specialist

With NGO partners and other key stakeholders, agree an approach to support people with serious mental illness with seeking employment

Draft approach agreed by December 2015 Implemented by July 2016


Acute impatient alternatives

Complete plan with stakeholders to implement a local response to supporting people with high and complex needs as a result of serious mental illness and/or addiction as per approval from TDH Board (paper due by May 2015) by September 2015

Identify potential partner(s) by March 2016

Contribute to regional stocktake and position paper regarding people with high and complex needs as a result of serious mental illness and/or addiction, and judge its relevance in Tairawhiti (date to be agreed)

Plan completed by December 2015 Potential partner(s) identified by March 2016 Stocktake and paper completed by agreed date

Service Development Plan Stocktake and Midlands position paper

Prioritised forensic adult mental health services development

Contribute to development and implementation of a regional forensic pathway to assess relevance and applicability to Tairawhiti (date to be agreed)

Pathway completed by agreed date


Kaupapa Māori Services

Work with Kaupapa Māori provider to complete implementation of the recommendations from the Review Report (released December 2014) of by October 2015

Work with Kaupapa Māori provider to evaluate effectiveness of service changes by June 2016

Recommendations implemented by October 2015 Evaluation completed by June 2016

Service Development Plan Evaluation report Board report

Support a coordinated multi-agency response for youth with complex interagency needs

Meet with local stakeholders in youth forensics to ensure processes are consistent in the central region by December 2015

Implement recommendations regarding provision of community-based respite for young people with serious mental illness and/or addiction by June 2016

Processes are consistent with central region by December 2015

Provision of community-based respite for young people with serious mental illness and/or addiction by June 2016

Service Development Plan Board paper

Specialist mental health services for

Establish local clinical network for perinatal and infant mental health, which

Local clinical network in place by December 2015


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Reporting

high-needs whanau with infants

feeds into the regional network, by December 2015

Contribute to regional work to review spend, develop access measures and pathways to after-hours services

TDH local network is represented at Midlands Clinical Network

Enhance the responsiveness of specialist addiction services to justice services

Complete stocktake of adult alcohol and other drug services to identify areas of need or oversupply by December 2015

Implement any resulting changes by June 2016

Stocktake completed by December 2015

Plan to address issues agreed by March 2016

Any resulting changes implemented by June 2016

Service Development Plan Stocktake & plan Board report

2.3.10. Maternal and Child Health

Our Approach

Local focus will be to continue the work of the Tairawhiti Integration Forum’s project E Tipu E Rea as

well as working with our primary care partners to improve immunisation rates (95% of 8 month olds),

and continuing our excellent performance in the B4 School checks and school-based health services.

We will also work with our primary care partners to ensure the delivery of the free under thirteen

years after hours service and implement the electronic ‘Child Health Platform’ (NCHIP). NCHIP will

provide the opportunity for Tairawhiti to look at the integration of service coordination and

administrative support under the E Tipu E Rea coordination hub.

During 2015/16, TDH will be working sub-regionally with other DHB colleagues and with Midland

Health Network in a Service Level Alliance Team to ensure that there is vertical and horizontal

integration across primary, community and secondary care through development of the child health

platform. As part of the Midland regional plan, we will also be continuing to work with our Midland

DHB partners to progress the implementation of the national maternity quality standards, as well as

implementation of the regional maternity programme looking to improve the workforce capacity

across DHBs.

Linkages

E Tipu E Rea





Rheumatic Fever Plan

Action Plan


E Tipu E Rea E Tipu E Rea service commencement (phase 1) 1 July 2015.

• Completion of review into DHB service

The targeted 20% service user cohort utilising E Tipu E Rea services.

Board Tairawhiti Integration

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disinvestment and reinvestment (so to support ongoing E Tipu E Rea funding) completed by January 2016.

E Tipu E Rea service delivery evaluation (against agreed outcomes and including qualitative reporting from service users and wider stakeholders) completed May 2016.

• E Tipu E Rea Network finalises all identified changes to the E Tipu E Rea service delivery model for 2016/17 by June 2016

• Continued progression of the Tairawhiti Well-being: a Collective Impact framework for E Tipu E rea (and other cross sector initiatives). This is phase 3 of E Tipu E Rea, i.e. moving to a cross sector service model

Investigate incorporating Children’s Action Team administrative and support function within the E Tipu E Rea coordination Hub

E Tipu E Rea community hub in place. Wider stakeholder and service user evaluation confirms E Tipu E Rea is reaching those most at risk-and applying a “whatever it takes” and whanau driven solution. Service disinvestment and reinvestment completed so that service delivery capacity aligns with service need.

Forum

Timely registration with an Lead Maternity Care (LMC)

TDH will work with the wider sector including Primary Care providers, Lead Maternity Carers (LMCs), WellChild/Tamariki Ora (WCTO) providers, Community Oral Health Services (COHS) and with local communities to achieve national maternal and child service access expectations. Increase number of women who register with a LMC by week 12 of their pregnancy through working with the Maternity Quality and Safety forum. Implementing the pregnancy Map of

Medicine pathway into primary care for early referral pathways from a positive pregnancy test

• Work with primary care to ensure every pregnant woman is enrolled with a PHO and registered with a GP.

Work with primary care and school health services to implement an active referral pathway and follow up from primary care to LMC following a positive pregnancy test and ongoing communication and relationship between primary care and LMC

Ensure that at all points of purchase of pregnancy test information on LMCs is available.

LMC’s are represented on the 2015/16 youth alliance team.

Through TIF, advocate for early implementation of the electronic ‘Child

At least 80 per cent of women register with an LMC by week 12 of their pregnancy. 98% of newborns are enrolled with a PHO, general practice, WCTO provider and COHS by three months. 95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC. New mothers are fully engaged with a WCTO provider before LMC’s handover

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Health Platform’ (ENCHIP) within Tairawhiti • Work towards progressing a system where

registration with LMC continues live births into the newborn enrolment system

Ensure that early enrolment with a LMC is covered by the E Tipu E Rea in both the high needs and universal work streams.

Pregnancy and parenting

Sufficient capacity is available to ensure that any pregnancy woman can access a pregnancy/parenting class Ensure pregnancy and parenting education meets the needs of first time mothers with a focus on the needs of vulnerable groups such as teen parents. E Tipu E Rea /mama and pepi model working with vulnerable mums Hauora work with these families anyway to stop them reaching next level Brief advice and smoking cessation is offered at each interaction between pregnant woman and the health service. Work with Gisborne Hospital sonographers to ensure the smoking damage is highlight to all pregnant smokers at each scan and that Cessation support services are readily available to provide follow up support Provide Smoking Cessation Support at key pregnant women/ health services interactions, such as first trimester ultrascan. Encourage pregnant women who smoke to participate on the WERO quit smoking competition

95% of pregnant women receive continuity of primary maternity care through a community or DHB LMC. 80% of women who register with an LMC do so in their first trimester. 30% of Māori, Pacific and teen pregnant women complete DHB funded pregnancy and parenting education Decrease in the percentage of mothers who smoke

Maternity Quality & Safety

Tairawhiti will review the Maternity Quality and Safety Programme and work with the Te Puia Springs facility to ensure the programme is fully operational across the district. . Tairawhiti DHB will continue to participate in the Midland regional data priorities group, to develop a comprehensive dashboard of top priorities for quarterly reporting. The following four indicators have been selected by the maternity clinical indictor team for Gisborne Hospital. These indicators have been chosen as they represent the four indicators which have the most significant variation to the national mean. Clinical Indicator 7. Standard primiparae sustaining a 3rd- or 4th-degree perineal tear

Review Maternity Plan developed and implemented for Te Puia Springs by Sept 2015. By September 2015 review the dashboard indicators to enable quarterly reporting

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and no episiotomy Clinical Indicator 9. Women having a general anaesthetic for Caesarean section Clinical Indicator 10. Women requiring a blood transfusion with Caesarean section Clinical Indicator 12. Premature births (between 32 and 36 weeks gestation) The team will by Sept 2015, have looked at in sufficient detail to ascertain the probability the variation seen for the four indicators is not the result of low volumes. The team will also learn and apply findings from this data review which will improve rates. Implement the national guideline for the screening, diagnosis and management of gestational diabetes – Mary Clare / Nicki

Reduction in negative variances between Gisborne Hospital and National means

Oral Health To improve referrals, completions and oral health outcomes for children 0-18 years of age by: • Continuation of an oral health project to

improve oral health outcomes • Community Oral Health Service will be

actively involved in the referral pathway between WCTO, OIS, B4 Schools and primary care

• continue the current campaign to raise the profile of the service to whanau and the importance of teenagers continuing with their oral health checks

• Work with the immunisation steering group to ensure referral pathways are in place from WCTO and B4 Schools and primary care

• Promote oral health and Lift the Lip with all community, primary and secondary providers of services to children and their families

• 95% of pre-school children are enrolled with child oral health services by June 2016

• 48% of five year old children being caries free at five years

• diseased, missing or filled teeth mean of 1.0 DMFT for year 8 children

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2.4. Improving Quality

Our Approach

Quality and patient safety are a top priority at TDH with many

initiatives successfully in place and others underway. But there is

always more to do. Staff want to make a difference for our patients

and their ongoing actions are critical to patient safety.

We are committed to implementing the initiatives specified by the

Health Quality and Safety Commission through its “Open for Better

Care” programme which is underpinned by the New Zealand Triple

Aim. AS part of this programme in 2013 TDH published its first

Quality Account which recorded the quality improvement which abound in the organisation to

improve patient quality and safety. All DHB staff, clinical leaders and managers are responsible for

improving quality and participating in quality improvement initiatives and projects.

The key work areas are:

Continuing to keep our patients safe

- By participating in the national patient safety campaign – reducing falls resulting in harm,

reducing surgical site infection, reducing peri-operative harm (including safety in theatres

and venous thromboembolism (VTE)) and reducing medication errors

- Improving our hand hygiene compliance

- Reducing the number of patients who develop a pressure injury whilst in hospital

- Minimising seclusion practice in mental health

Continuing to improve the quality of end of life care for our patients

Continue to work to improve our escalation process when a patient’s condition deteriorates

Improve our customer care and responsiveness to patient needs

These areas were chosen because of the common themes identified from our serious event

investigations or because our patients raised them as concerns.

Quality of care, listening to our consumers and community and preventing harm are at the centre of

TDH’s quality improvement plan. This work is both directed from a clinical governance framework

and from a floor up approach.

Linkages

TDH Quality Plan

TDH Quality Account

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Action Plan


Improving Quality

During 2015/16 Tairawhiti DHB intends to - Fall Prevention: - We are intent on improving the percentage of patients who have an individualised care plan when the falls risk assessment shows that they are at risk of falling whilst in our care. Individual wards will be reporting to the senior management team on both the QSMs on a weekly basis and will be held accountable when this has not been achieved. We will also review our current Falls Prevention policy and implement changes through orientation and regular updates throughout the year. Wards audit their falls risk assessments and display on their “knowing How we are Doing” Boards as part of the Fit approach. We continue to use all the resources that have been produced by the HQSC . The Tairawhiti falls prevention group is a well attended multi agency group and we intend to pursue falls prevention across the region through the work of this group which now reports quarterly to the Health of Older people group.

Hand Hygiene: - we will continue to audit and report on our compliance rate against the 5 moments three times a year.. We had reached our target but have had difficulty sustaining this over the past year.. This has been discussed at Clinical Board and Leadership Team with a commitment of senior clinicians to ensure there is frontline ownership of the patient safety practice. We also want to re-launch hand hygiene with a focus on patient involvement. If patients were empowered to ask staff about washing their hands we believe this will help us maintain / improve the target. We have a total of 4 gold hand hygiene auditors who are encouraged to do at least 100 moments at every audit.

Surgical Safety Check List – TDH participate with the HQSC’s focus topic with different activities planned on a monthly basis. These included setting the scene & the reason for change, launching the surgical safety check list as a quality improvement programme within theatre; inviting observers to watch surgical teams carry out the safety check list at all three stages and continuous audit. This work will now refocus in line with the next stage of reducing perioperative harm which embraces the importance of teamwork and communication. Tairawhiti District Health have opted to go in cohort 2 of the training that is being rolled out to support this next stage.

Antibiotics for hip and knee surgery: - This has and will continue to be a focus area for TDH. It is a policy requirement and surveillance is continuously monitored and reported. Any breach will be investigated via an incident reporting system.

90% older patients are given a falls risk assessment All patients deemed at risk will have an individualised care plan documenting interventions that will help reduce their risk of falling. 80% compliance with good hand hygiene practice all three parts of the surgical safety checklist are used 100% of the time 95% hip and knee replacement patients receive cephazolin ≥ 2 g as surgical prophylaxis100% of patients undergoing hip and knee replacements will have the recommended skin antisepsis in surgery using alcohol &

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TDH will work with HQSC to participate in quarterly data collection of patient experience. The patient safety, quality & risk plan identifies that consumer involvement is required in all services and will be using the experience of mental health where consumer involvement is well embedded. Consumers will be invited to participate in any service re-design or new service commencing. We are implementing a policy around patient registration and identification as previously we did not collect email addresses. This has provided an opportunity to improve our systems and processes around this important area. Once training has been given we anticipate that we will be able to participate fully in the patient engagement survey and thereby have meaningful data to improve the experience for our patients.

TDH will introduce electronic medicine reconciliation in

line with the National rollout and will participate in HQSC

Safe Use of Opioids Collaborative to reduce the side

effects of these drugs. A charter has been developed with

an action plan.

Quality Account to be produced in 2015/16 will be

informed by HQSC guidance and feedback on the previous

year’s account. We intend to make the document more

representative of health providers across Tairawhiti

rather than just a “provider Arm” account. To do this we

intend to engage first with Planning and Funding and then

with the CEs of the PHOs at their June meeting by

developing a paper for that meeting. This process has

commenced. During the ensuing process we aim to also

have consumers inform the content of the Quality

Account.

We commit to maintaining appropriate mortality and

morbidity review systems, including supporting national

mortality review committee processes.

chlorhexididne or povidone / iodine and 100% of these patients will receive prophylactic antibiotics 0 – 60 minutes before incision Performance updates published by HQSC and will be included in DHB local quality account Quarterly Reporting on patient experience as set out in performance measure DV3 ‘Improving patient experience’ Patient safety medication stickers will be used when an opioid is prescribed. The 2014/15 Quality Account will be published in December 2015.

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2.5. Living Within Our Means

Our Approach

We will be focusing on the following initiatives to enable us to live within our means:

Funding Health Benefits Limited to support and advance their initiatives to achieving savings

and efficiencies for DHB Provider Arms;

Funding and/or participating in all other National Entity Initiatives as required by the Minister

and the Ministry. The financial impacts of the National Entity initiatives have been included in

full in the Annual Plan, as expected by the Minister;

Care Capacity Demand Management and Releasing Time to Care (implemented together as

the Fit Approach) in wards and departments to ensure the best possible matching of patient

need to staff resources which will lead to improved outcomes for patients, increased staff

satisfaction and lower overall cost of service;

Working to maintain Provider Arm staffing levels with a consequent net saving in Outwards

IDFs;

These initiatives will all have a role to play in ensuring TDH operates in a financially sustainable

manner, ensuring delivery of agreed services within available funding. This is important for the

resident population and also for the “health” of the organisation generally and will better enable TDH

to respond to the low funding increase environment in 2015/16 and forecast into the future.

Linkages

Stewardship Module


Action Plan


Living within our means

Operate within agreed financial plans

Appropriate clinical and executive leadership

Actions include:

Continue the implementation of Shared Services actions aligned with Health Benefits Limited (HBL) work programmes as agreed

Increase theatre utilisation

Proactive management of employment cost growth and improved use of workforce

Reconfigure current service delivery models

Increase in service outputs delivered within a primary care and/or community setting, relative to hospital delivery, and reduction in demand for acute hospital services

Further roll-out of the Fit Approach

System Integration 3: Ensuring delivery of Service Coverage

Ownership OS3: Inpatient Length of Stay

Ownership OS8: Reducing Acute Readmissions to Hospital

Output 1: Output Delivery against Plan.

Savings target is met

Financial targets are met

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and completion of revised staffing profiles for wards/departments.

Allocated savings actions are carried through to completion by the assigned responsible leader.

2.6. Supporting Delivery of Regional Priorities

Our Approach

Workforce and training plans illustrate the collaborative work of the Regional Director of Training

and General Managers of Human Resources building whole of health solutions and also working

alongside the Clinical Networks to meet some of their key deliverables that pertain to workforce and

training.

Within the Midland Regional Plan we aim to develop the principles of culture, capability, capacity and

change leadership. We recognised that there are longstanding gaps and weaknesses in our

knowledge around the current workforce, particularly relating to the capability and capacity.

In 2015/16 the overarching imperative for TDH to meet our goals, are collaboration and

connectedness locally, regionally and nationally.

Linkages

Stewardship Module


Action Plan


Actions to Support Delivery of Regional Priorities

Trauma • Tairawhiti will participate in the Regional

Trauma Team MDTs and in the regional training network

• The mission of Tairawhiti Trauma Service is simple: To ensure best practice in trauma care to patients and their families along the journey from point of injury to optimal function.

• Tairawhiti DHB will provide scenario training for ED staff to ensure staff competency in the event of major trauma

• Tairawhiti DHB will continue to provide a dedicated trauma resource

• work towards Trauma Centre Accreditation (level III)

• Monthly mortality and morbidity reviews of major trauma and fulfilling learning/action points (loop closure)

• Aiming for bi-monthly mock trauma calls to test the system and enhance multi-disciplinary team work, including time for debrief and resulting

Attendance at regional trauma meetings Number of scenario training sessions delivered to ED staff Monitoring key trauma performance indicators to track improvements made As per national requirements

Quarterly

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action points • Senior clinician involvement in trauma care

quality improvement programme audit and training

Growing the Health Workforce through Strengthening Recruitment, Retention and Repatriation

• Retention and recruitment strategies for primary care workforces

• Review and improve strategies around the management of the ageing workforce

• Review and improve recruitment and retention strategies for rural vulnerable workforces

• Implementation of the Midland Training Network (MRTN) action plan

Establish ‘warm welcome here’ sites in each DHB in order to recruit, orient and socialise new health professionals to rural areas and to facilitate collegiality within the sector

Quarter 4

Strengthening Health Workforce Intelligence

Tairawhiti will continue to support the provision of a demographic information and forecasting model for all workforces identified by the Clinical Networks and some base line intelligence to target vulnerable, hard to recruit, new & emerging workforces

Participation and contribution to workforce planning to:

- Improve our understanding of current demographics

- Enable us to model workforces for future needs

Quarter 4

Shaping the Future Workforce through Transformative Change

Identify the potential capacity and capability of the ageing workforce and model how this cohort will continue to contribute to healthcare delivery within the Midland Region

Feasibility to introduce:

- Flexible work arrangements

- Phased retirement options

- Third age (post retirement) employment

Quarter 4

Building and Expanding the Capability of the Health Workforce

Develop a Midland Region platform and suite of e-Learning programmes for the health workforce

Develop a business case that proposes the future model of the Managed Virtual Learning environment (MVLE)

Quarter 1

Delivery of Regional IT Priorities

A current focus is on regional deployment the CSC ePharmacy application that will provide the underpinning for the regional deployment of the medication management pilot

The other programme currently under review is the deployment of the Orion CWS application within the Midland region. This will require significant reprioritisation of current activities at both a local and regional level to enable this to be brought forward.

Further information is available in the Midland DHBs RSP for 2015/16

Successful introduction of the ePharmacy application Quarterly reporting against RSP activities

Quarterly

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2.7. National Entity Priority Initiatives

Our Approach

We are expected to align our planning with the planning intentions of key national agencies. Each of

these national agencies has initiatives for the 2015/16 year, which will impact our DHB. The national

agencies and aligning activities of support are included in the below action plan.

Linkages

• Midland Regional Services Plan 2015/16 • Letter of Expectations • Module 2.4 Improving Quality • Module 2.5 Living Within Our Means • Module 4 Financial Performance • Module 5 Stewardship.

Action Plan

Initiative Description Benefits Tairawhiti’s Commitment

Health Shared Services (HSS)

Finance, Procurement & Supply Chain (FPSC)

HBL and DHBs are working together to implement a national Finance, Procurement and Supply Chain programme to combine their purchasing power - through standardising the ways goods and services are ordered, delivered, stored and paid.

Replanning. Revised numbers to be advised at the conclusion of this process.

The DHB will commit resources to the implementation of the FPSC initiative, and fully factor in expected budget benefit impacts.

Food HSS and DHBs are currently assessing options as part of completing the detailed business case for reducing the costs of Food services. It is a priority to improve the overall quality of hospital food service to ensure good nutrition for all patients.

Financial modelling in the Detailed Business Cases currently with DHBs for approval indicates that over the proposed 15 year contract term total sector benefits will be between $155m - $190m on a NPV basis. Individual DHB budgetary benefits will be advised when the Detailed Business Cases are approved, in line with existing agreements with DHB CFOs.

Linen and Laundry HBL and DHBs are currently assessing options as part of completing the detailed business case for reducing the costs of Linen and Laundry services, while improving service delivery quality.

Financial modelling in the Detailed Business Cases currently with DHBs for approval indicates that over the proposed 10 year contract term total sector benefits will be between $65m - $85m on a NPV basis. Individual DHB budgetary benefits will be advised when the Detailed Business Cases are approved, in line with existing agreements with DHB CFOs.

We will look at resources pending the decision reached in relation to the Detailed Business Case.

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National Infrastructure Platform (NIP)

The vision is for a national infrastructure platform with agreed standards and policies and a single governing organisation, delivered out of significantly fewer than the 40-50 current physical data centres. It will also align the health sector’s infrastructure services with the Government’s overall Information Communications Technology goal of harnessing technology to deliver better, trusted public services.

Financial modelling in the Detailed Business Cases currently with DHBs for approval indicates that over a 10 year timeframe total sector benefits will be $169m on a NPV basis. Individual DHB budgetary benefits will be advised when the Detailed Business Cases are approved, in line with existing agreements with DHB CFOs.

