hospital advisory committee meeting · 1. welcome and apologies mrs katie o ˇconnor, chair,...

HOSPITAL ADVISORY COMMITTEE MEET ING

To be held in the Board Room, Old Nurses Home, Southland Hospital,

Invercargill, at 2.00pm

9 December 2009

“Quality and Humanity in Health”

Remember to Visit Our Website at www.sdhb.govt.nz

http://www.pdfcomplete.com/cms/hppl/tabid/108/Default.aspx?r=q8b3uige22

SDHB HAC Meeting – 9 December 2009 Agenda

HOSPITAL ADVISORY COMMITTEE MEETING

Wednesday, 9 December 2009 2.00pm

Board Room, Old Nurses Home, Southland Hospital, Invercargill

AGENDA

Sections Page Welcome, Introduction and Apologies

1 Interests Registers Members’ Interests Register 5 Management and Staff Interests Register 7

2 Confirmation of Minutes Hospital Advisory Committee Meeting held 11 November 2009 9 Matters Arising from the Minutes

3 Review of Action Sheet 17

4 Chief Operating Officer’s Report 19

5 Director of Nursing and Midwifery Update 89

6 Financial Report 103



Resolution That the HAC moves into committee to consider the following agenda items:

- Risk Report - Regional Procurement - Medical Officers’ Unit Report - Value for Money Dashboard - ODHB Performance and Monitoring Report

The general subject of each matter is to be considered while the public is excluded. The reason and the specific grounds under Section 32, Schedule 3 of the NZ Public Health and Disability Act (2000) for the passing of this resolution are as follows: General Subject Reason for passing this

resolution Grounds for passing the resolution

Risk Report Clause 32(a) – to allow the public to be excluded where it is necessary to prevent the disclosure of information that could be withheld under the Official Information Act.

• Where it is necessary to protect the privacy of natural persons, including deceased natural persons – section 9(2)(a)

• Where it is necessary to enable Southland District Health Board to carry on without prejudice or disadvantage, negotiations – section 9(2)(j)

• Where it is necessary to maintain legal professional privilege – section 9(2)(I)

Regional Procurement

Clause 32(a) – to allow the public to be excluded where it is necessary to prevent the disclosure of information that could be withheld under the Official Information Act.




Medical Officers’ Unit Report





Value for Money Dashboard





ODHB Performance and Monitoring Report






SDHB HAC Meeting – 9 December 2009 Management and Staff Interests Register

SOUTHLAND DISTRICT HEALTH BOARD (SDHB) HOSPITAL ADVISORY COMMITTEE (HAC)

MANAGEMENT AND STAFF INTERESTS REGISTER HAC Management Member

General Notice of Interest (for example, Shareholder, Director, Officer or Trustee) in other entities (S36(3), Sch 3)

Brian Rousseau • Director of South Island Shared Services Agency Limited (SISSAL) • Trustee of New Zealand Institute of Rural Health (NZIRH) • CEO of Southland and Otago DHBs • Trustee of Southern Health Welfare trust

Lexie O’Shea • Trustee, Gilmour Trust

• Regional Deputy CEO of Southland and Otago DHBs

Karyn Penno • Officer of Southland and Otago DHBs

Leanne Samuel • Trustee of Southern Health Welfare Trust

• Member of Community Trust of Southland, (CTOS), Murihiku Health Committee

• Member, Southern Institute of Technology, Nursing Board of Studies

• Officer of Otago DHB

• Member of the Southland Medical Foundation( Inc)


SDHB HAC Meeting – 11 November 2009 Members’ Interests Register


MEMBERS’ INTERESTS REGISTER

SDHB HAC Members

General Notice of Interest (for example, Shareholder, Director, Officer or Trustee) in other entities (S36(3),

Sch 4) Paul Menzies • Daughter – Staff member, Provider Arm, Southland DHB

Kaye Crowther • Employee of WHK Cook Adam (Internal Auditors) • Trustee of Plunket Foundation • Chairperson of the Management Committee for the car seat rental scheme

for Plunket Southland • Trustee of Wakatipu Plunket Charitable Trust • Corresponding member for health and family affairs, National Council of Women

Susie Johnstone • Deputy Chair Otago District Health Board • Deputy Chair Tourism New Zealand • Council Member Otago Polytechnic • Principal Shand Thomson Ltd (and associated entities) • Accountant Clutha Community Health Company Ltd • Accountant Clutha Health Incorporated • Associated with Chair Clutha Community Health Company Ltd • Shand Thomson Nominees Ltd; Shand Thomson Nominees 2005 Ltd;

Abacus STO1 Ltd, Abacus STO2 Ltd, Abacus STO3 Ltd, Abacus STO4 Ltd • Director and Shareholder, Lyddon Investments Ltd • Director and Shareholder, Johnstone Afforestation Ltd • Spouse – Accountant Wyndham Rest Home Incorporated • Spouse – Accountant Tuapeka Community Health Co Ltd • Spouse – Accountant Tuapeka Health Incorporated • Spouse – Accountant West Otago Health Ltd • Spouse – Accountant Roxburgh and Districts Medical Services Trust Board

Fiona McArthur

• Theme and event work, HQNZ Ltd • Event work, Focus NZ (part of Grand Pacific Tours) • Working group member for Queenstown Plunket Rooms • Trustee and Board Member, Disabilities Resource Centre,

Queenstown • Ex Officio Board Member of the Central Otago Kindergarten • Volunteer for Wakatipu Victim Support • Wine House and Kitchen Ltd • High Plains Wine Ltd

Katie O’Connor • Chair, Tui Motu: Independent Catholic Magazine Limited • Guidance Counsellor, St Peter’s College

Tahu Potiki • Arataki Associates (Director) • Representative to Te Runanga o Ngai Tahu • Trustee of Ngai Tahu Charitable Trust • Board Member, Relationship Services NZ

Tim Ward • Partner, BDO Spicers Invercargill, Chartered Accountants

Dot Wilson

• Member of National Executive Committee, Disabled Persons’ Assembly (DPA) • Secretary of DPA Southland • President of Workbridge Council • DPA representative on Workbridge Council • District Advisor on the Personal Advocacy Trust • Workplace Support Chaplain


SDHB HAC Meeting – 11 November 2009 Members’ Interests Register


MEMBERS’ INTERESTS REGISTER

SDHB HAC Members

General Notice of Interest (for example, Shareholder, Director, Officer or Trustee) in other entities (S36(3),

Sch 4)

• Parent to Parent Southland


Southland DHB HAC Meeting Minutes – 11 November 2009

Minutes of the Southland District Health Board Hospital Advisory Committee meeting, held on Wednesday, 11 November 2009, in the Southland DHB Board Room, Old Nurses’ Home, Southland Hospital, Invercargill, commencing at 2.04pm.

Present: Mrs Katie O’Connor (Chair, Hospital Advisory Committee) Mrs Kaye Crowther Mrs Susie Johnstone Ms Fiona McArthur Mr Paul Menzies Mr Tahu Potiki Mr Tim Ward Ms Dot Wilson In Attendance: Mrs Lexie O’Shea (Chief Operating Officer/Regional Deputy Chief

Executive Officer) Mrs Leanne Samuel (Regional Chief Nursing and Midwifery Officer) Mrs Bron Anderson (Senior Business Analyst, Southland DHB) Miss Jo Harvey (Communications Officer, Southland DHB) Miss Natasha Nicolson (Senior Administrative Officer, Southland DHB) Apologies: Mr Brian Rousseau (Regional Chief Executive Officer)

1. Welcome and Apologies Mrs Katie O’Connor, Chair, welcomed members to the Southland District Health Board (DHB) Hospital Advisory Committee (HAC) meeting. In particular she welcomed new member, Mr Tim Ward, to his first HAC meeting. An apology was received from Mr Brian Rousseau and an apology for lateness was noted from Mrs Susie Johnstone. It was moved: “That the apologies be accepted”

Moved: Mr P Menzies Seconded: Ms F McArthur

Carried 2. Members’ Interests Register There were no changes to the Interests Register. The Chair reminded members of their responsibility to declare any conflicts of interest throughout the course of the meeting. 3. Confirmation of Minutes The minutes of the 07 October 2009 HAC meeting were attached to the agenda. It was resolved:

“That the minutes of the HAC meeting, held on 07 October 2009 be confirmed.”

Moved: Mr P Menzies Seconded: Ms F McArthur

Carried



4. Matters Arising from the Minutes There were no matters arising from the minutes that were not covered in the agenda. 5. Review of Action Sheet The COO/RDCEO, Mrs Lexie O’Shea, advised that the changes requested had been made to the Terms of Reference. The changes related to the quorum and the monitoring of the capital expenditure budget. The Chairman asked that the updated and revised version be distributed to HAC members for their information. 6. Chief Operating Officer’s/Regional Deputy Chief Executive Officer’s Report The COO/RDCEO, spoke to her report and in discussion the following key points were noted:

• Case weight delivery remains above budget, especially in acute inpatient delivery which was 16% above plan. Electives were 4% below plan. The key areas of acute demand were outlined. There had been more demand for service in the areas of paediatrics and general medicine than previous years, which was not unusual for the time of year.

• Attendances at Lakes District Hospital (LDH) Emergency Department (ED) continued to

track above plan, whilst Southland Hospital ED is in line with plan.

• There was under delivery in the first specialist assessment areas and further detail relating to this is included within the divisional reports.

In response to a query, The COO/RDCEO advised that the shortage in Anaesthetics was not affecting paediatrics and general medicine as they were non-surgical specialties. The acute cases are those who present mostly via ED and are always unplanned.

• The breakdown of actual volumes against budget was included for members’ information. Due to the mapping tool not collating the data in some areas accurately there was a delay in providing the data.

• The COO/RDCEO referred to the patient and key performance indicators (KPIs). The

increase in admission rates and the national patient satisfaction results were highlighted. The COO/RDCEO also noted the new graph relating to ED presentations staying less than six hours noting that the target had been met for the first quarter. She outlined the planning work being done to stay on target.

Medical Division Report – In discussion the following key points were noted:

• The COO/RDCEO outlined the difficulties encountered with recruiting to the Allied Health Manager and professional leader role as outlined under the clinical governance framework. Discussion was held on the issues encountered.

• The COO/RDCEO advised that the Ministry of Health (MoH) had advised DHBs not to

charge co-payments, as was intended following advice that the Accident Compensation Corporation (ACC) Endorsed Provider Network (EPN) contract for Physiotherapy services would be changed. The MoH was exploring a nationally consistent approach.

• Mrs Susie Johnstone noted the value of the contract and financial performance data on

page 32 and 33 of the agenda. In response to a query by Mrs Johnstone, the Senior Business Analyst (SBA), Mrs Bron Anderson, advised the impact of phasing. The COO/RDCEO advised that departments were required to report on variances of 10% or more. A wide ranging discussion was held on phasing and trends in some areas.



• Members expressed concern at the additional cost that would be incurred by Southland DHB. The COO/RDCEO advised that management is reviewing all the ACC contracts to check financial viability.

Discussion was held on the ACC funding for injuries to visitors from overseas. The risk with bulk funding was noted.

• Discussion was held on triaging and the challenges around recording the data real time into the Emergency Department Information Systems (EDIS). The COO/RDCEO advised on management’s proposed plans to remedy the issues being experienced. She also noted that the reporting against ED triage was part of the SOI and would continue for the current financial year but was likely to be discontinued in 2010/11.

Mental Health Services – In discussion the following key points were noted:

• In October 2009 a Memorandum of Understanding (MoU) was signed between the Pacific Island (PI) Advisory and Cultural Trust and Mental Health Services to work together in the delivery of Mental Health Services in the community. Mental Health continues a significant amount of activity with integration with the primary health sector. The work was recognised by the Accreditation and Certification team.

• The Committee acknowledged the efforts in the Knowing the People Planning (KPP) with

the first quarter of the reporting year resulting in 97.5% of people with up-to-date crisis prevention resiliency plans.

• The COO/RDCEO outlined the process for feedback following the accreditation and

certification visit.

• In response to a query by Mrs Johnstone the COO/RDCEO advised the ‘access targets’ had not been included in the mental health report. She advised that the Mental Health Divisional Team set their own targets, which are in the DAP. She outlined the priorities in the area and confirmed it was demand driven. She outlined the funding model for Mental Health. The COO/RDCEO undertook to provide an update from the Divisional Manager for the meeting in December 2009.

Surgical Division Update – In discussion the following key points were noted:

• Elective service performance indicators (ESPIs) were green in August 2009. • Orthopaedics was compliant but was still at risk in the Outpatient’s area for first specialist

assessment and long wait surgical procedures. The team was working with medical staff to ensure the ESPIs remained green in this specialty.

• The shortage in anaesthetic resources has affected elective delivery, with 48 theatre

sessions not proceeding due to the shortage.

• Mr Potiki noted the Did Not Attend (DNA) results for the month of October 2009 indicated a decline in numbers. The COO/RDCEO advised that is was too soon to comment on the trend of results, but acknowledged it was the third month in a row that the numbers were lower.

• The Board Chairman acknowledged the positive results outlined on the theatre dashboard.

