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

Counties Manukau District Health Board

Community & Public Health Advisory Committee Meeting

Agenda Wednesday, 18

th June 2014 at 1.30pm – 3.30pm, Manukau Boardroom, Lambie Drive

Time Item Page No

1.30pm – 1.35pm 1. Welcome

1.35pm – 1.45pm 2. Governance

2.1 Attendance & Apologies

2.2 Disclosure of Interests/Specific Interest

2.3 Acronyms

2.4 Confirmation of Public Minutes (21 May)

2.5 Action Items Register

1

2-5

6

7-11

12-15

1.45pm – 2.15pm

2.15pm – 2.45pm

3. Presentation

3.1 Community Panel – Soli Henare, Community

Liaison Manager

3.2 Oral Health – Christine MacKay, Portfolio

Manager, Oral Health

16-25

26-40

2.45pm – 3.15pm 4. Director of Primary Health & Community Services

Report – Benedict Hefford

Glossary

Summary

1. National Health Targets

2. Primary Health

3. Child Youth & Maternity

4. Mental Health & Addictions

5. Adult Rehabilitation & Health of Older People

6. Intersectoral Initiatives

7. Progress with Systems Integration

8. Locality Reports

9. Financial Report

41

42

43-45

46-47

48-50

51-54

55-57

58-60

61

62-66

67-68

3.15pm – 3.20pm 5. For Information

5.1 Q3 Performance Report

69-85

6. Resolution to Exclude the Public 86

3.20pm – 3.30pm

7. Confidential Items

7.1 Confirmation of Confidential Minutes (21 May)

7.2 Action Items Register

87-92

93

Next Meeting: Wednesday 16th

July 2014, Lambie Drive

1

BOARD MEMBER ATTENDANCE SCHEDULE 2014 – CPHAC/DiSAC Name

Jan 26 Feb 26 Mar 16 Apr 21 May 18 June 16 July 20 Aug 24 Sept 22 Oct 26 Nov 17 Dec

Lee Mathias

No

Mee

ting

Colleen Brown

Sandra Alofivae (Chair)

X

David Collings

X *

George Ngatai

Dianne Glenn

Reece Autagavaia

X

Mr Sefita Hao’uli

X

Ms Wendy Bremner

Mr Ezekiel Robson

X

* Attended part meeting only

2

BOARD MEMBERS’ DISCLOSURE OF INTERESTS

18th June 2014 Member Disclosure of Interest

Dr Lee Mathias • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Chair Health Promotion Agency • Deputy Chair Auckland District Health Board • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • Chairman, Unitec

Sandra Alofivae

• Chair of the Auckland South Community Response Forum (MSD appointment)

• MSD Member, Auckland Social Policy Forum, Auckland Council

• Member, Fonua Ola Board • Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship • Board member Pacifica Futures

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Colleen Brown • Chair Parent and Family Resource Centre Board (Auckland Metropolitan Area)

• Member of Advisory Committee for Disability Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair, Early Childhood Education Taskforce for

COMET • Member, Manurewa Advisory Group • Member, Child Advocacy Group – Manukau • MSD Member, Auckland Social Policy Forum,

Auckland Council • Deputy Chair, Auckland City Council Disability

Strategic Advisory Group • Chair ECE Implementation Team Auckland South • Chair 11Much Trust

3

George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board member Manurewa Marae

Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland

Council • Life Member – Business and Professional Women

Franklin • President – National Council of Women

Papakura/Franklin Branch • Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic Gardens

and Member of the Friends Trust • Member – Friends of Regional Parks • Life Member – Ambury Park Centre for Riding

Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Member, Auckland Council Pacific Peoples Advisory

Panel • Board Member, United Otara Market

Sefita Hao’uli

• Trustee Te Papapa Pre-school Trust Board • Deputy Chair: Anau Ako Pasifika Inc. (Pacific ECE

provider) • Member Tufungalea Tonga Inc. (Promoting and

Growing Lea Tonga) • Member Tonga Business Association & Tonga

Business Council Advisory roles: • Counties Manukau District Health Board • Toko Suicide Prevention Project (Ministry of Health) • Tala Pasifika (NZ Heart Foundation Pacific Tobacco

Control) • (On short-list for the Pacific Advisory Board, Auckland

Council) • Primary ITO & MBIE: Ola e Fonua Project. Consultant: • Government of Tonga: Manage RSE scheme in NZ • Alliance Health: Community Engagement &

Communication Advice.

4

• Ministry of Business Innovation and Employment: Policy Advice and Leadership Training

• Pacific Perspectives/Auckland University: Health research projects

• NZ Heart Foundation (Tala): Communication Strategy and Advice.

• NZ Translation Centre: Translates government and health provider documents.

• Mana Trust: Advice on health literacy collaboration between Maori and Pacific providers.

• Member Pacific Advisory Panel of the Auckland Council.

Ezekiel Robson • Auckland Council Disability Strategic Advisory Group • Department of Internal Affairs Community

Organisation Grants Scheme Papakura/Franklin Local Distribution Committee

• Be.Institute/Be.Accessible ‘Be.Leadership 2011’ Alumni

Wendy Bremner • CEO Age Concern Counties Manukau Inc

• Member of Auckland Social Policy Forum • Member of Health Promotion Advisory Group (7 Age

Concerns funded by MOH)

5

COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 18 June 2014 Director having interest Interest in Particulars of interest Disclosure date Board Action Mr George Ngatai

CMH Quit Bus Mr Ngatai is a Director of Transitioning Out Aotearoa who is a partner provider along with CMDHB and Waitemata PHO in the Quit Bus.

26th March 2014 That Mr Ngati’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations or decisions.

Ms Kathy Maxwell

Community Pharmacy Owner Kathy the Chemist Ltd, which has a contract with CMDHB for Pharmacy Services.

26th March 2014 That Ms Maxwell’s specific interest is noted and the Committee agree that she may remain in the room and participate in any deliberations or decisions.

Mr Sefita Hao’uli

Rheumatic Fever national campaign

Mr Hao’uli is currently undertaking some work with the Ministry of Health on the Pacific campaign on Rheumatic Fever for next 2-3 weeks.

16th April 2014 That Mr Hao’uli’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations or decisions.

Mr Geraint Martin

Renewal of the Regional After Hours Agreement

Mr Martin’s wife is the Executive Director of Takanini Care Medical Services Limited Partnership. The company comprises 2 A&M clinics and 2 general practices at the same location.

21st May 2014

That Mr Martin’s specific interest is noted and the Committee agree that he may participate in the deliberations of the Committee in relation to this matter because he is able to assist the Committee with relevant information, but is not permitted to participate in any decision making.

6

Glossary

ACC Accident Compensation Commission ADU Assessment and Diagnostic Unit ARDS Auckland Regional Dental Service BT Business Transformation CADS Community Alcohol, Drug and Addictions Service CAMHS Child, Adolescent Mental Health Service CNM Charge Nurse Manager CT Computerised Tomography CW&F Child, Women and Family service DNA Did not attend ESPI Elective Services Performance Indicators FSA First Specialist Assessment (outpatients) FTE Full Time Equivalent ICU Intensive Care Unit iFOBT Immuno Faecal Occult Blood Test MHSG Mental Health service group MoH Ministry of Health MTD Month To Date MOSS Medical Officer Special Scale OHBC Oral health business case ORL Otorhinolaryngology (ear, nose, and throat) PACU Post-operative Acute Care Unit PHO Primary Health Organisation PoC Point of Care SCBU Special care baby unit SMO Senior Medical Officer SSU Sterile Services Unit TLA Territorial Locality Areas WIES Weighted Inlier Equivalent Separations YTD Year To Date

7

Minutes of the meeting of the Counties Manukau Health

Community & Public Health Advisory Committee Wednesday 21 May 2014

held at Counties Manukau Health Boardroom, 19 Lambie Drive, Manukau

commencing 1.30pm

COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Ms Sandra Alofivae (Committee Chair) Ms Colleen Brown Mr David Collings Mr George Ngatai Ms Dianne Glenn Mr Apulu Reece Autagavaia Mr Sefita Hao’uli Ms Wendy Bremner Mr Ezekiel Robson

ALSO PRESENT: Mr Geraint Martin (Chief Executive) Ms Margie Apa (Director, Strategic Development) Mr Benedict Hefford (Director, Primary Health & Community Services) Dr Campbell Brebner (Chief Medical Adviser, Primary & Integrated Care) Ms Karyn Sangster (Chief Nursing Adviser, Primary & Integrated Care)

APOLOGIES: There were no apologies received for this meeting. WELCOME The Committee Chair welcomed all those present. 2.2 DISCLOSURE OF INTERESTS The Committee noted Apulu Reece Autagavaia is now a Board member of the United Otara Flea Market. 2.2 SPECIFIC INTERESTS The Committee noted Mr Geraint Martin’s specific interest in relation to the Renewal of the Regional After Hours Agreement. 2.3 ACRONYMS The Acronym list was noted.

8

2.4 CONFIRMATION OF PREVIOUS MINUTES Confirmation of the Minutes of the Counties Manukau Community & Public Health Advisory Committee meeting held 16 April 2014 (agenda pages 7-16). Resolution (Moved Ms Dianne Glenn/Seconded Mr George Ngatai) That the minutes of the Counties Manukau Health Community & Public Health Advisory Committee meeting held on 16 April 2014 be approved. Carried 2.5 ACTION ITEMS REGISTER Resolution (Moved Ms Dianne Glenn/Seconded Mr George Ngatai) That the Action Items Register of the Counties Manukau Health Community &Public Health Advisory Committee be received. Carried 3. PRESENTATIONS 3.1 Intersectoral Community Action for Health / The Southern Initiative – Transformational Change Ms Jude Woolston, Project Manager Healthy Housing and Mr John McEnteer, Southern Initiative Auckland Council provided powerpoint presentations. Copies of these presentations are available on the CMDHB website. Acknowledged that the key determinants of health lie outside the jurisdiction of the health sector. Projects/programmes are targeted at populations/communities with high health, housing, social, employment and education needs. The Southern Initiative (TSI) – opportunities to collaborate with CMH:

• Retrofit Home Insulation – use CMH influence to assist TSI to get $1m per year for the next 10 years from the Auckland Council to put into retrofitting home insulation.

• Smokefree Implementation – create a Manukau metropolitan centre that is a Smokefree precinct.

• Healthy families – use of Council leisure centres, parks and recreation services to change lifestyle and improve wellness.

The Chair thanked both presenters for their time and the information on their intersectoral work. The presentations were received.

9

3.2 Renewal of the Regional After Hours Agreement Mr Benedict Hefford, Director Primary & Health Community Services and Ms Lisa Gestro, GM Primary Care took the Committee through the tabled paper. This is a regional contract that CMH host and lead. The contract has been renewed for another 12 months through to 30 June 2015. A new business case will be coming to the Board in August to inform a sustainable future model of care for After Hours. Noted that the clinics in the Network will be asked to make it clear how accessible their facilities are, how disability confident their staff are and what their plan is going forward so that that part of the community know what clinics they can access. Resolution (Moved Ms Dianne Glenn/Seconded Ms Sandra Alofivae) That the Recommendations in the Renewal of the Regional After Hours Agreement paper are agreed. Carried 3.3 Census 2013, Population Counts for Planning Drs Wing Cheuk Chang, Public Health Physician and Doone Winnard, Public Health Physician provided a powerpoint presentation and tabled paper. A copy of the presentation is available on the CMDHB website. Dr Doone Winnard undertook to:

1. look into why the over 65yrs are not included in the NZDep indicators for internet access and report back to the Committee; and

2. provide some further information in relation to the general social survey and the request for disability information in it to the Committee.

The Committee requested an updated presentation in relation to disability data once the Disability Survey results are out later in the year. The Committee requested a presentation on the Government’s budget in relation to health items/issues including information on whether the funding for Inter-Rai has been reduced. The Chair thanked Drs Cheuk Chang and Winnard for their presentation. 4. Director of Primary Health & Community Services Report Mr Benedict Hefford took the Committee through his report. Community Pharmacy Services Agreement – consultation out currently nationwide with the pharmacists moving away from paying pharmacists a dispensing fee per item to a funding model which recognises pharmacists’ contribution to managing long term conditions, working as part of a wider multi-disciplinary team. The Committee requested a more in depth update at a future meeting in relation to the Community Pharmacy Services Agreement.

10

Developing an Integrated Model of Care – Mr Hefford tabled a report from Synergia for the Committee’s information. We think we can do a lot better in the area of self-care. It is becoming increasing clear there is a missed opportunity here to help people understand their conditions, medications, how to manage them. If we can do that then we can actually get both better outcomes and reduce costs. The Committee requested an updated report about this campaign/programme and around extending self-management support and improving health literacy. Resolution (Moved Ms Colleen Brown/Seconded Mr David Collings) That the Director of Primary Health & Community Services report be received (agenda pages 72-101). Carried 7. Healthy Families NZ Initiative The papers were tabled for the Committee’s information (agenda pages 114-131). 5. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Ms Dianne Glenn/Seconded Mr Sefita Hao’uli) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

6.1 Confirmation of Previous CPHAC Minutes 16th April

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

6.2 Action Items Register

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for

Confirmation of Action Items Register For the reasons given in the previous meeting.

11

withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Carried 3.47pm – 3.50pm Public excluded session. 3.50pm – Open meeting resumed. The Chair thanked all those present for their participation in the meeting. The meeting concluded at 3.51pm. Signed as a correct record of a meeting of Counties Manukau Community & Public Health Advisory Committee held 21 May 2014. Chair Ms Sandra Alofivae Date

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

12

Community & Public Health Advisory Committee Meeting – Action Items Register – 18 June 2014 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

26.2.2014 4.0 Update from Auckland Regional Public Health

Service every 6 months on current issues.