National Health Committee (NHC)

Pull model prioritisation (proactive work programme)

Prioritise future work programmes by undertaking review of two or three major programme budget spends (Tier 1 comparative analysis). Business Plan intentions to compare musculo-skeletal and eye, and endocrinology and neoplasm. A second tier of work will analyse specific disease states for suitability to undertake Health Technology Assessments and to lead the sector to develop improved models of care. Stakeholder engagement throughout process including with National Prioritisation Working Group to be established in early 2015.

Clinical outcomes are improved and the cost curve for health is bent by using a programme budget to identify large and fast growing health sector spends where there are models of care which deliver outcomes which can be improved and there is a reliance on technologies for which the evidence is untested. Notional budget will be identified through cost avoidance, efficiency and quality improvements and re-prioritisation.

The DHB will work collaboratively with the NHC to solve sector issues by: • Referring technologies that

are driving fast-growing expenditure to the NHC for prioritisation and assessment where appropriate.

• Engaging with and providing advice on prioritisation and assessments including through the National Prioritisation Reference Group

• Introducing consistently or not introducing emerging technologies based on the NHC recommendations

• holding technologies, which may be useful, but for which there is insufficient evidence, or which the NHC is assessing for further diffusing or out of business as usual

•Providing clinical and business expertise and research time to design and run field evaluations where possible.

Push model prioritisation (reactive work programme)

Call for sector to refer significant technology issues to the NHC for assessment. Process undertaken with assistance from the National Prioritisation Working Group.

Clinical outcomes are improved and the cost curve for health is bent by identifying new and significantly expanding technology cost drivers for the sector which are not captured by the NHC through the proactive referral process. Notional budget will be identified through cost avoidance, efficiency and quality improvements and re-prioritisation.

Innovation fund evidence generation activity

Trial promising technologies outside business as usual while evidence is gathered for final recommendations.

Hold technologies, which may be useful, but for which there is insufficient evidence, out of business as usual while the evidence is gathered in a standardised manner to support improved clinical outcomes in a fiscally sustainable manner. Notional budget will be identified through cost avoidance, efficiency and

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Initiative Description Benefits Tairawhiti’s Commitment quality improvements and re-prioritisation.

Health Quality and Safety Commission (HQSC)

Surgical site infection programme (SSIP) - National Infection Surveillance Data Warehouse

DHB support for ongoing hosting costs of the national surveillance data warehouse from July 2015 ($0.24m p.a.).

Goal - Removal / reduction in preventable patient harm resulting from surgical site infections throughout the New Zealand health and disability sector. An ability to deliver a consistent approach to the monitoring of SSIs. An ability to provide accurate outcome measures for SSI. Measurement of reduction in SSI rates. Financial benefits will vary by DHB. The additional cost of treating patients with an SSI has been conservatively estimated at $21,000 per SSI

The DHB will commit to meeting infection control expectations in accordance with Operational Policy Framework - Section 9.8.

Surgical site infection programme (SSIP) - DHB Infections Management systems (ICNet NG system)

DHB adoption of Infections Prevention and Control Systems investment and implementation including local integrations. Both Hospital and Community with National hosting. Costs are dependent on DHBs' decision to take up the system. Overall sector costs estimated at $1.5m capital and $2.5m ongoing operating.

National and local surgical site infection surveillance system to generate verifiable information that drives practice change and improvement

The DHB will continue development of infection management systems at our local DHB level.

National inpatient patient experience survey and reporting system - Patient experience indicators

National in-patient survey to be used by all DHBs quarterly that can be incorporated in existing local patient experience surveys that provides a nationally consistent model of patient experience indicators

Patient experience indicators help measure and report how consumers and patients actually experience the health system. eg. what happened to them and how did it make them feel? By capturing this consistently and coherently across New Zealand’s health system, this information can be used to make substantial improvements to both the experience and the actual quality of care received. Efficiencies are achieved with one nationally consistent system and

The DHB commits to surveying patient experience of the care they received using the national core survey, at least quarterly.

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Initiative Description Benefits Tairawhiti’s Commitment contract, compared to individual, and/or non-compatible systems.

Capability and Leadership Programmes to support improvement science and increased clinical leadership.

Building sector capability and clinical leadership and a culture of quality and safety improvement. Uptake of increased sector leadership, good practice and transfer of improvements skills and expertise. Financial benefits will vary by DHB. Outcome measures still under development

The DHB will meet expectations in accordance with Operational Policy Framework Section 9.3 & 9.4.6.

Primary Care - patient experience survey and reporting system

Similar proposal to the national in-patient experience survey to be used by PHOs

Help measure and report how consumers and patients actually experience the health system from a primary care perspective.

The DHB will support this work through linkages to the IPIF programme

National Health Information Technology Board

eMedicines Reconciliation (eMR) with eDischarge Summary

Implementation of electronic reconciliation of medicines on admission and discharge from hospital.

Without medicines reconciliation, studies have shown that there is up to a 50% error rate in the patient's drug chart. eMR reduces this rate to below 10%. eMR enhances both patient safety, the quality of clinical decision-making and the efficiency of managing the patient's drug chart.

Regional Clinical Workstation (CWS) and Clinical Data Repository (CDR)

Implementation of a regional Clinical Workstation (Orion, Concerto) and Clinical data repository (mixed products). The CWS is a web based system, accessed via a single sign-on that connects multiple clinical applications and data sources to provide clinicians with secure access to patient data. A CDR is a database of patient identifiable clinical information such as medications, laboratory results, radiology reports, care plans, patient letters and discharge summaries.

Clinical Workstation and Clinical Data Repository allow a patient centric view of clinical information from a hospital (or community) setting. It is the basis for a regional electronic health record and is the essential platform enabling support of other high value functionality like eMR, electronic orders, results sign-off. It will also support a person's on-line access to their own health record

Tairawhiti commits to implementation the regional clinical workstation (CWS) and clinical data repository (CDR) See Module 2.8 Actions to supporting Regional delivery of Regional Priorities for actions on how the DHB will be meeting this requirement

National Patient Flow MoH contribution to National Patient Flow

National Patient Flow will create a new national collection that provides a view of wait times, health events and outcomes in a patients journey through secondary and tertiary care.

National Patient Flow aligns with the vision of better integrating care so that patients can receive the appropriate services, in the right setting and in a timely way to improve overall health outcomes. Patients, referrers and providers need to better understand demand for services and waiting times.

The DHB commits to collecting Phase 2 information from July 2015 and to collecting Phase 3 information from July 2016.

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Patient and Provider Portals (formerly self-care portals)

Portals are an on-line IT tool that will enable individuals to have access to their own health information. It will also allow hospital based services, in particular, ED, to have access to a summary view of primary care information. In later phases, it will enable patients to communicate with their primary health practitioners and add information to their health record. Each of the General Practice Patient Management System (PMS) vendors are developing portals, and Orion Health is developing a portal in conjunction with Canterbury DHB eSCRV project.

This is an essential delivery to achieve the IT Board's vision of “a core set of personal health information available to [patients] and their treatment providers regardless of setting". Portals will enable people to take more control of their own care. They will change the way care is delivered and save time for patients and practices. Recent surveys indicate that 15 to 20% of patients are interested in enrolling for portal access.

The DHB will develop an implementation plan with relevant PHOs to enable individuals to have access to their own health information and allow hospital based services, in particular, ED, to have access to a summary view of primary care information.

Health Promotion Agency (HPA)

Campaign support for health targets

1. Rheumatic fever public awareness

2. Immunisation

(1) To deliver a rheumatic fever public awareness campaign targeted at Pacific and Maori parents of at risk children and young people from April 2015 to August 2015. The main objectives are to raise awareness about: 1. the link between sore throats and rheumatic fever 2. the importance of getting sore throats in at risk children checked by a health professional 3. the importance of completing the full antibiotics course for children who have Group A streptococcal bacteria 4. how people at-risk of rheumatic fever can keep their children safe in their own homes. (2) Immunisation is one of the most effective and cost-effective medical interventions to prevent disease. The Ministry of Health has contracted the Health Promotion Agency to promote immunisation in New Zealand, through various workstreams. The Health Promotion Agency also supports the Ministry of Health by developing new resources of providing reprints as the need is identified. The programme provides critical information for parents of infants, school aged children, teens and adults. The information provided helps parents make informed health choices for their babies and children, and alerts and prompts New Zealanders to get themselves or their families vaccinated at the appropriate times. See Module 2.1.4 Increased Immunisations and Module 2.2.1

The Immunisation Programme supports the meeting of the following health targets: :- Infant imms (target of 95% of eight months old will have their primary course of immunisations -6 weeks, 3 months and 5 months; on time by Dec 2014 and maintained until 2017; - 95% of all two year olds are fully immunised). HPV immunisation (target of 60% of young girls will receive the three doses of HPV reducing the burden of cervical cancer in New

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Initiative Description Benefits Tairawhiti’s Commitment Reduced Incidence of Rheumatic Fever

Zealand.

Alcohol Pregnancy and Alcohol Screening and Brief Intervention

The Alcohol and Pregnancy work programme is to contribute towards a reduction in harms related to prenatal alcohol exposure by: 1.reducing the number of women consuming alcohol while they are pregnant 2.increasing public awareness of the risk associated with alcohol consumption during pregnancy 3. supporting health professionals (particularly primary care providers) to respond in a routine, effective and consistent way to women who are drinking while pregnant or planning to become pregnant. HPA also has a programme of work to support Alcohol Screening and Brief Intervention in primary settings. This aligns with DHB work in this area.

Aligns with government and non-government initiatives and calls for action in this area, including: (1) Government's response to the Health Select Committee's inquiry into improving child health outcomes, (2) expectation from industry that the Government will undertake other activites to promote alcohol and pregnancy messages, to support their voluntary pregnancy warning labelling efforts, (3) Ministry of Health's work to develop a FASD action plan. Harmful alcohol use was estimated to cost New Zealand $4.9 billion in 2005/06 (Berl 2009). However, previous estimates have ranged from $735 million to $16.1 billion (Law Commission, 2009, p168) This aligns to Government health priorities, health outcome impacts, and health system enablers. There is also evidence that if delivered across the population, SBI can reduce alcohol-harm in the community.

The DHB will support work undertaken by the HPA to reduce alcohol consumption during pregnancy, including, for example, encouraging primary and secondary care health professionals to engage with and support alcohol and pregnancy initiatives and working with HPA to identify and support innovative local practice that supports women to reduce alcohol consumption during pregnancy. The DHB will support work undertaken by the HPA re alcohol screening and brief intervention

Health Workforce New Zealand (HWNZ)

Increasing the number of sonographers

The sonographer workforce needs to grow by 300 full time equivalent (FTE) employees over the period to 2023, more than double the current FTE numbers, to enable more timely delivery of healthcare services, and meet the faster cancer health target, increased demand from demographic change and growth of sonography as a diagnostic tool. In 2013, HWNZ funded 33.2 FTEs and in 2014, 46.2 FTEs.

Increasing the sonographer workforce will enable more timely delivery of healthcare services, meet faster cancer health targets and meet increased demand for sonography as a diagnostic tool. HWNZ is contributing $27,000 per trainee per annum to employers for their trainees over the 3 year training programme

The DHB supports the regional approach being undertaken to address key workforce requirements with respect to the sonography workforce

Expanding the role of nurse practitioners, clinical nurse specialists and palliative care nurses

A Government policy 2014 health workforce commitment is to expand the role and number of nurse practitioners, clinical nurse specialists

Nurse practitioners can, amongst other services, assess, diagnose and prescribe medicines for

The DHB supports the regional approach to reviewing the roles of nurse practitioners, clinical nurse specialists and

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Initiative Description Benefits Tairawhiti’s Commitment and palliative care nurses. specific groups.

Clinical nurse specialists cover a wide range of specialties including diabetes, cardiology, respite care, wound care, care of the elderly, mental health and addiction. Expansion of the nurse practitioner and clinical nurse specialist role, especially the palliative care nurse role will enable medical staff to undertake more complex procedures and improve service delivery HWNZ is already funding the training component of these roles

palliative care nurses

Create new nurse specialist palliative care educator and support roles

A Government policy 2014 health workforce commitment is to create 60 nurse specialist palliative care educator and support roles at hospices.

Palliative care nurse specialist will provide training, mentoring and hands on support for staff across aged residential care, GP practices and home-based support services. The investment will be consistent with HWNZ's current investment in postgraduate nurse training. Government policy commitment September 2014: $7m to create 60 nurse specialist palliative care educators and support roles at hospices

We will support the regional approach to implementing nurse specialist palliative care educator and support roles.

Expanding the role of specialist nurses to perform colonoscopies

A Government policy 2014 health workforce commitment is to expand the role of nurses and train specialist nurses to perform colonoscopies. The Ministry of Health is developing and implementing an advanced nursing role in endoscopy for senior nurses with relevant post-graduate education and experience.

Nurse endoscopists will be able to identify whether a person has bowel cancer and can find an remove pre-cancerous growths. Nurse endoscopists will make a direct contribution and an indirect contribution to service delivery, including enabling release of medical staff to undertake more complex procedures. Development of the nurse endoscopist role is critical to the delivery of bowel screening in New Zealand. Government policy commitment September 2014: $8m over 4 years to increase the number of colonoscopies performed

We will support the regional approach to implementing nurse specialist palliative care educator and support roles.

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Increasing the number of medical physicists

There is a low retention rate of graduates from the Medical Physics programme and a low number of postgraduate positions available to graduates, despite reported staff shortages. The number of medical physicists needs to grow to enable more timely delivery of health care services and meet the faster cancer health target.

Radiation therapy is reliant on an adequate supply of medical physicists to plan and implement patient treatment programmes. Increasing the number of medical physicists will allow succession planning of a small workforce, vital to DHB workforce and service planning HWNZ is already funding the training of medical physicists

The DHB supports the regional/national approach to addressing key workforce requirements with regard to the medical physicist workforce

Increasing the number of medical community based training places and providing access to primary care/community settings for prevocational trainees

As part of the revised New Zealand Curriculum Framework for Prevocational Medical Training, the Medical Council will require PGY1 and PGY2 interns to undertake one clinical attachment in a community-based setting by the end of 2020. HWNZ is working with the Medical Council, the Royal New Zealand College of General Practitioners and district health boards to ensure employment and funding arrangements support these requirements.

More medical trainees are exposed to quality community-based training experiences, and will have increased experience of integrated care and and choose to vocationally train in general practice. An increase in the number and availability of prevocational clinical attachments across DHB will support RMO career progression. HWNZ is reviewing funding arrangements to support community-based placements

The DHB supports the regional approach to providing access to community-based placements

PHARMAC

National contracting of medical devices

National contracting is the first stage towards full management of hospital medical devices. This activity is building PHARMAC's capability.

Helps achieve national consistency in medical devices, improve transparency of decision-making and improve the cost-effectiveness of public spending to generate savings for re-investment into health, i.e. Reflects Cabinet requirement (August 2012) for PHARMAC to assume this role. A minimum level of savings is achieved from nationally negotiated contracts based on the current mix of product use (current contracts have achieved more than $2 million minimum savings per annum). The level of savings achieved could significantly increase if DHBs shift to the national contracts and increase the

We will continue to support PHARMAC's national contracting activity for hospital medical devices. This includes committing to implement new national medical device contracts, when appropriate and assisting with product evaluations where possible.

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Initiative Description Benefits Tairawhiti’s Commitment National contracting towards steady state - which includes assessment of new devices, health technology assessment, active category management, category reviews and tendering

amount of these products in their overall product mix. PHARMAC expect to shift towards product standardisation in at least one category it is already working in during 2015. This will lead to increased national consistency in product use Product standardisation will lead to additional commerical gains beyond those achieved with national contracting.

We will support effective implementation of any product standardisation undertaken by PHARMAC during 2015/16.

2.8. Supporting Delivery of Regional Priorities

Our Approach

Within the Midland Regional Plan, we aim to develop the principles of culture, capability, capacity

and change leadership. In 2015/16 the overarching imperative for Tairawhiti in order to meet our

goals, is collaboration and development of good relationships locally, regionally and nationally.

We recognise that there are longstanding gaps and weaknesses in our knowledge around the current

workforce, particularly relating to the capability and capacity. Workforce and training plans illustrate

the collaborative work of the Midland Regional Training Network (MRTN), Regional Director of

Training and General Managers of Human Resources building whole of health solutions and working

alongside the regional clinical networks and regi

onal groups to meet key deliverables that pertain to workforce and training.

Linkages



Action Plan


Spinal Cord Impairment Action Plan

We will ensure information and actions outlined in the plan are disseminated to clinicians via its clinical governance mechanism and will ensure pathways that explicitly outline process and align with the action plan are developed.

A confirmation and exception report in the second quarter of 2015/16 on progress made against actions in the Spinal Cord Impairment Action Plan in 2014/15 and to date in 2015/16. A confirmation and exception report in the fourth quarter of

Quarterly

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2015/16 on actions identified in the DHB’s 2015/16 Annual Plan.

Delivery of Regional Information Technology (IT) priorities

The Midland Regional Information Service will implement the Midland Region Information Services Plan and advance National Health IT Board priorities, specifically the implementation of the National Health IT Plan priority areas. Work in this area is done within the context of the affordability envelope of the Midland DHBs The regional platform will be transitioned to the National Infrastructure Programme (NIP) at a similar time to Tairawhiti transition enabling Tairawhiti to utilise the regional platform for ePharmacy, Clinical Work Station (CWS), Clinical Data Repository (CDR). The CSC ePharmacy programme will be implemented from September 2015. We will implement the Orion CWS and this should be completed by Dec 2015.

Actions to be implemented and Programme to be implemented by 31 August 2015 Orion CWS to be implemented by Dec 2015

Reporting will be on a quarterly basis

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Module 3 – Statement of Performance Expectations

We have worked with other DHBs in the Midland region, our primary care partners as well as

other key stakeholders to develop the Statement of Performance Expectations (SPE) in which

we provide measures and forecast standards of our output delivery performance. The actual

results against these measures and standards will be presented in our Annual Report 2015/16.

The performance measures chosen are not an exhaustive list of all of our activity, but they do

reflect a good representation of the full range of outputs that we fund and / or provide. They

also have been chosen to show the outputs which contribute to the achievement of national,

regional and local outcomes (see modules 1 and 2). Where possible, we have included with

each measure past performance as baseline data.

Activity not mentioned in this module will continue to be planned, funded and/or provided to

a high standard. We do report quarterly to the Ministry of Health and / or our Board on our

performance related to this activity.

3.1 Output Classes

DHBs must provide measures and standards of output delivery performance under aggregated

output classes. Outputs are goods and services that are supplied to someone outside our DHB.

Output classes are an aggregation of outputs, or groups of similar outputs of a similar nature.

The output classes used in our statement of forecast service performance are also reflected in

our financial measures. The four output classes that have been agreed nationally are

described below. They represent a continuum of care, as follows:

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3.2 Guide to reading the statement of service performance The following points provided should be kept in mind when reading the rest of this

module:

• Further detail of the performance story logic and rationale is contained in section 1.2

• Baseline and national/regional figures for the output performance measures are for

the 2014/15 financial year unless otherwise stated

• In the performance measures table, and where available, the average column

presents the national or regional average for the output performance measure

• Most measures have been adopted regionally

• Some measures fall across more than one impact. Where this is the case they have

only been included once.

• Measurement type key: qn = Quantity t = Timeliness ql = Quality

• There are some services we provide that support the rest of the health system so we

have included these in a “Support Services” section of our performance story

• Detailed information about the rationale for each output measure is provided in

appendix 8.3.