The COO/RDCEO advised that the HAC Committee had received the dashboard much earlier than the Surgeons. The Surgeons were still becoming familiar with the information and how it affects their departments. She highlighted the length of time required to make the change and see the consequent results and provided an update on the various areas.

• Following a query by Ms McArthur the COO/RDCEO advised that the e-texting programme

trial had concluded and once the results had been analysed a report would be submitted to



HAC with a recommendation. She highlighted there will be a cost involved with implementing the programme permanently.

• The COO/RDCEO noted there was a focus on acute delivery in Obstetrics and

Gynaecology (O&G) and advised that management was confident the other areas would reach their elective surgical targets.

• In response to a query regarding the plastics department, the COO/RDCEO advised that

the service that the Southland DHB provides is oral-maxillo facial and she advised that there was not a long waiting list for this service. She also provided an update in relation to Urology.

• The COO/RDCEO noted the two amber areas in Ear Nose and Throat (ENT) ESPIs and

advised that the team was addressing the issue but it would take time to return to a green status.

Women’s and Children’s Division – The following key points were noted:

• A new consultant has joined the (O&G) department. He has recently returned from Otago after completing orientation, which is a requirement of the Medical Council. The area remained challenging in terms of recruitment.

• The Committee acknowledged and congratulated Dr Tim Mackay on his recent secondment

to the role of Chief Dental Officer for the MoH. The COO/RDCEO advised that Dr Mackay remained in Southland and also worked regionally across Otago and Southland.

• The achievements within Well Child services with Before School Checks (B4SC) were

noted.

• Family Violence received a very pleasing report from the recent audit against health targets from the MoH.

• The COO/RCDEO acknowledged the $55k Southland DHB received from Fresh Futures.

Mrs Crowther noted her disappointment that the Board members were not invited to the hand over for the cheque and the COO/RDCEO acknowledged and apologised for the oversight. She advised that the $55k would be used to purchase equipment.

Human Resources (HR) Update – The following key points were noted:

• The COO/RDCEO provided an update on the Incubator Programme. She advised the final stage of the programme had been completed with the first group of students and the team currently reviewing the findings and they would produce a report for the HAC in early 2010. She noted the requirements for the funding application for ongoing funding for year two of the programme. The COO/RDCEO confirmed Southland DHB could accommodate the commitment to an increased number of schools. She noted a total of $63k was being sought from funders and Southland DHB would fund the Programme Coordinator for eight hours per week. The programme can only run with the support of the community funders.

• The Regional Chief Nursing and Midwifery Officer (RCNMO), Mrs Leanne Samuel,

provided an update on the success of the Murihiku Scholarship Trust, noting this applied to both primary and secondary care.



It was moved: “That the Hospital Advisory Committee notes the request and recommends to Southland DHB that approval be given to submit Programme Funding Applications with the Invercargill Licensing Trust, ILT Foundation and the Community Trust of Southland for the 2010 Southland DHB Incubator Programme”.

Moved: Mrs S Johnstone Second: Mrs K Crowther

Carried • In response to a query by Mrs Johnstone, the COO/RDCEO confirmed that Southland

DHB’s HR strategy was aligned with the national HR strategy in terms of recruitment to essential positions.

• In discussion the COO/RDCEO acknowledged the high cost of advertising vacancies. She

acknowledged the importance of working regionally and noted the positive feedback from the recruitment strategies adopted. She advised the success of various strategies was being monitored.

• Six notices of industrial action have been received and contingency planning is underway.

• Mrs Johnstone queried if there was another way to report vacancy factors. Clarification was

provided by the COO/RDCEO on how the vacancies were calculated. Mrs Johnstone queried whether budgeted vacancies could be recorded against the four personnel classifications. The SBA noted the difficulty to provide that. The COO/RDCEO outlined the process undertaken by management. Mrs Johnstone highlighted the need to manage the vacancies closely.

• Discussion was held around the vacancies and budgeting for Nursing. The COO/RDCEO

advised that vacancies were filled in line with budget. The COO/RDCEO advised that it was intended to change the way vacancies are reported for the 2010/11 year and sought feedback from members in relation to that.

Information Group Update – In discussion the following key points were noted:

• Work continues around video conferencing units within the DHBs. The COO/RDCEO highlighted the importance of this facility functioning efficiently as the DHBs move towards regional clinical services.

• An IPM upgrade is scheduled to be completed by the end of 2009. • Work continues towards a wireless infrastructure being established for areas such as the

ED to aid in the clinical input of information. • In response to a query from the Chair the COO/RDCEO advised that an exit interview is

offered to anyone leaving the organisation. She advised that in some areas significant effort was put in to obtaining this information, e.g. the Senior Medical Officers (SMOs). She noted the challenges with having a part time Chief Medical Officer (CMO) at the current time. She also acknowledged the importance of collating the information and sharing the findings.

Quality and Risk Dashboard – in discussion the following key points were noted:

• A risk management procedure review is currently out for consultation across both DHBs. The COO/RDCEO noted the procedure was new to Southland DHB.



7. Regional Chief Nursing and Midwifery Officer’s (RCNMO) Update The Regional Chief Nursing and Midwifery Officer (RCNMO), Mrs Leanne Samuel, spoke to her report and the following key points were noted:

• Occupancy for September 2009 remained high for most areas. • There were a high number of patient watches required for a number of areas, but

particularly in the rehabilitation - psycho geriatrics areas.

• The medical ward staffing remains challenging. The Allied Health professional advisor role remains vacant. Applications are currently being processed for the CTA funding for post graduate funding in all nursing areas, including primary care.

• The nursing KPIs were included for the Committee’s information.

• Discussion was held on the tasks included in the Nursing and Midwifery dashboard.

• In response to a query, the RCNMO outlined the meaning of the term ‘failure to rescue’.

• In response to questions raised by Mrs Crowther the RCNMO provided an update on

occupancy in maternity and neo-natal, noting that occupancy was down on the figures for the previous year. The RCNMO agreed to provide the birthing figures and length of stay for the December 2009 meeting. She advised that the primary units were managed by Planning and Funding. Discussion was held on the variables such as length of stay and the reasons for that. The Board Chairman requested that the COO/RDCEO advise the General Manager, Planning and Funding (RGMP&F), Mr David Chrisp, of the Committee’s request to enable the data from the rural maternity facilities to be captured also. Mrs Crowther noted the recent media coverage in relation to the rural facilities. Mrs Crowther outlined her concerns and Mrs Johnstone noted the value of providing the average length of stay (ALOS) as a starting point.

8. Financial Report The Senior Business Analyst (SBA), Mrs Bron Anderson, spoke to her report and in discussion the following key points were noted:

• The September 2009 result was favourable against plan. • The SBA noted the emerging trends that she had included in the year-to-date (YTD)

forecast.

• Overall revenue was favourable for the month and YTD.

• The SBA noted an internal revenue error of 100k that will be recognised in the October 2009 financials. This relates to a journal entry and will reduce the positive variance.

• The monthly variance for Clinical Training Agency (CTA) revenue was due to the release of

an over provision relating to the previous year. The same trend continues around filling junior doctor positions, meaning the revenue cannot be received from the CTA.

• Accident Compensation Corporation (ACC) revenue was above budget especially in

relation to assessment, treatment and rehabilitation (AT&R) and imaging.

• The oral health business case is making good progress. The SBA noted the project and the budget were not aligning, resulting in an unfavourable variance of $46k each month. This relates to appointment to positions, depreciation and capital charge.



• Discussion was held on the impact of non-resident bad debts and ways of managing that. The SBA advised that the DHB does not factor in the bad debt rate when deciding on the rate for non-residents.

• YTD the costs for salaries are under budget but FTEs are over budget. • Medical salaries are favourable for the month and YTD. The SBA reminded members of the

need to look at the salary line in conjunction with the outsourced line.

• The SBA highlighted the overtime payments that junior doctors were picking up. They were being paid a premium for that which could impact on the budget. It was noted that some of the senior medical staff were also undertaking additional duties.

• RMO costs were $251k within budget and SMO costs were $227k within budget. Mrs

Johnstone highlighted the timing differences and the impact of that into the future. Following a query by Mrs Johnstone, the SBA advised on the treatment of annual leave.

• Nursing salaries are unfavourable for the month by 20k. YTD the variance is unfavourable

by 180k. The amount incurred for parental leave was noted.

• Allied Health FTEs were above budgeted parameters for the month of October 2009.

• Management administration was under budget due to the lower FTE against budget and no provisioning for expired Multi Employer Collective Agreements (MECAs).

• Outsourced clinical services were within plan for the month of October 2009. These costs

related to outsourced services such as Southern Blood and Cancer.

• Clinical supplies are unfavourable to budget with the reasons outlined in the financial report.

• Infrastructure and non clinical supplies were unfavourable against budget for the month and

YTD. The key items were noted. The SBA highlighted the forecast for the first quarter included in the financial report. In response to a query by Mrs Johnstone, the SBA advised that the assumptions related to the current trends MECA assumptions and recruitment into positions.

• The SBA noted that she had not stated which items were purchased in the Capital Commitments and advised this would be included in the December 2009 HAC report.

• In response to a query by Mrs Johnstone the SBA advised what was included within

treatment disposables. She advised that treatment disposables were the largest driver of the unfavourable variance. Discussion was held in relation to this cost.

• In response to a query from Mr Ward the SBA advised that some of the factors are included

in the budget, but not all of the ‘value for money’ (VFM) was included in the budget. Mrs Johnstone clarified the situation for Mr Ward. The SBA concurred with the comment made by Mr Ward that the variance in the budget should make allowances for the recovery plan. The SBA advised that the VFM savings were factored in with the one liner not individually allocated out.

It was moved:

“That the committee receives the management and financial reports”.

Moved: Mr P Menzies Seconded: Mrs F McArthur

Carried



Ms D Wilson left the meeting at 4.25pm. 9. General Business To reduce the size of the agenda and prevent duplication the members agreed to the acronyms being removed entirely from the HAC agenda and that no copies would be needed. The COO/RDCEO advised that the information section from the HAC agenda has also been removed and will be included in the Board agenda only. 10. Confidential Section It was moved: “That the Committee move to the Public Excluded Section of the business at 4.45pm.” Moved: Mr P Menzies Seconded: Mrs S Johnstone Carried The Committee rejoined the Public Section of the meeting at 5.00pm. 11. Meeting Conclusion The meeting closed at 5.00pm. 12. Confirmation of Minutes Confirmed __________________________________________ Date ________________ Chairman


SDHB HAC MEETING – 09 December 2009

HOSPITAL ADVISORY COMMITTEE (HAC) ACTION SHEET

HAC Meeting held on 11 November 2009

Action Point No.

SUBJECT

ACTION REQUIRED

BY

STATUS

EXPECTED COMPLETION

DATE 58-09/11 Terms of Reference

(Minutes Item 5) An updated and revised version be distributed to HAC members for their information.

Minute Secretary Completed December 2009

59-09/11 Mental Health Update (Minute Item 6)

An update from the Divisional leader for the meeting in December 2009.

COO/RDCEO Completed December 2009

60-09/11 Birthing Figures (Minute Item 7)

Provide the birthing figures and length of stay figures.

RCNMO Completed December 2009

61-09/11 Birthing Figures (Minute Item 7)

Advise the General Manager, Planning and Funding (RGMP&F), Mr David Chrisp, of the Committee’s request to enable the data from the rural maternity facilities to be captured.

COO/RDCEO Completed December 2009

62-09/11 Acronyms (Minute Item 9)

For acronyms to be removed entirely from the HAC agenda.

Minutes Secretary

Completed December 2009


SDHB HAC Meeting – 9 December 2009 Chief Operating Officer’s Report

CHIEF OPERATING OFFICER’S REPORT

HAC Meeting Date: 9 December 2009 Report Prepared By: Lexie O’Shea, Chief Operating Officer Date Prepared: 25 November 2009

Recommendation That the Committee receives and notes this report.

1. Overall Contract Performance

Total case weight delivery is above budget plan for year to date (YTD) October 09. Acute volume is 16% (508 case weighted discharges (CWD)) above plan and elective volume is 4% (48 CWD) below plan YTD October 09. The key areas of inpatient acute demand are general medicine, general surgery and paediatrics. The emergency department in Lakes District hospital (LDH) tracks higher than planned with 707 attendances above budget YTD. Southland Hospital attendances are on plan. Outpatient attendances overall are on track with over delivery in follow up appointments YTD balanced against under delivery in some first specialist assessment areas. The key outliers are further explained within the divisional reports. Provider Arm DAP Project Dashboard 09/10. This is attached as appendix 1.

2. Medical Division Update

Attached as appendix 2 is the full report prepared by the leadership team – Medical Division.

3. Mental Health Division Update

Attached as appendix 3 is the full report prepared by the leadership team - Mental Health Division.

4. Surgical Division Update

Attached as appendix 4 is the full report prepared by the leadership team - Surgical Division.

5. Women and Children Update

Attached as appendix 5 is the full report prepared by the leadership team - Women and Children Division.