July Mr Hefford

26.3.2014 Presentation from the Community Panel – overall profile

June Mr Hefford

26.3.2014 Presentation from National Hauora Coalition on Rheumatic Fever programme; MoH national awareness campaign

August Mr Hefford/Mr Martin

26.3.2014 4.0 Localities/PHO presentation updates TBC – After Board

Mr Hefford

26.3.2014 5.0 Oral Health presentation July/June Mr Hefford

26.3.2014 5.0 Feedback to Ms Bremner on what support looks like for the aging population, DDS v health funding

TBC Ms Gestro

16.4.2014 4.0 Health of Older People/geriatric services presentation

August Mr Hefford

21.5.2014 3.3 Information on why the over 65yrs are not included in the NZDep indicators for internet access. Provide further information in relation to the general social survey and the request for disability information. Updated presentation in relation to disability data once the Disability Survey results are out later in the year.

June June Date TBC

Dr Winnard Dr Winnard Mr Hefford/Dr Winnard

21.5.2014 3.3 Presentation on the Government budget in relation to health items/issues including information on the Inter-Rai funding.

Date TBC Mr Martin

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

13

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

21.5.2014 4.0 Directors Report Indepth update on the Community Pharmacy Services Agreement. Developing an Integrated Model of Care – updated report on this programme and around extending self-management support and improving health literacy.

Date TBC Date TBC

Mr Hefford Mr Hefford

14

Action Items – CPHAC Meeting 21 May “Dr Doone Winnard undertook to:

1. look into why the over 65yrs are not included in the NZDep indicators for internet access and report back to the Committee; and

2. provide some further information in relation to the general social survey and the request for disability information in it to the Committee.”

1. Why the internet variable in the NZDep is restricted to those under age 65 years:

Below is the sentence explaining the rationale from the document summarising NZDep2013: “That is, Internet access is as much an integral part of day-to-day living in 2013 as the telephone was considered to be in 1996, the first time such communication information was available from the census dwelling forms. The Internet variable is currently restricted to those aged <65 because of the strong age-related (cohort) effect (which will diminish rapidly over coming years).” If the Committee would like to give further input in relation to that it would best be directed to the University of Otago staff who work on NZDep; there contacts are at the link below. http://www.otago.ac.nz/wellington/research/hirp/otago020194.html#overview

2. Provide some further information in relation to the General Social Survey and the request for

disability information in it to the Committee: The NZ General Social Survey has been undertaken 2 yearly since 2008. It is designed to provide information on the well-being of New Zealanders aged 15 years and over. It covers a range of social and economic outcomes and provides a view of how well-being outcomes are distributed across different groups within the New Zealand population. It is used to provide information for monitoring social outcomes over time and across different population groups, and to make international comparisons. Topics include:

• Life satisfaction • Financial well-being and job satisfaction • Social contact and isolation, participation in voluntary work • Safety and security • Housing quality, emergency preparedness, and council services • Self-assessed health • Human rights, voting, and discrimination

15

• Support across households. Unfortuntately, in the results available by region, the whole Auckland region is reported as one. There has been a recent consultation on the content of future social surveys and we gave feedback that breaking Auckland down into smaller units would be very helpful. In addition, we also noted in our submission that people with disability are largely invisible in the General Social Surveys and there are limited other sources of information about disability at a population level (primarily the survey after each Census). We recommended that those organising the survey work with the disability community to identify how the General Social Survey could be strengthened to better represent their realities at a population level.

Date: Created by:

Community Panel

016

Community Partnership

017

Purpose of Community Panel

• “A community partnership”

• Bring a community perspective to development of DHB plans, policies, publications and significant operational decisions

• Identify key organisational forums where community representation and participation will be mutually beneficial, and identify individuals to participate

018

019

The Community Panel

Members are representative of the Counties Manukau community

Well networked with broad community perspectivesGeographically, ethnically, disability sector, faith-based communities, rural, youth, older person’s, Migrant, Maori,

Pacific, Asian, South Asian, Other

Involved in the local community and health and social services sectorE.g. Police Youth Aid, Youth Justice, Justice of the Peace, Asian Crime Prevention, Child Abuse, Domestic Violence,

Marae Social Services, Ethnic Council, Health NGO, CCS disability, St Johns, Werry Centre (mental health), Local government, Citizen’s Advice Bureau, School Board of Trustees, Youth mentor, Marriage Celebrant

Provide broad consumer perspectivesArthritis, Asthma, Cancer, Diabetes, Gout, Haemophilia, Hearing impaired, Mental health illness, Motor Neurone

Disease, Palliative care, Pregnancy - first child, Spina bifida, Visually impaired, Emergency Department, Out-patients clinics, Orthopaedics, Ophthalmology

020

Community representation and

participation in key DHB forums

• Way finding Advisory Group (Martine)

• CMDHB Credentialing Committee (Sandy)

• Metro Auckland Clinical Governance Forum (Rosalie)

• 20,000 Days Leadership group (Sandy)

• Information systems governance group (Rosa)

• Patient and Whanau Centred Care Programme Board (Rosalie)

• Clinical Advisory Group (Sandy and Marama)

021

Inform DHB decision making

022

Feedback

John Buchanan (Honorary Associate Professor Quality Improvement Section of Epidemiology and

Biostatistics, School of Population Health, University of Auckland) to a colleague.

•I attended a meeting of the Community Panel several weeks ago and I was impressed by the

comments that the members of the panel made following presentations in regard to development

and planning of one sort or another

Trevor Lloyd, Portfolio Manager Pharamacy Services following feedback from panel members

re: proposed Pharmacy page on Health Point:

• Thank you very much Soli – this feedback is pure gold. I can’t guarantee that all

recommendations will be adopted but I will try my best.

Ernie Newman, Chairman, National Health IT Board Consumer Panel

•I really appreciated your support in pointing me to your documentation, talking me through your

interview process, and smoothing my introduction to the panel members. It saved me a lot of

duplication and I was very impressed with the way your Panel has been organised.

023

Community Partnership

Challenges

024

The Future?

025

Date:

Oral Health Update to CPHAC

Created by: Christine McKay, Portfolio Manager Oral Health, CMDHB

Date: 4th May, 2014 026

Counties Manukau Dental Services

Aim: for any child to enter adulthood pain free and disease free, with functional dentition, and positive dental self esteem

– Funded (regular) dental services, from birth up to 18th birthday – Hospital or community dental services for high needs vulnerable Key challenges – Largest preschool population; some 43,000 from 0 to 4 yrs. – Largest child population; some 70,000 from 5 years to year 8 of school (12/13) – Largest adolescent population; some 36,000 from year 9 (13/14) up to and

including 17 years – High deprivation concentration, 38% adults and 54% of children &

adolescents in deprivation 9&10 – Poor oral health statistics and persistent DNAs….. – Cultural diversity and context - high population of Pacific & Māori & Asian /

South Asian, Middle Eastern, Latin American, African communities ● Myth that baby teeth don’t matter – they will fall out and are replaced

with strong permanent teeth ● Event based dental care for all …..

027

Counties Manukau Dental Service Provision

Children • aged 0 to year 8 of school (12/13) • FREE regular dental care • Measures of Enrolments, Caries Free

% at 5 years; Decayed Missing Filled Teeth (DMFT) at year 8 of school; Arrears, DNAs

• Auckland Regional Dental Service (ARDS) school dental • CMH dental facilities integration services – 18 dental clinics, 11

transportable dental clinics, 6 mobile dental vans • 55 contracting dentist practices Special Dental Services (SDS) Children

and Adolescents • Hospital dental services at Middlemore, Greenlane, Starship • Mighty Mouth Preschool Tooth-brushing program

Adolescents • aged from year 9 of school (13/14)

up to and including 17 years • FREE regular dental care • Measures of utilisation, treatments

• 80 contracting dental practices Oral Health Services for Adolescents (OHSA); 55 practices Special Dental Services (SDS) children and Adolescents

• Hospital dental services at Middlemore, Greenlane

Adults Emergency Dental / Relief Of Pain • aged 18 plus, high deprivation • Community Services Card (CSC)/

Pension with CSC

• Subsidised with patient co-payment • Adult community dental clinic Middlemore and Buckland Road Adult

Emergency Dental / Relief of Pain (ED/ROP) • 6 contracting dental practices Adult Emergency Dental / Relief of Pain

(ED/ROP)

High Needs Vulnerable People • All ages • Special needs • Disabled • Medically compromised

• Hospital services Outpatients & Inpatients at Middlemore, Greenlane • Trauma, Maxillofacial, Prosthetics, Plastics, Cleft Palate • MOH Pilot for low cost Oral Health Diabetes in Pregnancy (OHDIP)

dental pilot

028

Oral Health intervention is required

• Disparities in oral health and access to dental services still exist in oral health status by deprivation level, ethnicity, and age group, and this is evident in Counties Manukau *

• People from the lowest SES Groups experience the greatest lack of affordability of private dental care; have worse subjective oral health

• Poor oral hygiene with food & drinks left on teeth all day, overnight – 85% of 2-4 years and 60% of 5-11 years do not meet tooth-brushing

guidelines – One third of adults of all ages do not brush teeth twice a day

• Poor nutrition – High consumption sweetened drinks – High consumption sweet foods

• Lack of engagement in oral health services – Nearly 70% adults do not get regular dental checks

• Early Childhood Caries (ECC) remains the most prevalent chronic (irreversible) disease in the Western world, eg 50% kids have caries

To get step change in improved oral health, we need to change knowledge, attitudes and behaviours, oral hygiene, engagement with dental services, and healthy nutrition.

* NZ Oral Health Survey, 2009

Host and teeth

Substrate (diet)

Micro flora

Ref. Fisher-Owens, S. A. et al. Pediatrics 2007;120:e510-e520

029

Dental disease starts in the 1st year of life

1. Disease in baby teeth is usually followed by decay in permanent teeth 2. Approximately only half of 5 year old children make it to school with caries free teeth

in Counties Manukau 3. Substantial lack of knowledge in pregnant women about their own and their

children’s oral health needs, and about dental services available 4. There are links between dental and periodontal disease in the mother, transmission

of infection to the unborn child, and adverse outcomes of pregnancy. 5. Clear interplay between chronic infection and disease, eg diabetes and CVD, such

that early oral health intervention may improve health outcomes

1. Maternal and Child Oral Health - Systematic Review and Analysis; A report for the New Zealand Ministry of Health, Kilpatrick NM, Gussy MG, Mahoney E.; Murdoch Children’s Research Institute, Sept 2008.

2. An exploratory study of pregnant women’s knowledge of child oral health care in New Zealand; Rothnie, Walsh, Wang, Morgaine, and Drummond; New Zealand Dental Journal, December 2012;

3. Epidemiology and Prevention of Periodontal Disease in Individuals With Diabetes; Katz et al, Diabetes Care Vol. 14, No 5, May 1991; 4. CMDHB oral health outcomes reporting; Preschool photos ARDS Lift the Lip training

030

Preschool Public Policy Oral Health targets

PP-11 Increase Percentage Caries-Free in Age 5 Children Reported annually at calendar year • Improvements are due to greater preschool enrolment and engagement with dental

services at a younger age before decay starts.

PP-13(a) Increase Enrolment of Preschool Children Reported annually at calendar year, tracked monthly • Improvements due to targeted enrolments, enrolment at preschool centres; opportunistic

at community events, greater and earlier enrolments WC/TO providers, enrolment at siblings dental appointments

Source ARDS Titanium reports; 2013 Stats NZ Pop Projections

Percentage Caries-Free 2010

Actual 2011

Actual 2012

Actual 2013

Actual 2014

Target 2015

Proposed Maori 38 38 40 39

One target

Pacific 28 32 32 35 One target Other 62 64 65 66 Total 45 48 49 51 53 54

Preschool Enrolment Children aged 0 to 4 years

2010 Actual

2011 Actual

2012 Actual

2013 Actual

2014 Target

2015 Proposed

Percentage Enrolment 61% 67% 72% 77% 85% 95%

Number enrolled 25,322 28,337 30,767 31,686 35,606 39,550

Eligible population 41,415 42,240 42,455 41,115 41,890 41,700

031

Severity of Early Childhood Caries (ECC)

• Approximately only half of all Counties Manukau children make it to school caries free, less for Maori and Pacific

• Preschool dental disease starts earlier for Maori and Pacific

• High DNAs for preschool on average 40% specifically Maori and Pacific

• Severe caries may require multiple tooth extraction under General Anaesthetic – approx. 300 to 400 CMH preschool children per year; or half of all hospital surgical dental in Auckland region are Counties Manukau preschool children

• Correlation ECC and lifetime oral health This has driven our preschool strategy to

reduce Early Childhood Caries, and Our strategy to reduce arrears and DNAs

1. CMDHB oral health outcomes reporting 2. Maternal and Child Oral Health - Systematic Review and Analysis; A report for the New Zealand Ministry of Health, Kilpatrick NM, Gussy MG, Mahoney E.; Murdoch

Children’s Research Institute, Sept 2008.