3.3 People are supported to take greater responsibility for their

health

Lo

ng

Te

rm

Imp

act People are supported to take greater responsibility for their health

Inte

rmed

iate

Imp

acts

Fewer people smoke Reduction in vaccine

preventable diseases

Improving health

behaviours

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3.3.1 Fewer People Smoke

Outputs Output

Class Measure

Type Baseline

Target 2015/16

National /Regional

Percentage of hospitalised smokers offered advice to quit (Health Target)17

Māori Non Māori Total

1 qn/t

96% 95% 95%

95% 95% 95%

Midland

96% 95% 95%

National

96% 95% 95%

Percentage of PHO enrolled smokers offered advice to quit (Health Target & IPIF)


1

qn/t

94% -All Not

Ethnically Reported

90% 90% 90%

Midland

90%-All Not

Ethnically Reported

National

88%-All Not

Ethnically Reported

Percentage of pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit (Health Target and MHP)


1 qn/t

New measure

Progress towards

90%

New measure

3.3.2 Reduction in Vaccine Preventable Diseases

Outputs

Output Class

Measure Type

Baseline Target

2015/16 National

/Regional

Percentage of eight month olds fully immunised (Health Target,IPIF & MHP)


1 qn/t

91% 92% 91%

95% 95% 95%

Midland

91% 92% 91%

National

93% 93% 94%

Percentage of the population >65 years who have received the seasonal influenza immunisation (PPP & MHP)

High Needs Total

1

qn/t

64% 67%

75%

N/A N/A

68% 69%

17 Data for the quarter 1 July 2012 to 30 September 2012.

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3.3.3 Improving Health Behaviours

Outputs

Output Class

Measure Type

Baseline Target

2015/16 National

/Regional

Percentage of infants who are partially, fully or exclusively breastfed at 6 months (MHP)


1

qn/t

53% 66% 56%

>59%

Midland

57% 65% 63%

National

N/A

The number of people participating in the GRx (Green Prescription) programmes18

Total

1 qn/t

992

1024

Midland

4931

National

49,729

Reduce the prevalence of gonorrhoea

(local indicator)

1 qn/t

75 per

100,000

72 per

100,000

Midland

N/A

National

15 per

100,000

3.4 People Stay Well in Their Homes and Communities

Lo

ng

Te

rm

Imp

act

People stay well in their homes and communities

Inte

rmed

iate

Imp

acts

An improvement

in childhood oral

health

Long-term conditions

are detected early and

managed well

Fewer people are

admitted to hospital

for avoidable

conditions

More people

maintain their

functional

independence

18 A Green Prescription (GRx) is a health professional’s written advice to a patient to be physically active, as part of the patient’s health management

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3.4.1 An improvement in childhood oral health

Outputs Output Class

Measure Type

Baseline Target

2015/16

National /Regional

Percentage of children (0-4) enrolled in DHB funded dental services (PP13)


2 qn

77% 92% 81%

90%

Midland

63% 76% 72%

National

46% 79% 87%

Percentage of enrolled pre-school and primary school children (0-12) overdue for their scheduled dental examination (PP13)

2

qn/t

11% 10% 9% 12%

Percentage of adolescent utilisation of DHB funded dental services (PP12)

2 qn

71% 85% 70% 72%

3.4.2 Long-Term Conditions are Detected Early and Managed Well


Measure Type

Baseline Target

2015/16

National /Regional

Per cent of the eligible population will have had their cardiovascular risk assessed in the last five years (Health Target, IPIF & MHP)


2

qn

83% 89% 86%

90%

Midland

80% 90% 88%

National

83% 85% 84%

Improve the proportion of patients with good or acceptable glycaemic control (PP20)

2 ql

34% 90%

N/A

N/A

Percentage of eligible women (20-69) have a cervical cancer screen every 3 years (IPIF and MHP)


1 qn/t

67% 75% 73%

75%

Midland

63% 81% 77%

National

63% 77% 80%

Percentage of eligible women (50-69) have a breast screen in the last 3 years (MHP)


1 qn/t

68% 73% 73%

70%

n/a n/a n/a

68% 73% 73%

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3.4.3 Fewer People are admitted to Hospital for Avoidable Conditions


Measure Type

Baseline Target

2015/16

National /Regional

Percentage of Rest Home residents receiving vitamin D supplement from their GP

4 qn

61% 70%

Midland

National

N/A

Percentage of all Emergency Department presentations who are triaged at levels 4 & 5

2&3

qn 24% 20% 16% 11%

Percentage of eligible population who have had their B4 school checks completed

High Needs Total

1 qn/t

99% 91%

90%

83%

80%

Incidence rates per 100,000 for rheumatic fever

2&3 qn/t 23.6 15.0 N/A 4.7

Hospitalisation rates per 100,000 for acute rheumatic fever

2&3 qn/t 9.6 8.4 N/A 5.3

Increased coverage numbers of Year 9 students receiving HEEADSSS assessment in decile 1-3 schools


1 qn/t baseline is Decile 1 & 2 schools

only

650

3.4.4 More People Maintain their Functional Independence


Measure Type

Baseline Target

2015/16

National /Regional

Percentage of older people receiving long-term home support who have had a comprehensive clinical assessment and a completed care plan in the last 12 months

4 qn/t

100% 100%

Midland

N/A

National

N/A

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3.5 People Receive Timely and Appropriate Specialist Care

Lo

ng

Te

rm

Imp

act

People receive timely and appropriate care

Inte

rmed

iate

Imp

acts

People receive

prompt and

appropriate acute

and arranged care

People have

appropriate access

to elective services

Improved health

status for people with

a severe mental health

illness and/or

addiction

More people with end-

stage conditions are

appropriately

supported

3.5.1 People Receive Prompt and Appropriate Acute and Arranged Care


Measure Type

Baseline Target

2015/16 National /Regional

Acute Re-admission rate 3

qn/t/ql

5.40% ≤4.3% Midland

7.26% National 7.77%

Inpatient average length of stay (elective) (Ownership Dimension 3)

3

qn/t 3.14 days 1.59 days 3.12 days 3.23days

Percentage of patients who require radiation or chemotherapy are treated with 4 weeks (Health Target)

3

qn/t 100% 100% 100% 100%

Faster Cancer Treatment – Proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment with 31 days of diagnosis

3 qn/t

82% 100% 66% 67%

Faster Cancer Treatment – Proportion of patients with a high suspicion of cancer receive their first cancer treatment within 62 days or less

3 qn/t

80% 85% 82% 83%

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3.5.2 People Have Appropriate Access to Elective Services


Measure Type

Baseline Target


Percentage of patients waiting longer than four months for their first specialist assessment (Elective Service Performance Indicator 2)

3 qn/t

1.20% 0%

Midland

3.8%

National

3.8%

Number of surgical discharges under the elective initiative (Health Target)

3 qn

2,133 2,552 34,827

N/A

Did-not-attend percentage for outpatient services (Māori Health Plan)


3 qn/t

15% 6%

10%

10%

15% 6% 8%

12% 5% 6%

3.5.3 Improved Health Status for those with Severe Mental Illness and/or addictions


Measure Type

Baseline Target 2015/16

National /Regional

Percentage of people referred for non urgent mental health or addiction services are seen within 3 weeks (Policy Priority 8) Mental Health

0-19 yr olds 20-64 yr olds 65+ yr olds

Addictions 0-19 yr olds 20-64 yr olds 65+ yr olds

3 qn/t

68% 77% 76%

54% 80% 87%

80%

80%

Midland

68% 73% 83%

85% 76% 79%

National

67% 82% 84%

82% 82% 83%

Improving the percentage of long-term child clients with up to date relapse prevention/treatment plans (Policy Priority 7)

<20 yr olds Māori Non Māori Total

20+ yr olds Māori Non Māori Total

3 qn/t/ql

N/A N/A N/A

87% 72% 80%

95%

95%

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Measure Type


National /Regional

Average length of acute inpatient stays (KPI 8)

3 qn/t/ql 19 Days

14-21 days

n/a n/a

Rates of post-discharge community care (KPI 18)

3 qn/t/ql 56% 90% n/a n/a

3.5.4 More People with End Stage Conditions are Supported Appropriately


Measure Type


National /Regional

Number of Aged Residential Facilities utilising advanced directives

3

qn

New Measure

Increase Midland N/A

National N/A

3.6 Support Services


Measure Type

Baseline Target


Improved wait times for diagnostic services - accepted referrals for CT and MRI receive their scan within 6 weeks (Developmental Measure 2)

CT MRI

2 ql/t

86% 93%

85% 95%

Midland

65% 76%

National

82% 64%

Non urgent community laboratory tests are completed and communicated to practitioners within the relevant category timeframes.

2 ql/t

100%

100%

n/a

100%

Number of community pharmacy prescriptions

2 qn 449,943 450,000 1,963,086

4,470,707

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Module 4 – Financial Performance

4.1 Financial Performance

The DHB continues its commitment to manage expenditure within the provided funding and live

within our means. The DHB is therefore committed to achieving breakeven results for the plan year

and each of the three subsequent projected years, i.e. from 1 July 2015 to 30 June 2019.

The budgeted financials are very much based on a “business as usual” scenario adjusted for the

possible financial effects of anticipated savings and efficiency activities. In relation to this, the key

points that underpin the financial budgets are:

Revenue – The base funding package provides a 1.23% increase after allowing for top slices,

etc. The total revenue increment available for 2015-16 is calculated to be approximately

1.35%;

Expenditure – It is expected that continuing to work with NGO Providers will enable

population health community expenditure on primary care to be well-managed and

therefore the associated total cost constrained, allowing for future-based investment;

Inter-District Flows – It is expected that the work of the population health team,

complemented by an historically healthy staffing situation in the DHB Provider will enable

IDF outflows to be managed to a below-budget level;

National initiatives – DHBs have invested heavily in national programmes at the behest of

Government, and continue to do so. The minimum expected returns from these investments

have been built into the budgeted savings programmes and it is essential for the

achievement of the budgeted financial results that the agencies involved – healthAlliance,

PHARMAC and NZ Health Partnerships Ltd - deliver on them;

Personnel costs – have been budgeted to increase at almost double the rate of CPI for the

last year. The clinical labour force is a significant factor in the overall cost of providing health

services, as they are generally quite labour-intensive. TDH is currently well-staffed, and

therefore the negotiation and settlement of national MECAs is an area of risk for small,

provincial DHBs that tend to have lower funding increments, while the risk for NGO Providers

is in their ability to maintain appropriate permanent staffing levels.

The following table sets out TDH’s key financial planning metrics:

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 $000 $000 $000 $000 $000 $000

ACTUAL FORECAST PLANNED PROJECTED PROJECTED PROJECTED

Revenue (after adjustments) 161,478 164,532 166,753 167,767 168,939 170,120

Net Surplus/(Deficit) 144 (2,500) 316 316 316 316

Total Non-Current Assets 64,133 64,411 65,291 64,789 64,278 63,758

Net Assets 35,160 31,781 31,715 31,649 31,583 31,517

Term Borrowings and Provisions

16,786 16,674 16,554 16,425 16,287 16,138

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Many cost increases have the potential to affect the DHB’s operating costs at greater rates than the

increments in the December 2014 funding package. This includes utilities, personnel costs –

particularly the effects of “step” increments - and costs driven by commodity prices or a weaker

exchange rate. The DHB will manage this by strong procurement practices, robust industrial

negotiations and service prioritisation to ensure best value for money.

Operating cash flows remain challenging but manageable within available facilities throughout the

forecast period. This is assisted by the national DHB shared Banking and Treasury programme, which

includes the daily bank sweep and pool arrangements managed by NZ Health Partnerships Limited.

Prospective Financial Statements

Prospective Statement of Comprehensive Revenue and Expenses

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


REVENUE

Government Revenue 158,137 161,556 163,790 164,819 165,970 167,130

Inwards Inter- District Flows 1,925 1,716 2,044 2,058 2,072 2,087

Other Revenue 1,177 982 799 769 775 780

Financial Income 239 278 120 121 122 123

TOTAL REVENUE 161,478 164,532 166,753 167,767 168,939 170,120

EXPENDITURE

Employee Costs 59,306 60,626 58,782 59,193 59,608 60,025

Outsourced Services 6,272 7,482 5,683 5,722 5,763 5,803

Clinical Supplies 13,377 14,874 14,190 14,289 14,389 14,490

Infrastructure and Non Clinical Supplies

11,590 11,909 12,250 12,337 12,422 12,509

Payments to Non DHB Providers

46,871 49,700 52,834 53,054 53,425 53,798

Outwards Inter-District Flows

20,544 19,343 19,612 19,748 19,887 20,027

Financial Costs (including Capital Charge)

3,556 3,571 3,436 3,460 3,484 3,509

TOTAL EXPENDITURE 161,516 167,505 166,787 167,803 168,978 170,161

Share of Profit of Associates 182 473 350 352 355 357

NET (SURPLUS)/ DEFICIT 144 (2,500) 316 316 316 316

OTHER COMPREHENSIVE EXPENDITURE

Loss on Revaluation of Land & Building

0 0 0 0 0 0

TOTAL COMPREHENSIVE (SURPLUS)/DEFICIT

144 (2,500) 316 316 316 316

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Prospective Statement of Changes in net assets /equity

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


Crown equity at start of period 35,398 35,160 31,781 31,715 31,649 31,583

(Surplus)/Deficit for the period 144 (2,500) 316 316 316 316

Contributions from Crown

Distributions to crown (382) (382) (382) (382) (382) (382)

Revaluation & other movements

(497)

Crown Equity at end of period 35,160 31,781 31,715 31,649 31,583 31,517

Consolidated Prospective Statement of Financial Position as at 30 June

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


CROWN EQUITY 35,160 31,781 31,715 31,649 31,583 31,517

Current Assets 7,615 5,928 5,928 5,928 5,928 5,928

Non-Current Assets 64,133 64,411 65,291 64,789 64,278 63,758

TOTAL ASSETS 71,748 70,339 71,219 70,717 70,206 69,686

Current Liabilities 19,802 21,884 22,950 22,644 22,338 22,032

Non-Current Liabilities 16,786 16,674 16,554 16,424 16,285 16,137

TOTAL LIABILITIES 36,588 38,558 39,504 39,068 38,623 38,169

NET ASSETS 35,160 31,781 31,715 31,649 31,583 31,517

Consolidated Statement of Prospective Cash Flows

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000

ACTUAL FORECAST PLANNED PLANNED PLANNED PROJECTED

CASH FLOWS FOR THE PERIOD

Operating cash flows 5,460 (1,657) 2,679 3,716 3,740 3,765

Investing cash flows (3,635) (2,958) (3,519) (2,155) (2,165) (2,175)

Financing cash flows 65 (1,349) (1,240) (1,237) (1,260) (1,275)

NET TOTAL CASH FLOWS 1,890 (5,964) (2,080) 324 315 315

Net increase/(decrease) in cash held

1,890 (5,964) (2,080) 324 315 315

Add opening cash balance 197 2,087 (3,877) (5,957) (5,633) (5,318)

CLOSING CASH BALANCE 2,087 (3,877) (5,957) (5,633) (5,318) (5,003)

made up from

Balance Sheet Cash, Bank, and Short Term Investments

2,087 (3,877) (5,957) (5,633) (5,318) (5,003)

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Consolidated Prospective Statement of Commitments and Contingent Liabilities

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


COMMITMENTS

Capital Commitments 1,966 313 1,000 1,000 1,000 1,000

Operating Lease Commitments 449 763 450 450 450 450

TOTAL COMMITMENTS 2,415 1,076 1,450 1,450 1,450 1,450

CONTINGENT LIABILITIES 0 50 0 0 0 0

Prospective Summary of

Revenues and Expenses by

Output Class

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


PREVENTION

Total Revenue ($6,227) ($4,019) ($5,321) ($5,358) ($5,396) ($5,434)

Total Expenditure $5,551 $4,705 $5,311 $5,348 $5,386 $5,423

Net (Surplus)/Deficit $676 ($686) $10 $10 $10 $11

EARLY DETECTION AND MANAGEMENT Total Revenue ($41,326) ($44,125) ($44,091) ($44,248) ($44,557) ($44,868)


Net (Surplus)/Deficit $994 ($131) $83 $83 $83 $82

INTENSIVE ASSESSMENT AND TREATMENT SERVICEs

Total Revenue ($99,332) ($99,065) ($99,350) ($100,044) ($100,743) ($101,447)


Net (Surplus)/Deficit ($596) ($1,278) $188 $188 $188 $188

REHABILITATION AND SUPPORT Total Revenue ($14,775) ($17,796) ($18,340) ($18,468) ($18,597) ($18,727)


Net (Surplus)/Deficit ($930) ($405) $35 $35 $35 $35

Total Comprehensive (surplus)/deficit

144 ($2,500) $316 $316 $316 $316

Equity and Long Term Debt Facilities

The DHB relies on a mix of debt and equity to fund assets utilised in the delivery of health services.

Government policy requires the DHB to source all equity and long-term borrowings from the Crown

through the Ministry of Health. The long-term borrowings are secured by a negative pledge.

A working capital facility is currently maintained through the mechanism of the DHB shared banking

pool. Westpac Banking Corporation provides transactional banking services.

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As at 30 June 2015, the DHB has the following borrowings from the Ministry of Health:

Principle Rate Maturity Expiry

$000

%

Date Date

$1,679 @ 4.310 p.a. 17.12.2017 31.12.2021

$4,600 @ 3.250 p.a. 15.15.2020 31.12.2021

$1,700 @ 5.250 p.a. 15.04.2016 31.12.2021

$2,100 @ 6.490 p.a. 15.12.2017 31.12.2021

$500 @ 2.940 p.a. 15.12.2017 31.12.2021

$250 @ 3.890 p.a. 15.03.2019 31.12.2021

$3,500 @ 3.110 p.a. 15.03.2019 31.12.2021

$500 @ 3.390 p.a. 15.05.2021 31.12.2021

$14,829

The borrowings are secured by negative undertakings. Without prior written consent, the DHB cannot perform the following actions:

Create any security interest over its assets except in certain circumstances;

Lend money to another person or entity (except in the ordinary course of business and then only on commercial terms) or give a guarantee;

Make a substantial change in the nature or scope of its business as presently conducted or undertake any business or activity unrelated to health;

Dispose of any of its assets except disposals in certain circumstances in the ordinary course of business; and

Provide services to or accept services from a person other than for proper value and reasonable commercial items

Prospective Estimates of Debt and Equity as at 30 June 2015 to 30 June 2019

Prospective Estimates of Debt and Equity as at 30 June

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000 ACTUAL FORECAST PLANNED PLANNED PLANNED PLANNED

Crown Equity 35,160 31,781 31,715 31,649 31,583 31,517

Long-term Debt 16,786 16,674 16,554 16,424 16,285 16,137

TOTAL Debt and Equity 51,946 48,455 48,269 48,073 47,868 47,654 percentage debt to debt + equity

32% 34% 34% 32% 32% 32%

All debt is unsecured other than by undertakings as above.

Capital Expenditure

As a result of the environmental mix under which TDH has operated for over the last 20 years, i.e.

being one of high service improvement demand mixed with constrained funding, TDH has for many

years only been able to finance a capital expenditure program that utilises the free cash flow derived

from the depreciation expense. However, as TDH has made deficits for many years, operating cash is

now minimal and is becoming constrained. The result of this is both positive, in that it has forced

clear prioritisation of spend - and that spend has only been on items that are undeniably required -

and negative, in that the asset lives are “pushed” as cash resources dwindle. To compound this,

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there is no operating surplus being generated for capital investment in new technology and

equipment to support new clinical practice.

For 2015-16, TDH will be adopting the same philosophy and strategies. The program will be tailored

to the depreciation-based free cash flow and will comprise the items ascribed the highest priority by

Board, acting on advice from the Leadership Team.

Planned Capital expenditure is set out in the table below:

Projected Baseline Capital Expenditure

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


Buildings and Plant 215 894 901 300 300 300

Clinical Equipment 2,474 1,737 941 1,988 2,002 2,015

Other Equipment 66 62 37 50 50 50

Information Technology 168 141 745 135 140 145

Intangible Assets (Software) 475 816 1,265 100 100 100

Motor Vehicles 3 59 100 60 60 60

TOTAL Baseline Capital Expenditure

3,401 3,709 2,615 2,633 2,652 2,670

It is intended that this will be funded 100% internally from depreciation free cash flow. Additional projects may be approved from time to time, but will either cause a re-prioritisation of the program, or will bring a financial benefit sufficient to pay the additional costs of capital. An exception to this arose in relation to the replacement of the (currently leased) MRI Scanner, which is under action at this time, and which will be funded through a finance leasing arrangement with the supplier.

Asset Management

The TDH Asset Management Plan (AMP) was updated in 2014 and will be updated again in 2016.

TDH has been actively involved in the development of the Midland Region Asset Management Plan

and will continue to be involved in its further development in 2016 and beyond. This process is

somewhat constrained by a need to develop appropriate information systems to support planning

and by the lack of a national clinical service plan to inform future direction for asset and

infrastructure planning.

Financial Performance by Functional Arm

The following tables set out the planned financial performance for each of TDH’s three functions:

DHB Funds Prospective Statement of Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


REVENUE


Inwards Inter- District Flows 1,922 1,716 2,044 2,058 2,072 2,087

Other Revenue 132 176 95 60 61 61

TOTAL REVENUE 151,799 153,887 156,932 157,878 158,981 160,091

EXPENDITURE

Personal Health 116,556 117,975 120,619 121,463 122,313 123,169

Mental Health 14,811 14,305 14,481 14,583 14,685 14,788

Disability Support Services 13,793 14,488 15,740 15,698 15,808 15,919

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Public Health 713 851 1,034 1,042 1,049 1,056

Māori Health 2,179 2,257 2,292 2,309 2,325 2,341

Governance and Administration 2,360 2,511 2,450 2,467 2,485 2,502


NET RESULT (SURPLUS)/ DEFICIT (1,387) (1,500) (316) (316) (316) (316)

DHB Governance Prospective Statement of Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


REVENUE

Government Revenue

Internal revenue (DHB Funds to Governance)

2,360 2,511 2,450 2,467 2,484 2,502

Other Revenue

TOTAL REVENUE 2,360 2,511 2,450 2,467 2,484 2,502

EXPENDITURE

Personnel Costs 1,150 1,145 1,210 1,218 1,227 1,236

Outsourced Services 197 204 268 270 272 274

Clinical Supplies

Infrastructural and Non Clinical 913 1,162 972 979 985 992

Internal Allocations to/from Provider


NET RESULT (SURPLUS)/ DEFICIT (100) 0 0 0 0 0

DHB Provider Prospective Statement of Financial Performance

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000


REVENUE


Internal revenue (DHB Funds to Provider)

80,639 80,833 81,720 82,292 82,868 83,448

Other Revenue 1,285 1,084 825 830 836 841

TOTAL REVENUE 90,316 91,478 91,541 92,181 92,827 93,476

EXPENDITURE

Personnel Costs 58,156 59,481 57,572 57,974 58,381 58,789

Outsourced Services 6,076 7,278 5,414 5,452 5,490 5,528

Clinical Supplies 13,377 14,874 14,190 14,289 14,389 14,490

Infrastructural and Non Clinical 14,050 13,845 14,365 14,466 14,567 14,669

Internal Allocations to/from Provider


NET RESULT (SURPLUS)/ DEFICIT 1,343 4,000 0 0 0 0

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Financial Assumptions

The financial statements have been prepared in accordance with Generally Accepted Accounting

Practice in New Zealand (NZGAAP).

The financial estimates are based on informed judgments on the expected price and cost movements

over the period of the Plan, including the funding intentions of Government and the Ministry.

Considerable weight has been given to the Ministry’s indications on revenue expectations and views

on expected cost inflation over the period.

The financial effects of savings expected to arise from efficiency gains have been incorporated into

the financial plan, as have savings expected to result from Government and cooperative initiatives,

the tripartite Health Sector Relationship Agreement and enhanced clinical leadership. Cost savings

anticipated to flow through to TDH from national (healthAlliance (FPSC) Ltd and NZ Health

Partnerships Ltd) and regional (HealthShare) initiatives have been included at the estimated

additional cost of the programmes that will generate the savings.

The DHB has made a number of significant assumptions in arriving at its Prospective Financial

Performance Statements as summarised below:

Assumption 2015/16 2016/17 2017/18 2018/19

Crown CFA Revenue 1.49% 1.47% 1.44% 1.42%

Sector Cost Increases 0.7% 0.7% 0.7% 0.7%

Staff Costs (average

movement)

0.7% 0.7% 0.7% 0.7%

Staff Costs (numbers) 641 629 628 628

Interest Rate – CHFA 4.6% 4.6% 4.6% 4.6%

Interest Rate - Working

Capital

5.5 5.5 5.5 5.5

Capital Charge Rate 8% 8% 8% 8%

NZD[1]/AUD[2] 0.87 0.87 0.87 0.87

NZD/USD[3] 0.85 0.85 0.85 0.85

Mitigation of Financial Risk

It is recognised that it will be challenging to meet these targets. However, management will be

working intensively to ensure that expenditure on core services is constrained to the funding streams

available. As stated above, the cost inflation rates are based upon Treasury economic forecasts,

combined with trend analysis of cost inflation within TDH. A risk assessment and sensitivity analysis

relating to these key cost assumptions is set out below:

[1] New Zealand Dollar

[2] Australian Dollar

[3] United States of America Dollar

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Assumption Risk Assessed potential effect

Revenue Revenue expectations are not met. TDH’s budgeted consolidated revenue totals approximately $157M. For every 1% that revenue is lower than the budgeted levels, there is a potential financial detriment to TDH of $1.57M.