6. Human Resources (HR) Update

Attached as appendix 6 is the full report prepared by Ms Karyn Penno, Regional, General Manager - HR.

7. Information Systems (IS) Update

Attached as appendix 7 is the full report prepared by Mr Grant Taylor, Regional Chief Information Officer.

8. Medical Officers Unit Report

This report is included in the Public Excluded Business for the reasons outlined in the agenda.



9. Procurement Report


10. Risk Report


11. Value for Money Dashboard


12. Report Audit




1. Volumes – October 2009

COMPARISON SUMMARY OF ACTUAL VOLUMES AGAINST BUDGET

October 2009

Description Monthly Volume

Budgeted Volume

Monthly Volume Variance

Actual YTD Volume

Budgeted YTD Volume

YTD Volume Variance

DAP Annual Volume 2009/10

2008/09 Actual

Volume

Costweighted Contract Lines

Dental Acute 1.72 1.56 0.16 7.03 6.23 0.80 18.70 30.57

Dental Elective 12.86 15.99 (3.13) 53.78 63.96 (10.18) 177.66 165.78

Plastics Acute 2.74 2.41 0.33 9.97 9.65 0.32 28.95 43.84

Plastics Elective 1.27 2.00 (0.73) 4.85 8.00 (3.15) 22.21 26.25

ENT Acute 0.33 2.51 (2.18) 4.17 10.05 (5.88) 30.16 23.54

ENT Elective 29.83 30.08 (0.25) 119.02 120.33 (1.31) 334.24 329.45

Ophthalmology Acute 3.16 3.23 (0.07) 4.59 12.93 (8.34) 38.78 12.29

Ophthalmology Elective 45.94 29.18 16.76 165.41 116.72 48.69 324.21 375.40

General Surgery Acute 135.08 118.87 16.21 625.93 475.49 150.44 1426.46 1464.51

General Surgery Elective 108.15 94.60 13.55 409.45 378.39 31.06 1051.08 1078.30

Gynaecology Acute 22.61 14.17 8.44 68.67 56.69 11.98 170.07 158.70

Gynaecology Elective 12.33 35.25 (22.92) 81.82 141.01 (59.19) 391.69 342.03

Orthopaedics Acute 153.95 150.70 3.25 693.25 602.81 90.44 1808.44 1733.30

Orthopaedics Elective 95.17 96.81 (1.65) 336.23 338.84 (2.61) 1210.15 1015.98

Paediatric Surgical Acute - 0.44 (0.44) - 1.75 (1.75) 5.26 -

Paediatric Surgical Elective - 4.26 (4.26) 11.97 17.06 (5.09) 47.38 48.91

Urology Acute 14.73 9.07 5.67 40.23 36.26 3.97 108.79 142.52

Urology Elective 26.19 31.42 (5.23) 85.92 125.68 (39.75) 349.10 341.10

General Medicine Acute 361.07 310.67 50.40 1372.65 1242.67 129.98 3728.00 3673.50

General Medicine Elective 7.64 5.97 1.67 33.78 23.90 9.89 66.38 84.88

Paediatric Medicine Acute 72.92 52.04 20.89 303.64 208.14 95.50 624.43 709.64

Paediatric Medicine Elective - 0.86 (0.86) 3.37 3.45 (0.08) 9.58 8.43

Specialist Neonates Acute 56.78 45.85 10.93 187.70 183.40 4.30 550.19 580.29

Maternity Acute 109.51 101.72 7.79 442.99 406.86 36.13 1220.58 1170.34

Maternity Elective - 4.78 (4.78) 3.16 19.11 (15.94) 53.07 46.50

Acute Costweights 934.61 813.23 121.38 3760.82 3252.93 507.88 9758.81 9743.04

Elective Costweights 339.38 351.21 (11.82) 1308.76 1356.42 (47.66) 4036.75 3863.01

Total Costweights 1274.00 1164.44 109.56 5069.58 4609.35 460.23 13795.56 13606.05

Pregnancy and Childbirth 352.48 339.66 12.82 1979.20 1358.65 620.55 4069.58 5151.56

Emergency Department Attendances

2919.00 3023.33 (104.33) 12753.00 12093.33 659.67 36280.00 37420.00

Outpatients - Allied Health 764.00 863.33 (99.33) 3510.00 3453.33 56.67 10360.00 9058.00

Rural Inpatients 196.00 217.00 (21.00) 773.00 861.00 (88.00) 2555.00 1939.00

Mental Health (Capacity) 780.87 788.42 (7.56) 3189.27 3172.20 17.07 8554.55 8571.33

Mental Health (PVC) 37.07 42.87 (5.80) 143.07 171.47 (28.40) 44.70 33.27

HOP Lines (DHB Funded) 1385.00 1399.07 (14.07) 5701.00 5575.86 125.14 16645.98 16535.00

DSS Lines (MoH Funded) 150.00 487.83 (337.83) 852.00 1949.71 (1097.71) 5842.54 2794.00

Outpatients - Medical and Surgical 5115.29 5529.15 (413.85) 21265.17 22018.17 (753.01) 63654.18 56736.00

Public Health 22.00 47.83 (25.83) 154.00 191.33 (37.33) 574.00 527.00



2. Patient and Quality Key Performance Indicators – October 2009 PATIENT AND QUALITY KEY PERFORMANCE INDICATORS Emergency Department Triage Times – Categories 1, 2 & 3 DEFINITION: Triage Level 1: The percentage of patients attending the Emergency Department triaged to

Category 1 who are attended to immediately. Triage Level 2: The percentage of patients attending the Emergency Department triaged to

Category 2 who are attended to within 10 minutes. Triage Level 3: The percentage of patients attending the Emergency Department triaged to

Category 3 who are attended to within 30 minutes.

Emergency Department Triage Level 1 2008/09 v 2009/10

0%

20%

40%

60%

80%

100%

% Emergency Triage Rate 1 09/10 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 0% 100% 100%


District Annual Plan 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun YTD Oct

YTD


0%

20%

40%

60%

80%

100%



District Annual Plan 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60%


YTD


0%

20%

40%

60%

80%

100%



Dist rict Annual Plan 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60%


YTD



Acute Readmissions (Rate per 1,000) DEFINITION: A measure of the rate at which discharged patients are admitted unexpectedly to a hospital within seven days of a previous discharge. Numerator: The number of acute admissions that occur within seven calendar days of a

previous discharge Divided By Denominator: Total Inpatient Discharges

Acute Readmission Rate 2008/09 vs 2009/10

-

5.00

10.00

15.00

20.00

25.00

30.00

A cute Readmission Rate 09/10 20.45 19.08 22.46 17.10 - - - - - - - - 19.79 19.79

A cute Readmission Rate 08/09 24.02 22.09 26.10 12.48 22.97 19.80 23.64 28.22 17.58 23.27 13.76 24.91 21.49 21.28

Target 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00

Jul A ug Sep Oct Nov Dec Jan Feb M ar A pr M ay Jun Total YTD

Complaints Resolved Within 30 Days DEFINITION: The number of formal written and verbal complaints resolved, within 30 days of receipt, during the month, expressed as a percentage of total formal complaints received during the month.

Complaints Resolved Within 30 Days - 2008/09 v 2009/10

0%

20%

40%

60%

80%

100%

% Of Complaints Reso lved 09/10 71% 69% 87% 80% 0% 0% 0% 0% 0% 0% 0% 0% 78% 78%

% Of Complaints Reso lved 08/09 78% 67% 80% 86% 50% 100% 85% 75% 100% 83% 54% 84% 80% 80%

District Annual P lan 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunYTD Oct

YTD



ADMISSION/DISCHARGE RELATED PERFORMANCE INDICATORS Inpatient Admissions and Discharges (Includes Mental Health)

Comparison of Inpatient Admissions - 2008/09 vs 2009/10

0

250

500

750

1000

1250

Inpatients 09/10 1087 1104 1111 1070 0 0 0 0 0 0 0 0 4372 4372

Inpatients 08/09 1051 1046 1051 966 973 936 992 973 1051 1027 990 953 4114 12009

Jul Aug Sep Oct Nov Dec Jan Feb M ar A pr M ay Jun YTD Oct

YTD

Comparison of Day Patient Admissions - 2008/09 vs 2009/10

0

100

200

300

400

500

600

700

Day Patients 09/10 660 600 674 668 0 0 0 0 0 0 0 0 2602 2602

Day Patients 08/09 536 585 540 567 577 502 480 508 626 546 599 497 2228 6563


YTD

Comparison of Total Admissions - 2008/09 vs 2009/10

0200400

600800

10001200

140016001800

Total 09/10 1747 1704 1785 1738 0 0 0 0 0 0 0 0 6974 6974

Total 08/09 1587 1631 1591 1533 1550 1438 1472 1481 1677 1573 1589 1450 6342 18572

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunYTD Oct YTD

Comparison of Total Discharges - 2008/09 vs 2009/10

0200400

600800

10001200140016001800

Discharges 09/10 1760 1677 1781 1754 0 0 0 0 0 0 0 0 6972 6972

Discharges 08/09 1582 1630 1609 1522 1567 1465 1438 1453 1706 1547 1599 1445 6343 18563

Jul Aug Sep Oct Nov Dec Jan Feb M ar A pr M ay JunYTD Oct

YTD



Readmissions DEFINITION: An unexpected admission for further treatment of the same condition, a related condition, or complication of the condition, for which the patient was previously hospitalised (with 28 days of discharge). Includes day stay patients but excludes patients re-admitted to the Emergency Department only.

Unplanned Readmissions by Specialty - October 2009

0

100

200

300

400

500

600

Disc

harg

es

0

5

10

15

20

25

Read

mis

sion

s

Dischar ges 53 79 176 155 61 537 160 46 39

Readmissi ons 0 0 4 2 2 22 1 3 0

EAR NOSE AND THROAT

EYEGENERAL SURGERY

ORTHOPAEDIC UROLOGYGENERAL MEDICINE

PAEDS GYNAECOLOGY DENTAL

Unplanned Readmissions - YTD October 2009As a % of Raw Discharges

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

Percent age 0.00% 0.00% 3.31% 1.20% 1.79% 4.57% 0.31% 3.37% 0.00%

EAR NOSE AND THROAT

EYEGENERAL SURGERY

ORTHOPAEDIC UROLOGYGENERAL MEDICINE

PAEDS GYNAECOLOGY DENTAL

Trend of Unplanned ReadmissionsAs a % of Raw Discharges

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

GENERAL SURGERY ORTHOP AEDIC UROLOGY GENERAL M EDICINE PAEDS GYNAECOLOGY

Perc

enta

ges

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10



OTHER PERFORMANCE INDICATORS Returns To Theatre DEFINITION: Unplanned refers to the necessity for a further operation for complication(s) related to a previous operation/procedure in the operating room. Calculated by the number of patients having an unplanned return to the operating room during the same admission.

Unplanned Returns to Theatre - 2008/09 vs 2009/10

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

Unplanned Ret urns % 09 /10 0.17% 0.00% 0.19% 0.18% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.14% 0.14%

Unplanned Ret urns % 08 /09 0.21% 0.19% 0.39% 0.18% 0.17% 0.00% 0.21% 0.00% 0.37% 0.72% 0.56% 0.82% 0.32% 0.32%

District Annual Plan 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun YTD Sep YTD

Hospital Acquired Blood Stream Infections (per 1,000 inpatients) DEFINITION: The number of hospital acquired Staphylococcus Aureus blood-stream infections, occurring 48 hours or more after admission per 1,000 inpatients.

Hospital Acquired Infection Rate - 2008/09 v 2009/10

0.0

0.1

0.2

0.3

0.4

0.5

0.6

A cquired Bacteremia Rate 09/10 0.19 0.37 0.18 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.23 0.23

A cquired Bacteremia Rate 08/09 0.17 0.00 0.18 0.42 0.21 0.22 0.00 0.00 0.00 0.38 0.18 0.19 0.16 0.16

District Annual P lan 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5

Jul A ug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunYTD Oct

YTD

0



PROCESS AND EFFICIENCY KEY PERFORMANCE INDICATORS Resourced Beds Inpatient Occupancy Rate DEFINITION: Inpatient beds in service: The sum of set-up and stated daily beds in service for the month, where a daily bed is one resourced overnight. Nursery beds adjacent to a mother’s bed do not count as an additional bed in service. Cot facilities separate from the mother’s bed count as inpatient beds in service, if staffed and ready for use in the period. Calculated as: Inpatient bed days as a percentage of resourced bed days.

Resourced Bed Inpatient Occupancy Rate 2008/09 vs 2009/10(Medical, Surgical & ATR Only)

0%

20%

40%

60%

80%

100%

Occupancy By M onth 09/10 90% 90% 91% 93% 0% 0% 0% 0% 0% 0% 0% 0% 91% 91%

Occupancy By M onth 08/09 94% 92% 91% 80% 86% 84% 87% 90% 93% 91% 91% 92% 89% 89%

Dist rict Annual Plan 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%


Avg

Casemix Weighted Average Length Of Stay For Medical and Surgical Inpatients Only DEFINITION: Inpatients exclude the following:

Well babies, boarders, Mental Health, Assessment and Rehabilitation services and continuing care.