1.56

2.08

1.52

2.71

0.76

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0 1 2 3 4 Age years

Preschool age of decayed missing filled (dmft) teeth, 2013 data CMDHB

Asian

Maori

Other

Pacific

European

52%

66%

42%

78%

0%10%20%30%40%50%60%70%80%90%

100%

0 1 2 3 4 Age years

Preschool Caries Free % age 2013 data CMDHB

Asian

Maori

Other

Pacific

European

032

Preschool dental strategy

Increase Well-child/ Tamariki Ora provider awareness and engagement, training, and

Earlier enrolment in dental services, move to enrolment at 5 months immunisation to enable earlier engagement between 9 and 12 months, and

Earlier and regular attendance at dental appointments, and Potential 1st screening at preschool centres in supportive environment;

follow up dental treatment accompanied by parents at dental clinics, and Increase Maternity / Post-natal awareness of oral health, and Preschool Tooth-brushing programme - targeted 150 high deprivation

communities preschools, high Maori and/or high Pacific roll ● Oral Health education, tooth-brushing and nutrition links to Te

Whaariki early childhood education curriculum

033

Child Public Policy Oral Health Targets

Child dental services free for all residents and delivered in mix of mobile (outreach) dental facilities and clinics on school and DHB sites Child dental services measures: - Enrolment, achieved targets of 95 to 99% of eligible children aged 5 years to year 8 of school (12/ 13

years) - Arrears (children not seen within 30 days of recall date), 2014 target 7%, achievement May is 6.3% - DNAs estimated at 20%, however strategies developed for client centred appointments including

evening week nights at hub clinics, notification and follow up by text and phone; - The oral health outcome measurement is mean number of Decayed Missing Filled Teeth (DMFT) at

year 8 (12/13 years), affected by earlier engagement, attendance at dental appointments, arrears, oral hygiene and diet

- Completion of treatment and transfer to adolescent dental services at end of year 8, target 100%

Mean DMFT Score Children at year 8 of school

2010 Actual

2011 Actual

2012 Actual

2013 Actual

2014 Target

2015 Proposed

Maori 1.59 1.70 1.76 1.63 One target

Pacific 1.72 2.00 1.88 1.79 One target Other 0.90 1.00 0.90 0.89 Total 1.29 1.44 1.32 1.27 1.15 1.08

Target PP-10 Reduce Mean DMFT Score for Year 8 Children (12/13 years) - Noted improvement versus prior year but specifically the high needs target group of Maori and Pacific.

034

School Dental Service and Facility rebuilding

● The Oral Health business case aimed to replace ageing dental clinics, only open part-time and often more than 40 years old, that did not comply with infection control, OSH, or modern dentistry requirements, with modern fit for purpose and clinically safe dental facilities.

● At the same time everything changed in the model of care to prevention versus only treatment, new equipment and processes, longer opening hours and open all year except Christmas New year

● Staffing changes to additional Dental Therapists, Dental Assistants, Receptionists / Patient Care Assistants for hub clinics, plus Community Dentist operating in the school dental service

● By using a mix of fixed dental clinics and mobile dental services we can reduce barriers to access and take the service to smaller schools and Marae preschools that can’t support a full-time dental clinic and reach out into the community and rural areas.

● Building programme: planned 19 new dental clinics and 17 mobile clinics replacing 65 smaller and part time clinics

– 17 new dental clinics are operational, plus 1 older clinic to be refurbished – 11 Transportable Dental Units and 6 Mobile Dental Vans are operational, and operate out

of approximately 131 school sites plus community and Marae sites. 1 is still to be refurbished

035

11

Flexible Child & Adolescent Dental Services delivery

036

Adolescent Public Policy Oral Health Targets

Adolescent dental services free for all residents from year 8 of school up to including 17 years at school or not.

⁻ Delivered in mix of 80 private contracting dentist practices including 3 dental providers with mobile dental vans

⁻ Mobile dentist providers on-site at secondary schools continue to pick up the students who would not normally attend a dental clinic. Mobile dental services accounts for 55% of adolescents

⁻ Mobile dental services are delivered at 28 school plus Youth Justice and CYFS residence; just 2 large secondary schools and 4 private schools left to take up mobile dentist services.

⁻ PP-12 Increase Adolescent Utilisation of Oral Health Services - reported annually, tracked quarterly

⁻ Achievement 2013 estimated final result of 76% utilisation, target 2014 of 80%, target 2015 of 85%

44% 45%

53% 54% 56% 62%

68% 71%

74.4% 76%

85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2004 2005 2006 2007 2008 2009 2010 2011 20122013 Interim result2014 MOH Target

Northern Region DHBs Adolescent utilisation of dental services

Northland

Auckland

Waitemata

Counties-Manukau

037

Community & Hospital Dental ● Adult Emergency Dental / Relief of Pain treatments limited at 2 DHB clinics and 8 locality based

dental clinics for adults with a community services card. Subsidised service with patient co-payment

● High Needs Vulnerable patients - limited dental services treated as inpatient or outpatients ● Scoping project for model of care, facility and service provision for High Needs Vulnerable Ministry of Health funded - CMDHB Oral Health Diabetes in Pregnancy (OH DIP) dental pilot ● 1 of 3 DHBs Low Cost Trial Initiatives to provide dental service to high needs vulnerable s ● Women with Diabetes in Pregnancy (DIP), targeted more to high deprivation, cohort of 400 ● High clinical needs, very positive results with transformation as women become pain and disease

free, and are often able to eat and speak without embarrassment ● Originally 2 year pilot, MOH funded and proposed extension to Dec 2015 Ministry of Health - Health Literacy Review Project ● CMDHB is 1 of 3 DHBs projects; and will produce a reusable guide for evaluation of health literacy

in any health service ● Our project is based on Oral Health Services; draft findings available, report due September 2014 ● Interviews and observations of DHB, dental & primary care, clinicians & patients, documents

038

Counties Manukau Cross Evaluation of Direct and Indirect Oral Health Interventions

CMDHB Oral Health

Diabetes in Pregnancy trial

initiative

CMDHB Preschool

Toothbrushing evaluation

mums & pre-schoolers

NZ Oral Health Survey 2009

Insights into impact of direct and indirect interventions on children, mothers and their families’ oral health attitudes, knowledge and

behaviours 039

Counties Manukau Oral Health evaluation

● Very little information internationally on the impact of direct and indirect oral health interventions. Preschool programs are very difficult to evaluate, Scottish national program 2013.

● **Cross evaluation of the impact of direct and indirect interventions on mothers and their family’s oral health attitudes, knowledge and behaviours, and evaluation of the impact of a preschool program. Target Maori and Pacific women, Maori and Pacific pre-school children

● Triangulation of women’s knowledge behaviour and attitudes between 3 studies: – CM Health Diabetes in Pregnancy (OH DIP) dental pilot – CM Health Preschool Tooth-brushing program Mothers and – 2009 NZ Oral Health Survey*

● The results are very positive and point towards success of the direct intervention with the mothers of preschool children in the Tooth-brushing program, and the direct dental intervention with mothers in the Maternity pilot

– Mothers of children in the Mighty Mouth Tooth-Brushing Program also recognise the importance of taking care of baby teeth and agree it is as important as taking care of adult teeth.

– Qualitative interviews undertaken during clinical intervention for women in the OHDIP point to the positive impact of the Trial on women’s own oral health knowledge and habits for themselves and their families.

● Evaluation of the impact of a preschool tooth-brushing program versus children not in program – Overall the Mighty Mouth Tooth-Brushing Program targeted to Maori and Pacific is most successful at

changing tooth brushing knowledge and habits over knowledge and behaviour of healthy food and drink choices.

● Potential for 2 tracking studies on the dental pilot women and also the preschool children to prove cost benefits and long term impacts of oral health interventions. Ethics approved and potential to publish and share results.

* NZ Oral Health Survey, 2009; Litmus April 2014

040

41

Counties Manukau District Health Board

Director Primary Health & Community Services’ Report

Recommendation

It is recommended that the Committee receive the report of the Director Primary Health &

Community Services.

Prepared and submitted by Benedict Hefford, Director Primary & Community Services

Glossary of Terms Acronyms Description

A&D / AOD Alcohol and Drug

A&E Accident and Emergency Department

ACP Advanced Care Plan

ADHB Auckland District Health Board

AH+ Alliance Health Plus

AT&R Assessment, Treatment and Rehabilitation

AWHI Auckland Wide Healthy Housing Initiative

B4SC Before School Checks

BSMC Better, Sooner, More Convenient

CCM Chronic Care Management

CHWs Community Health Workers

CPHAC Community and Primary Health Advisory Committee

DHB District Health Board

DHS Director Hospital Services

DiSAC Disability Support Advisory Committee

DNA Did Not Attend

EOI Expression of Interest

GAIHN Greater Auckland Integrated Health Network

GAS+ Group A Streptococcal Positive

GP General Practitioner

hA healthAlliance

HBSS Home Based Support Services

HHC Home Health Care

HOP Health of Older People

IDF Inter District Flows

IFHC Integrated Family Health Centre

IT Information Technology

MMH Middlemore Hospital

NHC National Hauora Coalition

PHN Public Health Nurse

PHO Primary Health Organisations

POAC Primary Options to Acute Care

PRIMHD Project for the integration of mental health data

RN Registered Nurse

SUDI Sudden Unexplained Death of Infant

VHIU Very High Intensive User

VLCA Very Low Cost Access

42

Summary

• The latest preliminary data is showing good progress on national health targets with indications that all

targets will be met by 30 June. The coverage for Maaori and Pacific is showing steady improvement on

all targets.

• A new PHO Services Agreement is being put in place from 1 July. The agreement includes changes to

rural services funding, and use of the ‘Integrated Performance and Incentive Framework’ for selected

areas/indicators.

• Child health indicators relating to the oral health, immunisation and Before School Checks are all

showing improvement compared to 2013/14 performance.

• The ‘Handle the Jandal’ campaign to build resilience amongst Pacific Young People is gathering

momentum, with 200 young people engaged in taking action to improve Youth Mental Health.

• The Memory Service has received 257 referrals since starting last year. The next phase of the services

development is to implement an integrated model which includes GP, PN and Alzheimers Auckland

involvement.

• Warm-Up Counties has now insulated over 1,800 homes this financial year, with 2,700 referrals

generated.

• The main focus of Systems Integration and Locality activity this month as been on the At Risk

Individuals Programme, which goes live 1 July.

Contents

1. National Health Targets

2. Primary Health

3. Child, Youth and Maternity

4. Mental Health and Addictions

5. Adult Rehabilitation & Health of Older People

6. Intersectoral Initiatives

7. Progress with Systems Integration

8. Locality Reports

9. Financial Report

43

1. National Health Targets OBJECTIVES

Target 13/14 Q1 Q2 Q3 Q4 On Track

More Heart and Diabetes Checks 90% 80% 83% 86% Yes

Better Help for Smokers to Quit 90% 59% 69% 77% Yes

Immunisations 90% 90% 91% 91% Achieved

PROGRESS

More Heart and Diabetes Checks Target (Cardiovascular Disease - CVD - Risk Assessment)

The official MoH Results for Quarter 3 are; 85.7% for total population, 80.1% for Maaori and 86.1% for

Pacific. The graph shows PHO performance.

The preliminary April results show continued, steady progress towards the 90% target. ProCare and East

Health are the two highest performing PHOs for this reporting period.

44

As most practices have now screened a high percentage of their patients the challenge is to reach those

that have not responded to recall letters, text messages and phone calls.

Strategies to reach this group of people include positive news stories in the local courier paper, offering

transport for those who have issues and offering Point of Care testing or Phlebotomy (including Saturday

clinics) for those who have not yet had their bloods taken. The use of Test Safe data and being able to

access blood results faster is also proving helpful. Some providers are now calling outside of hours to reach

patients.

Maaori, Pacific and other high-risk populations are actively targeted through the use of:

• Specific practice queries and recall systems, including queries on patients who are turning 35 within

the next three months

• Appointment scanners (which can be used to identify patients who are booked in for a consultation

with the GP or PN that day so a heart check can be offered opportunistically)

• Outreach services, using community health workers to transport patients

• Practice competitions and rewards for practices with most improved screening rates for Maaori

and Pacific

Practices that do not have enough resource are also supported by two secondary care screening nurses

who spend one day each out in the community at practices identified by the PHOs.

Better Help for Smokers to Quit

The MoH Quarter 3 results show that CMH has reached 76.7% which is a 7.6% increase from the last

quarter. Preliminary April data is not yet available from all PHOs, but where provided, shows an

accelerating improvement towards the 90% target, with ProCare and East Health at 86%.

45

The PHOs are using cessation support services such as Quit Line, face to face consultations and group

cessation sessions. The Smokefree Co-ordinator and Smokefree Target Champion are continuing to spend

time at low performing practices and encouraging these practices to implement quality processes that will

ensure sustainable activity towards the 90% target. Childhood Immunisation – 8 months

The eight month immunisation target for year ending June 2014 requires 90% of all eligible children to have

completed their scheduled course of immunisation.

For the period ending 25 May 2014 the coverage rate for CM Health for all eight month old babies

remained static at 91%. The coverage for Maaori babies has improved by 2% and is now at 85%. The

coverage rate for Pacific babies has declined by 1% and currently is at 94%.

The target coverage rate for two year old children is 95%. The coverage rate for CM Health for two year old

children has remained static at 94%.

Consultation with PHOs has resulted in an agreed process for practice level reporting of children not fully

immunised to be reported to the practices on a weekly basis. This will assist practices in targeting effort

where required.

The National Immunisation Schedule changes are effective as of 1 July 2014. This will see the introduction

of Rotavirus which should have an immediate effect on avoidable admissions for gastroenteritis in the

under 12 month cohort.

46

2. Primary Health

OBJECTIVE: To deliver comprehensive in and out of hours primary health care which is ‘Better, Sooner, and

More Convenient’.

PROGRESS

PHO Services Agreement Version 2, 2014-15

CM Health has been working with the Ministry of Health and the PHO Services Agreement Amendment

Protocol (PSAAP) to finalise Version 2 of the PHO Services Agreement. An update on key changes for the

year ahead is provided below.

Rural Services Funding

Rural services and funding can be transitioned to a district alliance as long as the key stakeholders,

including PHOs and practices receiving rural funding, agree on the approach. In CM Health, two PHOs and

their practices in the Franklin Locality (ProCare, Tuakau Health Centre and Alliance Health Plus, Waiuku

Health Centre) currently receive rural primary care funding. CM Health has initiated planning with

stakeholders to establish a Franklin Rural Service Level Alliance Team by 1 July 2014. Membership will

consist of representatives from PHOs and practices currently receiving the funding and from the Franklin

Locality Leadership Group. The Franklin Locality General Manager and CMDHB Primary Care Portfolio

Manager will also be on the alliance team.

General Medical Services (GMS)

GMS claiming will be extended to suitably qualified health practitioners working in a general practice

setting. DHBs and the Ministry of Health are working with PHOs to strengthen existing controls and

establish new processes to monitor and manage claiming behaviour.