While there are good indications in relation to base CFA funding, there is a risk that actual funding may be curtailed and/or other revenue streams are less than anticipated.

To mitigate this risk, TDH actively works to maintain, develop and diversify its revenue streams.

Labour cost inflation

Labour cost inflation is higher than expected, driving above-budget staff and outsourced services costs.

For every 1% that wage settlements exceed the budgeted levels, there is a potential additional expense of $578k in the cost of staff and outsourced services. To mitigate this risk, TDH uses collaborative negotiating and informs employee representatives of the Minister’s expectations and the net CCP that has been allocated to TDH for the planning period.

Supply cost inflation

Supply cost inflation is higher than expected, driving above-budget clinical, infrastructure and non-clinical supply costs.

For every 1% increase in inflation above budgeted levels, there is a potential additional expense of ~ $200k. To mitigate this risk, TDH utilises collaborative procurement options, preferred supplier arrangements, fixed price agreements, outsourcing of support services and tender processes.

Exchange rate NZ Dollar is less robust than expected, driving above-budget clinical supply costs.

For every 10% reduction in the value of the NZD against the currencies of the countries from which clinical supplies are sourced, there is a potential additional expense of ~ $100k. To mitigate this risk, TDH uses the same mechanisms as those used to mitigate supply cost inflation.

Interest rate Interest rates rise more than budgeted, driving over-budget finance costs on term loans.

For every 1% rise in interest rates, there is a potential additional expense of $141k. To mitigate this risk, TDH adopts a policy of spreading the maturity dates and interest review periods on its borrowings.

Demand-driven costs

Demand-driven costs exceed budget and revenue, creating a deficit situation in the Funds function.

TDH monitors all demand-driven costs and proactively works to address cost overruns with providers, including NASC services.

Significant Accounting Policies

The accounting policies used in the preparation of the financial statements can be found in the

Tairawhiti DHB 2014/15 Annual report. There have been no significant changes in the accounting

policies, which are reproduced hereunder:

Reporting / Economic Entity

Tairawhiti District Health (TDH) is a Health Board established by the New Zealand Public Health and

Disability Act 2000. TDH is a crown entity in terms of the Crown Entities Act 2004, owned by the

Crown and domiciled in New Zealand.

TDH is a public benefit entity, as defined in the external reporting board standard A1.

The group consists of TDH, its subsidiary company Tairawhiti Laundry Services Limited (TLSL), which

holds the associated partnership share in Gisborne Laundry Services (GLS), and its associated

companies HealthShare Limited and TLab Limited.

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The group activities involve delivering health and disability services and mental health services in a

variety of ways to the community.

Statement of compliance

The prospective financial statements of the DHB have been prepared in accordance with the

requirements of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act

2004, which include the requirement to comply with generally accepted accounting practice in New

Zealand (NZ GAAP).

The financial statements have been prepared in accordance with Tier 1 PBE accounting standards.

These financial statements comply with the PBE accounting standards. These financial statements

are the first financial statements presented in accordance with the new PBE accounting standards.

Presentation Currency and Rounding

The financial statements are presented in New Zealand Dollars rounded to the nearest thousand

($000). The functional currency of TDH is New Zealand dollars.

Standards issued and not yet effective and not early adopted

In May 2013, the External Reporting Board issued a new suite of PBE accounting standards for

application by public sector entities for reporting periods beginning on or after 1 July 2014.

In October 2014, the PBE suite of accounting standards was updated to incorporate requirements

and guidance for the not-for-profit sector. These updated standards apply to PBEs with reporting

periods beginning on or after 1 April 2015. TDH will apply these updated standards in preparing its 30

June 2016 financial statements. TDH expects there will be minimal or no change in applying these

updated accounting standards

The financial statements have been prepared on a historical cost basis modified by the revaluation of

certain property, plant & equipment and the Ministry of Health loans.

Basis of Preparation

The financial statements are presented in New Zealand Dollars rounded to the nearest thousand. The

functional currency of TDH is New Zealand dollars. The financial statements have been prepared on a

historical cost basis modified by the revaluation of certain Property, Plant & Equipment and the

Ministry of Health loans.

The preparation of financial statements in conformity with NZIFRS requires management to make

judgements, estimates, and assumptions that affect the application of policies and reported amounts

of assets and liabilities, income and expenses. The estimates and associated assumptions are based

on historical experience and various other factors that are believed to be reasonable under the

circumstances, the result of which form the basis of making the judgements about carrying values of

assets and liabilities that are not readily apparent from other sources. Actual results may differ from

these estimates.

Accounting Policies

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The following particular accounting policies, which materially affect the measurement of financial

results and financial position, have been applied:

Basis of Consolidation: Purchase Method

The consolidated financial statements include the parent DHB, its subsidiary Tairawhiti Laundry

Services Limited and its associates. The subsidiary is accounted for using the purchase method, which

involves adding together corresponding assets, liabilities, revenues and expenses on a line by line

basis. In the parent Board financial statements investments in subsidiaries are stated at the lower of

cost and net realisable value.

All significant inter organisation transactions are eliminated on consolidation.

Associates

The group has a significant influence over commercial and financial policy decisions of HealthShare

Limited, the Gisborne Laundry Services partnership and TLab Limited.

Interest in an associate is reflected in the consolidated financial statements using the equity method,

which shows the share of surplus/ (deficit) in the consolidated Statement of Comprehensive Income

and the share of post-acquisition increases/decreases in net assets in the consolidated statement of

financial position.

Basis of Recognising Components of the Financial Statements

Revenue

Revenue from the Crown

TDH is primarily funded from the Crown, which is restricted in its use for the purpose of TDH meeting

its objectives as specified in the statement of intent. The fair value of revenue from the crown has

been determined to be equivalent to the amounts due in the funding arrangements.

Revenue from Other DHBs

TDH receives revenue when a patient from another district is treated at TDH, this revenue is paid via

an Inter District Flows mechanism after the patient is discharged.

Interest

Interest revenue is recognised using the effective interest method.

Donated services

Certain operations of TDH are partially reliant on services provided by volunteers. Volunteer services

received are not recognised as revenue or expenditure.

Donated assets

Where a physical asset is gifted to or acquired by TDH for nil consideration or at a subsidised cost,

the asset is recognised at fair value and the difference between the consideration provided and fair

value of the asset is recognised as revenue.

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Expenditure

Capital charge

The capital charge is recognised as an expense in the financial year to which the charge relates.

Borrowing costs

Borrowing costs are recognised as an expense in the financial year in which they are incurred.

Finance Leases

Leases, which effectively transfer to TDH substantially all the risks and benefits incident to ownership

of the leased items, are classified as finance leases. These are capitalised at the lower of the fair

value of the asset or the present value of the minimum lease payments. The leased assets and

corresponding lease liabilities are recognised in the statement of financial position. The leased assets

are depreciated over the period the TDH is expected to benefit from their use.

Operating Leases

Leases where the lessor effectively retains substantially all the risks and benefits of ownership of the

leased items are classified as operating leases. Payments under these leases are recognised as

expenses in the periods in which they are incurred

Cash and Cash equivalents

Cash and cash equivalents comprises cash balances, call deposits with a maturity of no more than

three months.

Receivables

Short-term receivables are recorded at their face value, less any provision for impairment.

A receivable is considered impaired when there is evidence that TDH will not be able to collect the

amount due. The amount of the impairment is the difference between the carrying amount of the

receivable and the present value of the amounts expected to be collected.

Investments

Investments, including those in subsidiaries, are stated at fair value. Any decreases are recognised in

the Statement of comprehensive revenue and expense.

After initial recognition, these investments are measured at their fair value with gains and losses

recognised in other comprehensive revenue and expense, except for impairment losses that are

recognised in the surplus or deficit.

A significant or prolonged decline in the fair value of the investment below its cost is considered

objective evidence of impairment. If impairment evidence exists, the cumulative loss recognised in

other comprehensive revenue and expense is reclassified from equity to the surplus or deficit.

Inventories

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Inventories held for distribution in the provision of services that are not supplies on a commercial

basis are measured at cost, determined on weighted average cost basis.

Inventories acquired through non-exchange transactions are recorded at fair value at the date of

acquisition.

The amount of any write-down for the loss of service potential or from cost to net realisable value is

recognised in the surplus or deficit in the period of the write down.

Property, Plant and Equipment

Property, plant and equipment consists of the following asset classes: land, buildings, clinical

equipment, other equipment, information technology and vehicles.

Property, Plant and Equipment Vested From the Hospital and Health Service

Under section 95(3) of the New Zealand Public Health and Disability Act 2000, the assets of Tairawhiti

Healthcare Limited (a Hospital and Health Service) were vested in TDH on 1 January 2001.

Accordingly, assets were transferred at their net book values as recorded in the books of the Hospital

and Health Service. In effecting this transfer, the Board has recognised the cost and accumulated

depreciation amounts from the records of the Hospital and Health Service. The vested assets will

continue to be depreciated over their remaining useful lives.

Property, Plant and Equipment Acquired Since the Establishment of TDH

Assets acquired by the Board since its establishment, other than those vested from the Hospital and

Health Service and land and buildings, are recorded at cost less accumulated depreciation. This

includes all appropriate costs of acquisition and installation, including materials, labour, direct

overheads, financing, and transport costs.

Land is measured at fair value, and buildings are measured at fair value less accumulated

depreciation. All other asset classes are measured at cost, less accumulated depreciation and

impairment losses.

Revaluations

Land and buildings are valued by an independent qualified valuer at least 3 yearly to confirm that

their carrying value in the financial statements of the organisation reflect their fair value. Valuations

will be undertaken more regularly if necessary to ensure that no class of assets is included at a

valuation that is materially different from its fair value. Where fair value of an asset is not able to be

reliably determined using market-based evidence, optimised depreciated replacement cost is

considered the most appropriate basis for determination of fair value.

Land and buildings revaluation movements are accounted for on a class-of-asset basis.

The net revaluation results are credited or debited to other comprehensive revenue and are

accumulated to an asset revaluation reserve in equity for that class of asset. Where this would result

in debit balance in the asset revaluation reserve, this balance is not recognised in other

comprehensive revenue but is recognised in the surplus or deficit. Any subsequent increase on

revaluation that reverses a previous decrease in value recognised in the surplus or deficit will be

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recognised first in the surplus or deficit up to the amount previously expensed, and then recognised

in other comprehensive revenue.

The results of revaluing land and buildings are credited or debited to an asset revaluation reserve for

that class of asset. Where a revaluation results in a debit balance in the asset revaluation reserve, the

debit balance will be expensed in the Statement of comprehensive revenue and expense.

Additions between revaluations are recorded at cost less depreciation

Disposals

Any gain or loss on disposal is determined by comparing the proceeds with the carrying amount of

the asset and this amount is included in the net surplus or deficit.

Depreciation

Depreciation is provided on a straight line basis on all Property, Plant and Equipment other than

freehold land, at rates which will write off the cost (or revaluation) of the assets to their estimated

residual values over their useful lives.

The useful lives and associated depreciation or amortisation rates of major classes of assets have

been estimated as follows:

Buildings - Structure 42 - 75 years (1.3 - 2.4%)

Buildings - Fit out 5 - 41 years (2.43 - 20%)

Equipment 2 - 50 years (2 - 35%)

Information Technology 3 – 12.5 years (8 - 33%)

Intangible Assets 3 – 12.5 years (8 - 33%)

Motor vehicles 6 - 12 years (6.67 - 15%)

The residual value and useful life of an asset is reviewed, and adjusted if applicable, at each financial

year end.

Work in progress is recognised at cost less impairment and is not depreciated. The total cost of a

project is transferred to the relevant asset category on its completion and then depreciated.

Intangibles

Acquired computer software costs are capitalised on the basis of costs incurred to acquire and bring

to use. Ongoing staff training and maintenance costs are recognised as expenses when incurred.

The carrying value of an intangible asset with a finite life is amortised on a straight line basis over its

useful life. The amortisation charge is recognised in the Statement of comprehensive revenue and

expense

Impairment

TDH does not hold any cash-generating assets. Assets are considered cash-generating where their

primary objective is to generate a commercial return.

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Property, plant and equipment and Intangible assets that have a finite useful life are reviewed for

impairment each year. An impairment loss is recognised for the amount by which the asset’s carrying

amount exceeds its recoverable amount. The recoverable amount is the higher of an asset’s fair

value less costs to sell and value in use.

Value in use is determined using an approach based on either a depreciated replacement cost

approach, restoration cost approach, or a service units approach. The most approraiate approach

used to measure value in use dependes on the nature of the impairment and availability of

information.

The total impairment loss, or reversal of impairment loss, is recognised in the surplus or deficit.

Creditors and payables

Creditors and other payables are measured at fair value, and subsequently measured at amortised

cost using the effective interest rate method.

Provisions

A provision is recognised for future expenditure of uncertain amount or timing when there is a

present obligation (either legal or constructive) as a result of a past event, it is probable that an

outflow of future economic benefits will be required to settle the obligation, and a reliable estimate

can be made of the amount of the obligation.

Provisions are measured at the present value of the expenditure expected to be required to settle

the obligation using a pre-tax discount rate that reflects current market assessments of the time

value of money and the risks specific to the obligation. The increase in the provision due to the

passage of time is recognised as an interest expense and is included in “finance costs”.

Borrowings

Borrowings are initially recognised at their fair value plus transaction costs. After initial recognition,

all borrowings are measured at amortised cost using the effective interest method.

Borrowings are classified as current liabilities unless TDH has an unconditional right to defer

settlement of the liability for at least 12 months after balance date. Borrowings where TDH has an

unconditional right to defer settlement of the liability for at least 12 months after balance date are

classified as current liabilities if TDH expects to settle the liability within 12 months of the balance

date.

Employees

Employee entitlements

Provision is made in respect of TDH’s liability for annual, parental, long service, sick, leave sabbatical,

retirement, and conference leave. Annual leave, Parental Leave and Conference leave have been

calculated on an actual entitlement basis at current rates of pay whilst Long Service and Retirement

provisions have been calculated on an actuarial basis. The liability for sick leave is recognised, to the

extent that compensated absences in the coming year are expected to be greater than the sick leave

entitlements earned in the coming year. The amount is calculated based on the unused sick leave

entitlement that can be carried forward at balance date; to the extent the DHB anticipates it will be

used by staff to cover those future absences.

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Superannuation schemes

Defined contribution schemes

Employers contributions to Kiwisaver, the Government Superannuation Fund, and the State Sector

Retirement Savings Scheme are accounted for as defined contribution schemes and are recognised

as an expense in the surplus or deficit as incurred.

Defined benefit schemes

The DHB makes employer contributions to the Defined Benefit Plan Contributors Scheme (the

scheme), which is managed by the Board of Trustees of the National Provident Fund. The scheme is a

multi-employer defined benefit scheme.

Insufficient information is available to use defined benefit accounting, as it is not possible to

determine from the terms of the scheme the extent to which the surplus/deficit will affect future

contributions by individual employers, as there is no prescribed basis for allocation. The scheme is

therefore accounted for as a defined contribution scheme.

Equity

Equity is measured as the difference between total assets and total liabilities. Equity is disaggregated

and classified into the following components.

• contributed capital

• accumulated surplus/(deficit);

• revaluation reserves

• other reserves

Budget figures

The budget figures are those approved by the Board and published in its Statement of Intent and

have been prepared in accordance with generally accepted accounting practice and are consistent

with the accounting policies adopted by the Board for the preparation of the financial statements.

Goods and Services Tax

All items in the financial statements are exclusive of goods and services tax (GST) with the exception

of receivables and payables, which are stated with GST included. Where GST is irrecoverable as an

input tax, it is recognised as part of the related asset or expense.

The net GST recoverable from or payable to the Inland Revenue Department is included as part of

receivables or payables in the Statement of Financial Position.

The net GST paid to, or received from the Inland Revenue Department, including the GST relating to

investing and financing activities, is classified as an operating cash flow in the statement of cashflows.

Taxation

TDH is a public authority under the New Zealand Public Health and Disability Act 2000 and is exempt

from income tax under Section CB3 of the Income Tax Act 2007.

Trusts and bequest funds

Donations and bequests to TDH are recognised as revenue when control over assets is obtained or

entitlement to receive money is established. A liability, rather than revenue, is recognised where

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fulfilment of any restrictions attached to those assets is not probable. Those donations and bequests

with restrictive conditions are appropriated from Retained Earnings to the Trust Funds component of

Equity. When expenditure is subsequently incurred in respect of these funds, it is recognised in the

Statement of comprehensive revenue and expense, an equivalent amount is transferred from the

Trust Funds component of Equity to Retained Earnings.

Financial instruments

TDH and the Group is party to financial instruments as part of its normal operations. These financial

instruments include bank accounts, short term deposits, investments, debtors, creditors, and loans.

All financial instruments are recognised in the Statement of Financial Position and all revenues and

expenses in relation to financial instruments are recognised in the Statement of comprehensive

revenue and expense.

Except for loans, which are recorded at cost, and those items covered by a separate accounting

policy, all financial instruments are shown at their estimated fair value.

Cost of service statements

The cost of service statements, as reported in the statement of objectives and service performance,

reports the net cost of services for the outputs of TDH and are represented by the cost of providing

the output less all the revenue that can be allocated to these activities.

Cost allocation

Direct costs are charged directly to output classes.

Indirect costs, those which cannot be identified in an economically feasible manner to a specific

output class, are charged to output classes based on cost drivers and related activity/usage

information.

The cost of internal services not directly charged to outputs is allocated as overheads using

appropriate cost drivers such as actual usage, staff numbers, and floor area.

There have been no changes to the cost allocation methodology since the date of the last audited

financial statements.

Critical accounting estimates

In preparing these financial statements, TDH has made estimates and assumptions concerning the

future. These estimates and assumptions may differ from the subsequent actual results. Estimates

and assumptions are continually evaluated and are based on historical experience and other factors,

including expectations of future events that are believed to be reasonable under the circumstances.

The estimates and assumptions that have a significant risk of causing a material adjustment to the

carrying amounts of assets and liabilities within the next financial year are discussed below.

Estimating useful lives and residual values of property, plant, and equipment

At each balance date, the useful lives and residual values of property, plant, and equipment are

reviewed. Assessing the appropriateness of useful life and residual value estimates of property, plant,

and equipment requires a number of factors to be considered such as the physical condition of the

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asset, expected period of use of the asset by TDH, and expected disposal proceeds from the future

sale of the asset.

An incorrect estimate of the useful life or residual value will affect the depreciation expense

recognised in the surplus or deficit, and carrying amount of the asset in the statement of financial

position. TDH minimises the risk of this estimation uncertainty by:

• physical inspection of assets;

• asset replacement programs;

• review of second hand market prices for similar assets; and

• analysis of prior asset sales.

TDH has not made significant changes to past assumptions concerning useful lives and residual

values.

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Module 5 – Kōwae Tuarima/Stewardship

In delivering on our functions as a DHB and participating in the health sector, we have a broad set of

responsibilities and interact with a diverse range of individuals and groups. To be as effective as

possible, we must have capable leadership, an engaged workforce, a healthy organisational culture,

sound relationships, robust and rigorous systems and the right infrastructure and assets.

This module describes how we intend to perform our functions and conduct our operations to

achieve the outputs and impacts we seek to deliver. It provides further detail on the resources /

inputs portion of our performance story.

Diagram: Our Performance Story: Resources / Inputs

5.1 Te whakahaere i to tatou Pakihi / Managing our Business

As detailed in Module 1, the environment we are operating in is changing, and there are a number of

implications which will affect DHBs. The levels of our success over the next few years will depend on

our ability to adapt to the changing environment as we continue to improve the health of the

Tairawhiti population and reduce or eliminate health inequalities.

For the 2015/16 year we are nationally required to produce a workforce strategy which is

summarised in section 5.3 of this module.

5.1.1 To tatou iwi / Our people

The central part of our capability is our people. Providing health and disability services now and into

the future depends on having a workforce that is well matched to the health needs of the community

and appropriately skilled and located. We will look to create an environment to unleash innovation

by staff empowerment.

Key points of note about our workforce (as at 31 December 2014) are:

• we employed 862 staff, 702 permanent, 160 casuals • 81% of staff were female, • we have a multi-cultural workforce with 37 different ethnicities working together to provide

health services in many settings • the Maori workforce make up around 24% of the overall staffing numbers • Maori are underrepresented in the medical workforce however the proportion of Maori is

gradually increasing • New Zealand non-Maori make up the largest single ethnic group of employees • Our workforce is older than that of other DHB’s. The mean age is 48.7 compared with the

average DHB mean age of 45.9

Kō

wae

Tuarim

a

People Performance

Management

Clinical Integration/

Collaboration /

Partnerships

Information

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The following table highlights the various areas of occupation (as at 31 December 2014):

Staff Turnover: 9.1%

5.1.2 Organisational Performance Management

Our performance is assessed on both non financial and financial measures. The table in section 5.6.2

of this module provides an overview of the external reporting. Our planned performance as a

planner, funder and provider of health services is outlined in this plan and our service plans.

Non financial performance reporting

Non financial performance, which relates to volume and performance expectations for health service

provision by Tairawhiti DHB, PHOs and the NGOs we fund is monitored regularly

As a funder we monitor the agreements we have with providers through effective portfolio

management which includes regular performance reports and data analysis. We also monitor the

quality of services provided through reporting of adverse incidents, routine audits, service reviews

and issues-based audits.

We report (on the indicators due each quarter) to the Ministry of Health on the indicators in the DHB

Non Financial Monitoring Framework and regularly feed into benchmarking and quality programmes

to compare our performance with other providers.

We report to our Board through the quarterly narrative reporting process on our performance

against all the indicators in this Annual Plan. As part of our narrative reporting process the report is

also review by the CEO’s direct reports. These reports are provided and discussed in Board Meetings

and the reports are available to the public as part of the relevant Board agenda available on our

website.