Medical & Surgical Inpatients exclude:

Elective day cases for Ophthalmology, Paediatrics and Palliative Care.

ALOS Calculated as: Total Inpatient Days Divided By Total Inpatient Discharges (VCWD)

ALOS 2008/09 vs 2009/2010

0.000.501.001.502.00

2.503.003.504.00

ALOS By M o nth 09/10 3.23 3.04 3.24 3.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.24 3.24

ALOS By M o nth 08/09 3.66 3.15 3.17 3.26 3.20 3.27 3.00 2.96 2.99 3.45 3.16 3.50 3.30 3.23

District Annual P lan 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35




Did Not Attends (DNAs) DEFINITION: A rate based measure of the proportion of patients that do not attend their specialist clinic appointment at the scheduled time. Numerator: Number of patient Did Not Attends for specialist clinic appointments Divided By Denominator: Number of scheduled specialist clinic appointments

DNA Rate - 2008/09 vs 2009/10

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

DNA Rate 09/10 9.18% 8.86% 7.79% 10.02% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 8.98% 8.98%

DNA Rate 08/09 10.88% 9.78% 9.41% 9.46% 9.03% 9.94% 11.04% 9.63% 9.52% 9.60% 9.41% 8.67% 9.62% 9.82%

District Annual P lan 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00%

Jul A ug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun To tal YTD

ORGANISATIONAL HEALTH KEY PERFORMANCE INDICATORS Staff Turnover (Voluntary) DEFINITION: The number of Provider Arm employees who cease employment due to voluntary resignation during the period expressed as a percentage of the total headcount of Provider Arm employees at the beginning of the period.

Staff Turnover (Voluntary) - 2008/09 v 2009/10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Staff Turnover (Vo luntary) 09/10 3.0% 2.5% 1.9% 1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.3% 2.3%

Staff Turnover (Vo luntary) 08/09 5.0% 3.4% 3.4% 3.1% 2.8% 3.1% 3.1% 2.9% 2.8% 2.7% 2.7% 2.8% 2.1% 3.1%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunYTD Oct

YTD

Sick Leave DEFINITION: The total number of paid and unpaid sick leave hours taken by Provider Arm employees during the period, expressed as a percentage of the total of Provider Arm accrued full time equivalent hours.

Sick Leave Rate - 2008/09 v 2009/10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Sick Leave Rate 09/10 3.3% 2.9% 3.4% 2.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 3.1% 3.1%

Sick Leave Rate 08/09 3.5% 4.3% 3.2% 3.1% 3.0% 3.4% 1.6% 1.8% 2.7% 1.9% 3.1% 3.8% 3.0% 2.9%




Workplace Injuries or Illnesses DEFINITION: All occurrences of work related injury or illness resulting in whole days or shifts lost for work by Provider Arm employees during the period, expressed as a percentage of hours worked by all Provider Arm employees.

Workplace Injuries - 2008/09 v 2009/10

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Work P lace Injuries 09/10 6.2 0.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 1.5

Work P lace Injuries 08/09 0.0 14.7 0.0 6.5 0.0 0.0 0.0 8.8 14.7 6.1 4.9 0.0 4.6 4.6


YTD

Staff Stability DEFINITION: The number of employees leaving the organization with less than two years service divided by the total number of contracted employees. This excludes RMOs, temporary and casual staff, and consultants. Note: Subtracting the ratio from one provides a measure of stability.

Staff Stability Rate - 2008/09 v 2009/10

0%

20%

40%

60%

80%

100%

Staff Stability Rate 09/10 98% 99% 99% 99% 0% 0% 0% 0% 0% 0% 0% 0% 99% 99%

Staff Stability Rate 08/09 97% 100% 98% 98% 99% 100% 99% 99% 98% 99% 98% 99% 99% 99%


Cumulative Discharges DEFINITION: Increasing elective discharges. SDHB target 3282

Cumulative Total Discharges

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

YTD 2009/10 353 670 953 1,271

Actual 2008/09 262 532 854 1,192 1,576 1,841 2,097 2,382 2,707 3,013 3,363 3,584

Budget 2009/10 281 568 854 1,144 1,440 1,674 1,922 2,213 2,513 2,747 3,047 3,282

Jul Aug Sep Oct No v Dec Jan Feb M ar Apr M ay Jun


October 2009 Appendix 1

STRATEGIC GOALS:

Creating a high performance culture

Achieving Health Targets

Leadership Development

PROGRESS

PROJECT B

eh

ind

On

targ

et

Co

mp

lete

COMMENT

Provider Arm

Achieving IPM convergence

As per IS report in the Chief Operating Officer’s (COO) report.

Emergency department Information system implementation

Completed.

Emergency Department waiting time less than 6 hours

A work group are reviewing current statistics and developing a plan to achieve this target. Target was met for quarter 1 of 2009/10.

Clinical Leadership A clinical leadership programme is underway.

Regional Clinical Services The project manager role has been appointed to.

Community Paediatrics An advanced trainee in Paediatrics has been appointed for the 2010 calendar year to complete many of the duties of a fourth paediatrician to enable the community paediatric service to be further developed but this is a one year position and the provider arm will continue to recruit into the fourth paediatrician role for the 2011 calendar year.

Healthy Eating Healthy Action (HEHA) implementation

For the month of November the HEHA team are running a series of seminars, cooking demonstrations and activities for staff with the view to supporting a healthy and active lifestyle.

Oral Health Business Case The first mobile surgery has arrived in Southland and is currently undergoing acceptance testing. It is scheduled to go into service in term 1 2010. Progress on fixed clinics remains on schedule, and work on clinical and operational convergence with Otago is tracking slightly ahead of plan.

Theatre Efficiency As per theatre dashboard from Theatre Compass attached to the Surgical division report.

Better help for smokers to quit

Promotion of the project is underway to staff. All systems are in place including feedback on progress to service areas being provided monthly.

ESPI Compliance ESPIs remain green.

Elective Surgical delivery As reported in the surgical division report.

Devolution of secondary to primary

Initial meeting held between the Provider Arm and PHO leadership team to discuss, further work exploring diagnostic access underway.

Improving Mental Health services

The service submitted its report of progress against Te Kokiri, The Mental Health and Addiction Action Plan 2006-2015 to Planning and Funding at the end of the 2008/09 year. Reporting against Te Kokiri is an annual reporting requirement.

New born hearing implementation

Discussion continues with planning and funding, initial planning underway.

Provider Arm DAP Project Dashboard 2009/10


SDHB HAC Meeting – 9 December 2009 Medical Division Update

MEDICAL DIVISION UPDATE

Report prepared by: Ian Winwood, Divisional Manager Dr Alasdair Millar, Divisional Director Jenny Hanson, Director of Nursing Date Prepared: 25 November 2009

1. Service Summary

Lakes District Hospital • Lakes District Hospital update is attached as (appendix 2a)

• Discussion paper on options for Lakes District Hospital is attached as (appendix 2b)

Assessment Treatment and Rehabilitation (AT&R) Services • due to the geriatricians being on leave, clinics volumes are down for October 2009. With

the resignation of one geriatrician from January 2010 we are following up a locum geriatrician to assist in managing the waiting list

Diagnostic Testing • the diagnostic testing department has modified how respiratory clinic patients are tested

prior to their appointment with the Physician. They have now commenced booking all the respiratory patients directly into diagnostic testing clinics, rather than patients walking in as they arrive, leading to potential delays. This will improve preparation for patients attending a respiratory outpatient clinic and maximise use of the time for the technicians

Medical Imaging • all of the recommendations needing to be completed following the external audit by

International Accreditation New Zealand (IANZ) have been actioned Medicine • the department of medicine is anticipating being short of medical registrars for the start of

2010. There are 4 staff finishing in the period January to March 2010 and no new appointments have been made to these positions, due to a lack of suitable candidates. The team is considering additional options for recruitment and contingency plans of how to manage acute medicine with no permanent registrars. Some positions are filled by locum medical staff, but insufficient to run the current roster patterns

Pharmacy • an audit has been completed looking at the origin of Hospital Exceptional Circumstance

(HEC) prescriptions presented to the pharmacy department between September 7 and October 7 2009 shows a large percentage of prescriptions attract no funding. The prescription is dispensed but has no associated outpatient or inpatient activity to cover the expense, after the initial consultation which initiated the therapy. This will be reviewed with Planning and Funding as this expense relates to community dispensing of pharmaceuticals as this enables a new model of care for patients



2. Quality Initiatives

AT&R Services • A project is underway to provide a service guideline for occupational therapy within

AT&R. This should identify assessment processes, time frames, equipment and resources required, and provide a consistent service framework between clinicians

• A programme of education for registered comprehensive nurses regarding

psychogeriatric and mental health needs of the older person has been prepared

3. Contract performance

HAC Group Actual YTD

Volume Budgeted

YTD Volume

YTD Volume Variance

% of YTD Budget

Reached

Mitigation Comments

Inpatients

General Medicine Inpatient

1406.43 1266.56 139.87 11.04% Monitor Increased demand during the winter months

Outpatients

Diabetes Outpatient 36.00 172.80 (136.80) (79.17%) Adjust volumes Change in counting general medicine

Endocrinology Outpatient

- 25.92 (25.92) (100.00%) Adjust volumes Change in counting general medicine

General Medicine Outpatient

253.00 309.60 (56.60) (18.28%) Adjust volumes Change in method of counting general medicine

Infectious Diseases Outpatient

- 20.16 (20.16) (100.00%) Review coding and correct

Coding error

Respiratory Outpatients

200.00 291.60 (91.60) (31.41%) Additional clinics to be held as planned within budget

Decreased clinics due to junior doctor shortage

Emergency Department

Lakes ED 2307.00 1600.00 707.00 44.19% Review staffing. Consider primary care options

Increased demand from skiing and H1N1. Decrease observed in October.

Southland ED 10446.00 10493.33 (47.33) (0.45%)

A review of the mapping for outpatient activity has demonstrated that any patient seen by a general medicine physician should be mapped to that speciality. This requires correction of activity in general medicine and is currently under reporting the activity but other lines are over reported. This will be corrected by December 2009 and will be fully reported in the next Hospital Advisory Committee report.



Medical Imaging Waiting Times Department This month Last month Target MRI Urgent same day same day same day semi urgent 2 weeks 2 to 3 weeks 2 to 3 weeks routine

outpatient 6 weeks 6 weeks 6 to 8 weeks

ACC 13 days 15 days 10 days Private 13 days 15 days 10 days CT urgent ASAP (within 24

hours) ASAP (within 24 hours)

Same day

Semi urgent 1 to 2 weeks (OP)

1 to 2 weeks (OP) 2 to 3 weeks

routine outpatient

5 to 6 weeks 6 to 7 weeks 6 to 8 weeks

ACC Within 10 days Within 10 days 10 days Private Within 10 days Within 10 days 10 days Ultrasound all ultrasounds 24 to 28 weeks 24 to 26 weeks 8 weeks X-Ray appointments

routine 6 weeks 8 weeks 8 weeks

intravenous urograms

6 weeks 4 to 6 weeks 4 to 6 weeks

barium procedures

6 weeks 4 to 6 weeks 4 to 6 weeks

Mammography Urgent 3 weeks 1 to 3 weeks 1 week semi-urgent 2 to 4 weeks 2 to 4 weeks 2 to 4 weeks routine 24 weeks 4 to 6 weeks recall patients 12 weeks for out

of town patients 8 weeks 4 weeks

Nuclear Medicine

urgent * 2 weeks * 2 days to 2 weeks

* 2 days to 2 weeks

semi urgent 4 weeks 4 weeks 4 weeks routine

outpatient 4 weeks 4 weeks 4 to 6 weeks

ACC 10 days 10 days 10 days Private 2 weeks 15 days 10 days Cardiac 4.5 months 4 months 2 months

* If there is generator activity then urgent Nuclear Medicine Scans would be performed within 2 days.



4. Financial performance

The medical division is reporting a favourable variance of $130k for October 2009.

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$'000 $'000 $'000 FTE FTE $'000 $'000 $'000 $'000

391 403 (12) Revenue 1,703 1,613 90 4,839(1,973) (1,984) 11 285.51 283.78 Less Personnel Costs (7,970) (7,712) (258) (23,614)

(155) (277) 122 Less Outsourced Costs (770) (1,155) 385 (2,983)(506) (514) 8 Less Clinical Supplies (2,072) (2,040) (32) (6,054)(179) (180) 1 Less Infrastructure & Other Costs (737) (716) (21) (2,122)

(2,422) (2,552) 130 285.51 283.78 Net Surplus/(Deficit) (9,846) (10,010) 164 (29,934)Add Divisional Share of Savings Target (3) 142 (145) 426Result After Savings Target Adjustment (9,849) (9,868) 19 (29,508)

Month Year to Date

Revenue is $12k unfavourable in October 2009, mainly due to Accident Compensation Corporation (ACC) income in rehabilitation, revenue from other DHB and non-residents income.