Integrated Performance and Incentive Framework

DHBs and PHOs have now been presented with a draft of the schedule for the Integrated Performance and

Incentive Framework (IPIF). The schedule is still at a high level as much of the detail around IPIF is yet to be

developed.

The MOH is in the process of developing a joint IPIF Steering Group involving the MOH, DHB and PHO

representatives, and clinical leaders. This group will lead the next steps while the clinically-led advisory

group is being established. CM Health will work with the sector to further develop the framework and to

support implementation.

For the first year (2014-15) incentive payments will be linked to five existing measures and data sources

including the three preventive national health targets:

• more heart and diabetes checks

• better help for smokers to quit

• increased immunisation rates at eight months old

• increased immunisation rates at two years old

• cervical screening coverage.

Refugee Primary Care Services

CM Health has been consulting with PHOs and other stakeholders on the re-design of primary care services

for refugees residing in or accessing services in the Counties Manukau district. Historically services have

been provided through a small number of practices with targeted services for refugees. PHOs are in support

of a new approach which includes each of the five PHOs providing wrap around primary care services to

enrolled refugees. This includes a comprehensive first assessment, use of interpreting services, training for

47

practice staff, extended consultations and linkages with other support services for refugees. The proposed

service components are aligned with those of Auckland and Waitemata and for CM Health there will also be

alignment with the At Risk Individuals programme. Planning is on track for services to be in place from

1 July 2014.

After Hours

Work continues in earnest on the finalisation of the business case for sustainable funding and the

underpinning model of care. The proposed approach will be presented to the Board for approval later in

2014.

Pharmacy Services

Consultation on the next transition step of the Pharmacy Services Agreement

The new Community Pharmacy Services Agreement aims to align pharmacy services with long term

condition management initiatives. Consultation began in May on the ‘Stage 4’ funding proposal which

moves payment for pharmacy services to a ‘casemix’ approach to reflect patient complexity.

48

3. Child, Youth and Maternity Services OBJECTIVE(S)

To integrate maternal and child health services; reduce perinatal mortality; improve care in the First 2,000

Days of life; intervene early to support vulnerable children; reduce Rheumatic Fever by two-thirds to

1.4 cases per 100,000; and improve youth services.

PROGRESS

Maternity Care

Feedback from the MoH was received for the Draft Maternity Quality and Safety Annual Report. The

feedback was positive noting the level of detailed response to the maternity quality improvement areas.

The Ministry of Health’s feedback has been taken into consideration for the final report due at the end of

June 2014.

First 2,000 Days Programme

The three workstreams under this project are: Planned and Healthy pregnancies; Infant and Maternal

Nutrition and Healthy Attachment Development and Parenting Skills. All workstreams are on target with

the programme objectives/milestones.

Sudden Unexpected Death of Infant (SUDI)

The CMH SUDI Governance Group has approved the implementation of a pepi pod pilot. The use of pepi

pods (safe sleep devices) is endorsed within the regional safe sleep strategy and is currently being tested

for acceptability within our community. Referral and access criteria are being finalised and the pilot will

commence at the end of June. Feasibility work continues for the wahakura weaving programme.

Before School Checks (B4SC)

CMH is currently reporting at 86% overall and 78% high deprivation for ‘Before School Checks’ (B4SC). The

target is to complete 8,058 by the end of June 2014. To date a total of 6,829 checks have been completed

to date (an increase of 808 checks since last report).

CMH are still tracking slightly behind the targeted volume, however strategies implemented such as the

Saturday joint clinics at the Manukau Super Clinic and local advertisements over the last month have

proven successful. Indications from the Ministry of Health are that our target for the 2014/2015 financial

year will remain similar.

Child and Adolescent Oral Health Oral Health strategies to improve oral health service access and health for children 0-18 years of age:

o Infants are enrolled with dental services at 5 months immunisation visit to increase engagement of

under 2 years children; Well child / Tamariki ora providers receive ‘Lift the Lip’ training annually o CMH Oral Health pilot for dental care for 400 women with Diabetes in Pregnancy or at high risk

(2013- 2014); oral health education to midwife cluster meetings o Oral health education to all preschool centres; 150 preschools in high deprivation communities get

supervised tooth-brushing programs o Extending hours of service at community dental hub clinics to weekday evening and Saturdays

subject to localised demand, to also assist in reduction DNAS o SMS/text message reminders or phone calls to book client centred appointments for preschool and

school children to assist in reduction DNAs o Increase access to adolescents by offering mobile dental services at secondary schools, from 28 to

30 schools

49

Reduce Scheduled Examination Arrears Rate in patients aged 0 to year 8 of school (12/13 years) The May arrears rate was 6.5% ahead of the target of a reduction down to 7% by 30 June 2014. Increase Percentage Caries-Free in Oral Health of preschool and in Age 5 Children The Caries-free percentage has increased to 51%, versus the prior year actual of 49%.

Improvements are due to greater preschool enrolment and engagement with dental services at a younger

age before decay starts. However achievement is not as great as would be expected given all preventative

treatments and earlier examinations so further clinical investigative work is in progress to understand why

we still have caries in preschool children, in particular Maori and Pacific.

The strategy to enrol pre-schoolers at the five month immunisation visit has been trialled with great

success in one well child provider in March and April and noted the enrolments of babies and older

preschool siblings. Planning is in progress to roll out the initiative across all well child providers in the

district.

Adolescent Dental The contracted dentists have started the year well with the incoming year 9 students. Mobile dentist

providers on-site at secondary schools continue to pick up the students who would not normally attend a

dental clinic. Apart from the private schools we have just three large and a few small secondary schools left

to take up mobile dentist services.

50

Adult and Family Community Dental 1. We continue to provide Adult Emergency Dental / Relief of Pain treatments at two DHB clinics and

eight locality based dental clinics for adults with a community services card. 2. The low cost dental trial with a cohort of 400 women with diabetes in pregnancy and after the birth is

progressing well with 290 women under treatment and the remainder waiting on appointments.

Analysis of the intervention outcomes suggest the results are very positive, and point towards success of

direct intervention with the mothers in the maternity dental pilot, but also success of the indirect

intervention of the mothers of pre-schoolers in the tooth-brushing program.

The results were presented to the NZ Dental Association oral health forum and MOH chief dental officer

with very positive reception. Children’s Action Plan

CMH was included in the latest announcement of Children’s teams to be opened by March 2015. The areas

identified include Papakura, Manurewa and Clendon. Meetings are being setup with the MoH to get the

planning process underway.

Mana Kidz - Rheumatic Fever (RF) Prevention Programme The four areas under the RF prevention programme are school based services; drop-in clinics; a Community

Engagement Strategy and the Auckland Wide Housing Initiative (AWHI). The school based programme is

fully implemented with throat infection (GAS+) rates at 13%.

The RF Winter Awareness campaign has begun with advertising on bus shelters, television and radio.

The MoH have also released a request for proposal (RFP) to address the ongoing issue of antibiotic

adherence. CMH Child Health Alliance Forum will submit a proposal via the National Hauora Coalition.

51

4. Mental Health and Addictions VISION: That the communities of Counties Manukau will support mental health and wellbeing and be able to

get support when they need it, quickly and easily, in their local community.

PROGRESS

Service Access Rates and Waiting Times

Total access rates to Mental Health services for all ethnicities and ages are being met or exceeded except

for Older Adults. However, there are no wait times for these services indicating that demand for clinical

services is being met. A new contract for a community support work service for Older Adults will begin on

1 July 2014 and we would expect to see increase in access rates for those over 65.

Note that there is a three month report lag due to national data assurance requirements:

Figure 1: Graph showing access rates for mental health services from Jul to Feb 2014 (NGO & DHB services).

52

0

200

400

600

800

1000

1200

Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14

12 months period ending

Clients seen by Organisation Type, AOD

clients aged 12-19, Ethnicity - Total

DHB Only NGO Only Both DHB and NGO

Figure 2: Graph showing number of 12-19 year olds seen by AOD services from Jul 13 to Feb 14; both DHB and NGO.

The above graph shows the increase noted in January has continued on with 29 more 12-19 years olds seen

in February than in January, and an increase of 386 since Dec 2013. The increased focus on this age group,

as part of the Prime Minister Youth Mental Health project, is showing a positive impact.

Wait time targets for non-urgent mental health and addiction services are that 75% (0-19) of those referred

(non-urgent) are seen within three weeks and 95% within eight weeks. To January 2014 both these targets

are being met across DHB and NGO services including the target for AOD NGO services. This is a marked

improvement from previous months and it is positive to see the results of the hard work that has gone into

improving wait times at the local, regional and national level. Regular workgroups continue to support

providers with their submissions and ensure the focus on reducing wait times and the data through to

February 2014 is demonstrating the approach is working.

53

Figure 3: Graph showing waiting times for NGO AOD services from Mar 13 to Feb 14.

Ensuring services are more flexible and responsive

Over the last few years we have been working with NGO providers of Community Support Work (CSW) and

Iwi Support Work (ISW) services to align to our Community Mental Health Centres locality areas and

understand better how these services are being used. Based on the information we have on utilisation and

feedback received, we have identified the need to make some contractual changes to ensure we are

actively using our current resources more effectively.

We are shifting the focus to time spent with clients rather than measuring client caseload with the aim that

these contractual changes will allow support staff to adjust time spent with clients in response to changing

client need. We are also wanting to strengthen the role of the CSW/ISW as a link between specialist and

primary care services so that these roles can support those transitioning from specialist to primary care,

those under a shared care model, those who need additional support and may have previously needed

specialist care to support their mental health as well as those who meet the eligibility criteria and are

currently receiving care through primary care services.

Northern Region Acute Mother and Baby Mental Health Project

New funding has been made available to the Northern region to expand the continuum of acute mental

health services available for mothers (and fathers or primary carers) and babies.

Counties Manukau has an existing Maternal Mental Health Respite service that is being enhanced through

this additional funding, so we will lead the way in defining the model of care.

‘Handle the Jandal’ campaign

A youth-led campaign, Handle the Jandal seeks to build resilience skills and youth-led support structures

within and around Pacific youth to help them identify, acknowledge, anticipate, and cope with various

sources of pressure (competing school and family obligations primary amongst them). Overseen by

Ko Awatea, this campaign was developed using the principles and practices of community organising to

engage Pacific youth. From April to October 2013, Handle the Jandal engaged at least 191 Pacific youth and

families in taking preventive actions around youth mental health. As it moves forward, the campaigns

54

seeks to create a more formal network of youth-led “cell groups” through which youth can create resources

within their own community to help each other handle various pressures.

The Non-Government Organisation (NGO) Sector

Platform, the national peak body for mental health and addictions NGOs, is preparing to launch a national

media campaign – the ‘Fair Funding Campaign’ which they describe as arising from:

• Inconsistent passing on of the Contribution to Cost Pressures (CCP) to NGOs

• An unsustainable environment for NGOs – although Northern Region DHBs are signalling an intent

to pass on CCP this year, the gap arising from inconsistency over the last five years has impacted

the sector

• An uneven playing field in respect of reporting requirements for NGOs, providing an example of

contact time required by staff – some DHBs requiring 80% of NGO staff time to be face to face,

compared with the current level of around 25% of DHB clinical staff time as reported through the

national KPI programme

• Disinvestment by DHBs in NGOs – through lack of CCP pass through, and also reduction in pricing

through competitive tendering processes

In relation to Counties Manukau, the CCP price adjustment has been passed on to the NGO sector three of

the last five times and we have made significant investment in the NGO sector in this district with one of

the highest investments nationally at 35%.

55

5. Adult Rehabilitation and Health of Older People OBJECTIVE: To support older people in their homes and communities with integrated, locality based services

that maximise independence through rehabilitation and quality care.

PROGRESS

Home Health Care - Community District Nurses and Allied Health Teams

The Home Health service is available to people in their own home or at a clinic facility at four sites aligned

to the four localities. The Home Health teams consist of allied health, district nursing, care assistants and

other locality based staff with professional, clinical and cultural skills. Home Health Care received 1,215

referrals and 1,396 discharges and completed 9,908 contacts across all bases.

Did Not Attend Rates – Orakau 11%, Papakura 1%, Pukekohe 4% and Howick 2%.

1000

2000

3000

4000

5000

Apr

il

May

June

July

Aug

ust

Sept

embe

r

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

July

Aug

ust

Sept

embe

r

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

2012 2013 2014

HHC Contacts

Botany

Orakau

Papakura

Pukekohe

Community Allied Health - (delivered from Home Health Care)

The Allied Health wait list in Home Health continues to decrease. The casual Occupational Therapist

appointed to 1 FTE to support the Locality continues to focus on referrals that are over specification.

Casual Physiotherapists assisting in Howick and Orakau Home Healthcare have been able to contribute to

the decrease in the overall waiting list from 82 last month to 41 for the month of May. Papakura Home

Health care redesign will assist in future, to inform all bases how a redesigned triage and service model can

be implemented to improve overall efficiency of allied health workload and service delivery.

Previous

month Total Orakau Papakura Pukekohe Howick

Waiting list Dietetics 17 6 1 0 4 1

Contacts Dietetics 100 62 23 19 18 25

Waiting list Occ Therapy 178 143 40 32 11 60

Contacts Occ Therapy 331 418 157 118 37 106

Waiting list

Physiotherapy 82 41 1 18 0 22

Contacts Physiotherapy 221 323 63 90 127 43

56

Assessment and Coordination of Care for Older People – (Reported Quarterly in arrears)

For the quarter ended 31 December 2013, 38% of all CMDHB aged residential care facilities have completed

training in the nationally mandated ‘InterRAI’ assessment and care planning system, and 63.2% of home

support clients have received a current interRAI assessment. This puts the service ahead of target for the

roll out of InterRAI. The next quarterly report on this data is due shortly.

Early Supportive Discharge – Supporting Life after Stroke

Supporting Life after Stroke has actively worked with 29 patients since pilot commencement. Length of

stay on ward 23 for mild to moderate stroke prior to the project was 22.7 days this is now 5.1 days. The

team presented at learning session 3 in May on Implementation and this was very well received. They

continue to exemplify what collaborative team work should look like and are being regularly contacted by

other services both within counties and regionally for information about the project.