We support the national expectation that the public should be informed about health system

performance by publishing our performance against the national health targets. The information on

our non financial performance is one of the tools used by the organisation to identify issues and

inform decision-making to improve our performance.

TDH DHB Staff as at 31 Dec 2014

Occupational Group Head Count

Percentage Full Time Equivalent (FTE):

Admin/Management 149 21.2% 135.8

Allied Health 103 14.7% 86

Medical 68 9.7% 62.6

Nursing 307 43.7% 236.6

Support 75 10.7% 56.8

Total 702 100% 577.8

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Financial performance reporting

As part of our annual planning process we submit a set of financial templates to the Ministry of

Health. The templates inform the tables and narrative presented in module four. We report monthly

to the Ministry of Health against the financial templates.

We report on our financial performance monthly to our Board. This report includes commentary and

financials as well as actions planned to improve financial performance.

As part of our financial reporting we include full time equivalent (FTE) reporting. This covers areas

like:

• Accrued FTE

• Management / Administration FTE Cap

• Clinical FTE

• Out Sourced Services FTE

The information on our financial performance is one of the tools used by the organisation to identify

issues and inform decision-making to improve our performance.

5.1.3 Pūtea me te Whakahaere Pūtea / Funding and Financial Management

The following table sets out our key financial indicators:

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

$000 $000 $000 $000 $000 $000 ACTUAL FORECAST PLANNED PROJECTED PROJECTED PROJECTED

Revenue (after

adjustments)

161,478 164,532 166,437 167,451 168,623 169,804

Net Surplus/(Deficit) 144 (2,000) 0 0 0 0

Total Fixed Assets 63,483 63,549 63,055 62,553 62,042 61,522

Net Assets 35,160 32,778 32,396 32,013 31,631 31,249

Term Borrowings and

Provisions

16,786 16,674 16,554 16,425 16,287 16,138

Our longer term forecast is set out in the following table.

2014/15 2015/16 2016/17 2017/18 2018/19 2019/2020 2020/2021

$M $M $M $M $M $M $M

Forecast Budget Planned

Net Surplus/ (Deficit)

(2.000) 0 0 0 0 0 0

We use our long term financial plan for the next 20 years to model capital affordability so we can

determine the timing of delivery of the programme.

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5.1.4 National Rängai Hauora tari / National Health Sector Agencies

We are expected to align our planning with the planning intentions of key national agencies. Each of

these national agencies has initiatives for the 2015/16 year, which will impact on our DHB. The

national agencies are:

National Health Information Technology Board (NHITB)

Health Quality and Safety Commission (HQSC)

PHARMAC

Health Workforce New Zealand

National Health Committee

For further information and actions that the Tairawhiti DHB are supporting in relation to the National

Health Sector Agencies to improve performance are notably presented through Modules 2.5 National

Entity Initiatives and 2.6 Living Within Our Means of this plan.

5.1.5 Risk Management

TDH runs a top-down and bottom-up approach to risk management that aligns with the NZ Standard.

Risk Plans are prepared at the service level, coordinated through the Quality and Risk function of the

DHB and then used as the basis for the Board's overarching Risk Plan which is signed off by the

Finance, Audit and Information Technology (FAIT) Committee of the Board. Risks identified by the

services tend to be more operational and those identified by the Board more environmental. The

Risk Plan is used to drive the Internal Audit Plan, the Quality Plan and service improvement initiatives

including the replacement of capital equipment. Where appropriate, risks identified by the Board will

be disseminated to the services for inclusion in relevant plans.

The Ministry of Health’s Sector Services Unit also provide a range of routine and special audits on

behalf of Tairawhiti DHB with respect to primary care services and fee for service agreements

(including pharmacy, dental, home based support services and aged care).

5.1.6 Performance19 and Management of Assets

We have developed a formal asset management plan in accordance with Ministry of Health

requirements.

In line with national expectations we will participate in the provision of a regional commentary to sit

alongside the Midland DHB region Asset Management Plans. The regional commentary will take into

account the long term direction on service delivery settings and clinical and economic sustainability.

19 Availability / utilisation / functionality / condition

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5.1.7 Shared Decision-Making

A cornerstone of stewardship is cooperation and partnerships with key stakeholders. A large

component of that is joint decision-making around funding and service development with

clinicians, NGOs, the community, Iwi partners and other inter-agency and government

agencies. We cooperate with other health and disability organisations, stakeholders and our

community to decide what health and disability services are needed and how to best use the

funding we receive from Government to improve, promote and protect the health and

wellbeing of our population. We cooperate because working together with other groups on

targeted areas brings better outcomes than those groups working in isolation in the same

area.

Clinical Governance

A commitment to quality and patient safety places responsibility on the DHB to have effective

mechanisms in place for planning, monitoring and managing the quality of clinical care

provided. Attempting to make the fundamental changes to the health system for the sector to

‘live within its means’ will require strong clinical engagement and leadership. TDH is driven by

clinical engagement commitments through a range of documents including Time for Quality

and In Good Hands, and clear focus on releasing time to care. In supporting Tairawhiti to

become financially and clinically sustainable, as well as improve the health outcomes of this

population, clinical leadership and engagement is critical.

Clinical input into decision making is facilitated by a model of shared management and clinician

leadership at all levels within the DHB. Our Clinical Directors are formally part of the TDH

Leadership team and are involved in the financial and clinical management of their services.

The TDH Clinical Board is a multidisciplinary clinical forum, whose membership includes

representatives from the primary, secondary and community sectors. The Clinical Board is

chaired by the Chief Medical Officer. The Clinical Board oversees the DHB’s clinical activity,

provides advice to the Chief Executive and Board on clinical issues and takes a proactive role in

setting clinical policy and standards, encouraging best practice and innovation. Members

support and influence the DHB’s vision and values and play an important clinical leadership

role, leading by example to raise the standard of patient care within the DHB and across the

sector.

TDH has also established a Clinical Leaders Forum across primary and secondary clinical staff to

identify core actions that we can cooperate on to improve the patient flow and address

blockages in the system. This Forum has identified a list of actions from improving

communication flow between GPs and hospital specialists through to improving clinical

pathways for access to diagnostics. Working directly with clinicians to identify local issues, and

commitment to resolving these in an expedient way, is another bridge in strengthening

relationships and improving health outcomes for the population.

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Māori Participation in Decision Making

We engage at many levels with Māori

providers and community. TDH observes

the Treaty principles within the framework

of the New Zealand Public Health and

Disability Act 2000 for all issues related to

Māori health and disability issues. In the

Tairawhiti context these are:

Partnership: - TDH has in practice

processes that enable Māori to engage

and contribute to decisions at all levels of decision-making based on mutual understanding

and cooperation.

Participation: - TDH is a joint partner in identifying priority areas for Māori health gain

within Tairawhiti. Māori are involved in overall strategic and operational planning

processes.

Protection: - TDH is committed to a bi-cultural approach in its delivery of health and

disability services which includes the utilisation of tikanga Māori. TDH is working with Māori

to ensure the protection of Māori cultural concepts, values, practices and other taonga.

Tikanga a iwi is adhered to with bi-culturalism actively promoted. The Board and staff are

trained in bi-cultural approaches to health and disability service funding and provision with an

in-house programme entitled Te Kete Kawerua. This is supplemented for clinical staff by a

programme of cultural competence entitled Tikanga Best Practices. In the role of funder TDH

is actively fostering Māori processes within all health and disability support service providers,

and consistently applies the Health Equity Assessment Tool (HEAT) to all its funding decisions.

To meet responsibilities under the NZPHD Act TDH is expressly:-

- Targeting services to vulnerable population groups by improving health and

disability outcomes for Māori and other population groups.

- Fostering the development of Māori capacity to participate in the health and

disability support sector and provide for the needs of Māori.

- Providing relevant information to Māori for the purpose of decision making within

the consultative processes.

Our Māori Health Plan commits us to establishing formal relationships with other Māori

representative groups. We continue to explore mechanisms to facilitate these formal

relationships and greater participation of Māori at an executive and governance level, as a

pathway to shared decision making.

Iwi Engagement

The TDH Board has a formalised relationship with each of the Tairawhiti Iwi representative

Boards. These relationships are in the form of a MoU that cements the bodies to joint actions

of shared interest, where we meet at least annually to assess progress on the respective

organisations and supported by regular management interaction.

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Te Waiora o Nukutaimemeha

TDH’s Māori Relationship Board (on behalf of Māori in Tairawhiti) is called Te Waiora o

Nukutaimemeha (TWON) and its role is to act in partnership with the TDH Board in accordance

with the Treaty of Waitangi to improve the health and well-being of Māori within the district.

TWON membership is a mixture of Iwi representation, provider representation and community

representation. The TWON Chair has a seat alongside the TDH Board and full participation and

decision-making rights.

TWON’s main objectives are to:

Implement processes for effective participation, engagement and input by Māori whanau,

hapu, and iwi;

Actively assist the development of an effective relationship between Māori whanau, hapu,

and iwi and the health sector; and

Progress workforce development within the TDH sector and promote cultural

effectiveness and competencies across the health sector and assist the development of

Māori providers.

Community Input

In the development of our services, both as a funder and provider, community input is critical

in understanding what the health needs are, how the community experience our health

system, and how improvements can be made to these services. TDH holds public meetings as

required on major service changes, and the CPHAC and ADSAC Committees of the Board have

a schedule of public meetings across the district to hear and respond to the health issues

facing those communities. This informs our planning and response to improving our health

services for our community.

Primary Health Alliance Leadership Teams

Tairawhiti Integration Forum (TIF) is the local Alliance Leadership Team (ALT) established with

our primary care partners; the Midlands Health Network, the National Hauora Coalition and

Ngati Porou Hauora PHO. TIF has selected three areas for close cooperation in 2015/16 these

are E Tipu E Rea, long term conditions and complex acute admissions.

Key clinical leaders, key managers from provider organisations, and District Health Boards staff

are selected to successfully lead our Alliance to achieve its objectives through the Tairawhiti

Integrated Committee (TIC) whose remit is to improve the clinical components of integrated

care within the district.

The purpose of TIF is to lead and guide TIC as they seek to improve health outcomes for our

populations. We aim to provide increasingly integrated and co-ordinated health services

through clinically-led service development and its implementation within a “best for patient,

best for system” framework. The key priority for the TIF is to implement the Business Cases

for the delivery of Better, Sooner, More Convenient Primary Health Care in Tairawhiti.

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Community Agencies

We work with other agencies (for example Gisborne District Council, Ministry of Education,

Ministry of Justice, Ministry of Social Development, Police, Tertiary Education Commission,

Housing NZ as well as other central government agencies) to improve the determinants of

health.

Examples of inter-sectorial collaboration include:

Whanau Ora Integrated Contracts

Long-term Community Council Plans

Street by Street

Strengthening Families

Children’s Team

Social Sector Trials

Safe Tairawhiti

Accident Compensation Corporation and DHB relationship

Progression of the Tairawhiti Welling- a Collective Impact framework

5.2 Te Kaha Building / Building Capability

This section outlines the capabilities we will need in the next three to five years as well as

touching on the approach in the short term to work towards developing these.

5.2.1 HealthShare Limited

HealthShare (HSL), established in 2001, is a regional Shared Services Agency jointly owned by

Waikato, Bay of Plenty, Lakes, Taranaki, and Tairawhiti District Health Boards. From August

2011 HSL has taken on an expanded role as a regional provider of non clinical service and now

provides operational support in a number of areas identified as benefiting from a regional

solution.

The Midland region DHBs determine the services that HSL will provide, and the level of these

services, on an annual basis. These determinations are made through the Regional Services

Plan (RSP) and regional business case processes.

Categories of possible regional service delivery include:

• Activities that support future regional direction and change through the development of

regional plans

• Facilitating the development of clinical service initiatives undertaken by regional clinical

networks and regional action groups that support clinical service change

• Key functions that support and enable change through the ongoing development of the

region’s workforce and information systems

• Back office service provision that can drive efficiencies at a regional level, alongside new

national back office shared services.

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The annually agreed regional services form the basis for HSL’s Business Plan which specifies the

company’s performance framework; the services to be provided; and the associated

performance measures. HealthShare’s Business Plan also details, at a service level, the

activities that have been purchased by the shareholding DHBs.

HSL has multiple planning and reporting relationships within the Midland region and to

national agencies as depicted in the diagram:

The following regional services are expected to be provided from HSL in 2015/16:

Regional planning and reporting facilitation

Regional Service Networks

Midland Cancer Network Midland Elective Services Network

Midland Mental Health and Addictions Midland Clinical Cardiac Network

Regional Clinical Networks and Regional Action Groups including:

Child Health Action Group Health of Older People Action Group Midland Maternity Action Group Midland Region Trauma System

Regional Emergency Departments Services*

Regional Projects

Radiology Stroke

Midland DHBs

Waikato

DHB Taranaki

DHB Lakes

DHB Bop

DHB Tairawhiti

DHB

HealthShare Board

Midland CEs Group

Minister & Ministry of Health National

Health

Board

Annual Report

Funding contracts & reporting

Business plan &

reporting

Regional

Contracts

Regional

Services Plan & reporting

Service level

agreements

Serving the Midland DHBs through network coordination and support excellence

DHB Shareholders

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Midland Region Training Network

Workforce development and intelligence support

Regional Information Services

Shared services including

Third party provider Audit and Assurance Service* Regional Internal Audit Service (Waikato, Lakes, Taranaki, Tairawhiti)*

Midland recruitment and selection service

* These areas are not included in the 2015/16 Regional Services Plan

Tairawhiti DHB has budgeted $761,261 for the purchase of the above services from

HealthShare in 2015/18.

5.2.2 Information Communications Technology

The Midland Regional IS service will implement the Midland Region Information Services Plan and

advance National Health IT Board priorities, specifically the implementation of the National Health IT

Plan priority areas. Work in this area is done within the context of the affordability envelope of the

Midland DHBs.

The process of prioritising the ICT work effort is done via the IS executive group with is comprised of

clinical leaders and business leaders from each of the Midland DHBs. This group reviews the

programmes of work and provides recommendations to the regional capital committee for funding

decisions.

A current focus is on regional deployment the CSC ePharmacy application that will provide the

underpinning for the regional deployment of the medication management pilot. There have been a

number of technical and contractual challenges that have slowed the delivery of the ePharmacy

programme. Currently, the final contractual issues are targeted to be resolved in quarter one 2013,

this will enable this project to commence in earnest.

The other programme currently under review is the deployment of the Orion CWS application within

the Midland region. This will require significant reprioritisation of current activities at both a local

and regional level to enable this to be brought forward.

Further information is available in the Midland DHBs RSP for 2015/16.

5.2.3 Integrated Contracting

We have been participating in the whanau ora integrated agreements developments across the

health and social services sectors, and currently have two providers operating under integrated

contracts. The process is being led by the Ministry of Social Development (MSD) who has nominated

the providers. This involves bringing together services across agencies (for example Ministry of Social

Development, Ministry of Justice, Tairawhiti DHB) to work with a defined population to ensure

increased cohesion of service delivery.

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We will continue to look to take up integration opportunities when they occur. When making

decisions on integration, considerations we will take into account are:

consistent population coverage position in the continuum of health services history of service / contract delivery integrating agreements will not result in service gaps

5.2.4 Capital and Infrastructure Development

Capital expenditure is planned and prioritised at both a Midland regional and local level. DHBs

capital intentions, which span 10 years, are consolidated to form a regional view. Large clinical

investments are collaborated with the aim of achieving best fit for the region.

The Midland region capital committee meets regularly to consider and approve business cases

requiring regional sign-off. Business cases are prepared and approved at a local Board level before

submission to the regional capital committee for approval.

During 2012/13 an exercise was undertaken to assess the seismic status of the Tairawhiti DHB

building stock. The work undertaken was similar to what hundreds of organisations have done since

the 2011 Christchurch earthquake. A number of buildings were identified as being earthquake

prone. It is expected that plans for the future of each earthquake prone building will be presented to

our Board progressively in 2015/16.

The main major capital and infrastructure investments Tairawhiti will be working towards in the

short term are

Midland regional Clinical Workstation, implementation will align with the Midland Region Information Services Plan and advance National Health IT Board priorities

Replacement of computed tomography scanner which is scheduled for the 2017/18 year

A new medical unit in 2015/16 which will have an oncology focus

Reconfiguration of the central sterile services department (CSSD) which should start in late 2015.

5.2.5 Cooperation

We cooperate with other health and disability organisations, stakeholders and our community to

decide what health and disability services are needed and how to best use the funding we receive

from Government. These cooperative partnerships also allow us to share resources and reduce

duplication, variation and waste across the whole of the health system to achieve the best health

outcomes for our community.

Regional Collaboration

In addition to the work happening regionally around our RSP development and implementation,

there is work occurring in other areas. An example of such an area is Public Health. There are four

Public Health Units in the Midland Region:

Toi Te Ora Public Health Service servicing the Bay of Plenty and Lakes DHBs

Te Puna Waiora, Tairawhiti District Health

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Public Health Unit, Taranaki DHB

Population Health, Waikato DHB

Midland DHBs Public Health Units have identified a number of areas where collaboration could be

strengthened. In 2015/16 the Public Health Units will continue to develop collaborative working

relationships by maintaining and developing regional linkages and contacts, sharing information,

contributing to the National Public Health Clinical Network and collaborating on relevant regional

projects. In line with national direction, a Midland Regional Public Health Network has been

established. The Network provides leadership and strengthens the performance and sustainability of

Public Health Units. The Network will also develop and maintain relationships with the Midland

Regional Services Planning Groups.

The goals of the Network are to:

Enhance the consistency, co-ordination and quality of public health service delivery across

the Region.

Plan together where there are benefits in doing so.

The Network’s specific areas of focus for 2015/16 are outlined in the following table.

Sale and Supply of Alcohol Act 2012

The Sale and Supply of Alcohol Act 2012 marks a shift in the approach to alcohol and its

management. As part of the change, there has been an increase in the legislated role of Medical

Officers of Health (MOsH) (and therefore public health units (PHUs)) in the sale and supply of

alcohol.

Many of the changes are developments on existing approaches (collaborative, Liquor Accord for

Regulatory Agencies (LARA) etc), but some specific changes have increased the direct workload of

MOsH. The major increase in day-to-day work has been the inclusion of special licenses within the

remit of MOsH. This has increased the strategic opportunities, for example, the development of a

common (NZ-wide) approach to school license applications has been led by Tairawhiti, as well as on-

going work with local School Principal associations to develop school policies.

Structural changes, specifically the development of a Local Alcohol Plan (LAP), increase the role of

the MOsH and PHU in the local strategic approach to alcohol and licensing.

The Sale and Supply of Alcohol Act 2012 allows for the delegation of many of the day-to-day

functions of the MOsH. TDH supports this delegation by employing sufficient Health Protection

Officers (HPOs) to enable this delegation locally. To date, this delegation has been made to two

HPOs. This includes routine delegation for sections 103; 129; 141; 152; 286 and 295; case by case

delegations for sections 204;205 and 206. The MOH has retained functions under s78 and s81.

TDH supports the new Sale and Supply of Alcohol Act 2012 by enabling the lead MOsH and HPOs to

attend national training on the Act. Similarly, the Health Promoting School (HPS) coordinator is

enabled to be involved in school alcohol policy development. MOsH are enabled to attend twice-

yearly national MOsH and MoH meetings, as well as additional training days. The lead MOsH also

attends on-going Continuing Medical Education (CME) training relevant to the Act which is supported

by TDH.

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Local Collaboration

We work with other agencies (for example Ministry of Education, Ministry of Justice, Ministry of

Social Development, Police, Tertiary Education Commission, Housing NZ as well as other central

government agencies and local government) to improve the determinants of health.

Examples of inter-sectorial cooperation include:

• Whanau Ora Integrated Contracts

• Long-term Community Council Plans

• Strengthening Families

• Accident Compensation Corporation and DHB relationship

• Healthy Homes initiatives

5.2.6 Long Term Demand Forecasting

We are experiencing an increasing mismatch of health service demand, supply and affordability. The

health sector cannot continue to operate in the same way as it has been if we expect to be clinically

and financially sustainable into the future.

Long term demand forecasting is one of the tools we must use to inform decisions around reforming

health sector configurations and related models of care if we are to move forward with a sustainable,

affordable and fit for purpose health sector. These reforms have already begun in the shape of:

programmes like the better, sooner, more convenient health care initiatives

expectations for closer integration of services across the care continuum to improve

convenience for patients and reduce pressure on hospitals

regional service planning.

We will continue to participate in demand forecasting work as well as exploring the use of modelling

and simulation techniques to assist in shaping services. These techniques can improve both

efficiency and quality of services through a range of applications including:

waiting time reduction

scheduling

bed capacity management

workforce planning

commissioning

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5.3 Kaimahi / Workforce

Health Workforce New Zealand (HWNZ) has overall responsibility for planning and development of

the health workforce. It aims to ensure that New Zealand has a fit-for-purpose, high quality and

motivated health workforce, keeping pace with clinical innovations and the growing needs and

expectations of service users and the public.

5.3.1 Managing Our Workforce within Fiscal Restraints

The State Services Commission requires all DHBs to produce Workforce Strategy aligning business

priorities, projected results and a planned approach to managing the people aspects of their business in

the medium-long term. Health Workforce New Zealand (HWNZ) has developed an overarching national

strategy and guidelines specific to the health sector to support DHBs to meet this requirement within

their annual planning process.

5.3.2 Strengthening our workforce

Health Workforce New Zealand (HWNZ)

Health Workforce New Zealand’s aim is to lead the development of a workforce that can respond to

changes in how health services are accessed. A key way to do this is to support demonstration sites where

new workforce roles, new models of care and new training programmes can be tested to find those with

the potential to:

• boost workforce productivity and efficiency • improve patient outcomes • offer value for money.