AnnualActual Budget Variance Actual Budget Variance BudgetFTE FTE FTE FTE FTE FTE FTE

23.07 20.75 (2.32) Medical Personnel 23.62 20.25 (3.37) 22.09137.12 138.31 1.19 Nursing Personnel 139.77 138.31 (1.46) 138.31

85.35 86.74 1.39 Allied Health Personnel 85.84 86.74 0.90 86.7439.97 37.98 (1.99) Management & Admin Personnel 36.78 37.98 1.20 37.98

285.51 283.78 (1.73) Total Personnel 286.01 283.28 (2.73) 285.12

Month Year to Date

Expenditure overall is $142k favourable in October 2009 and the main reasons for the variances include: • personnel is $11k favourable in October 2009. Medical is $38k unfavourable due to the

additional hours that have been worked by doctors. Nursing is $57k favourable which is reflective by 1.19 FTE under budget

• outsourced services costs are $122k favourable in October 2009. This variance relates to

senior medical outsourcing and is offset above with the over run against salaries • clinical supplies is $8k favourable in October 2009. Contributing to this result is

pharmaceuticals $28k favourable, instruments & equipment $12k favourable and treatment disposables $28k unfavourable. The treatment and disposables unfavourable variance mainly relates to blood intragram $32k unfavourable

5. Risks and Mitigation

Risk Mitigation changes signalled by ACC to the falls prevention contract and the Endorsed Provider Network contract for physiotherapy may decrease revenue. The ACC high technology imaging contract has been varied with a total of 20% decrease in revenue

Consider changes to the cost base to stay within the decreased revenue for these ACC contracts


SDHB HAC Meeting – 9 December 2009 Lakes District Hospital

Appendix 2a

LAKES DISTRICT HOSPITAL (LDH) HAC Meeting Date: 9 December 2009 Report Prepared by: Ian Winwood, Divisional Manager Dr Alasdair Millar, Divisional Director Jenny Hanson, Director of Nursing Date: 25 November 2009

RECOMMENDATION

It is recommended that • the additional staffing into Lakes District Hospital is supported while an

alternative model of care is developed and implemented

• the HAC recommends this to the Southland District Health Board

1. Introduction

This paper is to provide an executive summary and recommendation to HAC on measures to reduce the current potential clinical and staff risk at Lakes District hospital (LDH). Supplementary information is provided as an addendum to this summary. This is tabled for HAC approval as this will increase the staffing compliment and therefore cost base above budget.

2. Background

There has been steady growth in the number of presentations to the Assessment and Stabilisation (A&S) service. In the 2002/2003 financial year there were 1577 presentations to the A&S. In 2008/2009 this had grown to 5813 presentations and for the current year we are extrapolating to potentially over 7000 attendances. This represents a significant increase in A&S activity. The staff at LDH report that the volume and complexity of work is creating clinical risk for the patients and potential health and safety risks for the staff. On a number of occasions over recent years the staffing levels have been increased and reconfigured to support the increase in patient numbers. As well as potential patient and staff risks, there is also fiscal risk to the organisation as the revenue generated by LDH is significantly less than the cost structure required to maintain the level of services being provided.

The DHB is also undertaking a hospital capacity review that will potentially develop a new model of care for the Otago and Southland DHB region.

3. Plan for Lakes District Hospital

A temporary staff increase is already planned for the Christmas and New Year period. This will only address the potential clinical risk for a very short term, (three weeks). After careful review of a number of options and being cognoscente of the current hospital capacity review it is considered that the best option at this time is to extend the above short term staffing arrangements at Lakes District until June 2010.


SDHB HAC Meeting – 9 December 2009 Lakes District Hospital

The cost of this option is approximately $300k and will allow the nursing establishment to increase and provide an additional nurse on duty 7 days a week during peak times. It will also increase the medical staff establishment to provide 7 day cover with a swing shift, this will allow 2 doctors on the floor during peak times. If we are reliant on locum support for the additional staff the cost may be higher but if we are fortunate to att ract short term appointments then the cost will be less than this. During the period of temporary additional staffing the DHB will increase the emphasis on the work already undertaken by Cranleigh Health in the Hospital Capacity Review, to work with the stakeholders to develop a new model of care proposal for Queenstown. This work will be in collaboration with SDHB staff, the local general practitioners and other stakeholders. The options paper attached to this paper has been provided to the staff and the general practitioners and has resulted in some positive dialogue. The proposed plan is to move towards a model that utilises the advantages of a primary and secondary collaboration, making better use of healthcare resources in the Queenstown area. A new model of care will be consulted on prior to finalising.


Appendix 2b

Discussion paper on Options for Lakes District Hospital

Report prepared by: Divisional Leadership Team - Medical Division Date: 17 November 2009

1. Background

In December 2004 the General Practitioners (GPs) in Queenstown were asked to finish a fee for service contract for the provision of medical support to Lakes District Hospital (LDH). Since this time there has been significant effort put into developing a roster supported by five Medical Officers employed by Southland District Health Board (SDHB) directly.

There is was some expectation that this change in delivery of medical services would impact volume and attendances at LDH. The experience since 2004 is that the number of presentations to the Assessment and Stabilisation (A&S) service has shown a steady growth. The staff at LDH now report that the volume and complexity of work is creating clinical risk for the patients and potential health and safety risks for the staff. Of the current patient presentations to the A&S service, approximately 66% are in triage categories 3, 4 or 5, many of which can be safely managed by primary care. A full analysis is presented as appendix 1.

There are a number of possible factors for these changes which might include: the changing economic status of permanent residents; the increasing number of tourist in the region; alterations to after hours access by primary care; the implementation of Healthline; and changes in adventure activities in the area.

As well as potential patient and staff risks, there is also fiscal risk to the organisation as the revenue genera ted by LDH is significantly less than the cost structure required to maintain the level of services being provided. The revenue is the contract between SDHB Planning and Funding with SDHB Provider Arm, and reflects the work contracted through the Price Volume Schedule

The Minister of Health has signalled that the DHB must keep within the budget, but at the same time improve the delivery of services, in particular improving the waiting times in the emergency departments. To achieve these aims the DHB must consider a variety of options and balance this against the increasing volumes the hospital is currently seeing. This paper is outline some potential options for wider debate.

2. Strategic Context

Otago and Southland DHBs already have a project workstream underway that seeks to review rural hospital capacity and models of care. This is part of our DAP and is


considered a priority for the two Boards. The issues raised in this paper and options canvassed in fact have been identified as part of this work. Part of this project has now just released a document entitled Hospital Capacity Review - Current State Analysis which is report from Cranleigh Health commissioned by the DHBs. The next phase of the overall project is to develop new models of care that will be consulted on. Potentially these models may look similar to the options identified in this paper and poses a timing issue for the decisions on this reports recommendations. It is quite clear the DHB has no financial capacity to sustain increased or even current costs. Even a temporary increase is problematic as is taking a decision on a changed model of care (as proposed in this paper) prior to the release of the new models being developed that are to be consulted on. It is for these reasons that this paper seeks additional feedback from stakeholders.

3. Options

It is viewed that there are 4 possible ways to modify the current service and address the problems associated by the increasing patient presentations, these are:

1. Decrease the current workload 2. Modify the roster and/or staffing to better manage the workload 3. Increase staffing 4. Change the funding model

This paper will not consider a change to the funding model as this is outside of the scope for provider arm and a funding decision, but will focus on possible operational changes to address the current position.

1. Decrease the current workload Accept only urgent referred admissions from 2000 until 0800 This option is to close the hospital between 8pm until 8am, with only GP referrals and ambulance access. This change will ensure all patients treated at Lakes District Hospital will be appropriately reviewed by primary care and is intended to stop the walk-in patient presentations. Current experience is that many presentations after 8pm occur due to decreased availability of the general practitioners after the A&M services closes at Queenstown Medical Centre, and possibly the cost of general practice services. Advantages All presentations will be referred after close-off and will be hospital level

requiring assessment and stablisation Reduction in evening presentations Doctor will have greater opportunity to sleep, decreasing the cost of the medical

officer roster Potential to reconfigure the nursing roster to cover the change in patient

presentations Assumptions The change in presentations will allow the doctor roster to be modified, so that

cover is provided by 5 medical officers as per establishment There will not be a significant increase in daytime presentations Revenue will not decrease as the current contracted volume is already below the

actual level of presentations


The Primary Health Organisation (PHO) will support the move to increase use of primary care

Risks Mitigation Backlog of patients to present when

the hospital reopens

Encourage use of primary care when appropriate. Advertise primary care options to patients.

Not all Queenstown GPs provide after hours care

Communicate with all general practice to keep informed of changes

Lakes District staff will not support the change

Consult with staff during change process

Decrease the number of inpatient beds The proposal is to decrease the number of inpatient beds to 5 beds, in line with occupancy levels which for September 2009 were 55.7%. Occupancy is measured at midnight, the corresponding occupancy at 11am is 55.3%. The average number of movements in and out each day is 6.17 patients. The Hospital is currently staffed to 10 beds. This would lead to a reduction in nursing as the second nurse could be utilised in the A&S and be pulled back to the ward when required for safety. This will allow the K shift to be removed. Advantages Able to transfer nursing staff from the ward into the A&S and remove the K shift

Friday to Sunday Assumptions That occupancy gives a true reflection of the number of beds in use Decreasing the number of bed s will allow a decrease in the number of nurses There will be a potential increase in the number of transfers to Southland

Hospital Applying bed numbers according to average occupancy has no flow on effect on

days when demand is higher than average Risks Mitigation May create bed block for Southland

Hospital with inability to transfer patients back to LDH

Ensure patient pathways are developed to promote the right patient in the right bed

Some patients may not be admitted at Southland Hospital and returned to primary care in Queenstown

May create bed block for Lakes District Hospital and increase the number of transfers to Invercargill

Ensure adequate number of transfer staff and appropriate timely transfers

Some patients may not be admitted at Southland Hospital and returned to primary care in Queenstown

Insufficient resource at St Johns to manage the increase in patient transfers

Communication with St Johns

Possible impact on maternity cover as nurses provide cover to the maternity ward

Develop plan with the midwifery team which may involve recruitment of necessary staff to cover limited


facility maternity requirements Occupancy does not demonstrate

throughput and so higher numbers of beds may be in use at some parts of the day

Closing beds will force a change in bed usage and may decrease soft admissions. Make better use of beds located in the ED

Establish a general practice service Establish a general practitioner service within Lakes District Hospital for all or part of the day to stream all appropriate primary care patients away from the A&S service. This model could also be done in collaboration with local general practitioners, where patients are seen in their rooms and referred to the Lakes District assessment and stabilisation service if required. This is similar to the model operated by Dunstan Hospital Advantages Will stream all primary care patients into a GP led service Will allow a reduction in staff as only appropriate A&S patients will be seen by

the hospital staff Increased revenue for primary care Allow funding to be accessed from ACC for appropriate patients, by the general

practice and the GP can access capitation funding from the PHO for enrolled patients

Assumptions That there is a 50% reduction in the number of patients requiring assessment

through the hospital That all ambulance presentations will continue to be managed by the hospital

A&S service That the reduction in patient numbers will allow the medical and nursing staff to

be decreased back to budget levels or lower, whilst minimising clinical risk Risks Mitigation Patients may be reluctant to pay a

GP consultation fee when they present to a general practice based on the hospital grounds

Communication plan for change including comparison to Central Otago model of care

High patient co-payments in Queenstown may pose a barrier

Discussion with PHO and local general practices

General practitioners maybe reluctant to participate

Collaborate with the GPs during planning for the change

Facilities may require modification to establish a suitable consultation area

Establish service needs and identify costs for business case


Transfer provision of medical services to general practice This is return to the model in place before 2004. The hospital would not employ medical staff, but would contract the full provision of medical cover to the local general practitioners. They would assume responsibility for seeing all patients and could choose whether to do this in their rooms or as an A&S patient at the hospital. They would be responsible for covering all hospital call and inpatient activity. Advantages Removes responsibility for medical staffing from the DHB Promotes use of primary care for all appropriate patients Assumptions That the cost of the GP service could be met within current budget That the increased volume of patients can be decreased back to pre-2004 levels Risks Mitigation The smaller GP practices may feel

sidelined in this arrangement Engage with PHO to manage the

cover Some GPs may not be experienced

to manage high acuity patients Collaborate to provide training as

required through Southland Hospital General practitioners may be

reluctant to participate Collaborate with the GPs during

planning for the change Perception of high cost of service

provision prior to 2004, although costs have ballooned since the service was changed

Robust contract negotiation

Staff opposition to the change based on previous experience

Engage with staff during planning

Insufficient medical staff in Queenstown to maintain service in their private practice and at Lakes District Hospital

Transition arrangement with current medical staff at Lakes District Hospital


2. Modify the staffing Amend the medical officer roster Modify the doctor roster to provide consistent 7 day coverage within current establishment which is 6 medical officers. This requires agreement to make the additional medical officer a permanent increase, outside of budget. Advantages Improves the A&S medical cover to accommodate the higher patient numbers Maintain cost structure at current level, although this is higher than budget due

to temporary agreement for one addi tional medical officer Provides consistent 7 day coverage for medical officers Assumptions That there is no change in patient numbers Risks Mitigation Potential for gaps in service delivery

in the ward Establish clear protocol for moving

staff between the two areas Staff dissatisfaction over the

consequential need for more frequent weekends rostered-on duty

Consult with staff during the change process

Does not provide any cover for leave and therefore potential for high locum costs