National and Regional Spinal Strategy

A paper to Auckland District Health Board (ADHB) Board outlining acute spinal background proposed

referral pathway and communication plan has been sent for agreement and is awaiting feedback. The

Shared Care Trial has commenced with an aim to have 10 patients participating by September 2014.

Currently two patients are signed up, one outpatient and one newly injured patient recently discharged. A

third patient has agreed to participate in the trial and is in the process of being set up.

Community Geriatric Services

An important component of the Systems Integration/Locality developments is to provide additional

Geriatrician support to primary care practices and aged residential care facilities.

The nursing team had one Full Time Equivalent (FTE) vacancy in May due to a resignation - with a new

Clinical Specialty Nurse due to commence in early June.

The Community Geriatric Service (CGS) team continued to provide support to five General Practitioner (GP)

practices during the month of May. Prescribing rate for Vitamin ‘D’ for the quarter remains at 92%.

Target <80 Emergency Care presentations from residential facilities per month

- May 2014 saw 116 Aged Related Residential Care (ARRC) Clients present to Emergency Care. Of

these, 22 presentations were falls related and 25 were potentially avoidable.

0

20

40

60

80

100

120

140

Jul-

12

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Dec

-12

Jan-

13

Feb

-13

Mar

-13

Apr

-13

May

-13

Jun-

13

Jul-

13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun-

14

ARRC Presentations to EC

ARRC presentations to EC

20,000 Days Target 2012/13

Regional Target 2012/13

Potientially Avoidable

57

Memory Team 20,000 Days Collaborative – The Memory Team resumed service this month, the referral

rate has exceeded expectation which has focused staff on transferring patients onto Alzheimer’s Auckland

Charitable Trust (AACT) as soon as the intensive phase and diagnosis has been completed. There were

15 patients transferred with five of these enrolled onto E-Shared Care via their primary care, the remainder

have undergone the “quick-admit” function.

The Integrated Model has been developed to the extent that a baseline has been established of the

number of referrals by GP Practice. As Integration gains traction it is expected that the referrals to the

Memory Team will increase but the number of contacts will remain relatively stable due to the increased

involvement from GP, Practice Nurses/Coordinators and AACT transfer. The presentation of this stage to

the General Managers of the Localities, and their Clinical Lead was completed with a positive response.

The Hospital pathway for Memory Team clients has been completed, the alerts report is to be developed

and generated daily. The team has taken part in family meeting and multidisciplinary team reviews of

patients hospitalised to maintain continuity and prevent duplication.

As at end May 2014 the Memory Service had received 257 referrals, of which 61% were referred by

Primary Care.

Long Term Support Chronic Health Conditions (LTS CHC) Update on service mix provided – (Reported

Quarterly)

Counties Manukau Health LTS-CHC utilisation as at March 2014

There are 157 clients receiving LTS-CHC funding and who are receiving the following services:

Service Number of clients

Community Residential Services

Dementia 7

Hospital and Specialised Continuing Care 26

Rest Home 21

Respite 2

Rehab and Community

Carer support 24

Household Management 69

Personal Care 85

Individualised Funding 3

Dementia Day Care 2

Total 157

58

6. Intersectoral Initiatives

OBJECTIVE

Target populations/communities with high health, housing, social, employment and education needs to

improve the health status and reduce health inequalities.

PROGRESS

Warm Up – Counties Manukau (Retrofitting Home Insulation Project)

Warm Up Counties Manukau is a free home insulation programme that retrofits insulation into the homes

of low income families with high health needs. This programme is delivered and funded through a working

partnership between the Energy Efficiency Conservation Authority (EECA), Autex Industries Limited, The

Insulation Company, Right House Limited, Auckland Council -The Southern Initiative, Counties Manukau

Health and the Middlemore Foundation.

The programme partners have worked to ensure those households/families most at risk of poor health

outcomes are the ones that receive the service/s by using a targeted approach. We insulate the homes of

low-income families with health issues that may be related to housing, creating ‘healthier homes’ which are

more energy efficient, thus ensuring that the home contributes to the health of the family. In addition, we

offer a comprehensive health and social assessment for participating families to ensure that they are

accessing appropriate health and social services. This approach ensures that we can address both housing

and health issues.

To be eligible for the programme participating families/household are required to:

• live in Counties Manukau Health catchment (this includes Papakura and Franklin)

• live in a home built prior to 1st January 2000

• be the owner occupier or rent privately (i.e. NOT a Housing New Zealand home)

• the applicant must have a Community Services Card.

The programme is targeting health conditions that can be exacerbated by living in cold damp homes, in

particular respiratory conditions such as Asthma, Pneumonia, Chronic lung disease (Emphysema,

Bronchitis, Bronchiectasis). Priority is given to applicants if they have children (under 17 year of age) or

Older Adults (65 years and older) with respiratory problems living in their home.

59

Project Outcomes for the Warm up – Counties Manukau Project (1 July 2013 to 30 June 2014)

MONTH Total Number of Referrals Total Number of Homes Insulated Total Number of Home Visits

completed post install

July 2013 151 0 14

August 2013 91 179 38

September 2013 108 194 45

October 2013 173 173 34

November 2013 204 120 81

December 2013 193 134 47

January 2014 212 126 72

February 2014 546 183 107

March 2014 212 259 127

April 2014 376 222 61

May 2014 434 218 36

Total Number of Referrals Generated 2700 1808

662

Please note: Total Number of Referrals equals the approved applications sent to provider for install. There is a time

delay between referrals being received and the completion of the insulation install.

The PATHS (Providing Access to Health Solutions) Programme

PATHS is an intersectoral programme resulting from a partnership between Counties Manukau Health and

the Ministry of Social Development (MSD), that was established in Counties Manukau in 2004. It was

implemented in an effort to help tackle the growing problem of long-term benefit dependency. The aim of

the PATHS programme is to assist people in receipt of certain benefits who have a Medical Certificate.

The PATHS programme uses an intensive individualised case management model aimed at reducing health

barriers to employment. The health component of this plan may include an array of services delivered by

the public health sector or, where appropriate, a tailored PATHS package.

Figure Total Number of Voluntary Participant Enrolled onto the PATHS Programme

MONTH Total Number of Participants

enrolled

July 2013 22

August 2013 16

September 2013 14

October 2013 18

November 2013 21

December 2013 15

January 2014 10

February 2014 17

March 2014 23

April 2014 20

May 2014 22

Total Number 198

Other Initiatives of Note

Healthy Families New Zealand

The Ministry of Health has issued a Registration of Interest (ROI) to identify locally-based providers to act as

the lead for the implementation of Healthy Families New Zealand. The ROI closed mid May 2014, to be

followed by a closed RFP process and implementation is set to start October 2014. This new initiative is set

to operate in the four local board areas that make up the catchment of the Auckland Council’s Southern

Initiative and correspond to the Manukau and Manurewa/Papakura wards.

60

Counties Manukau Health encouraged our locally based community organisations to respond to the ROI

and are now awaiting the outcome of the ROI. We have highlighted to both the Ministry of Health and our

community providers the importance of this work for well-being in our communities and our readiness to

work with whoever is selected to proceed as our local lead provider.

Prevention of Obesity

A regional intersectoral approach to prevention of obesity is being led by ARPHS on behalf of the Auckland

Health Intersectoral Group (AHIG) of which we are a part

• Initially aiming to align current activities being led by health organisations then planning to engage

more widely across sectors

• A very successful Population Health Grand Round was held on 15th May with Professor Boyd

Swinburn as guest speaker on the topic of Obesity Prevention (the same presentation was given the

day before at ADHB)

• Collaborative work to improve the retail food environments across the three Auckland DHBs is

underway.

61

7. Progress with Systems Integration OBJECTIVES

• Improved health and equity for all populations

• Improved quality, safety and equity of care

• Best value for public health system resources

PROGRESS

At Risk Individuals Programme

The At Risk Individual programme design is completed and funding mechanisms have been agreed with

PHOs. Consultation is currently underway with PHOs regarding the ARI service specifications.

Planning is progressing for practices within tranche 1 (July –Oct 2014) to transition onto the programme.

There are 56 practices that have indicated they will be transitioning in tranche 1.

An implementation communications plan has been developed and focusses on ensuring secondary

clinicians are engaged. A plan for rolling out the CCMS eShared Care IT tool within secondary care has been

developed. Roll out aligns to those services that will be care team members for the At Risk population.

A small number of critical user reported issues within the CCMS system have been identified which are at

moderate risk of impacting the implementation timeframe. This is a priority for the project and vendor to

resolve, and ongoing engagement with users is ensuring that clear requirements are communicated to

HSAGlobal.

Resources and training have been developed and communicated to primary care, to achieve a consistent

and high quality approach to care planning and care co-ordination for this patient group.

Quality and Safety – Safety in Practice

The 23 general practice teams enrolled in the Safety in Practice programme are collecting data on their

selected bundle focusing on one of three identified high risk processes;

• Medication reconciliation following discharge

• Results handling systems

• Prescribing and monitoring of Warfarin

Practice-based meetings are in place to reflect on this data and to identify areas of change to be tested

within the practice.

Ongoing monthly training and communication sessions are in place where the Safety in Practice core

project team are meeting with the PHO nominated facilitators reviewing progress within the 23 general

practices enrolled in the Safety in Practice programme.

The Ko Awatea and Waitemata Improvement Advisors are working with the PHO staff within the general

practices providing quality improvement support and facilitation to assist with re-design of practice systems

and processes and up skilling teams in the model for improvement and PDSA testing of small scale change.

This month the facilitators have been introduced to the use of a Trigger Tool (structured case review) to be

used with a small sample set of patients to identify and reduce patient safety incidents. The Trigger Tool

will also be a key focus of the upcoming Learning Session attended by the enrolled practice teams and the

PHO facilitators, which is planned for 17 June.

62

8. Locality Reports

Eastern Locality Dashboard – April 2014

1. Acute Demand

Indicator

CMDHB

Ave YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

1.1 Unplanned readmission rate (28 days) 6.6% 6.3% 6.2% 9.4% 8.0% 6.8% 9.7% 8.1%

1.2 ASH rate per 1,000 enrolled patients 2.6 1.3 1.3 1.3 1.2 1.1 1.5 1.4

1.3 Average bed day usage in last 6 months of

life~~~ 13.0 13.7 9.2 10.3 11.1 11.1 11.6 12.2

~~~Numbers for previous months may change as additional mortality data is received

2. Quality

Indicator Target***

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2.1 Children fully immunised at 8 months 90% 96% 96% 96% 96% 94% 92% 91%

2.2 Children fully immunised at 24 months 95% 95% 95% 95% 96% 95% 94% 95%

2.3 Middlemore Radiology < 6 week wait time for

GP referrals 98% 99% 99% 99% 86% 89% 98% 89%

2.4 CCM+++ CVD patients on triple therapy 89% 91% 80% 71% 81% 82% 80% 78%

2.5 DAR and CCM+++ Diabetes patients with HBA1c

<= 64 mmol/mol 73% 81% 84% 86% 86% 83% 83% 83%

**** this is the MOH target for immunisation rates and the CM Health average YTD for the other indicators in this group

^^^ Relatively low August %s were unable to be verified.

+++ We are using CCM data pending availability of robust whole of population data

3. Shared Accountability Services

Item

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2014

YTD

2014

Proj

2014

Planned

3.1 ED presentations not admitted 227 204 255 249 217 233 230 2,269 2,723 2,685

3.2 Acute medical bed days 1,169 938 1,117 972 856 1,106 1,092 10,981 13,177 14,787

3.3 Acute casemix-funded non-medical

bed days 999 1,041 905 1,005 1,090 1,037 918 9,559 11,471 11,625

3.4 Medical outpatient attendances 1,883 1,964 1,582 1,783 2,012 2,105 1,814 18,786 22,543 20,561

Note: SAS volumes for previous months may change as IDF updates are received

4. Other

Indicator

CMDHB Ave

YTD Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14

4.1 Percentage e-Referrals 14% 18% 19% 13% 14% 18% 15% 15%

4.2 Medical Outpatient DNA rate 8.1% 3.7% 2.0% 2.0% 6.2% 3.3% 1.9% 2.6%

Eastern Locality Projects

At Risk Individual (ARI) programme

Business modelling is being completed for general practices and training is planned for the ARI

programme. This has been a primary focus in the Locality.

Falls Prevention Programme

The Falls Prevention Programme has 71 older people enrolled, which is a more than the planned

50 people. Participants are completing their six month programme and outcomes will be measured

over the next two months. The provision of group sessions for early osteoarthritis to prevent

progression and delay surgery is being investigated.

63

Change of model of service delivery

A small number of people visited Christchurch to learn about changing the model of service delivery in

general practice as this has worked very well in Christchurch and has a critical mass of general practices

undergoing changes now and demonstrating horizontal and vertical integration.

Mangere/Otara Locality Dashboard – April 2014

1. Acute Demand

Indicator

CMDHB

Ave YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

1.1 Unplanned readmissions (28 days) 6.6% 7.8% 7.6% 9.0% 8.9% 8.8% 9.5% 8.5%

1.2 ASH rate (per 1,000 enrolled patients) 2.6 3.0 2.7 2.6 2.7 2.7 2.9 2.8

1.3 Average bed day usage in last 6 months of

life~~~ 12.8 8.5 11.8 20.6 9.7 11.1 11.7 9.5

~~~Numbers for previous months may change as additional mortality data is received

2. Quality

Indicator Target***

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2.1 Children fully immunised at 8 months 90% 91% 92% 90% 91% 92% 93% 93%

2.2 Children fully immunised at 24 months 95% 94% 95% 95% 95% 94% 96% 97%

2.3 Middlemore Radiology < 6 week wait time for GP

refs 98% 99% 99% 99% 94% 96% 97% 90%

2.4 CCM+++ CVD patients on triple therapy 89% 91% 100% 86% 90% 90% 70% 83%

2.5 DAR and CCM+++ Diabetes patients with HBA1c

<= 64 mmol/mol 73% 51% 62% 60% 48% 56% 56% 68%

**** this is the MOH target for immunisation rates and the CM Health average YTD for the other indicators in this group

^^^ Relatively low August %s were unable to be verified.