Priority will be given to demonstrations in aged care, mental health and rehabilitation, and those that

align to government priorities. The aim is to:

• improve recruitment, retention and repatriation • devise new postgraduate training programmes and career pathways • share successful innovations with others in the health sector • reduce workforce expenditure with no compromise on patient safety or quality of care

Tairawhiti DHB regularly scans HWNZ activities to ensure alignment of our direction and to ensure that

there is no duplication of effort and our direction supports the HWNZ work plan with its particular focus in

2015/16 being on:

• Advanced Trainee Fellowship (ATF) Scheme • GP training • Health science and technical review • Regional Training Hubs

For further information on this year’s HWNZ work please read Module 2.5 National Entity initiatives

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Regional

The regional workforce programme will address the workforce change required to meet current and

future service need, and address the most commonly raised issues across the region, relating to the

future sustainability of the workforce. This includes the need to better anticipate future states and

investigate regional cooperative activity that supports this approach. Workforce development activity

underpins the collective response required to ensure access to quality, sustainable services across the

whole region.

Midland DHBs share responsibility for planning and undertaking forward-looking action on workforce

development that minimises duplication. This includes regional cooperation to investigate the impact of

reducing the rate of growth in health spending on design, capacity, and workforce utilisation in general.

The key workforce priorities for the Midland Region in 2015/16 are:

• Care assistant development (HCAs, orderlies, therapy assistants) • Strategies around the management of the ageing workforce • Recruitment and retention strategies for rural vulnerable workforces • Implementation of the Midland Training Network (MRTN) action plan • Kia Ora Hauora for the promotion of health as a career to Māori • Strategies around alternative workforces that add value and cost less or are cost neutral.

Midland Region Training Network (MRTN)

Workforce planning and training is about ensuring that the Midland region has the right numbers of

health professionals, are well skilled, have the competence to provide the best services to our populations

within the Midland region and display good collegial behaviours.

Workforce and Training is a key enabler to ensuring the Midland DHB’s capacity to fulfil its obligations

within this Regional Services Plan. The Midland Region has over ten thousand full time equivalents

employed by the DHB to provide healthcare to its population. The health workforce is large and complex

and requires sound strategic planning in order to maximise the contribution to health and have a

workforce ready to accommodate new ways of working.

This Midland Region workforce and training plan illustrates the collaborative work of the Regional

Director of Training and General Managers of Human Resources building whole of health solutions and

also working alongside the Clinical Networks to meet some of their key deliverables that pertain to

workforce and training.

Tairawhiti DHB will support a regional approach to address key workforces issues such as

• Supporting the training and development of a number of diabetes nurse prescribers both across the region and within Tairawhiti DHB, during 2015/16

• Implement and evaluate the General Practice Education Programme (GPEP) 2 registrars training alongside doctors registered in another vocational scope during 2015/16

• Increase the number of trainee sonographers, both across the regional and within Tairawhiti, to meet current and expected future demands

• Provide robust career advice, guidance and support to all HWNZ funded trainees enabling their career development

• From July 2015 implement the 70/20/10 funding criteria for post-entry training in medical disciplines.

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Local

Grow our own Nurses

Nursing turnover is stable at around 10 per cent per annum. TDH strongly supports the EIT Tairawhiti

Bachelor of Nursing training programme through clinical placements, collegial relationships with the

tutors, and for the graduates maintaining our Nurse Entry To Practice (NETP) programme at current

levels. New graduate placements are made in secondary and primary care, and these nurses take up

available positions during the year resulting from normal attrition.

Having graduate nurses entering TDH at the low end of the salary scale provides a cost management

benefit when they replace higher paid longer serving staff.

Growing our own Nurse Specialists

Future models of care will require a shift in the skills and competencies of our nursing workforce working

in community settings – for example, nurse led pre-admit clinics. We are developing new programmes

which require cross-skilling and pooling of existing resources into new services. Becoming more self-

sufficient and cost effective in transporting patients to tertiary services is being accomplished through the

development of our specialised Transport Nursing team. The Long Term Conditions team continues to

work to both enhance outcomes for individual patients while working in conjunction with primary care to

strengthen skills and ability to manage long term conditions in the community.

These changes are effected through shifting current FTE from in-patient staffing into community based

settings, and growing the skills from developing our own staff, linked to the new resources from the

graduate programme.

GP Training

Primary care practitioners improve health outcomes and reduce overall healthcare costs. TDH committed

significant resources from 2009 to 2012 to developing an extremely successful programme where General

Practitioner (GP) registrars were employed by the DHB for three years of their training to help address the

current shortage and future aging workforce pressures.

TDH also reviewed and increased RMO runs specifically with the view of providing attractive runs for

PGY2 doctors interested in subsequent GP training in order to increase the pool of young doctors

interested in GP training in Tairawhiti. RMOs are also approached and encouraged at TDH’s behest by GPs

and TDH staff to consider GP training in Tairawhiti i.e. a TDH facilitated evening for RMOs to “meet the

GPs” shortly after their arrival into the areas. TDH has also been working with and encouraging the

Midland Regional Training Network (MRTN) to develop a Midland wide approach to GP training with the

view for consistent workforce planning and sustainable solutions for the Midland Region. TDH supports a

GP training programme where GP registrars are employed for the full duration of their training with

significant explicit training components in all three years of their training.

RMO career planning support

Since the advent of the GP Training programme, TDH has continually reviewed the elements and run

mix for RMOs. This has included a boost to Paediatrics Diploma placements, implementing RMO

placements into ED, and using PGY2 RMOs on nights as a solution towards a second doctor in the

hospital after hours. Each of these new experiences is desirable for RMOs seeking a career as a GP

and therefore entering the local GP Training programme.

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TDH takes account of the 70/20/10 model for the allocation of postgraduate medical education funds

by assuming full compliance with the funding criteria and budgeting for the total 100% revenue

evenly across the year. TDH has complied with the HWNZ criteria for funding fully in the last two

years and will continue to do so in the 2015/16 year to ensure that the full funding is not placed at

risk

Capacity

Increasing nursing capacity and capability across Tairawhiti

Having a strong supply of well-trained nursing staff is an essential ingredient for provision of the

primary and secondary patient services in the district. To support this, a Tairawhiti wide nurse

leader’s integrated network has been established with an initial undertaking in 2014/15 of

developing a five year Tairawhiti nursing workforce strategy to identify future nursing workforce

staffing capacity and capability. This strategy will include provision for training and career

development and models of care.

Care Capacity Demand Management and Releasing Time to Care

TDH continues to progress the Care Capacity Demand Management (CCDM) system along with the

Releasing Time to Care (RTCC) project. The project is entitled FIT in reference to ensuring a workforce

and environment ‘fit’ to generate the best possible outcomes for patients while supporting an

enhanced working environment for staff. The joint implementation of these two programmes is a

first in NZ. The key parties to the project are Tairawhiti DHB, NHB, SSHW Unit and the health unions.

The goal will be to positively influence the following:

A well organised and appropriately resourced physical environment

The best possible match of staff to demand (number, mix & schedule)

A positive work environment for staff

Cost effective use of resources

A service that is well informed and is informing the wider organisation

A service that is readily able to adapt to variation and change

A service with a high level of self-efficacy

CCDM also supports a service to develop a robust set of markers and indicators that will alert the

service to any gap between demand and capacity

5.3.3 Safe and Competent Workforce

Culture

TDH aims to exceed its good employer obligations by maintaining a safe, supportive and healthy

environment for staff, where a strong culture of leadership, accountability, health, safety and

wellbeing is promoted and fostered. Employees and their respective unions are supported to

actively participate in the development of initiatives that improve workplace culture.

A staff engagement survey was recently completed through the HealthRound Table that achieved a

74% response rate from staff. The findings have been shared with all staff and their representative

unions. To support staff participation a committee made up of nominated staff from a cross section

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of workforce groups have been tasked with identifying areas and initiatives that can be targeted over

the next two years to continually improve the TDH culture.

The induction and orientation process will be reviewed to ensure that all new staff get an

organisation and service specific induction that will allow them to safely and competently perform

the relevant aspects of their jobs whilst employed by TDH.

TDH has effective health and safety practises in place that meet the tertiary standards of the ACC

Workplace Safety Management Practises (WSMP) scheme. TDH will ensure that it meets its

obligations as a good employer by maintaining tertiary accreditation through the WSMP standards

and reviewing its health and safety practises in line with the impending statutory amendments due

within the next year. The review will inform opportunities to further enhance workplace health and

safety.

The performance appraisal system called You-Time will be further developed to support career

planning, staff development and allow staff to discuss aspects important to their roles and wellbeing

such as work life balance.

The continuous learning culture that TDH has grown through its learning centre Ko Matakerepo and

centralised learning and development programme will be further enhanced through the introduction

of online learning opportunities which will provide greater learning accessibility to staff. TDH will

support all staff that hold leadership responsibilities or have been identified for leadership succession

with targeted leadership training, coaching and support.

The “Taking the Bully by the Horns” intuitive was strongly supported by staff and successful in

addressing bullying and harassment prevention. TDH will continue to work closely with staff and

unions to take a zero tolerance toward bullying and harassment to ensure the welfare and

psychological safety of its staff.

5.3.4 Child Protection Policies

Tairawhiti DHB recognises that there is a duty of care to any child/young person who has witnessed,

reported, disclosed or with suspected abuse or neglect that has presented to hospital or who has

been referred to and/or treated by community health staff. Reporting of all abuse or neglect of

children/young persons to Child, Youth and Family (CYFS) is mandatory and safety of the child is the

paramount consideration. To ensure that workers are ably equipped training on child abuse and

neglect is mandatory. There is a six step process that workers need to go through as outlined below:

Identify – See and recognise indicators of abuse and neglect

Provide emotional support for identified/suspected victims.

Assess Risk

Safety planning and referral

Document current past injuries

Referral to Child Youth Family Services or specialist social service agency

Debrief – Seek support for yourself. It is imperative that we all take responsibility and help reduce the impacts of child abuse and neglect.

Police vetting will continue and all staff that have contact with children as part of their role will be

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monitored. There has been greater alignment done with our child protection policies and the

Vulnerable Children’s Act and the policies can be accessed via our website20. These policies will be

reviewed every three years.

5.3.5 Children’s Worker Safety Checking

The purpose of the children’s worker safety checks as part of the Vulnerable Children’s Act 2014 is to

reduce the risk of harm to children by requiring people employed or engaged in work that involves

regular or overnight contact with children to be safety checked.

All new staff, students and volunteers employed and engaged at Tairawhiti DHB have undergone

police vetting and screening prior to employment, and organisational pre-screening questions inform

all candidates of this requirement, prior to employment. A system is in place to record this

information and the date for updating every three years.

Our onsite contractors OCS and Spotless are required to undertake police vetting and screening on all

staff working onsite.

A system of safety checks for existing workers, including police vetting and screening, confirmation of

the identity of the person, has been implemented by working through all departments.

All contracts and funding arrangements for services which provide services directly to children have

been required and supported to implement and have a system for worker safety checks three yearly.

Any exemptions or compliance issues are reported to the Chief Executive.

5.4 Whakahaere Hauora / Organisational Health

We need to make sure that we have the people, relationships, and processes that will enable us to

achieve our outcomes, impacts, and outputs. We cannot be successful without well-qualified and

motivated staff, sound management of resources and an effective working relationship between

staff and stakeholders.

5.4.1 Kāwanatanga / Governance

Our Board assumes the Governance role and is responsible to the Minister of Health for the overall

performance of the DHB. The Board’s core responsibilities are to set the strategic direction for the

DHB through developing policy that is consistent with Government objectives and which improves

health outcomes for our population.

The Board also ensures compliance with legal and accountability requirements and maintains

relationships with the Minister of Health, Parliament and the Tairawhiti community. Seven Board

members are elected by the Tairawhiti DHB community and four are appointed by the Minister of

Health.

20www.tairawhitidhb.health.nz

http://www.tairawhitidhb.health.nz/

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Three statutory advisory committees and three non statutory committees have been established to

assist the Board to meet its responsibilities. The Aged and Disability Advisory Committee (ADSAC),

Committee and Public Health Advisory Committee (CPHAC) and Hospital Advisory Committee (HAC)

all have delegated authority to allocate funds and approve agreements based on their approved

delegation. The membership of these committees is comprised of a mix of Board members and

community representatives who meet regularly throughout the year.

While responsibility for our DHB’s overall performance rests with the Board, operational and

management matters have been delegated to the Chief Executive. The Chief Executive is supported

by a Leadership Team, which includes the Group Manager of Planning, Funding, and Population

Health, Kaiwhakahaere Hauora Māori, Group Manager Finance, Group Manager HR, Group Manager

Information Services, Director of Nursing, Chief Medical Officer, Communications Manager, Clinical

Directors and Clinical Care Managers.

5.4.2 Ratonga whakamāherehere me te Pūtea Hauora me te Hauātanga / Planning and Funding

Health and Disability services

The Planning and Funding Division of our DHB, Te Puna Waiora, is responsible to the Chief Executive

for planning and funding health and disability support services across the Tairawhiti district, as well

as access to regional or national services in conjunction with regional DHBs and the NHB, and

determining how best to invest the funding we receive from Government to meet the health and

disability support needs of our population. The core responsibilities of the Funder arm are:

Assessing our population’s current and future health needs;

Determining the best mix and range of services to be funded;

Building partnerships with service providers, Government agencies and other DHBs;

Engaging with our stakeholders and community through participatory consultation;

Leading the development of new service plans and strategies in health priority areas;

Prioritising and implementing national health and disability policies and strategies in relation

to local need;

Undertaking and managing contractual agreements with service providers; and

Monitoring, auditing and evaluating service delivery.

Through our Planning and Funding team, we enter into service agreements or support arrangements

with the organisations or individuals who can best provide the health and disability services required

to meet the needs of our population, achieve the objectives of the DHB and enhance efficiencies

across the whole of the health system.

Local Prioritisation

Prioritisation is the allocation or reallocation of funding on the basis of evidence to services which are

most effective in improving health and reducing health inequalities. The fiscal environment facing the

health sector now and in out years means prioritisation processes must be particularly robust to

ensure we deliver on the Government’s commitment to better, sooner, more convenient healthcare

for all New Zealanders.

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As a funder, TDH faces the dual challenge of not only funding services which will deliver health

improvements and reduce health inequalities, but we must do this while attempting to bring our

overall costs down within what is affordable under the Population Based Funding Formula (PBFF).

Therefore, TDH will continue to undertake rolling line-by-line reviews of all its funded services, as

well as potential new existing investments, to ensure that we are utilising our population based

funding allocation to maximise health benefit. We will do this using accepted prioritisation and

inequalities tools.

When considering prioritisation decisions, TDH will apply the following decision-making principles:

Te whai huatanga / Effectiveness

Publicly-funded health and disability services should be effective. Effective services are those that

produce more of the outcomes we desire, such as reductions in pain, the maintenance of daily

activities, greater independence, and the prevention of premature death. Services that are shown

to be more effective than others should be given higher priority.

Uara mō te moni / Value for money

Publicly-funded health and disability services should be cost effective. Services that deliver the larger

gains in health outcomes and equity should be given higher priority.

Whakaiti ritekore / Reducing Inequalities

Publicly-funded health and disability services should improve health outcomes for at risk groups by

improving access, affordability and capacity to benefit. Services that reduce disparities in health

status between different groups should be given higher priority. The Health Equity Assessment Tool

(HEAT) tool is consistently applied to all funding and service development initiatives proposed and

implemented by TDH.

Ia fariihia / Acceptability

Publicly-funded health and disability services should be acceptable to the community. Services that

have been consulted on and are compatible with local and national strategies (for instance, the New

Zealand Health and Disability Strategy) should be given higher priority.

5.4.3 Te whakarato Hauora me te Ratonga Hauātanga / Providing Health and Disability Services

As well as being responsible for planning and funding the health and disability services that will be

delivered in the Tairawhiti district, we also provide a significant share of those services as the ‘owner’

of hospital and specialist services.

These services are provided through our Provider Arm from one facility being Gisborne Hospital in

the city. TDH provides a comprehensive range of emergency, acute and elective secondary services.

Gisborne Hospital is a Level 3 facility, providing a full range of services including medical, surgical,

paediatrics, obstetrics, gynaecology and mental health. Gisborne Hospital is also a base for a range

of associated clinical support services and allied health such as rehabilitation, speech therapy,

occupational therapy, physiotherapy, long term conditions support, district nursing, public health

nursing, health promotion, health protection, mental health and drug and alcohol programmes.

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There are 131 beds at Gisborne Hospital, including Neonatal (8 beds), Maternity (9 beds) and Mental

Health (12 beds). There are 78 beds available for medical and surgical patients (including critical

care) with a further 24 beds for children.

Waikato DHB serves as the hub for provision of tertiary services for Tairawhiti and within the

Midland region – except for tertiary mental health services (which are provided through Capital and

Coast DHB). The majority of out of district referrals are to Waikato, Auckland, Wellington and

Hawkes Bay.

The costs of providing services to people living in a district are met by the DHB of domicile and are

referred to as ‘inter-district’ services or Inter-District Flows (IDFs). Where services cannot be

provided by our DHB, we have funding arrangements in place enabling Tairawhiti district residents to

be provided care outside the district. We also deliver against service delivery contracts with external

funders, such as the Accident Compensation Corporation (ACC). We closely monitor IDFs and ACC

volumes to ensure our ability to provide for our own population is not adversely affected by demand

from outside the district.

5.5 Pūrongo Na Whakawhiti / Reporting And Consultation

5.5.1 Consultation with the Minister and the Ministry of Health

Implementing health policy is complex and challenging, with a multitude of difficult decisions to be

made. There is considerable public pressure to expand public spending on new medical technologies

and greater levels of care and interventions.

We follow an appropriate planning and consultation processes to avoid adverse financial, resource

and clinical impacts on the affected population(s) and avoid unnecessary service instability. A well-

managed process provides the confidence that:

a robust process is followed

there are sufficient controls in place to avoid unnecessary service instability

the change is clinically appropriate and public confidence is managed

There are a range of matters that we must consult / notify the Minister of Health, the National

Health Board and Ministry of Health. These matters are:

proposed service changes

acquisition of shares or other interests

entry into joint ventures and / or cooperative agreements / arrangements

capital expenditure if required by policy and / or legislation

otherwise as required by legislation, regulation or contract

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5.5.2 External Reporting

The Ministry of Health monitors our performance on behalf of the Minister. The mechanisms

currently in place to achieve this are outlined in the following table.

Table: External Reporting Framework

Reporting Frequency

Information requests Ad hoc

Financial reporting Monthly

National data collections Monthly

Risk reporting Quarterly

Health target reporting Quarterly

Crown funding agreement non financial reporting Quarterly

DHB Non financial monitoring framework Quarterly

Annual Report and audited accounts Annual

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Module 6 – Whirihoranga Ratonga / Service

Configuration

6.1 Ratonga Rohe / Service Coverage TDH acknowledges that it has responsibility to fund other services outside the district, and will do so

accordingly. The impact of this responsibility in the 2015/16 funding environment will largely be

limited to:

• determining alternative levels of services purchased from those indicated by Ministry of

Health forecasts where there have been indications that volumes need to be increased or

decreased in line with need and prioritisation

• funding any additional acute inpatient activity to meet demand

• purchasing services previously provided within the district from outside the district should

local provision be disrupted.

Services not directly funded or provided by us include, but are not limited to:

• Well Child services through Plunket, health camps

• National contracts (Organ transplants and new services purchased nationally in 2015/16)

• Emergency ambulance services

• Strengthening Families

• Family Start

• Community Forensic Mental Health Services

• Primary response in medical emergencies (PRIME)

We have little influence in these areas in respect of service coverage. We will, however, seek to

engage with the relevant providers as appropriate. There are also services such as Public Health and

Disability support services for people under 65 years of age which are directly purchased by the

Ministry of Health where the DHB along with other providers may deliver the services. In these areas

the DHB will seek to engage and work cooperatively however decisions in relation to services

purchased lie with the Ministry of Health.

TDH expects to meet Government service coverage expectations with the following exceptions and

caveats:

TDH is not able to take on the role as provider of last resort for Primary Maternity Services

as noted in the Operational Policy Framework given our financial deficit situation and the

need for the organisation to prioritise its funding resources into areas it has full

responsibility for under the national service specification framework requirements. If

becoming the provider of last resort for community primary maternity services is required

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(including diagnostic services), TDH will work with the Ministry to agree a delivery and

funding plan.

Meals on Wheels services within the district have always been provided on the basis that

the recipient of the meal will meet the full cost. It is not proposed that we will subsidise

meals on wheels in 2015/16

Although TDH expects to comply with national service specification framework requirements,

compliance may be limited where knowledge of requirements is incomplete or where staff shortages

occur.

6.2 Huri Ratonga / Service Change The following services have been highlighted to the NHB as potential areas of service change.

Change Description of change Benefits of change Link to

Lower

Funding

Path

Change due to Local,

regional or national

reasons?

Midland

Regional

Clinical

Services Plan

As part of the Regional Clinical Services planning process clinical action groups have been established for cardiology/cardiac services, maternity services, trauma, cancer, stroke and mental health. These multidisciplinary clinical networks are developing regional models of care. Any service changes that evolve as a result of this work are planned for in the RSP.

Reduce duplication of effort enabling DHBs to collectively develop sustainable solutions

Develop integrated approach to recruitment and retention within the global marketplace

Standardised planning, evaluation and procurement of new technology solutions within a clinical environment

YES This work is consistent with the national expectation of an increased focus on regional approaches, and with the strong focus on regionalisation agreed across the Midland DHBs

Home Based

Support

Services (HBSS)

reconfiguration

Midland DHB Region process to consider models of care and contracting for home based support services. This is intended to ensure that maximum value is achieved from funding available. There is the potential for resources to be focussed more on specific groups based on measures of need.

Supports regionalisation

Regional consistency Financial sustainability Sustainability of

services

NO Regional Initiative

East Coast

Review

Te Runanganui o Ngati Porou, Ngati Porou Hauora and Tairawhiti DHB are currently reviewing the delivery of services to the East Coast population. During 2015/16 a number of the review changes are likely to be implemented.

Increased access to primary care

Increased efficiencies and more sustainable model of health care

NO Local

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Change Description of change Benefits of change Link to

Lower

Funding

Path

Change due to Local,

regional or national

reasons?

Child Health

Services

Placeholder for E Tipu E Rea Decrease inequalities Increased efficiencies

and more sustainable model of health care

No Local

Co-location of

Administrative

functions of

information

systems aimed

at Children’s

services

With NCHIP becoming available within Tairawhiti, there will be an opportunity to align administrative function of existing information systems.