Consider appointment of one additional medical officer to provide leave relief utilising the budget set for leave cover

3. Increase Staffing

Increase medical and nursing staff Increase medical staffing to provide a 7 day service with a second doctor on duty during peak times. This requires 7 doctors for the roster and 8 to provide adequate leave cover and significantly decreased locum costs. Coincide this with an increase in the nursing overlap shift to a provide 7 day coverage. Advantages Improves the A&S cover to accommodate the higher patient numbers Allows the DHB time to review service delivery for the region and models of

care, whilst addressing potential risks Assumptions That there is no change in patient numbers That the length of the overlap shift will remain the same as at present on 4 days

of the week, extending to 7 days Risks Mitigation Increased cost on the budget Consider other cost saving ideas to

offset the increase in expenditure eg. Decrease in locum costs

Delay during recruitment and increased locum cost during this phase

Active recruitment campaign using the new regional recruitment team


Appendix 1 Introduction This paper results from submissions made by medical staff at Lakes District Hospital over a period of several months during which the current interim “swing shift” arrangements were extended to permit the gathering of information and analysis of the claim. These culminated in pressing opportunistic representations from the staff directly to Mr Brian Rousseau, CEO at a meeting in early August 2009 attended also by Ms Lexie O’Shea, COO and Leanne Samuel, Regional Chief Nurse and Midwifery Officer. The proposal to extend the current “swing shift” arrangements to cover the whole week requires addition of at least a 7th medical officer. The Medical Division determined to assess the requests on their merits under the current reality at LDH and without regard to several possible or proposed strategic changes to the delivery of public healthcare in Queenstown. Our aim was to assess the need for the additional staff members against the claim that the current working environment, with one MO on hand at any one time (except during the “swing shifts”) was intrinsically unsafe. Therefore, we have analysed the demand on the hospital using data for the most recent financial years [1/7/08 to 30/6/09 (for some analyses, 1/1/09 – 30/6/09]. Fig. 2 was kindly provided by the reporting team; all other data was extracted and graphed within the Division. Descriptive statistics Figure 1 The annual attendance at LDH has risen progressively in line with population trends each year since the present structure was set up in 2002 (Fig.1, above), without staffing changes until introduction of the swing shift in 2008. In the year under analysis, there were 5985 attendances, equivalent to an average daily attendance of 16.5 patients ± 4.5 (SD). There were no days on which zero patients attended, but 82 nights (from midnight to 0700 hrs) were free of attendances.

Total Lakes ED Presentations

0

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Nov-05

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Jul-0

6

Nov-06

Mar-07

Jul-0

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Nov-07

Mar-08

Jul-0

8

Nov-08

Mar-09


Figure 2 Waiting times in the Emergency Department at LDH have also been subject to a progressive increase. Fig 2 above shows the increase in waiting times by hour of day over the quinquennium 2004-2009. Figure 3 The distribution of attendances by day is skewed to the right and on visual inspection deviates from normality (see Fig. 3 above). This was corrected by log-transformation (not shown) but the corrected average was not much affected (15.7 vs 16.5 patients per day). Thus, reverting to the original distribution and assuming normality, a demand in excess of 21 patients (mean + 1 SD) will occur on about 73 days per year,

Histogram:presentations per day at Lakes1 Jan-30 Jun 2009

0

10

20

30

40

0 4 8 12 16 20 24 28Presentations per day


and a demand in excess of 25 patients (mean + 2 SD) will occur about 10-20 days per year. On the other hand, a demand fewer than 16 patients per day will occur half the time, about 183 days per year. Most patients attend during the 12 hour daytime period 9am to 9pm (4357 of 5928, 73%), an average of 1 patient per hour. Figure 4 There is no difference in the numbers attending on Mon-Thurs and Fri-Sun. The hourly pattern for these two periods is very similar, with a suggestion of a small late afternoon spike on the latter period (Fig 4 above) Figure 5 Fig 5 shows hourly variation in presentations to LDH. Peak presentation rate occurs from 11 am to noon, with a lull over lunchtime and an afternoon peak which is sustained until late evening. Modelling (not shown) suggests that the patient load expressed as patient numbers in ED is reduced by the additional doctor present in the swing shift.

Numbers at Lakes by hr and week period

00.20.40.60.8

11.21.41.61.8

1 3 5 7 9 11 13 15 17 19 21 23

Hr periods (0=Midnight - 1.00am)

Mon-ThurFri-Sun

Total

0

50

100

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0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

(bla

nk)

Count of Hr of triage

Hr of triage


Figure 6 Fig 6 above shows the day-to-day variation in attendances in two triage groups: categories 1 and 2 (brown plot) and 3-5 (blue (upper) plot). Figure 7 Fig. 7 above shows the variation in the number of attendances over the busiest hour of the day. Each column represents the number of days on which the number of patients plotted on the abscissa attended. The data indicate that 0, 1 or 2 patients are seen on the busiest hour of the day on 314 days of the year, and 3 or more patients are seen on the remaining 52 days (2008 was a leap year).

0

5

10

15

20

25

30

35

21

Count of Amended twice

Date_Of_Presentation

Amended twice

No. of days by No. of attendances, 11am-12 noon 1 July 2008-30 June 2009

0

20

40

60

80

100

120

140

0 1 2 3 4 5 6 7

No. patients seen in hr

No o

f day

s


Figure 8 Fig 8 above shows the minimum, maximum and average number of attendances by hourly period throughout the day. The pink line is the same as Fig 1 on a different scale. The minimum in any 1 hour period is always zero and the maximum, though substantially greater than the mean, is an uncommon event, consistent with the skew in the frequency distribution as discussed above Ward Activity In addition to attending ED, MOs at LDH have clinical responsibility for inpatients who are admitted from the ED for stabilization prior to discharge or transfer, or treatment of disorders not requiring the facilities or consultant-level expertise. Data from calendar year 2009 shows a LOS of less than one day and 5.6 patient movements per day (admissions plus discharges) on average. The 10 beds are fully occupied on 2 nights per year (measured as the census at 11pm). Discussion - Medical Staffing Day-to-day and hour-to-hour variation in any emergency facility is inevitable and is reflected in the above graphs, particularly Fig 6, which also demonstrates that both the average and peak loads are due, predominantly and exclusively respectively, to triage category 3-5 patients. Any policy under which the lower triage categories can be diverted to alternative service modes will substantially reduce the workload on hospital staff and the need for additional staff. There is no difference in attendances in the two weekly periods affected by different rosters and hence no logical basis, on grounds of patient demand, for two different roster systems on Mon-Thur and Fri-Sun. The workload shows a marked diurnal swing, as anticipated, and the average hourly rates of presentation vary from 0.2 to 1.8 patients per hour, on average. The highest number of patients presenting in any one hour (a single occurrence) was 7. The steep increase in patient numbers occurring just prior to noon is likely to be affected by the diversion of the medical resources to admitting, treating, and discharging inpatients. On the basis that each admission and discharge consumes about 30 minutes on average, this represents an average daily time requirement of nearly 3 hours, during which time patients are likely to bank up in ED. Thus when the MO on duty completes his or her inpatient duties on or around noon, 4 patients on average

Minimum, average and maximum No. of attendances, by hourly period 1 July 2008-30 June 2009

0

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Hour period (midnight - 0100 = 0)

Num

ber o

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ndan

ces


will be waiting to be seen in the ED. On busier days, where the backlog is even greater, it is likely that the backlog takes several hours to clear. Though these data are clearly the basis for the staffing requirement at LDH, the relationship between patient numbers attending the ED and the staff required to handle that workload under an optimum rostering system, taking account of leave and CME requirements, is not clear. According to the Australasian College of Emergency Medicine, a department seeing 25,000 patients per year should have 9.3-9.7 FACEM FTE depending on leave cover,* but this figure assumes sole ED duties (including non-clinical time) and presence of registrars. Departments with less demand are not considered because 25,000 is the minimum attendance required for ACEM accreditation. How the ACEM figure translates into a Medical Officer service with 6000 attendances per year and no registrar backup but including responsibility for 11 inpatient beds is problematical. After much thought and on listening to the witness of the medical staff concerned, the Division has concluded that the current demand at LDH with the current configuration of healthcare at that site is at about the limit that can be reasonably expected of a single-person operation. If it can be deemed that this condition has not been satisfied to date, then we have no doubts it shortly will. This point of view is emphasized by the attendance figures for July and August 2009, which show a quantum increase to 650 and 680 patients respectively (annualized, 8160, a potential increase of 37% over the fiscal year data used in our analysis). In addition, such peaks at other times of the year (Christmas, Easter) are well recognised.

* http://www.acem.org.au/media/policies_and_guidelines/G23_Constr_Workforce.pdf


Southland DHB HAC Meeting – 09 December 2009 Mental Health Division Update

MENTAL HEALTH SERVICES UPDATE

HAC Meeting Date: 09 December 2009 Report Prepared By: Louise Travers, Divisional Manager

Dr Alfred Dell’Ario, Divisional Director Jane Collins, Director of Nursing

Date Prepared: 25 November 2009 Recommendation That the Committee receives and notes this report.

1. Service Summary

• Mental Health Awareness Week was held on 05 – 11 October 09. A diverse range of successful events were delivered collaboratively by mental health and addiction service providers, mental health promotion and consumer and family groups. This activity attracted positive media attention

• Verona Cournane, clinical team leader for Wakatipu Community Mental Health received a community award by the Queenstown District Council for her work with mental health education

training and workforce development activity has included a joint workshop held with Otago mental health services and facilitated with Te Pou (national centre of mental health research, information and workforce development) on Health of the Nation Outcome Scales (HoNOS) outcomes. Matu Raki (national addictions workforce development centre) also provided a workshop to the sector on alcohol and addiction issues attended by 45 people

• currently the service has a very low level of vacancies. All psychologist positions have been recruited to

• Southland Mental Health Emergency Team saw an increase in first presentation clients to their service – 50 compared to 33 in the previous month. However, overall activity remained consistent with the previous month

2. Quality Initiatives Systems and Information Improvements • seclusion reporting via the Patient Management System (iPM) is now aligned with local clinical

processes and national manual reporting of events, and the Ministry of Health are now considering terminating the manual reporting aspect of this

• Needs Assessment Service Coordination (NASC) management system is now being upgraded to enable collection of actual start and end dates of non government organisation (NGO) delivered services

Workforce Development • Four “Hearing Voices” workshops were held for clinicians and consumers and their families.

The workshops focused on the use of digital media that allowed participants to experience the feeling of actually hearing voices while continuing a daily routine of interviews, shopping and complex tasks. Feedback was extremely positive from all attendees

• Mothers and Babies regional service workshop attracted the large number of 65 attendees from both the provider arm and non government organisation sector. The subject was “Early Attachment” which is an important theme arising in the child and adolescent mental health sector



Orientation for New Staff • this project is reviewing and updating the mental health orientation process to provide a generic

and consistent process across all teams. Consultation is underway on the first draft of the orientation booklet for new staff

Future Directions Network Representative Group Southland NGO forum met on 28 October 09 which included a quality development workshop

titled “Measuring Client Outcomes” which was facilitated by Te Pou. These forums continue to attract a diverse range of NGOs including new members

Te Pou held a one day NGO leadership workshop in Invercargill on 01 October 09 for NGOs from Southland and Otago. The workshop was an opportunity to give Te Pou feedback about local workforce development issues and priorities and included a presentation on the “Let’s Get Real” competencies framework

3. Contract Performance

Mental Health Promotion • the focus for this month was Mental Health Awareness Week with participation in a wide range

of health promotion activities

4. Financial Performance – October 2009

Month Year to Date Annual

Actual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

1,561 1,721 (160) Revenue 6,618 6,884 (266) 20,651(1,154) (1,291) 137 166.68 178.24 Less Personnel Costs (4,550) (5,107) 557 (15,239)

(114) (21) (93) Less Outsourced Costs (300) (85) (216) (254)(11) (13) 2 Less Clinical Supplies (43) (50) 7 (149)

(101) (122) 20 Less Infrastructure & Other Costs (404) (487) 83 (1,435)181 274 (93) Net Surplus (Deficit) before Overheads 1,321 1,154 166 3,573

(242) (266) 24 Overhead Allocation (1,099) (1,064) (36) (3,500)(61) 8 (70) Direct Net Surplus / (Deficit) 221 91 131 73

Add Divisional Share of Savings Target 26 18 8 53Result After Savings Target Adjustment 247 109 139 126

AnnualActual Budget Variance Actual Budget Variance Budget

FTE FTE FTE FTE FTE FTE FTE

10.81 13.83 3.02 Medical Personnel 10.22 13.85 3.63 12.7677.38 75.53 (1.85) Nursing Personnel 77.53 75.53 (2.00) 75.5352.39 61.02 8.63 Allied Health Personnel 50.83 61.02 10.19 61.02

0.00 0.00 0.00 Support Personnel 0.00 0.00 0.00 0.0026.10 27.86 1.76 Management & Admin Personnel 26.49 27.86 1.37 27.86

166.68 178.24 11.56 Total Personnel 165.07 178.26 13.19 177.17

Month Year to Date

Mental health services had an operating deficit of $61k for October 2009 against a budgeted surplus of $8k. This produced an unfavourable variance to budget of $70k with a favourable year to date (YTD) variance to budget of $131k. These figures are after the overhead calculation for October 2009 has been applied.