+++ We are using CCM data pending availability of robust whole of population data

3. Shared Accountability Services

Item

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2014

YTD

2014

Proj

2014

Planned

3.1 ED presentations not admitted 605 580 623 656 548 641 616 6,086 7,303 6,959

3.2 Acute medical bed days 1,851 1,798 1,514 1,744 1,931 1,564 1,763 18,486 22,183 23,001

3.3 Acute casemix-funded non-medical

bed days 1,459 1,485 1,365 1,418 1,709 1,675 1,536 14,909 17,891 20,588

3.4 Medical outpatients 2,643 2,652 2,071 2,105 2,496 2,808 2,631 26,177 31,412 29,455

Note: SAS volumes for previous months may change as IDF updates are received

4. Other

Indicator

CMDHB

Ave YTD Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14

4.1 E-referrals as % of all referrals 14% 11% 12% 9% 7% 10% 8% 8%

4.2 Medical Outpatient DNA rate 8.1% 13.5% 14.0% 14.7% 16.2% 13.6% 14.1% 14.4%

64

Otara/Mangere Locality Projects

‘At-Risk’ individuals Programme – Extensive work continues towards the roll out of the At Risk Individuals’

Programme on 1 July.

With the conclusion of the Papakura Home Health project to better integrate district nursing and allied

health roles and responsibilities, we a similar project for the Orakau Road Home Health Care Team is being

planned. This will be the first phase of a wider project to integrate the home health care team, inclusive of

NASC providers, into to the Locality Model of Care.

The Locality is working in partnership with the National Hauora Coalition through the Social Workers’

Network Group towards better integration of health and services. Nurse, doctor, podiatry and pharmacy

clinical network groups are active. Dietetics Clinical Network is starting. A Physiotherapy Clinical Network

Group is in the early planning stages with a view to being operational in August. The Clinical Network

Groups are enablers for the service integration change process so that change messages are consistent and

continuous and professional groups can co-design integrated models of care.

The Otara Maternal and Child Health Integration project is developing momentum through its structure of

small project working groups and a larger reference group governed by the Localities Leadership Group as

well as other strategic groups in CMDHB. The recruitment of clinical leads for GP, Tamariki Ora and

Midwives has started.

The Locality is collating a current state view of Youth Health Services and gaps so that by the time the

Whole of System Strategy Group deliver the Youth Health Whole of System Review, the Otara-Mangere

Locality Leadership Group is well placed to discern the direction for youth health service design and

development locally for the 2015/16 financial year and signal changes in the District Annual Plan

accordingly.

Manukau Locality Dashboard – April 2014

1. Acute Demand

Indicator

CMDHB

Ave YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

1.1 Unplanned readmission rate (28 days) 6.6% 7.4% 7.5% 9.7% 8.9% 9.3% 10.2% 9.7%

1.2 ASH rate (per 1,000 enrolled patients) 2.6 2.5 2.6 2.5 2.5 2.3 2.6 2.4

1.3 Average bed day usage in last 6 months of

life~~~ 13.0 10.9 10.0 10.8 9.8 15.2 14.1 11.6

~~~Numbers for previous months may change as mortality data is received and updated

2. Quality

Indicator Target***

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2.1 Children fully immunised at 8 months 90% 90% 89% 89% 90% 90% 91% 91%

2.2 Children fully immunised at 24 months 95% 94% 92% 92% 91% 91% 93% 95%

2.3 Middlemore Radiology < 6 week wait time for GP

Referrals 98% 99% 99% 99% 92% 88% 98% 94%

2.4 CCM+++ CVD patients on triple therapy 89% 96% 88% 88% 91% 87% 73% 100%

2.5 DAR and CCM+++ Diabetes patients with HBA1c

<= 64 mmol/mol 73% 75% 77% 77% 75% 71% 71% 69%

**** This is the MoH target for immunisation rates and the CM Health average YTD for the other indicators in this group

^^^ Relatively low August %s were unable to be verified.

+++ We are using CCM data pending availability of robust whole of population data

65

3. Shared Accountability Services

Item

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2014

YTD

2014

Proj

2014

Planned

3.1 ED presentations not admitted 682 670 732 720 613 632 650 6,693 8,032 7,771

3.2 Acute medical bed days 2,532 2,262 2,239 2,146 2,126 2,352 2,029 23,500 28,200 31,454

3.3 Acute casemix-funded non-medical

bed days 2,114 2,197 2,380 2,060 2,043 2,124 2,567 21,973 26,368 25,882

3.4 Medical outpatient attendances 3,797 3,807 3,014 2,956 3,384 3,542 3,451 35,867 43,040 41,510

Note: SAS volumes for previous months may change as IDF updates are received

4. Other

Indicator

CMDHB

Ave YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

4.1 E-referrals as % of all referrals 14% 11% 12% 9% 7% 10% 8% 8%

4.2 Medical Outpatient DNA rate 8.1% 13.5% 14.0% 14.7% 16.2% 13.6% 14.1% 14.4%

Manukau Locality Projects

‘At-Risk’ individuals Programme – ProCare successfully hosted the first information session for the first

cluster of 12 practices that are considering going live with ARI in July and August 2014. This session was well

received with the practices attending generally viewing the model in a positive light. Questions centred

around the need for the e-shared care tool to be functioning in an optimal manner to support this work and

also the transition of patients from the current CCM program. Practices that attended have been asking

for appointment times for the next stage of engagement with the whole practice team, and understanding

more of the detail about how the model can work in their practice. East Tamaki Health Care continue to

prepare for a July 2014 commencement and the National Haurora Coalition are preparing for commence-

ment in October 2014.

The Home Health project to improve efficiency and effectiveness of community nursing and allied health

within the Locality has developed the work packages that the team will begin to implement and these are

currently with the team for further feedback for the next two weeks. Small groups have been developed to

undertake work tasks in the three main areas of:

• Referral and triage

• Assessment and intervention

• Transition

This project will ensure links are maintained with other CMH wide projects such as continence, wound care

and e-referrals projects as examples to ensure that the team focus on the tasks within their scope, and that

those initiatives from these projects are integrated into the Papakura project.

Franklin Locality Dashboard – April 2014

1. Acute Demand

Indicator

CMDHB

Ave YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

1.1 Unplanned readmissions (28 days) 6.6% 7.6% 6.9% 8.0% 7.9% 8.4% 8.8% 8.6%

1.2 ASH rate (per 1,000 enrolled patients) 2.6 2.2 1.9 1.9 1.9 1.8 2.0 2.3

1.3 Average bed day usage in last 6 months of life~~~ 13.0 40.1 36.2 15.1 24.3 16.0 12.3 14.2

~~~Numbers for previous months may change as mortality data is received and updated

66

2. Quality

Indicator Target***

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2.1 Children fully immunised - 8 months 90% 88% 87% 86% 84% 87% 86% 83%

2.2 Children fully immunised - 24 months 95% 91% 92% 93% 93% 92% 90% 91%

2.3 Middlemore Radiology < 6 week wait time for GP

Referrals 98% 96% 100% 100% 91% 89% 98% 83%

2.4 CCM+++ CVD patients on triple therapy 89% 92% 88% 100% 100% 91% 100% 100%

2.5 DAR and CCM+++ Diabetes patients with HBA1c

<= 64 mmol/mol 73% 85% 80% 77% 80% 78% 76% 85%

**** This is the MoH target for immunisation rates and the CM Health average YTD for the other indicators in this group

^^^ Relatively low August %s were unable to be verified. +++ We are using CCM data pending availability of robust whole of population data

3. Shared Accountability Services

Item

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

2014

YTD

2014

Proj

2014

Planned

3.1 ED presentations not admitted 94 111 119 137 108 115 110 794 953 1,248

3.2 Acute medical bed days 964 672 704 676 817 598 622 5,053 6,064 8,686

3.3 Acute casemix-funded non-medical bed

days 482 669 684 572 585 608 589 4,189 5,027 7,858

3.4 Medical outpatient attendances 1,028 948 760 789 1,004 1,054 998 6,581 7,897 11,081

Note: SAS volumes for previous months may change as IDF updates are received

4. Other

Indicator

CMDHB Ave

YTD

Oct-

13

Nov-

13

Dec-

13

Jan-

14

Feb-

14

Mar-

14

Apr-

14

4.1 E-referrals as % of all referrals 14% 11% 12% 9% 9% 9% 15% 15%

4.2 Medical Outpatient DNA rate 8.1% 7.1% 5.5% 7.5% 4.6% 4.1% 6.0% 7.5%

Franklin Locality Projects

Terms of Reference for all of Franklin groups have been updated and have been distributed for comment.

The membership of the Leadership Group and Operational Group has also been discussed with suggestions

awaiting feedback prior to implementation.

The Rapid Response pilot evaluation was strongly supported by the Locality Leadership Group for ongoing

funding. If the service continues there is an expectation that referrals and contacts will increase

significantly. The Rapid Response group would report monthly on its progress to the Clinical Advisory

Network.

The project group for the At Risk Individuals meet fortnightly with good attendance across all sectors within

the Locality, the supporting PHOs and DHB support. The Nursing Network is organising ongoing education

updates for all nurses within the Locality to support the ARI project implementation. A super-user for

eShared Care programme has been appointed for a fixed term to assist with the training and support.

The draft Work Plan for the Locality has been completed for presentation at the next Leadership Group

meeting. A whole of System presentation for Health of Older People has been circulated for consideration

and alignment.

The Palliative care work stream pilot with Totara Hospice regarding after hours cover for the Franklin area

is still being discussed with a number of issues still to be resolved. A formal project group is being

formulated to assist with the implementation.

67

9. Finance Report

This report highlights net exceptions from agreed budget with a focus on the year to date variances and the likely full

year forecast result.

CPHAC Financial Report Mth Mth Mth YTD YTD YTD FY FY FY

As at April 2014 Actual Budget Var. Actual Budget Var. Actual Budget Var.

$000 $000 $000 $000 $000 $000 $000 $000 $000

Total Revenue 31,943 32,135 (191) 321,122 321,493 (371) 392,798 385,763 7,035 Expenditure Pharmaceuticals 8,253 8,243 (10) 83,140 82,433 (708) 99,919 98,919 (1,000) PHO/GMS/Rural Retention 6,640 6,649 10 66,783 66,493 (289) 80,139 79,792 (347) Primary Care NGOs 811 851 40 8,988 8,511 (477) 10,786 10,213 (573)

Chronic Health Conditions Programme (CCM) 833 577 (257) 7,194 5,858 (1,336) 8,632 7,011 (1,621) After Hours Regional Service 616 457 (159) 6,043 4,565 (1,478) 5,478 5,478 0 Maori & Pacific Health NGOs 546 533 (13) 5,623 5,334 (289) 6,748 6,401 (347) Child, Youth & Mortality 593 591 (2) 5,498 5,908 410 6,818 7,090 272 Oral Health 487 479 (7) 4,787 4,792 4 5,745 5,750 5 Localities/20k initiatives 414 691 277 5,137 6,906 1,769 7,164 8,287 1,123

LTS - Chronic Health Conditions 333 307 (26) 3,373 3,066 (307) 4,047 3,679 (368) Haemophilia 245 250 5 2,448 2,500 52 2,937 2,999 62 Immunisations 214 212 (2) 2,120 2,122 2 2,544 2,546 2

Primary Options for Acute Care (POAC) 182 187 5 1,825 1,873 48 2,200 2,247 48

> 65 Home Based Support Services 1,679 1,601 (77) 16,978 16,013 (965) 20,560 19,216 (1,344) > 65 Aged Residential Care 5,855 5,769 (86) 57,369 57,691 322 67,587 69,230 1,643 > 65 Other 312 398 86 3,555 3,982 428 4,974 4,779 (195) Mental Health NGOs 3,645 4,090 445 36,927 40,901 3,974 49,169 49,082 (88) Other 73 33 (40) 851 746 (105) 3,928 813 (3,116) Total Expenditure 31,729 31,919 190 318,639 319,695 1,056 389,376 383,533 (5,843)

Net contribution 214 216 (2) 2,483 1,799 685 3,422 2,230 1,192

A number of variances net off between costs and revenue. The net favourable full year forecast variance of

$1,192k is made up of the following highlights:

Localities & 20k days Initiatives (FY $1,123k favourable, 14%)

April YTD is favourable to budget by $1.7M and is forecast to run close to budget for the second half of the

year but the roll out of ARI in 14/15 rather than 13/14 will result in a favourable year end variance of

$990k.

Community Pharmaceuticals (FY $1,000k unfavourable, 1.1%)

The new pharmacy agreement’s effect on dispensing costs made budgeting for this service very difficult.

Trends at budget setting time have not been typical of expenditure year to date. There are signs of tracking

back to budget but forecast has been set conservatively until further clarification.

Health of Older People (“>65s”)

Generally, variances in one level of care e.g. Home Based Support are countered by variances in other

service lines (ARC).

68

The remaining net favourable variance is spread through various portfolios as the result of either FTE

variances or initiatives tracking below contract and budget.

69

Counties Manukau Health Quarter 3 Performance Report

Recommendation

It is recommended that the Community & Public Health Advisory Committee note this report was approved by ELT at their 4th June meeting to come to CPHAC for the Committee’s information.

Prepared and submitted by: Dawn Kelly, Planning Advisor

In this document:

1. Quarter 3 Health Target confirmed performance (Attachment 1) 2. Quarter 3 Health Target publication and media release 3. Quarter 3 Ministry of Health Confirmed Ratings (Attachment 2) 4. 2013/14 Northern Regional Health Plan Quarter 3 Top 10 Commitments (Attachment 3) 5. Quarter 3 Northern Region Alliance Workstream Progress Summary (Attachment 4)

2013/14 Summary of Health Target Performance for CM Health Quarter 3 reporting showed CM Health achievement of 4 of 6 health targets; as summarised below.