Closer integration of Primary and well child services

Increased resources available for frontline services

No Local, regional

Integrated

Community

Nursing

Services

The DHB and the three PHOs are working together to develop a more integrated and patient-focussed community nursing service in Tairawhiti. The project’s objective will be optimal outcomes for patients, and more specifically those receiving their care in the home. Its task will be to identify the best way to arrive at that point through an integrated ‘whole-of-system’ approach. This will include embracing new technology and working models, and exploring the most efficient use of resources. It is envisaged that developing a co-ordinated model of care will result in a streamlined service which would interface with General Practice, as well as hospital-based and other community-based services

Improving quality, safety and experience of care

Improving health and equity for all populations

Achieving best value for public health system resources

Exploring new ways of addressing growth in demand for acute care

Embracing and exploring innovations in chronic conditions management of patients in the community.

No Local

TDH has no current plans to acquire shares or interests in any company, trusts and/or

partnerships. Should that position change as a result of our local and regional work

programmes, TDH will follow Ministerial processes, in accordance with the

requirements to consult with the Minister. (CE Act s141 (1) (h)).

6.3 Take Ratonga / Service Issues TDH uses a risk monitoring framework that identifies on a regular basis any service

issues that need to be addressed. Currently, TDH has no particular service issues that

need escalation, and is confident that the Regional Clinical Services Plan can deliver on

regional service vulnerability issues in 2015/16.

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Module 7 - 2015/16 Performance Measures

The DHB monitoring framework aims to provide the Minister with a rounded view of performance using a range of performance markers. Four dimensions are identified that reflect DHBs functions as owners, funders and providers of health and disability services. The four identified dimensions of DHB performance cover:

• Achieving Government’s priority goals/objectives and targets or ‘Policy priorities’ • meeting service coverage requirements and Supporting sector inter-connectedness or

‘System Integration’ • providing quality services efficiently or ‘Ownership’ • purchasing the right mix and level of services within acceptable financial performance or

‘Outputs’. It is intended that the structure of the framework and associated reports assists stakeholders to ‘see at a glance’ how well DHBs are performing across the breadth of their activity, including in relation to legislative requirements, but with the balance of measures focused on government priorities. Each performance measure has a nomenclature to assist with classification as follows:

Code Dimension PP Policy Priorities SI System Integration OP Outputs OS Ownership

Performance measure 2013/14 Performance expectation/target

PP6: Improving the health status of people with severe mental illness through improved access

Age 0-19 Maori

5% Total

Age 20-64 Maori

5% Total

Age 65+ Maori

3% Total

PP7: Improving mental health services using transition (discharge) planning and employment

Long term clients Provide a report as specified

Child and Youth with a Transition (discharge) plan

At least 95% of clients discharged will have a transition (discharge) plan.

PP8: Shorter waits for non urgent

mental health and addiction

services

Mental Health Provider Arm

Age <= 3 weeks <=8 weeks

0-19 80% 95%

Addictions (Provider Arm and NGO)

Age <= 3 weeks <=8 weeks

0-19 80% 95%

PP10: Oral Health- Mean DMFT

score at

Year 8

Ratio year 1 Total 0.90

Ratio year 2 Total 0.88

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PP11: Children caries-free at five

years of age

Ratio year 1 Total 50%

Ratio year 2 Total 51%

PP12: Utilisation of DHB-funded

dental services by adolescents

(School Year 9 up to and including

age 17 years)

% year 1 85%

% year 2 85%

PP13: Improving the number of

children enrolled in DHB funded

dental services

0-4 years - % year 1 95%

0-4 years - % year 2 95%

Children not examined 0-12 years % year 1

9%

Children not examined 0-12 years % year 2

7%

PP20: improved management for long term conditions (CVD, diabetes and Stroke)

Focus area 1: Long term conditions

Report on delivery of the actions and milestones identified in the Annual Plan.

Focus area 2: Diabetes Management (HbA1c) Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control

Narrative quarterly report on DHB progress towards meeting its deliverables for Diabetes Care Improvement Packages (DCIP) identified in the 2015/16 annual plans

Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control

Improve proportion of patients with good or acceptable glycaemic control

Focus area 3: Acute coronary

syndrome services

70 percent of high-risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’)

≥70%

Over 95 percent of patients presenting with ACS who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days.

≥95%

Over 95 percent of patients undergoing cardiac surgery at the five regional cardiac surgery centres will have completion of Cardiac Surgery registry data collection with 30 days of discharge.

≥95%

Report on delivery of the actions and milestones identified in the Annual Plan,

including actions and progress in quality improvement initiatives to support the

improvement of ACS indicators as reported in ANZACS-QI

Focus area 4: Stroke Services

6 percent of potentially eligible stroke patients thrombolysed

≥6%

80 percent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway

≥80%


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PP21: Immunisation coverage

(previous health target)

Per cent of two year olds are fully immunised ≥95%

Percentage of five year olds fully immunised ≥95%

Percentage of eligible girls fully immunised with three doses of HPV vaccine 65% for dose 3

PP22: Improving system integration Report on delivery of the actions and milestones identified in the Annual Plan.

PP23: Improving Wrap Around

Services – Health of Older People


The % of older people receiving long-term home

support who have a comprehensive clinical

assessment and an individual care plan

Provision of data that

demonstrates an

improvement on current

performance

PP24: Improving Waiting Times –

Cancer Multidisciplinary Meetings Report on delivery of the actions and milestones identified in the Annual Plan.

PP25: Prime Minister’s youth

mental health project

Initiative 1: School Based Health Services (SBHS) in decile one to three secondary schools, teen parent units and alternative education facilities.

1. quarterly quantitative reports on the implementation of SBHS, as per the template provided.

2. quarterly narrative progress reports on actions undertaken to implement Youth Health Care in Secondary Schools: A framework for continuous quality improvement in each school (or group of schools) with SBHS.

Initiative 3: Youth Primary Mental Health 1. quarterly narrative progress reports with actions undertaken in that

quarter to improve and strengthen youth primary mental health (12-19 year olds with mild to moderate mental health and/or addiction issues) to achieve the following outcomes:

• early identification of mental health and/or addiction issues • better access to timely and appropriate treatment and follow up • equitable access for Maori, Pacific and low decile youth populations.

Initiative 5: Improve the responsiveness of primary care to youth. 1. quarterly narrative reports with actions undertaken in that quarter to

ensure the high performance of the youth SLAT(s) (or equivalent) in your local alliancing arrangements.

2. quarterly narrative reports with actions the youth SLAT has undertaken in that quarter to improve the health of the DHB’s youth population (for the 12-19 year age group at a minimum) by addressing identified gaps in responsiveness, access, service provision, clinical and financial sustainability for primary and community services for the young people, as per your SLAT(s) work programme.

PP26: The Mental Health &

Addiction Service Development Plan

Report on the status of quarterly milestones for a minimum of eight actions to be completed in 2015/16 and for any actions which are in progress/ongoing in 2015/16.

PP27: Delivery of the children’s

action plan Report on delivery of the actions and milestones identified in the Annual Plan.

PP28: Reducing Rheumatic fever Provide a progress report against DHB’s rheumatic fever prevention plan

Hospitalisation rates (per 100,000 DHB total population) for acute rheumatic fever are 55% lower than the average over the last 3 years

4.2 per 100,000

PP29: Improving waiting times for

diagnostic services

Coronary angiography – 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days)

95%

CT and MRI – 95% of accepted referrals for CT scans, CT - 95%

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and 85% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days)

MRI - 85%

Diagnostic colonoscopy – a. 75% of people accepted for an urgent

diagnostic colonoscopy will receive their procedure within two weeks (14 days) and

b. 65% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days)

Urgent - 75% within 14 days

65% within 42 days

Surveillance colonoscopy c. 65% of people waiting for a surveillance

colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date, 100% within 120 days

65% within 84 days

PP30: Faster cancer treatment

PP30: Faster cancer treatment

Part A: Faster cancer treatment – 31 day indicator

< 10 percent of the records submitted by the DHB are declined.

Part B: Shorter waits for cancer treatment – radiotherapy and chemotherapy

All patients ready-for-treatment receive treatment within four weeks from decision-to-treat.

Part C: Shorter waits for cancer treatment – radiotherapy and chemotherapy This indicator will be included within PP30 from quarter two 2015/16 (transitioning from health target).

All patients ready-for-treatment receive treatment within four weeks from decision-to-treat.

SI1: Ambulatory sensitive

(avoidable) hospital admissions.

Age 0-4 TBA

Age 45-64 TBA

Age 0-74 TBA

SI2: Delivery of Regional Service

Plans

Provision of a single progress report on behalf of the region agreed by all DHBs within that region ( the report includes local DHB actions that support delivery of regional objectives

SI3: Ensuring delivery of Service Coverage

Report progress achieved during the quarter towards resolution of exceptions to service coverage identified in the Annual Plan , and not approved as long term exceptions, and any other gaps in service coverage

SI4: Standardised Intervention Rates

(SIRs)

major joint replacement an intervention rate of 21.0 per 10,000 of population

cataract procedures an intervention rate of 27.0 per 10,000

cardiac surgery 6.5 per 10,000 of population

percutaneous revascularization 12.5 per 10,000 of population

coronary angiography services 34.7 per 10,000 of population

SI5: Delivery of Whanau Ora Report progress on planned activities with providers to improve service delivery and develop mature providers.

SI6: IPIF Healthy Adult - Cervical Screening 80% of eligible women have received cervical screening services within the last 3

years

OS3: Inpatient Length of Stay Elective LOS The suggested target is

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1.59 days, which represents

the 75th centile of national

performance.

Acute LOS 2.73 days

OS8: Reducing Acute Readmissions to Hospital

% total pop Maintenance of, or

improvement on baseline performance

% 75 plus Maintenance of, or

improvement on baseline performance

OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

Focus area 1: Improving the quality of identity data

New NHI registration in error >1.5% and

≤ 6%

Recording of non-specific ethnicity >0.5% and ≤2%

Update of specific ethnicity value in existing NHI record with a non-specific value

>0.5% and ≤2%

Invalid NHI data updates causing identity confusion %tbc

Focus area 2: Improving the quality of data submitted to National Collections

NBRS links to NNPAC and NMDS ≥97% and ≤99.5 %

National collections file load success ≥98% and ≤99.5 %

Standard vs edited descriptors ≥75% and ≤90%

NNPAC timeliness ≥95% and ≤98 %

Focus area 3: Improving the quality of the programme for Integration of mental health data (PRIMHD)

PRIMHD data quality Routine audits undertaken with appropriate actions

where required

Output 1: Mental health output Delivery Against Plan

Volume delivery for specialist Mental Health and Addiction services is within: a) five per cent variance (+/-) of planned volumes for services measured by FTE, b) five per cent variance (+/-) of a clinically safe occupancy rate of 85% for

inpatient services measured by available bed day, and c) actual expenditure on the delivery of programmes or places is within 5% (+/-

) of the year-to-date plan

Developmental measure DV4:

Improving patient experience No performance target set

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Module 8 – Appendices

The appendices to this Plan are as follows:

8.1 Glossary of Terms

8.2 Output Class Definitions

8.3 Output Class Revenue and Expenditure

8.4 Output Measure Rationale

8.5 Organisational Structure

8.6 Services funded but not provided by DHB

8.7 Māori Health Plan (MHP)

8.1 Glossary of Terms

Activity What an agency does to convert inputs to Outputs. Capability What an organisation needs (in terms of access to people, resources, systems,

structures, culture and relationships), to efficiently deliver the outputs required to achieve the Government's goals.

Crown agent A Crown entity that must give effect to government policy when directed by the responsible Minister. One of the three types of statutory entities (see also Crown entity; autonomous Crown entity and independent Crown entity)

Crown entity A generic term for a diverse range of entities within one of the five categories referred to in section 7(1) of the Crown Entities Act 2004, namely: statutory entities, Crown entity companies, Crown entity subsidiaries, school boards of trustees, and tertiary education institutions. Crown entities are legally separate from the Crown and operate at arms-length from the responsible or shareholding Minister(s); they are included in the annual financial statements of the Government.

Cost containment Reducing costs or cost growth in general, whether through improved efficiency, or other means such as contract negotiation/consolidation, changes to budget management, changes in structure etc.

Efficiency Reducing the cost of inputs relative to the value of outputs.

Effectiveness The extent to which objectives are being achieved. Effectiveness is determined by the relationship between an organisation and its external environment. Effectiveness indicators relate outputs to impacts and to outcomes. They can measure the steps along the way to achieving an overall objective or an outcome and test whether outputs have the characteristics required for achieving a desired objective or government outcome. http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf

Impact Means the contribution made to an outcome by a specified set of goods and services (outputs), or actions, or both. It normally describes results that are directly attributable to the activity of an agency. For example, the change in the life expectancy of infants at birth and age one as a direct result of the increased uptake of immunisations. (Public Finance Act 1888)

http://www.learningstate.govt.nz/display/glossaryitem.asp?id=140


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Activity What an agency does to convert inputs to Outputs. Impact measures Impact measures are attributed to agency (DHBs) outputs in a credible way. Impact

measures represent near-term results expected from the goods and services you deliver; can often be measured soon after delivery, promoting timely decisions; and may reveal specific ways in which managers can remedy performance shortfalls.(http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf

page 13)

Input The resources such as labour, materials, money, people, information technology used by departments to produce outputs, that will achieve the Government's stated outcomes. (http://www.ssc.govt.nz/glossary/)

Intervention An action or activity intended to enhance outcomes or otherwise benefit an agency or group. (Refer (http://www.ssc.govt.nz/glossary/)

Intervention logic model

A framework for describing the relationships between resources, activities and results. It provides a common approach for integrating planning, implementation, evaluation and reporting. Intervention logic also focuses on being accountable for what matters – impacts and outcomes (Refer State Services Commission ‘Performance Measurement – Advice and examples on how to develop effective frameworks: www.ssc.govt.nz)

Intermediate outcome See Outcomes

‘Living within our means’

Providing the expected level of outputs within a break even budget or National Health Board (NHB) agreed deficit step toward break even by a specific time.

Management systems The supporting systems and policies used by the DHB in conducting its business.

Measure A measure identifies the focus for measurement: it specifies what is to be measured

Objectives Is not defined in the legislation. The use of this term recognises that not all outputs and activities are intended to achieve “outputs”. For example, increasing the take-up of programmes; improving the retention of key staff; improving performance; improving Governance etc. are ‘internal to the organisation and enable the achievement of ‘outputs’.

Outcome Outcomes are the impacts on or the consequences for, the community of the outputs or activities of government. In common usage, however, the term 'outcomes' is often used more generally to mean results, regardless of whether they are produced by government action or other means. An intermediate outcome is expected to lead to an end outcome, but, in itself, is not the desired result. An end outcome is the final result desired from delivering outputs. An output may have more than one end outcome; or several outputs may contribute to a single end outcome. (Refer http://www.ssc.govt.nz/glossary/)

A state or condition of society, the economy or the environment and includes a change in that state or condition. (Public Finance Act 1888).

Output agreement Output agreement/output plan - See Purchase Agreement (refer to http://www.ssc.govt.nz/glossary/) An output agreement is to assist a Minister and a Crown entity (DHB) to clarify, align, and manage their respective expectations and responsibilities in relation to the funding and production of certain outputs, including the particular standards, terms, and conditions under which the Crown entity will deliver and be paid for the specified outputs (see s170 (2) Crown Entities Act 2004.

http://www.ssc.govt.nz/upload/downloadable_files/performance-measurement.pdf

http://www.ssc.govt.nz/glossary/


http://www.ssc.govt.nz/





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Activity What an agency does to convert inputs to Outputs. Output classes An aggregation of outputs, or groups of similar outputs. (Public Finance Act 1888)

Outputs can be grouped if they are of a similar nature. The output classes selected in your non financial measures must also be reflected in your financial measures (s 142 (2) (b) Crown Entities Act 2004).

Outputs Final goods and services, that is, they are supplied to someone outside the entity. They should not be confused with goods and services produced entirely for consumption within the DHB group (Crown Entities Act 2004).

Ownership The Crown's core interests as 'owner' can be thought of as: Strategy - the Crown's interest is that each state sector organisation contributes to the public policy objectives recognised by the Crown; Capability - the Crown's interest is that each state sector organisation has, or is able to access, the appropriate combination of resources, systems and structures necessary to deliver the organisation's outputs to customer specified levels of performance on an on-going basis into the future; Performance - the Crown's interest is that each organisation is delivering products and services (outputs) that achieve the intended results (outcomes), and that in doing so, each organisation complies with its legislative mandate and obligations, including those arising from the Crown's obligations under the Treaty of Waitangi, and operates fairly, ethically and responsively. (Refer http://www.ssc.govt.nz/glossary/).

Performance measures

Selected measures must align with the DHBs Regional Service Plan and Annual Plan. Four or five key outcomes with associated outputs for non financial forecast service performance are considered adequate. Appropriate measures should be selected and should consider quality, quantity, effectiveness and timeliness. These measures should cover three years beginning with targets for the first financial year (2012/13) and show intended results for the two subsequent financial years. (Refer to www.ssc.govt.nz/performance-info-measures)

Priorities Statements of medium term policy priorities.

Productivity Increasing outputs relative to inputs (i.e.: either more outputs produced with the same inputs, or the same output produced using fewer inputs)

Purchase agreement A purchase agreement is a documented arrangement between a Minister and a department, or other organisation, for the supply of outputs. Some departments piloting new accountability and reporting arrangements now prepare an output agreement. An output agreement extends a purchase agreement to include any outputs paid for by third parties where the Minister still has some responsibility for setting fee levels or service specifications. The Review of the Centre has recommended the development of output plans to replace departmental purchase and output agreements. (Refer http://www.ssc.govt.nz/glossary/)

NZDep Quintile New Zealand Deprivation quintile index is a measure of the level of socioeconomic deprivation in small geographic areas of New Zealand (mesh blocks). It is created using Census data for the following variables:

car and telephone access sole parenting

receipt of means-tested benefits educational qualifications

unemployment home ownership

household income home living space. The index ranges from 1 to 5. A score of 1 indicates that people are living in the least deprived 20 per cent (quintile) of New Zealand. A score of 5 indicates that people are living in the most deprived 20 per cent of New Zealand. Caution is necessary when interpreting NZDep data as the index is based on data referring to the average socioeconomic circumstances of the whole population of a mesh block, not to individuals.


http://www.ssc.govt.nz/performance-info-measures


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Activity What an agency does to convert inputs to Outputs. Regional cooperation Regional cooperation refers to DHBs across geographical ‘regions’ for the purposes of

planning and delivering services (clinical and non clinical) together. Four regions exist.

Northern: Northland DHB, Auckland DHB, Waitemata DHB and Counties Manukau DHB

Midland: Bay of Plenty DHB, Lakes DHB, Tairawhiti DHB, Taranaki DHB and Waikato DHB

Central: Capital and Coast DHB, Hawkes Bay DHB, Hutt Valley DHB, MidCentral DHB, Waitemata DHB and Whanganui DHB

Southern: Canterbury DHB, Nelson Marlborough DHB, South Canterbury DHB, Southern DHB and West Coast DHB

Results Sometimes used as a synonym for 'Outcomes'; sometimes to denote the degree to which an organisation successfully delivers its outputs; and sometimes with both meanings at once. (http://www.ssc.govt.nz/glossary/)

Standards of Service Measures

Measures of the quality of service to clients which focus on aspects such as client satisfaction with the way they are treated; comparison of current standards of service with past standards; and appropriateness of the standard of service to client needs.

Statement of service performance (SSP)

Government departments, and those Crown entities from which the Government purchases a significant quantity of goods and services, are required to include audited statements of objectives and statements of service performance with their financial statements. These statements report whether the organisation has met its service objectives for the year. (http://www.ssc.govt.nz/glossary/)

Strategy See Ownership (http://www.ssc.govt.nz/glossary/)

Sub regional cooperation

Sub regional cooperation refers to DHBs working together in a smaller grouping to the regional grouping, typically in groupings of two or three DHBs and may be formalised with an agreement. For example a Memorandum of Understanding.

Targets Targets are agreed levels of performance to be achieved within a specified period of time. Targets are usually specified in terms of the actual quantitative results to be achieved or in terms of productivity, service volume, service-quality levels or cost effectiveness gains. Agencies are expected to assess progress and manage performance against targets. A target can also be in the form of a standard or a benchmark.

Values

The collectively shared principles that guide judgment about what is good and proper. The standards of integrity and conduct expected of public sector officials in concrete situations are often derived from a nation's core values which, in turn, tend to be drawn from social norms, democratic principles and professional ethos. (http://www.ssc.govt.nz/glossary/)

Value for money The assessment of benefits relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource.








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8.2 Output Class Definitions

Prevention

Preventative services are publicly funded services that protect and promote health in the whole population or identifiable sub-populations comprising services designed to enhance the health status of the population as distinct from treatment services which repair/support health and disability dysfunction. Preventative services address individual behaviours by targeting population wide physical and social environments to influence health and wellbeing. Preventative services include health promotion to ensure that illness is prevented and unequal outcomes are reduced; statutorily mandated health protection services to protect the public from toxic environmental risk and communicable diseases; and, population health protection services such as immunisation and screening services. On a continuum of care these services are public wide preventative services. Early Detection and Management

Early detection and management services are delivered by a range of health and allied health professionals in various private, not-for-profit and government service settings. Include general practice, community and Māori health services, Pharmacist services, Community Pharmaceuticals (the Schedule) and child and adolescent oral health and dental services. These services are by their nature more generalist, usually accessible from multiple health providers and from a number of different locations within the DHB. On a continuum of care these services are preventative and treatment services focused on individuals and smaller groups of individuals. Intensive Assessment and Treatment Services

Intensive assessment and treatment services are delivered by a range of secondary, tertiary and quaternary providers using public funds. These services are usually integrated into facilities that enable co-location of clinical expertise and specialized equipment such as a ‘hospital’. These services are generally complex and provided by health care professionals that work closely together. They include:

Ambulatory services (including outpatient, district nursing and day services) across the range of secondary preventive, diagnostic, therapeutic, and rehabilitative services

Inpatient services (acute and elective streams) including diagnostic, therapeutic and rehabilitative services

Emergency Department services including triage, diagnostic, therapeutic and disposition services On a continuum of care these services are at the complex end of treatment services and focussed on individuals. Rehabilitation and Support

Rehabilitation and support services are delivered following a ‘needs assessment’ process and coordination input by NASC Services for a range of services including palliative care services, home-based support services and residential care services. On a continuum of care these services provide support for individuals.