FTEs for October 2009 are under budget by 11.56.

The revenue variance is $160k under budget for October 2009. The wash-up back to funder arm is $62k. YTD wash-up back to funder is $276k. An internal revenue error of $100k has been corrected in October 2009.



Expenses, including overheads, show a favourable variance of $90k for the month, YTD expenses are tracking $395k under budget.

• salaries are under budget by $137k for the month, YTD under budget by $557k. This is reflected in the 11.56 FTE variance to budget for the month and 13.19 FTE YTD

• outsourced expenses show a $93k unfavourable variance from budget for the month, YTD unfavourable variance of $216k being mostly locum cover for the senior medical staff vacancies

• infrastructure and non-clinical supplies show a favourable variance of $20k for the month, YTD favourable variance of $83k

5. Emerging issues/risks/mitigation

Emerging risks for the mental health division are: Risk Mitigation Ability to meet access targets may be compromised by not and/or staging appointments to vacancies

Monitoring by divisional leadership team

Difficulty in finding accommodation for patients with enduring mental illness is blocking acute inpatient beds

Ongoing discussions with planning and funding and providers locally and regionally to find placements

Potential gap in clinical service delivery for older people

Mental Health and Medical divisions are close to confirming a clear clinical pathway


SDHB HAC Meeting – 09 December 2009 Surgical Division Update

SURGICAL DIVISION UPDATE HAC Meeting Date: 09 December 2009 Report Prepared By: Peter Bramley, Divisional Manager David Tulloch, Divisional Director Helen McKenzie, Director of Nursing Date Prepared: 25 November 2009 Recommendation That the Committee receives and notes this report.

1. Service Summary

• elective service performance indicators (ESPI’s) were green in September 2009 (appendix 4c)

• orthopaedics is now complaint from an ESPI perspective – though continues to be at risk for both first specialist assessments (FSA) and long wait surgical procedures

• elective services delivered 331 case weighted discharges (CWD) for October 2009. The monthly target was behind plan by 7 CWD, and is now behind by 42 CWD YTD (appendix 4a)

• overall (acute and elective) the surgical division has delivered 201 CWD more than budget and 360 CWD more than at the same time last year. This highlights the high acute demand in 2009

• a shortage of anaesthetic resource has affected the delivery of elective surgery. Twenty-two theatre sessions in October 2009 did not go ahead due to the lack of anaesthetic consultants

• a regional plastics service for Southland and Otago has begun • a regional Ear Nose Throat (ENT) service is currently being scoped • performance by speciality (appendix 4b) • patients certainty wait time for treatment (appendix 4d) • the etexting pilot project has been completed. An update report is attached (appendix 4e)


• the patient focussed booking trial is being extended across more specialities • a project plan has been developed for the implementation of the recommendations from the

review of our referral processes. This project begins in November 2009 • the project plan has been scoped to review our pre-admission pathway to improve the

experience of our patients, and to minimise cancellations of elective surgery. Benchmark data is being collected from other hospitals




• Southland Hospital is 3 orthopaedic joints behind in its YTD planned delivery for October 2009. With respect to cataracts Southland Hospital is 3 behind in its planned delivery YTD

• key areas of variance with outpatient delivery –

HAC Group Actual YTD

Volume

Budgeted YTD

Volume

YTD Volume

Variance

% of YTD Budget

Reached

Comments

Breast Outpatients 377.00 194.40 182.60 93.93% Outpatient volumes are now being captured correctly. Corresponding decrease in General Surgery volumes

General Surgery Outpatients 1155.00 1494.00 (339.00) (22.69%) The arrival of the 4th general surgeon will facilitate the delivery of outpatient clinics

Ophthalmology Outpatients 1711.00 1440.00 271.00 18.82% Tracking ahead of target for outpatient delivery due to the timing of Ophthalmologist visits

Orthopaedics Outpatients 2753.00 1736.00 1017.00 58.58% High acute demand is impacting on outpatient volumes

Urology Outpatients 586.00 528.48 57.52 10.88% Higher volume reflects the arrival of the locum urologist

• the theatre compass project continues to drive improvement in theatre performance. A

project around improving the variance in actual to expected surgical case length for procedures has been started, with a view to reducing overruns, and provide more effective booking of surgical lists. A project has also begun to try and improve the utilisation of our acute theatre



4. Financial Performance

Month Year to Date Annual

Actual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

241 101 140 Revenue 643 405 238 1,215 (1,343) (1,476) 133 219.04 220.71 Less Personnel Costs (5,764) (5,770) 6 (17,373)

(336) (254) (82) Less Outsourced Costs (868) (1,015) 147 (3,279) (688) (629) (59) Less Clinical Supplies (2,629) (2,498) (131) (7,411) (114) (117) 3 Less Infrastructure & Other Costs (466) (465) (1) (1,379)

(2,240) (2,375) 135 Net Surplus / (Deficit) (9,084) (9,343) 259 (28,227)Add Divisional Share of Savings Target 16 131 (115) 448Result After Savings Target Adjustment (9,068) (9,212) 144 (27,779)

Annual

Actual Budget Variance Actual Budget Variance BudgetFTE FTE FTE FTE FTE FTE FTE

14.10 15.80 1.70 Medical Personnel 16.18 15.80 (0.38) 15.80 135.21 134.29 (0.92) Nursing Personnel 137.80 134.29 (3.51) 134.29

7.96 10.09 2.13 Allied Health Personnel 7.91 10.09 2.18 10.09 11.10 10.89 (0.21) Support Personnel 10.72 10.89 0.17 10.89 50.67 49.64 (1.03) Management & admin Personnel 50.52 49.64 (0.88) 49.67

219.04 220.71 1.67 TOTAL PERSONNEL 223.13 220.71 (2.42) 220.74

Month Year to Date

The surgical division is reporting a favourable variance of $135k for October 2009 and a year to date (YTD) variance of $259k favourable against budget. Revenue is $140k favourable for October 2009 and is $238k favourable YTD against budget. The variance is due mainly to:

• Accident Compensation Corporation (ACC) income is $98k favourable for October 2009 and $122k favourable YTD

• non resident income is $10k favourable for the month and $104k favourable YTD Expenditure overall is $5k unfavourable in October 2009 and is $21k favourable YTD against budget. The main reasons for the variance is:

• personnel costs are $133k favourable for the month and $6k favourable YTD. The October 2009 variance is due to medical personnel $115k favourable and nursing personnel $15k favourable

• outsourced costs are $82k unfavourable for October 2009 and $147k favourable YTD • overall medical personnel and medical outsourced costs are $146k favourable in October

2009 and $296k favourable YTD • clinical supplies are $59k unfavourable against budget in the month and $131k

unfavourable YTD, reflecting patient volumes – acute and elective work



5. Risks and Mitigation

Key risks for the surgical division continue to be around clinical staff resourcing. Risk Mitigation A shortage of anaesthetic consultants is limiting elective surgery

Ongoing recruitment

The upcoming retirement of the ENT consultant will potentially impact the delivery of ENT clinical services

Ongoing recruitment

A shortage of experienced theatre nurses will potentially limit elective service delivery

Ongoing recruitment


SDHB HAC Meeting – 09 December 2009 Performance by Department Update – 2009/10

PERFORMANCE BY DEPARTMENT This section illustrates the year to date performance of each department to October 2009 and progress towards SDHB meeting the objectives outlined. Dental The dental department at the end of October 2009 is 10 CWD behind its plan. Anaesthetic shortage has impacted elective delivery.

Dental - Cumulative Total Of Elective Costweights

-

20

40

60

80

100

120

140

160

180

200

YTD 2009/10 16 25 41 54

Actual 2008/09 20 34 46 58 78 100 113 128 143 153 159 166

Budget 2009/10 16 32 48 64 80 92 105 121 137 149 165 178

Jul Aug Sep Oct Nov Dec Jan Feb M ar A pr M ay Jun

Ear Nose and Throat (ENT) The ENT department at the end of October 2009 is 1 CWD behind its plan.

ENT - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 31 55 89 119

Actual 2008/09 29 50 74 100 133 154 166 190 236 267 301 329

Budget 2009/10 30 60 90 120 150 174 197 227 257 281 311 334




Ophthalmology The ophthalmology department at the end of October 2009 is 48 CWD ahead of its plan.

Ophthalmology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 47 89 119 165

Actual 2008/09 9 30 71 111 155 183 208 239 273 301 336 375

Budget 2009/10 29 58 88 117 146 169 191 220 250 272 302 324


General Surgery The general surgery department at the end of October 2009 is 31 CWD ahead its plan.

General Surgery - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

YTD 2009/10 134 240 301 409

Actual 2008/09 90 181 277 380 478 548 617 694 784 882 991 1,078

Budget 2009/10 95 189 284 378 473 547 620 715 809 883 978 1,051




Gynaecology The gynaecology department at the end of October 2009 is 59 CWD behind its plan. A shortage of obstetric and gynaecology consultants continued to impact elective delivery.

Gynaecology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

450

YTD 2009/10 28 56 69 82

Actual 2008/09 14 27 67 91 135 171 200 233 263 291 325 342

Budget 2009/10 35 71 106 141 176 204 231 266 302 329 364 392


Orthopaedics The orthopaedic department at the end of October 2009 is 3 CWD behind its plan.

Orthopaedics - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

1,400

YTD 2009/10 51 159 241 336

Actual 2008/09 36 129 216 314 408 490 608 690 793 865 941 1,016

Budget 2009/10 73 157 242 339 448 545 678 774 896 992 1,113 1,210




Paediatric Surgery Paediatric surgery at the end of October 2009 is 5 CWD behind its plan.

Paediatric Surgery - Cumulative Total Of Elective Costweights

-

10

20

30

40

50

60

YTD 2009/10 4 8 12 12

Actual 2008/09 5 5 10 10 14 22 22 25 31 37 44 49

Budget 2009/10 4 9 13 17 21 25 28 32 36 40 44 47


Urology The urology department at the end of October 2009 is 40 CWD behind its plan. Anaesthetic shortage impacted the elective delivery in urology.

Urology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 24 46 60 86

Actual 2008/09 26 61 99 132 174 192 227 244 272 307 325 341

Budget 2009/10 31 63 94 126 157 182 206 237 269 293 325 349




Plastics Plastics are procedures carried out by SDHB’s oral-maxillo facial surgeon who also contributes to the dental CWD. For the end of October 2009 this specialty is 3 CWD behind its plan.

Plastics - Cumulative Total Of Elective Costweights

-

5

10

15

20

25

30

YTD 2009/10 2 2 4 5

Actual 2008/09 1 7 9 10 12 14 14 15 20 22 24 26

Budget 2009/10 2 4 6 8 10 12 13 15 17 19 21 22

Jul A ug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun


MoH Elective Services OnlineComparison of surgical services for September 2009

Data Warehouse Refresh Date:

Report Run Date:

28/Oct/2009

28/Oct/2009

1.DHB services thatappropriately acknowledge

and process all patientreferrals within ten working

days.

2.Patients waiting longerthan six months for their

first specialist assessment(FSA).

3.Patients waiting without acommitment to treatment

whose priorities are higherthan the actual treatment

threshold (aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to treatmentbut not treated within six

months.

6.Patients in active reviewwho have not received a

clinical assessment withinthe last six months.

7.Patients who have notbeen managed according to

their assigned status andwho should have received

treatment.

8.The proportion ofpatients treated who wereprioritised using nationallyrecognised processes or

tools.

Service Name Level Status Imp.Req.

Level Status Imp.Req.