Achieving or exceed targets in relation to Emergency Department Stays, Elective Discharge volumes, advice and support for hospitalised patients to quit smoking, primary course of immunisation for 8 month olds and patients needing radiotherapy or chemotherapy treatment.

Not performing to expectation for Diabetes and Heart Checks. A positive trend continues with a continued point increase from Q2 (83%) to Q3 (86%), however this was not enough to meet the new national target of 90 % (2012/13 target was 75%). The programme is showing excellent progress and on track to meet the national target by July 2014.

Not performing to expectation in Advice and Support to Quit Smoking in Primary Care. An upward trend continues with a significant increase of 8 % from the previous quarter.

Quarter 3 Health Target Report Publication Refer to Attachment 1 for a copy of the preliminary (draft) internal communications regarding the Quarter 3 Health Target Report. This will be finalised on receipt of the Ministry related media package prior to release. The dates of note in relation to this process are as follows:

• 16 May – Confirmed health target ratings from the Ministry of Health • 26 May – Ministry of Health release media package to DHBs • 27 May – CM Health have local media release including update on SouthNet and email

distribution for Board members • 27 May – Ministry of Health have national media release on all Health Targets and CM

Health can update our internet site

70

Attachment 1: Quarter 3 Health Target Report – Publication Draft

Note that this is a working draft subject to confirmation on receipt of Ministry of Health’s media package.

*The national immunisation target 2012/13 was 85 per cent of eight month olds will have their primary course of immunisation at six weeks, three months and five months on time by July 2013. From quarter one 2013/14 the target increased to 90% by July 2014. ** The national CVD target for 2012/13 was 75 per cent of eligible population will have had their cardiovascular risk assessed in the last five years by July 2013. From quarter one 2013/14 the target increased to 90 per cent by July 2014. Shorter Stays in Emergency Departments – 95% (achieved target) 95 per cent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours • 95% of patients seen in ED this quarter were admitted, discharged or transferred from ED

within 6 hours

Improved Access to Elective Surgery – 113% (achieved target) The volume of elective surgery will be increased by at least 4,000 discharges per year • The target was to have performed 11,429 elective discharges by this quarter. We have

exceeded this by 1,470 discharges, performing 12,899 elective discharges by this quarter

Shorter Waits for Cancer Treatment – 100% (achieved target) All patients, ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy • 100% of patients, who were ready for treatment, received their radiotherapy and

chemotherapy within four weeks of the decision to treat in the Shorter waits for cancer treatment target

Secondary Primary

Quarter 2, 2012/13 96% 108% 100% 85% 95% 43% 55%

Quarter 3, 2012/13 97% 110% 100% 86% 96% 45% 61%

Achieved

Quarter 1, 2013/14 96% 114% 100% 91% 95% 59% 81%

Quarter 2, 2013/14 96% 114% 100% 90% 95% 69% 83%

Quarter 3, 2013/14 95% 113% 100% 92% 95% 77% 86%

Achieved

National goal 95% 100% 100% 90%* 95% 90% 90%**

71

Increased Immunisation – 92% (achieved target) 90 per cent of eight-month-olds have their primary course of immunisation at six weeks, three months and five months on time by July 2014, and 95 percent by December 2014. • 92% of eight-month-olds had their primary course of immunisation at six weeks, three months

and five months on time this quarter. This result places the DHB in a good position to achieve the end target of 95% of eight month olds fully immunised by December 2014.

• Maaori coverage has increased by two percentage points from 82% to 84% • Pacific coverage has seen a slight increase from 93% to 94%

Better Help for Smokers to Quit –Secondary Care – 95% (achieved target) 95 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 • 95% of patients who smoke and who were seen by a health practitioner in secondary care were

offered brief advice and support to quit smoking • 94% of Maaori patients who smoke were offered advice/support • 95% percentage of Pacific patients who smoke were offered advice/support

Better Help for Smokers to Quit – Primary Care – 77% (not achieved) 90 per cent of enrolled patients who smoke and are seen by a health practitioner in primary care will be offered with advice and help to quit by July 2013 • 77% of enrolled patients who smoke and were seen by a health practitioner in primary care

were offered brief advice and support to quit • Steady progress continues towards meeting this target with a percentage point increase of 8%

from quarter 2 (69%) to quarter 3 • Result above the national average

More Heart and Diabetes Checks – 86% (not achieved) 90 per cent of the eligible population will have had their cardiovascular risk assessed in the last five years • 86% of the eligible CM Health adult population have had their cardiovascular disease (CVD) risk

assessed in the past five years • Steady progress continues towards meeting this target

72

Attachment 2: Quarter 3 MOH Final Ratings This is a report for internal reference only and is intended to provide the DHB with a Ministry of Health perspective on DHB non-financial performance. The comments are used for internal consultation/query management and are to provide brief context to those measures not achieved.

Outstanding Achieved Partially Achieved Not Achieved

MEASUREMENT TARGET CURRENT PERFORMANCE

PLANNED PERFROMANCE Initial Rating Confirmed Rating

HEALTH TARGET

Shorter stays in ED

95% Target Achieved - 96%

HEALTH TARGET:

Improved access to elective surgery

100%

Target Achieved – 113%

HEALTH TARGET

Shorter waits for cancer treatment radiotherapy & chemotherapy

100% Target Achieved - 100%

HEALTH TARGET

Increased Immunisation

90% Target Achieved - 92% Maaori – 84% Pacific - 94% Dep 9 & 10 – 89%

HEALTH TARGET

Better help for smokers to quit - HOSPITALS

95% 95%

HEALTH TARGET

Better help for smokers to quit - PRIMARY

90% Result: 76.7%. A considerable increase of 7.6% on Q2. This result is above the national Q3 average.

Each PHO has redirected resource for final quarter including setting up after hour call centres to recall patients (CVD & smoking). Clinical Champion working extra hours in practices requiring more support.

HEALTH TARGET

Better help for smokers to quit - MATERNITY

(Working towards 90%)

Rank: 17th out of 20 DHBs, possible documentation error resulting in a drop in rank from Q2. This data represents only 80% of all pregnancies nationally so this is FYI only.

N/A

HEALTH TARGET

More Heart &

90% Result: 85.7%. A modest increase of

73

MEASUREMENT TARGET CURRENT PERFORMANCE

PLANNED PERFROMANCE Initial Rating Confirmed Rating

Diabetes Checks 2.4% on Q2

PP8: Shorter waits for non-urgent mental health & addiction services

80% by 3 weeks;

95% by 8

weeks

PP10: Oral Health Mean DMFT score at Year 8

1.09 The DMFT for all Year 8 children improved with significant improvement for Maori and Pacific relative to the 2012 results. The 2013 target was achieved for ‘other’ only.

Strategies include greater targeting of ‘at risk’ children to increase prevention and management of dental disease.

PP11: Children caries free at 5 years of age

52% The result for ‘other’ children of 66% ACHIEVED;

Targets for Maaori and Pacific not achieved.

PP13: Improving the number of children enrolled in DHB funded dental services

75%

PP18: Improving community support to maintain the independence of older people

95%

PP20

Improved management for LTC

PP20

Improved management for ACS

PP20

Improved management for STROKE

PP20

Improved management for DIABETES

74

MEASUREMENT TARGET CURRENT PERFORMANCE

PLANNED PERFROMANCE Initial Rating Confirmed Rating

PP21: Immunisation coverage

95% Result of 93%

PP22:

System Integration

Incomplete report resulted in not achieving the rating.

Due to Easter vacation two reports not submitted within time limit.

PP23: Improving Integration - HOP Wrap around services

PP24: Improving waiting times - Cancer MDMs

PP26: Rising to the Challenge: Mental Health & Addictions Service Development Plan

PP27: Delivery of the children’s action plan

PP28: Reducing Rheumatic fever

SI2:

Regional Service Planning

Refer to attached NRHP report.

SI4: Standardised intervention rates (SIRs)

OS3: Inpatient length of stay (ALOS) ACUTE

4.21 days

OS3: Inpatient length of stay (ALOS) ELECTIVE

3.21 days Result of 3.62 days. Continued incremental improvement achieved throughout the year.

OS8: Acute readmissions to hospital – 75+

<=11.8%

OS8: Acute readmissions to hospital – Total Population

<=8.0%

OS10: Improving the quality of data provided to national collection systems

75

MEASUREMENT TARGET CURRENT PERFORMANCE

PLANNED PERFROMANCE Initial Rating Confirmed Rating

DV1: Faster cancer treatment

CFA: 2% DSS Funding Increase

Reporting template was late by MOH Q3; completion for Q4 assured.

OP1: Mental Health Output Delivery Against Plan

CFA: Additional on-going funding for Alcohol Brief Interventions in Primary Care

CFA: Boost Hospice Care Initiative

CFA: B4 School Check Funding

CFA: National Immunisation Register Ongoing Administration

CFA: Electives Initiative & Ambulatory Initiative Variation

CFA: Establishment of Green Prescription Initiative

CFA: Primary Mental Health Initiative (PMHI) Service

Number of packages of care has dropped in Q3.

Due to recruitment issues a provider did not submit their quarterly report, also

coding issues in the PMS – practices were not coding correctly and the PHO could not collect the data resulting in greater counselling figures.

Both issues now resolved - we anticipate meeting target in Q4.

CFA: Well Child Tamariki Ora Services

76

Attachment 3: NRHP Quarter 3 Progress Report – Top 10 Commitments

The table below shows progress against the top 10 commitments as reported by the Northern Regional Alliance.

On track Some concerns regarding progress to target

Not achieved or declining performance

Commitment Status Notes

1 Achieve and maintain the Minister’s health targets

The Region has met the targets on the measures where data is available

2 Reduction in falls causing major harm to a rate less than 0.07 per 1,000 bed days in the acute sector

– Regional falls data (major harm) shows a static harm rate over this quarter at 0.09 per 1000 bed days.

– Despite the static rate of major harm there continues to be a marked decrease in the overall harm rate from falls.

3 Increase the percentage of Maori eligible population who have had their CVD risk assessed within the past 5 years

76% An increase on the previous quarter.

4 Increase in the number of people who have specialist consultation via telehealth for non-surgical cancer services

Q3 result = 0 ADHB and Northland have been working closely to provide hands-on SMO services in Northland, with recruitment to an SMO post. This obviates the need to deliver telehealth consultations in the short-medium term.

5 Hospitalisation rate per 100,000 region population for acute rheumatic fever is 10% lower than the average over the past 3-years

No result this Q as data analysed 6-monthly

6 100 more young people to be seen in Youth Forensic services

Tracking at 6% below YTD target

7 8% of stroke patients thrombolysed

7% This is a significant increase on previous quarter

8 Reduction in patients aged 75+ readmitted within 28 days

Rate remains static at 13% readmission rate

9 38,000 patients undergo retinal screening 8,400 screens in Q3. Target on track

10 2,000 patients will have conversations regarding Advance Care Plans

1578 conversations held in Q3 4,584 conversations reported to date this year.

77

Attachment 4: NRHP Quarter 3 Progress Summary for the Workstreams

Our Priority Goals

Workstream Foundation Patient

outcome results

Process results Achievements Challenges

First, Do No Harm • Transfer of Clinical Information ‘yellow envelope’ transitioned into business as usual

• Follow-up conducted from Regional Medication Safety Workshop held in December 2013

• Progressing towards obtaining monthly falls and pressure injuries data from residential aged care sector

• Training, coaching and mentoring with teams progressing • Strong linkages with other work programmes (i.e. Health

Quality & Safety Commission, Health of Older People Clinical Network) to ensure alignment with national and regional priorities

• Ongoing commitment required to ensure clear alignment between existing regional and national patient safety programmes and priorities

• Engagement and obtaining data from Aged Residential Care sector

• Ensuring messages and communications are reaching key groups in organisations in a timely way

Cancer • Faster cancer treatment (FCT) activities continue as data collection processes are continually refined and improved.

• The region submitted a tranche of responses to a national RFP for FCT, with outcomes due to be notified mid-April.

• DHBs are gearing up to comply with the Ministry requirement to provide FCT data monthly from 1 July 2014.

• The achievement of colonoscopy indicators remains of concern, with the Cancer Governance Board (CGB) having commissioned a regional report identifying issues and potential solutions.

Child & Youth Health

Child Health

• Project manager appointed (shared position with GAIHN) • SUDI hui being organised to engage community to implement

regional SUDI Action Plan. Regional policy being implemented. SUDI workforce training particularly with midwives in DHBs.

• Rheumatic fever rapid response clinics being implemented. Lab test contract for throat swabs under negotiation. Regional technical advisory group meeting to ensure evidenced based decision process and monitoring of quality issues. Discussions underway to resolve issues for the referral

78

Workstream Foundation Patient

outcome results

Process results Achievements Challenges

process to the Healthy Housing Hub. • Implementation of pathways for skin infections and LRTIs • Monitoring framework under development • Auckland Councils Plan for unintentional injuries in children

being supported • Children’s Team progressing well in Northland • Engaging with Tertiary Education to develop long term

planning strategies for research into child health issues Youth Health

• Foundation work underway with network membership and ToR and KPI development

CVD • All cardiac KPIs achieved • All Northern Region hospitals now using ANZACS QI. • Further progressing CVD Risk Assessment including staff risk

assessments, appointment of LTC coordinators to support poor performing practices and workplace screening.

• Continued development of CVD risk registry. • Two new pathways developed for GPs (Atrial Fibrillation and

Chest Pain) to be included on Health Point.

• Inability to access live NHIs which would allow us to provide primary care with relevant information around patients and practices

Diabetes • Nurse Led Clinics tool kit under development to support safe and effective running of clinics for diabetes patients

• WDHB has commenced a recruitment drive to fill the pilot positions for the quality improvement team

• Supported by an external evaluator (Dr Tim Kenealy) the Partners in Health scale has been confirmed as the preferred tool, subject to some diabetes specific variation being made. It is currently being piloted by a DSME provider.