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8.3 Output Class Revenue and Expenditure

Total Cost and Revenue

2014/15 2015/16 2015/16 2016/17 2017/18

$000 $000 $000 $000 $000

Forecast Budget Projected Projected Projected

Revenue ($165,005) ($167,102) ($168,118) ($169,293) ($170,476) Costs 167,505 166,786 167,802 168,977 170,160

Surplus/(deficit) ($2,500) 316 316 316 316

Prevention

Forecast Statement of Cost and Revenue for Prevention

2013/14 2015/16 2015/16 2016/17 2017/18

$000 $000 $000 $000 $000

Forecast Budget Projected Projected Projected Revenue ($4,019) ($5,321) ($5,358) ($5,396) ($5,434) Costs 4,705 5,311 5,348 5,386 5,423

Surplus/(deficit) ($686) 10 10 10 11

Early Detection and Management

Forecast Statement of Cost and Revenue for Early Detection and Management

2013/14 2015/16 2015/16 2016/17 2017/18

$000 $000 $000 $000 $000


Revenue ($44,125) ($44,091) ($44,248) ($44,557) ($44,868)

Costs 44,256 44,008 44,165 44,474 44,786

Surplus/(deficit) ($131) 83 83 83 82

Intensive Assessment and Treatment

Forecast Statement of Cost and Revenue for Intensive Assessment and Treatment

2013/14 2015/16 2015/16 2016/17 2017/18

$000 $000 $000 $000 $000


Revenue ($99,065) ($99,350) ($100,044) ($100,743) ($101,447) Costs 100,343 99,162 99,856 100,555 101,259

Surplus/(deficit) ($1,278) 188 188 188 188

Rehabilitation and Support

Forecast Statement of Cost and Revenue for Support and Rehabilitation

2013/14 2015/16 2015/16 2016/17 2017/18

$000 $000 $000 $000 $000


Revenue ($17,796) ($18,340) ($18,468) ($18,597) ($18,727) Costs 18,201 18,305 18,433 18,562 18,692

Surplus/(deficit) ($405) 35 35 35 35

Output class reporting is a different way of slicing our information and we do not yet have embedded variance analysis

in place, making it difficult to explain variance and trends. The output class financial reporting for 2013/14 is built from

an allocation of costs by responsibility centre and an allocation of revenue by purchase unit code. The out years are

based on the same cost and revenue ratios being applied to total cost and revenue.

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8.4 Output Measure Rationale

Measure Rationale Output class / Category

Dimension of Performance

Per cent of patients who smoke

and are seen by a health

practitioner in public hospitals

are offered brief advice and

support to quit smoking

Providing brief advice to smokers is shown to

increase the chance of smokers making a quit

attempt

Prevention

Services/Health

Promotion and

Education

Quantity

per cent of patients who smoke

and are seen by a health

practitioner in primary care are

offered brief advice and

support to quit smoking

Providing brief advice to smokers is shown to

increase the chance of smokers making a quit

attempt

Prevention

Services/Health

Promotion and

Education

Quantity

Percentage of pregnant women

who identify as smokers at the

time of confirmation of

pregnancy in general practice or

booking with Lead Maternity

Carer are offered advice and

support to quit

Pregnancy is a period during which women are

motivated to quit smoking, and evidence-based

tobacco cessation programmes can significantly

increase the likelihood of this. Reducing

smoking in pregnancy would be well supported

by New Zealanders, is easy to understand and

leads to significant positive outcomes across the

whole of life span

Prevention

Services/Health

Promotion and

Education

Quantity

Percentage of eight month olds

fully immunised

Immunisation can protect against harmful

infections, which can cause serious

complications, including death. It is one of the

most effective, and cost-effective medical

interventions to prevent disease

Prevention Services/

Immunisation Quantity


Immunisation/Well

Child

Quantity/

Timeliness

Percentage of population over

65 years who are immunised

against influenza


Immunisation/Well

Child

Quantity/

Timeliness

Percentage of infants fully and

exclusively breastfeed at six

months

Breastfeeding is the unequalled way of providing

ideal food for the healthy growth and

development of infants and toddlers. This

measure supports the sector to get ahead of the

chronic disease burden.

Prevention Services /

Health Promotion and

Education

Quantity/

Timeliness

The number of referrals to the

GRx (Green Prescription)

programmes

A Green Prescription (GRx) is a health

professional’s written advice to a patient to be

physically active, as part of the patient’s health

management. Research published in the New

Zealand Medical Journal indicates that a Green

Prescription is an inexpensive way of increasing

activity.

Prevention Services /

Health Promotion and

Education

Quantity

Reduce the teen birth rate

Having babies at a very young age can increase

maternal risk factors such as high blood pressure

and preeclampsia. There is also the increased

likelihood of those without parental/guardian

support receiving less pre-natal support.

Prevention

Services/Health

Promotion and

Education

Quantity

Reduce the rate of teenage Teenage pregnancy is associated with difficulties Prevention Quantity

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terminations of pregnancy in psychological, sexual and overall health. We

also want to measure both teen pregnancy and

termination rates to ensure that one does not

increase while the other decreases.

Services/Health

Promotion and

Education

Percentage of children under

five years of age (i.e. aged 0 – 4

years of age inclusive) who are

enrolled with DHB-funded oral

health services

Research shows that improving oral health in

childhood and adolescence has benefits over a

lifetime.

Early Detection and

Management

Services/Oral Health

Quantity

Percentage of pre-school and

primary school children (0 – 12

years) who are overdue for

their planned recall period

Quantity

Percentage of adolescents

accessing DHB funded oral

health services

Quantity

Percentage of population

enrolled with a primary health

organisation

Access to primary care has been shown to have

positive benefits in maintaining good health. It

can reduce the economic cost of ill health by

intervening early.

Early Detection and

Management Services/

Primary Healthcare

Quantity

Percentage of people who are

enrolled with a primary health

organisation and have had their

cardiovascular risk assessed in

the last five years

By increasing the percentage of people being

checked for long-term conditions ensures these

are identified early and managed appropriately,

and aid in the promotion and protection of good

health and independence.

Early Detection and

Management Services/

Primary Healthcare

Quantity

Improve or, where high,

maintain use of statins or lipid

lowering medication in people

with diabetes and CVD risk

greater ≥15 % over 5 years

Percentage of eligible women

(20-68) have a cervical cancer

screen every 3 years

Cervical cancer is one of the most preventable of

all cancers. Having regular cervical smears can

reduce a woman’s risk of developing cervical

cancer by 80 per cent


Population Based

Screening

Quantity

Percentage of eligible women

(50-68) have a breast screen in

the last 3 years

Breast screening is a proven way for finding

breast cancers early to reduce the risk of dying

of breast cancer


Population Based

Screening

Quantity

Percentage of Rest Home

residents receiving vitamin D

supplement from their GP

Vitamin D supplementation has been

demonstrated to improve mineral bone density

and reduce falls.

Prevention

Services/Health

Promotion and

Education

Quantity

Percentage of all Emergency

Department presentations who

are triaged at levels 4&5

Emergency department services utilise a scale of

one to five triage, with one being the most

urgent. Triage category four and five may more

appropriately be seen in primary care.

Intensive Assessment

and Treatment

Services/Acute Services

Quantity

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Percentage of eligible children

have their B4 School Checks

completed

A nationwide programme offering a health and

development check for four year olds


Well Child Quantity

Hospitalisation rates per

100,000 for acute rheumatic

fever

Rheumatic fever arises as a result of a throat

infection with Group A Streptococcal bacteria. It

predominantly affects children between 5 and

14 years of age. In New Zealand, evidence

points to poorer housing conditions (especially

overcrowding) and general social deprivation as

risk factors for rheumatic fever.


Well Child Quantity

Increased coverage of Year 8

students receiving HEEADSSS

assessment in decile 1-3 schools

The assessment ensures that the most

vulnerable children’s Home environment;

Education/ employment; Eating and exercise;

Activities and peer relationships; Drugs,

cigarettes, alcohol; Sexuality; Suicide,

depression, mood screen; Safety; Spirituality are

assessed and where a need arises are referred

onto the relevant services


Well Child Quantity

Percentage of older people

receiving long-term home

support who have had a

comprehensive clinical

assessment and a completed

care plan in the last 12 months

More consistent and comprehensive assessment

of the older person which enables determination

of service capacity and service planning

information

Rehabilitation and

Support Services/Needs

Assessment and Service

Coordination

Quantity

For those with aged related and

chronic health conditions we

aim to reduce the rate of rest

home level of residential care

to home based support and

respite funding

By focusing the models of care in community

services such as home based support and respite

services to have a more restorative approach we

expect that the proportion of funding required

to allocate to rest home residential care to

comparatively reduce.

Rehabilitation and

Support Services / Age

Related Residential

Care Services

Increased number of clients

accessing respite services

In line with community services for older people

having a more restorative approach and a focus

on meeting the needs of informal carers we

expect the number of clients accessing respite

services will increase.

Rehabilitation and

Support Services / Quantity

Acute re-admission rate

Unplanned readmissions will usually present to

emergency departments, and may result in

admission to hospital for further treatment. This

puts pressure on emergency departments and

inpatient hospital capacity, efficiency and

productivity.

An unplanned acute hospital readmission may

often (though not always) occur as a result of

the care provided to the patient by the health

system. Reducing unplanned acute admissions

can therefore be interpreted as an indication of


and Treatment

Services/Acute Services

Quality

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improving quality of acute care, in the hospital

and/or the community, ensuring that people

receive better health and disability services.

Average length of inpatient stay

By shortening hospital length of stay, while

ensuring patients receive sufficient care to avoid

readmission, we will positively impact hospital

productivity through freeing up beds and other

resources so it can provide more elective

surgery, reduce waiting times in the emergency

department or make savings. Supporting

patients to return home sooner may, in part, be

achieved by reducing the rate of patient

complications and better use of the time clinical

staff spend with patients. Patients will also be

less at risk of contracting nosocomal infections.


and Treatment

Services/Elective

Services and Acute

Services

Quality

Percentage of patients who

require radiation or

chemotherapy are treated with

4 weeks

Specialist cancer treatment and symptom

control is essential in reducing the impact of

cancer


and Treatment

Services/Elective

Services and Acute

Services

Quantity

Faster Cancer Treatment –

Proportion of patients with a

confirmed diagnosis of cancer

who receives their first cancer

treatment with 31 days

Implementation of Faster cancer treatment

supports the overarching goal of Better, Sooner,

More Convenient Health Services for New

Zealanders. The key 2013/14 (strategic)

planning considerations of integration,

regionalisation and value for money are all

supported by implementation of these

indicators.


and Treatment

Services/Elective

Services

Quantity

Arranged Caesarean deliveries

without catastrophic or severe

complication as a % of total

deliveries

The longer-term aim is to reduce the risks

associated with an unnecessary Caesarean

section, reduce the number of women at risk of

a subsequent Caesarean section and reduce the

number of women who experience difficulties

with their second and subsequent births as a

consequence of a primary Caesarean section.


and Treatment

Services/Elective

Services

Quantity

Percentage of patients waiting

longer than four months for

their first specialist assessment

Patients have a much better chance of

recovering and getting on with their lives where

they are diagnosed and treated and returned

home in a timely way.


and Treatment

Services/Elective

Services

Quantity/

Timeliness

Number of surgical discharges

under the elective initiative

Elective surgery reduces pain or discomfort, and

improves independence and wellbeing.

Increasing delivery should will improve access

and reduce waiting times.


and Treatment

Services/Elective

Services

Quantity

Percentage of people who did

not attend (DNA) their schedule

appointment for an outpatient

Reducing did not attends is a key objective in

terms of removing waste in the system


and Treatment

Services/Elective

Quantity

E91




service Services and Acute

Services

Percentage of people referred

for non urgent mental health

services are seen within three

weeks

Access and shorter waits are very important to

patients. Earlier treatment in the progression of

illness links to better outcomes as evidenced in

international literature. Timeliness is also a key

quality indicator in calls for improvement to the

health care system.


and Treatment

Services/Specialist

Mental Health and

Addiction Services

Timeliness/

Quality

Improving the percentage of

long-term clients with up to

date relapse

prevention/treatment plans

When long term clients with serious mental

illness have agreed relapse prevention plans that

enable them to better co-produce their mental

health and well being outcomes


and Treatment

Services/Specialist

Mental Health and

Addiction Services

Quantity

Average length of stay in an

adult mental health and

addiction inpatient unit

Mental health and addiction services seek to

support service users in the least restrictive

environment. Performance on this indicator

provides some information about the extent to

which this is being achieved.

Length of stay is the main driver of variation in

inpatient episode cost and reflects differences

between mental health service organisations’

resources, service practices and service user

case-mix.

This indicator, alongside others promotes a

more complete understanding off an

organisation’s overall model of service delivery.


and Treatment

Services/Specialist

Mental Health and

Addiction Services

Quantity

Rates of post-discharge

community care

A responsive community support system for

people who have experienced an acute

psychiatric episode requiring hospitalisation is

essential to maintain clinical and functional

stability and to minimise the need for hospital

readmission. Service users leaving hospital after

an admission with a formal discharge plan

involving linkages with community services and

supports are less likely to need early

readmission. Research indicates that service

users have increased vulnerability immediately

following discharge, including higher risk for

suicide.


and Treatment

Services/Specialist

Mental Health and

Addiction Services

Quality

A reduction in the percentage

of palliative care clients who

have had an Emergency

Department presentation

The Tairawhiti Palliative Care Strategy

highlighted the need for an increase in the

generalist workforce who are trained and

supported by our Specialist Palliative Care

Provider to provide quality palliative care

underpinned by Advanced Care Planning. We

expect that delivery of enhanced palliative care


and Treatment Services

E91




pathways, particularly in aged residential care,

will lead to a reduction in the percentage of

palliative care patients who present to our

Emergency Departments.

Improved wait times for

diagnostic services – accepted

referrals for CT and MRI receive

their scan within 6 weeks

(Developmental Measure 2)

Diagnostics are a vital step in the pathway to

access appropriate treatment. Improving

waiting times for diagnostics can reduce delays

to a patient’s episode of care and improve DHB

demand and capacity management.


and Treatment

Services/Elective

Services

Quantity/

Timeliness

Non urgent community

laboratory tests are completed

and communicated to

practitioners within the

relevant category time-frames

Laboratory tests are a vital step in the

pathway to access appropriate treatment.

Consistent waiting times for laboratory tests

provides certainty to a patient’s episode of

care and can assist in improving DHB

demand and capacity management.

Early detection and

management/Pharmacy

Services

Quantity/

Timeliness

Number of community

pharmacy prescriptions

The new Community Pharmacy contract will

encourage greater efficiency and a more patient

focused service. We expect volume of

prescriptions to decrease overall

Early detection and

management/Pharmacy

Services

Quantity

E91


8.5 Organisational Structure

Jim Green

CEO

Surgical

Clinical Care Group

Women Child & Youth

Clinical Care Group

Te Puna

Waiora (TPW)

Planning, Funding &

Population Health

Medical/Mental Health

Clinical Care Group

Medical/Medical Mgmt/

Admin

Mental Health &

Addictions including

Awhina House

Te Whare Awhiora

(Mental Health Inpatient)

Medical Ward (Ward 5)

Intensive Care/Coronary

Care (ICU/CCU)

Physicians

Tui Te Ora (Long Term

Conditions)

WCY Mgmt/Admin

Child Assessment &

Development

Child, Adolescent Mental

Health Services (CAMHS)

Paediatricians

Neonatal Unit

Children's Ward (Planet

Sunshine)

- Play Specialist

Maternity

Well Child

School Dental

Cervical Screening

Sexual Health

Gynaecology

Surgical Mgmt/Admin

Emergency Department

Medical Secretaries

Theatre including

Recovery & Sterile

Services

Day Ward

Surgical Ward (Ward 8)

Orthopaedic/Rehab Ward

Anaesthetics

Orthopaedics

Ear, Nose & Throat (ENT)

Ophthalmology

General Surgery

Dental Surgery

Planning & Funding

Needs Assessment

Service Coordination

(NASC)

Population Health

Group Manager HR

Human Resources

Payroll

Group Manager Finance

Finance

Materials Management

Building & Engineering

Electronics

Chief Medical Officer

RMO’s

Director of Nursing

Occupational Health

Infection Control

Quality Services

Graduate Nurse Prog

Nursing Education

Shared Services

Clinical Care Group

Shared Services Mgmt/

Admin

Rehab Day Unit

Occupational Therapy

Physiotherapy

Social Workers

Family Violence

Intervention

Speech Therapy

District Nursing

Orthotics

Dietetics

Pharmacy

Outpatients

Ambulatory Clerical

Audiology

Radiology

Medical Technical

TLab (Contracted

Laboratory)

Group Manager & Public

Health Physician

Clinical Director Surgical

& Clinical Care Manager

Clinical Director Women,

Children and Youth & Clinical

Care Manager

Clinical Director Medical

Mental Health & Clinical Care

Manager

Clinical Care Manager

Group Manager Information

Information Technology

Clinical Records

Commercial Support

Clinical Library

BoardClinical Board

Hospital Advisory Committee

(HAC)

Community & Public Health

Advisory (CPHAC)

Aged & Disability Support Advisory

Committee (ADSAC)

Finance, Audit & IT Committee

(FAIT)

GP Training

Information Services

Clinical Liaison

Tairawhiti Integration

Comittee

Personal Assistant

Communication Manager

Kaiwhakahaere Hauora Maori

Maori Health Services

Director of Allied Health

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199

8.6 Services funded but not provided by the DHB

Table: DHB funded services provided by other organisations

Personal Health Services

Pharmaceuticals Subsidised pharmaceuticals dispensed by 8 pharmacies across

our district.

Community Laboratories One private laboratory undertaking all the testing with 2

collection sites

PHOs and GP services Three PHOs with 11 primary care practices

Medical / surgical inpatient and

outpatient services and primary

care inpatient services

Included within this service area are arrangements with a private

provider called USL for urology services and inpatient beds in one

rural facility.

Māori health Includes a range of community based services including whanau

ora, koroua and kuia services, and mobile Māori disease state

management positions delivered by Māori providers.

Other personal health Range of services biggest spends are in the areas of:

dental

NGO maternity facilities

travel and accommodation

palliative care

Mental Health and Addiction Services

Community and other services Included in this category are approximately 83 full time

equivalent community based (mental health and/or alcohol and

other drug) positions, together with residential services for

mental health and addictions (including youth) funded on a

capacity basis.

Health Of Older People Services

Residential Included in this category is expenditure on hospital level,

dementia and rest home services provided at 8 facilities ranging

in size.

Other Services Included within this category are a range of community based

and respite services including day programmes, home support

and household management, respite and carer support services

and disability information.

E91


200

8.7 Māori Health Plan Unless stated otherwise, the baseline will be 2012/13 data and the Target 2015/16.

Priorities Indicator

Baseline 2013/14 2014/15 2015/16 Target

Māori Non

Māori Māori Non

Māori

Whakaaturanga Huanga/ Data Quality

% of Māori enrolled in PHOs 98% 98% 100% 93% >99%

Putanga ki te Oranga / Access to Care

ASH rates percentage relative to National Result (as at 31 Dec 2013)

0-4 yrs. 166% 151% 156% 147% <125%

45-64 yrs. 194% 121% 196%% 122% <116%

Hauora Taitamariki / Child Health

% of children breastfed (year end 31 Dec 2014)

6 Weeks (fully or exclusively breastfed)

73% 73% 73% 77% >75%

3 Months (fully or exclusively breastfed)

44% 52% 41% 49% >60%

6 Months (receiving breast milk at 6 months)

58% 65% 57% 57% >65%

Mate Iaiamanawa / Cardiovascular and Diabetes

% of eligible Māori males aged 35-44 having CVD risk assessment in the past five years

83% 89% 85% 90% >90%

Tertiary Cardiac Intervention waiting times

% of High Risk Angiograms performed within 3 days

60% 33% >70%

% of Acute Coronary Syndrome patients with ANZAZS QI ACS and Cath/PCI registry data collection completion within 30 days

97% 100% 100% 50% 100%

Mate Pukupuku / Cancer

Breast Screening Rate, 50-69 Age Group 66% 73% 68% 74% ≥70%

Cervical Screening Rate, 25-69 Age Group 70% 79% 66% 80% ≥80%

Tupeka / Tobacco

% of Pregnant Māori women smoke free at 2 weeks postnatal

56% 68% 66% 80% >95%

Whakato Kano Arai Mate /

Immunisation

% of 8 Month babies fully immunised 87% 91% 90% 92% >95%

% of population 65 and over who are immunised against influenza

59% 63% 63% 66% >75%

Kai Honokoiwi / Rheumatic Fever

Reduction in 3 year average of Rheumatic Fever Hospitalisations

9.3 per 100,000 9.0 per 100,000 4.2 cases

per 100,000

Hauora Niho / Oral Health

Increase in preschool children enrolled in DHB funded dental services

92% 92% 90% 99% >95%

Hauora Hinengaro /

Mental Health Mental Health Act: Section 29: Community treatment orders

121 per 100,000

33 per 100,000

198 per 100,00

0

58 per 100,000

Reduce disparity

E91


201

Priorities Indicator

Baseline 2013/14 2014/15 2015/16 Target

Māori Non

Māori Māori Non

Māori

Local Priorities

WCTO Contacts Infants receive all WCTO core contacts due in their first year

71% 73% 82% 82% 95%

Immunisation 2 year olds fully immunised 91% 92% 94% 93% >95%

Failure to Treat (Did not Attend

rates)

Reduce the disparity between Māori and Non Māori rates

13% 5% 15% 9% Reduce

Disparity

ASH Rates Reduction in the Ambulatory Sensitive Hospitalisations (ASH) 00-74 age group

181% 136% 175% 132% <118% of National

rate

tairawhiti dhb annual plan 2015/16 - gisborne hospital€¦ · tairawhiti dhb annual plan 2015/16...

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