• Lack of access to encrypted data via TestSafe hinders the regions ability to track key indicators

• Despite active recruitment efforts we have not secured a Clinical Lead.

• Progress of the Quality Improvement Team is stalled within CMDHB due to various locally driven obstacles/competing priorities.

79

Workstream Foundation Patient

outcome results

Process results Achievements Challenges

Health of older people

• The Northern Region Psycho-Geriatric (PG) Bed Review

completed and endorsed by the CEO/CMO Forum. The review found; variability of managing residents in PG beds across all DHBs with opportunities for better use of PG beds in terms of sub-specialisation and consistent entry/discharge processes. The emphasis in the short-medium term is making better use of existing resources. There is widespread support from DHB and ARRC stakeholders, following extensive consultation. A copy of the report has been sent to the MOH

• Other dementia developments include: sign-off of a regional dementia dynamic pathway, co-hosting a talk by Professor Graham Stokes in partnership with Bupa, and participation in the MOH project to develop education resources for people with dementia and caregivers.

• Comprehensive training and support for falls and pressure injury in ARRC, continues. The number of ARRC providing data has increased, and we are working with a large corporate provider to submit one aggregated file for all facilities. A survey of ARRC providers to assess whether they meet all four criteria which constitute a “falls reduction programme”. Shows 28% meet the criteria. Preparation of the business case for the Quality Care for Older People to collect data and report KPIs, has been delayed due to other priorities. We are also assisting St John with a national referral form and process for people they attend in the community who have had a minor fall.

• 99% of the ARRC sector are now signed up to interRAI and interm analysis indicates that the % of long term HBSS clients receiving an interRAI assessment is close to target (this will be reported and confirmed in Q4).

• The review of PG beds across the Northern Region has been more complex and therefore taken more network resource than first anticipated. The review was instigated at the request of DHBs and fell outside of the HOP RSP to a certain extent and has displaced some of the other actions. However the importance and value of the review outweighs other actions in the plan.

• While engagement of ARRC providers in the regional falls/pressure injury reduction programmes are slowly increasing, it is unlikely the 75% target will be met. Strategies around group reporting and the Quality Care for Older People database are being worked on to increase participation.

80

Workstream Foundation Patient

outcome results

Process results Achievements Challenges

Mental Health • YTD 363 unique clients seen by Youth Forensics; tracking at

6% below target. • 80% of Prison admissions to Adult Forensic inpatient meet

agreed targets; increase on Q2 (67%) & baseline (48%) • 1.1% of young people aged between 12 & 19 accessed AoD

specialist services • Full implementation of Perinatal & Infant Mental Health Acute

service options is underway. • High and/or Complex needs report endorsed and submitted to

MoH. Implementation process initiated

• Work underway to improve the accuracy of data extraction for Youth Forensic services activity

• Achieving the necessary levels of agreement on the proposed Eating Disorders model of care to enable new funding arrangements and implementation planning for adjustments to occur

• Developing consistency and visibility around the management and application of service information at local and regional levels

• Gaining access to information on Primary MH Initiatives

Stroke • Q3 regional thrombolysis target is 7%. SMO/Registrar

education is increasing through the use of an on-line learning tool and attendance at training workshops (see Appendix B)

• Admission of patients with stroke to a dedicated stroke bed is 74%. The network is focussing on clarity around what constitutes a “stroke unit”, consistent data definitions, quarterly review of DHB occupancy, and where required, drilling down to further understand adverse DHB variance.

• 75% of stroke patients transferred to rehabilitation within 2 weeks of the acute admission (target is 90%). Further analysis has been undertaken to understand the profile of days from acute stroke to rehabilitation. This has resulted in an adjustment to the rehab KPI in the 2014/15 regional plan for stroke. We are participating in national discussions on defining rehabilitation and community rehab KPIs.

• The rate of thrombolysis will continue to be a major focus with a number of strategies being used to increase the rate, such as; encouraging earlier presentation of patients by GPs & St John, ED engagement, and training for non-Stroke clinicians.

81

Workstream Foundation Patient

outcome results

Process results Achievements Challenges

Advance Care Planning

• 1578 conversations held in Q3 (note data integrity issues

continue as we have no electronic means of recording and reporting ACP activity. We therefore rely on self reporting and the numbers received are likely to be an underestimation).

• ADHB has appointed an ACP Project Manager • Conversations That Count Day (April 16th) is being promoted

across the country. • Regional uptake and interest in ACP Level 2 training courses

remains high.

• Lack of an electronic system to record and report on ACP activity

• Level 2 trained staff continue to anecdotally report time as a barrier to holding ACP conversations with patients

• Resignation of key staff, including Northland and Counties ACP project managers and the regional Training Programme Coordinator. Recruitment underway

Clinical Services

Workstream Foundation Patient outcome results

Process results Achievements Challenges

Laboratory • Transition of community referred Clinical Pathology services from DML to Labtests has been completed with minimal service impacts and positive feedback from key stakeholders,

• Courier service for AP specimens transitioned in preparation for the transition of the balance of the service in October 2014.

• Workforce transition progressing with offers and acceptance process completed for Scientific, Technical and Support staff and in progress for Anatomical Patholgoists

• Planning for the transition of community referred Anatomical Pathology services is progressing with a scheduled transition date of Q2 2014/15.

• Business case for LabPLUS Fourth Floor shell fit out endorsed by ADHB Board

• Reporting on non schedule tests provided to DHBs to support analysis of test ordering and management of

• Managing the transition of anatomical pathology and the HR risks associated with this

• Demand growth substantive due primarily to increased CVD risk assessment and rheumatic fever testing

82

Workstream Foundation Patient outcome results

Process results Achievements Challenges

demand. • Work progressing to support IS upgrades and to develop a

business case for specimen tracking

Radiology • Sonographer training pilot will commence Semester 2. HWNZ is contributing additional funding.

• Revised set of national PET-CT indications finalized and approved for implementation

• Consistent Regional Pricing model progressing • Proposal submitted for funding to support improvements to

diagnostics for cancer patients • Northland and Counties progressing CT and MR business

cases

Pharmacy • Continuing to focus on supporting the implementation of the national CPSA.

• Continuing to engage with prescribers regarding CPSA as opportunities arise. Started working at locality level and piloting eShared Care.

• Working with GAIHN ACN: “high risk individuals” programme including pharmacy LTC service as one within a suite of interventions that a patient may receive.

• Metro Auckland Pharmacy Advisory Group (MAPAG) in situ • Draft procurement process for collection and disposal of

medicines waste completed and under DHB legal review.

• Engaging general practice staff difficult despite PHO endorsement. Revising strategy to up-skill pharmacists to create relationships with individual general practice staff.

• National mandate needed to propagate development and use of shared care platform for medicines adherence plans

• Integration of PhMS with regional CDR and other electronic systems to achieve efficiencies in LTC service delivery.

• Bureaucracy associated with delivering pharmacy services under CPSA is not reduced as envisaged

• Ability to monitor success of CPSA implementation still very limited.

Elective Services

Project 1 – Regional Framework • Regional Score Card tool finalised • Implementation of the Regional Score Card tool • Regional Theatre Utilisation measure developed

Project 2 – NDHB Pathway into Metro Auckland • Project plan developed.

Project 3 – eReferrals Inter and Intra DHB

• Significant work is required to resolve the differences in

83

Workstream Foundation Patient outcome results

Process results Achievements Challenges

• Understanding of the clinical requirements of the tool underway

current elective service workflow, processes and systems at different DHBs

Other Service Developments

Forensic MH: The Northern region continues to access 5 additional acute inpatient beds at Capital & Coast DHB's Regional Forensic Services as a negotiated national solution. The Northern region project on high & complex was endorsed at regional CE/CMO level and provided to MoH. A implementation sponsor group are established and developing greater detail on the implications of implementation. MH & ID Services: No material update. Eating Disorders Services: Funding sustainability: MoH have agreed to defer CFA funding for an additional year to enable work on the model of care/funding model going forward to be agreed supra-regionally. Neonatal Services: High occupancy rates in metro DHBs Neonatal Units continue above 80 – 85% but the overall pressure on cot capacity has reduced due to the decrease in births (nationally about 6%). Most of the issues are now in managing peaks in level 3 cots demand. The regional Neonatal Units continue to work together in managing the peaks and how best to allocated cots and transfer babies in times of high demand. Middlemore Hospital will have an additional 2 level 3 cots which will provide a small increase in physical cot capacity for the region. Work is also underway to look at developing a regional nursing/neonatal nurse specialist pool form where nurses could be deployed to work between the Neonatal Units in the region at times of high demand. Acute Spinal Injury: Regional model agreed for future service delivery, and work commencing on implementation planning.

Long term service for chronic health conditions

• 5 Clients with a service package of $80k pa or over have been reviewed and monitored by the Regional Review Panel

• Work is ongoing to identify a Rehabilitation model of care for LTS CHC clients.

• Ongoing regional support is provided through the LTS CHC Regional Review Panel, Peer and NASC review groups.

• ACC and LTS CHC are working together to support a client with an ACC model of care to better meet the client’s needs.

• A response is still pending from DSS for LTS CHC to access DSS contracts for similar clients.

• The Region has supported the start-up and ongoing function

• 10 clients with unclear funding streams between LTS CHC and DSS, and 1 client for shared funding resolution between LTS CHC and Mental Health.

• Compared to last year’s top slice the collective regional PBFF allocation has dropped by $2.7m for this year with the respective DHB shares altering markedly.

84

Workstream Foundation Patient outcome results

Process results Achievements Challenges

of the National LTS CHC & DSS Resolution Panel. • For 2013/14 current year a financial model has been agreed

that transitions from the regional risk share to a local utilisation and cost model. For 2014/15 and beyond DHBs will continue to manage their own LTS CHC risk and utilisation costs through their respective PBFF and adopt the national process for LTS CHC IDFs

Enablers

Workstream Foundation Patient outcome results

Process results Achievements Challenges

Workforce Refer full report in Appendix B Refer full report in Appendix B

IS Refer full report in Appendix C

Procurement and Supply Chain

Procurement

• Savings delivered stands at 90% of target in Q3 ahead of scheduled 75% expected at this point. Reporting of and tracking of savings to DHBs is advancing well.

• National collaboration is progressing with joint savings initiatives between the Northern Region, Waikato, Canterbury and Capital & Coast delivering savings for all involved.

• hA contracted by HBL to deliver a further $15.1M national savings in addition to regional procurement initiatives, this projected is ontrack to deliver by 30th June 2014.

• New reporting tool made available for Finance Community to track purchasing off-Catalogue and identify opportunities for DHB driven savings

• Sourcing and Category Management is now well imbedded into the Procurement team. Customer and supplier feedback is very positive with the approach. Maturing of initiative continues with sourcing plans

Procurement

• Ramp up towards national FPSC Go Live is one of the key focus areas, a management plan is in place to manage the workload

• National activities around standardising policies and processes are preventing progress at the regional level. National Procurement policy in final stages of development by HBL.

• Regional DHB’s experiencing some frustration in absence of information on 14/15 national programme

• Ensuring that the focus remains during the change to the national approach

85

Workstream Foundation Patient outcome results

Process results Achievements Challenges

either in place or under review for all categories

Supply Chain

• Continuing implementation of DHB specific projects as a result of implementing the regional purchasing controls policy. Data cleansing of suppliers and items for data migration

• National supply and distribution operating model work continued with HBL, specifically understanding the effect of changed roll out plans and detailed process design for the national end to end supply chain services. hA was also involved in negotiating the Onelink contract for the 3PL process.

• The supply chain optimisation projects at ADHB have continued to progress well, and at CMDHB are implemented and largely handed over to the DHB. The move to the new Harley Gray Building required large scale relocation and commissioning of stock rooms.

• Joint procurement and supply chain meetings continued with NDHB and ADHB. A business case in respect of NDHB was presented by hA in March.

• A new governance forum with WDHB commenced in February. • hA operational staff have continued to complete hazardous

substances awareness and handler training and include interactive health and safety sessions

Supply Chain

• The issue of inadequate funding base in the budget remains unresolved. The base funding for in-hospital staff has no backfill provisions. In the past, absences of in-hospital staff were back filled by other DHB staff. A meeting was held in March to progress the issue.

Capital • Completed regional collation and review of all the Northern region DHB draft capital intention plans to inform the first draft overview of regional capital and next year’s work-planning

• Engaged with MoH and initiated work with DHBs to commence development of the Regional Capital Plan. Initial emphasis has been placed on documenting key facility and infrastructure projects in the Region and the identification of opportunities for improvements to DHB and regional capital related processes.

• Assessing the relative priorities of different capital projects

• Balancing IT/IS capital priorities with the affordability of the projects

86

Counties Manukau District Health Board

Community & Public Health Advisory Committee Meeting – 18th

June 2014

6.0 Resolution to Exclude the Public

Resolution:

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ

Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the

reasons and grounds set out below:

General Subject of

items to be considered

Reason for passing this resolution in

relation to each item

Ground(s) under Clause 32 for

passing this resolution

6.1 Confirmation of

Previous CPHAC

Minutes 21st

May 2014

That the public conduct of the whole

or the relevant part of the

proceedings of the meeting would

be likely to result in the disclosure of

information for which good reason

for withholding would exist, under

section 6, 7 or 9 (except section

9(3)(g)(i))of the Official Information

Act 1982.

[NZPH&D Act 2000 Schedule 3,

S32(a)]

Confirmation of Minutes

For the reasons given in the previous

meeting.

6.2 Action Items

Register

That the public conduct of the whole

or the relevant part of the

proceedings of the meeting would

be likely to result in the disclosure of

information for which good reason

for withholding would exist, under

section 6, 7 or 9 (except section

9(3)(g)(i))of the Official Information

Act 1982.

[NZPH&D Act 2000 Schedule 3,

S32(a)]

Confirmation of Action Items

Register

For the reasons given in the previous

meeting.