Dental 1 of 1 100.0 % 0 X 0.0 % X 3 0.0 % 0 0 0.0 % 0 15 4.4 % 0 0 0.0 % 0 15 4.4 % 0 32 100.0 % 0 %

Ear, Nose & Throat 1 of 1 100.0 % 0 42 3.3 % -17 9 0.0 % 0 0 0.0 % 0 43 7.2 % -14 0 0.0 % 0 23 3.8 % 0 61 100.0 % 0 %

General Surgery 1 of 1 100.0 % 0 0 0.0 % 0 33 3.6 % 0 0 0.0 % 0 17 1.8 % 0 0 0.0 % 0 16 1.7 % 0 47 100.0 % 0 %

Gynaecology 1 of 1 100.0 % 0 12 1.3 % 0 4 0.0 % 0 0 0.0 % 0 4 0.0 % 0 1 0.0 % 0 3 0.0 % 0 28 100.0 % 0 %

Neurosurgery 1 of 1 100.0 % 0 0 X 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 0 0.0 % 0 X X X

Ophthalmology 1 of 1 100.0 % 0 5 0.0 % 0 28 3.6 % 0 0 0.0 % 0 1 0.0 % 0 1 0.0 % 0 0 0.0 % 0 57 100.0 % 0 %

Oral Maxillo 1 of 1 100.0 % 0 0 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 0 0.0 % 0 X X X

Orthopaedics 1 of 1 100.0 % 0 50 1.4 % 0 4 0.0 % 0 0 0.0 % 0 28 5.0 % 0 1 0.0 % 0 28 5.0 % 0 54 100.0 % 0 %

Paediatric Surgery 1 of 1 100.0 % 0 1 0.0 % 0 0 0.0 % 0 0 0.0 % 0 2 0.0 % 0 0 0.0 % 0 2 0.0 % 0 5 100.0 % 0 %

Plastics 1 of 1 100.0 % 0 0 0.0 % 0 10 34.5 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 3 100.0 % 0 %

Urology 1 of 1 100.0 % 0 1 0.0 % 0 11 3.0 % 0 0 0.0 % 0 1 0.0 % 0 0 0.0 % 0 1 0.0 % 0 28 100.0 % 0 %

Total 111 102 0 111 3 88 315

This report displays ESPI results for individual surgical services. The ESPI results do not include non-elective patients or elective patients awaiting planned and staged procedures. ESPIs 3, 7 and 8 assess surgical specialties where patients areprioritised using nationally recognised tools - including General Surgery from 01 January 08 and Vascular and Urology from 01 July 08. So, Medical specialties are currently excluded from the ESPI results. Please contact the Ministry of Health's ElectivesTeam if you have any queries on the ESPI definitions (details on electives website). NZHIS's Analytical Services Team can assist with providing variations of this information e.g data for a particular DHB or period (details on the NZHIS website -http://www.nzhis.govt.nz/ ).

DHB Name: Southland

http://www.nzhis.govt.nz/

MoH Elective Services OnlineSummary of Patient Flow Indicator (ESPI) results for each DHB

This report displays overall ESPI results for a DHB over a 12 month period. The ESPI results do not include non-electives or elective patients awaiting planned / staged procedures. ESPIs 3, 7 and 8 assess surgical specialtieswhere patients are prioritised using nationally recognised tools - including General Surgery from 01 January 08 and Vascular and Urology from 01 July 08. So, Medical specialties are currently excluded from the ESPI results.Please contact the Ministry of Health's Electives Team if you have any queries on the ESPI definitions (details on electives website). NZHIS's Analytical Services Team can assist with providing variations of this information e.g datafor a particular DHB or period (details on the NZHIS website - http://www.nzhis.govt.nz/ ).

Page 1 of 1Data Warehouse Refresh Date:

Report Run Date:

03/Oct/2009

05/Oct/2009

1.DHB services thatappropriately

acknowledge andprocess all patientreferrals within ten

working days.

2.Patients waitinglonger than six

months for their firstspecialist

assessment (FSA).

3.Patients waitingwithout a

commitment totreatment whose

priorities are higherthan the actual

treatment threshold(aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to

treatment but nottreated within six

months.

6.Patients in activereview who have not

received a clinicalassessment withinthe last six months.

7.Patients who havenot been managedaccording to their

assigned status andwho should have

received treatment.

8.The proportion ofpatients treated who

were prioritisedusing nationally

recognisedprocesses or tools.

20080901

Level

26 of26

229

67

0

88

11

78

329

2008

Sep

Status %

100.0%

1.8%

1.9%

0.0%

2.6%

6.2%

2.3%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081001

Level

26 of26

252

70

0

84

4

69

360

2008

Oct

Status %

100.0%

2.0%

2.0%

0.0%

2.4%

0.0%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081101

Level

26 of26

252

134

0

75

7

61

417

2008

Nov

Status %

100.0%

1.9%

3.6%

0.0%

2.0%

0.0%

1.7%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081201

Level

26 of26

246

72

0

64

7

57

282

2008

Dec

Status %

100.0%

1.9%

2.0%

0.0%

1.7%

0.0%

1.5%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090101

Level

26 of26

254

44

0

68

7

60

293

2009

Jan

Status %

100.0%

1.9%

1.2%

0.0%

1.8%

0.0%

1.6%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090201

Level

26 of26

256

114

0

79

7

71

309

2009

Feb

Status %

100.0%

2.0%

3.0%

0.0%

2.1%

0.0%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090301

Level

26 of26

251

81

0

85

9

74

377

2009

Mar

Status %

100.0%

1.9%

2.1%

0.0%

2.2%

0.0%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090401

Level

26 of26

211

85

0

93

10

81

328

2009

Apr

Status %

100.0%

1.6%

2.2%

0.0%

2.4%

4.7%

2.1%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090501

Level

26 of26

180

65

0

111

9

91

377

2009

May

Status %

100.0%

1.3%

1.6%

0.0%

2.8%

0.0%

2.3%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090601

Level

26 of26

146

39

0

113

6

88

290

2009

Jun

Status %

100.0%

1.1%

1.0%

0.0%

2.8%

0.0%

2.2%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090701

Level

26 of26

149

84

0

98

6

83

377

2009

Jul

Status %

100.0%

1.1%

2.1%

0.0%

2.4%

0.0%

2.0%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090801

Level

26 of26

140

104

0

99

5

83

331

2009

Aug

Status %

100.0%

1.0%

2.6%

0.0%

2.4%

0.0%

2.0%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

Target

> 90%

< 2%

< 5%

< 5%

< 5%

< 15%

< 5%

> 90%

DHB Name: Southland

http://www.nzhis.govt.nz/

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at October 2009 (Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

34

9 88 7

4 2 2 0 1 0 2 2

264

114 11575 74

45 31 24 10 12 2 8 13

0

50

100

150

200

250

300

350

400

0 1 2 3 4 5 6 7 8 9 10 11 >=12

Months Waiting

No

of

pa

tie

nts

Dental ENT General Surgery Gynaeco logy Ophthalmology Oral M axillo Facial Orthopaedics Paediatric Surgery Uro lo gy To tal Bo oked


SDHB HAC Meeting – 9 December 2009 Minimising DNAs

MINIMISING DID NOT ATTENDS (DNA) HAC Meeting Date: 09 December 2009 Report Prepared By: Peter Bramley, Divisional Manager David Tulloch, Divisional Director Helen McKenzie, Director of Nursing Date Prepared: 25 November 2009 Recommendation That the Committee receives and notes this report.

1. Background

• a text messaging system was used as way of communicating a reminder with patients one day before an outpatient appointment with the purpose of lessening DNAs

2. Outcome

• the project was trialled for three months from July - September 2009

• only 36% of people attending a clinic were able to be sent a text reminder

• a comparison of DNA rates for the same clinics for the same period in 2008 compared to 2009, showed the DNA rate decreased by 3.1% - from 11.7% to 8.6%

• this decrease in DNA rates represented an additional 263 patients attending their clinic appointment

• the cost of the project for three months was $2,328.38

3. Challenges Identified

• to fully implement this solution changes to administration processes are required to support the introduction of the texting service

4. Next Steps

• SDHB will continue with texting reminders and consider implementing this service to all clinical services, once a full costing has been done and the challenges identified have been mitigated

• there will be a continued focus to securing cell-phone numbers for patients


SDHB HAC Meeting – 09 December 2009 Women and Children Division Update

WOMEN AND CHILDREN DIVISION UPDATE HAC Meeting Date: 09 December 2009 Report Prepared By: Lynley Irvine, Women and Children’s Division

Dr Ian Shaw, Divisional Director Jenny Humphries, Director of Nursing and Midwifery

Date Prepared: 25 November 2009

Recommendation That the Committee receives and notes this report. 1. Service Summary Commercial Services

• a final decision has been made to bring food services in house and this will be part provided from Otago district health board (DHB)

• demolition of the rear wings of the nurses home is underway and staff have been

relocated as required Obstetrics and Gynaecology Services

• recruitment continues with several candidates to commence in the new year for contracts of between 3 – 12 months. This will ensure some stability in the workforce for 2010. Candidates for permanent posts are still being sourced

Oral Health Services

• a number of procurement initiatives are underway in an effort to reduce clinical consumable costs

• recruiting of dental therapists will be crucial to cover expected retirements. New

graduates have indicated the wish to practice as hygienists and therapists creating problems as funding is not available for hygiene work.

Well Child Services

• statistics for phase three of before school checks (B4SC) for the first quarter are to be made public with Southland DHB sitting at 8.1% on the table (in progress or complete). This was due to the delay in recruitment of staff for the cont inuation of this programme, the end of October 2009 data shows SDHB is at 33% of the 2009/10 target

Maori Health

• a course regarding living a healthy life which is being led by the Maori health unit and Awarua social and health services begun in early November 2009. This is a collaborative initiative being piloted in the community which will target people living with a chronic condition


• a policy on infant feeding is being finalised in conjunction with the lactation consultant and the director of midwifery. Guidelines for formula and bottle feeding has also been developed

• the process for managing reportable events is currently under review in order to

improve times from date of incident to date of receipt by the quality unit



3. Service Highlights Education Review Office (ERO) visit The hospital playroom underwent a visit from the education review office in late October 2009. The review was largely positive with a particular mention of the sense of “belonging” to the service which is fostered through the play specialist service. The team commented on how busy the playroom was on the day of observation, (even mentioning that in fact it had been the busiest session they had observed including Christchurch and Dunedin). This day had been a very busy theatre morning and observations of preparation for surgery of children and their families and a strong interface with ward staff being commended. The reviewers commented on a well resourced playroom and a well supported team environment that was evident from early in the visit. The ward environment had a strong child focus with notice boards for parent education and children’s artwork added to the great sense of belonging of the many children within the area. It is expected that the written report will be available in a few weeks time.




HAC Group Actual YTD Volume

Budgeted YTD

Volume

YTD Volume

Variance

% of YTD Budget

Reached

Mitigation Comments

Inpatients

Dental Acute 7.03 6.23 0.80 12.78% Demand driven

Dental Elective 53.78 63.96 (10.18) (15.92%) Additional session will be undertaken when available

YTD position remains static

Plastics Elective 4.85 8.00 (3.15) (39.36%) Very low volume of variance influenced by the Acute workload

Gynaecology Acute

68.67 56.69 11.98 21.14% Demand driven

Gynaecology Elective

81.82 141.01 (59.19) (41.98%) Plans to increase outpatient clinics in new year

Impact of staff shortage and low volume of outpatient clinics

Paediatric Surgical Acute

- 1.75 (1.75) (100.00%) Small volume of Acute work usually IDF

Paediatric Surgical Elective

11.97 17.06 (5.09) (29.82%) No elective surgery undertaken in month due to anaesthetic availability

Paediatric Medicine Acute

303.64 208.14 95.50 45.88% Sustained high volume of demand

Maternity Elective 3.16 19.11 (15.94) (83.46%) Review Acute and Elective together, 4.7% variance on total volume

Outpatients

Emergency Dental Outpatient

513.00 600.00 (87.00) (14.50%) Lessening demand increasing YTD variance

Paediatric Medical Outpatient - New

181.00 216.00 (35.00) (16.20%) Planning for extra clinics from Dec 2009 forward

Paediatric Medical Outpatient - FU

896.00 807.84 88.16 10.91%

Gynaecology - New

203.00 253.08 (50.08) (19.79%) Staffing levels Jan 2010 on should improve variance

Affected by Staff shortage

Gynaecology - FU 259.00 379.80 (120.80) (31.81%) Staffing levels Jan 2010 on should improve variance

Affected by Staff shortage

Paediatric Surgery Outpatient - FU

79.00 61.20 17.80 29.08% Extra outpatient clinics in lieu of surgery greatly improved YTD position from September

Plastics (including Burns and Maxillofacial) - New [Dental]

128.00 95.76 32.24 33.67% Reflects the changes to mapping procedures. Volume realignment to be considered

Plastics (including Burns and Maxillofacial - FU [Dental]

148.00 91.80 56.20 61.22% Reflects the changes to mapping procedures. Volume realignment to be considered



5. Financial Performance

Month Year to Date AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

116 142 (27) Revenue 373 570 (197) 1,709(1,024) (1,156) 132 165.88 173.61 Less Personnel Costs (4,217) (4,541) 324 (13,647)

(83) (122) 38 Less Outsourced Costs (526) (486) (40) (1,458)(192) (213) 22 Less Clinical Supplies (830) (847) 17 (2,514)(228) (238) 10 Less Infrastructure & Other Costs (921) (953) 32 (2,803)

(1,411) (1,586) 175 Direct Net Surplus / (Deficit) (6,122) (6,257) 135 (18,712)Add Divisional Share of Savings Target 17 43 (26) 245Result After Savings Target Adjustment (6,105) (6,214) 109 (18,467)

AnnualActual Budget Variance Actual Budget Variance Budget

FTE FTE FTE FTE FTE FTE FTE

8.79 9.84 1.05 Medical Personnel 9.71 9.85 0.14 9.8499.32 99.45 0.13 Nursing Personnel 98.33 99.45 1.13 99.4531.32 37.85 6.53 Allied Health Personnel 31.06 37.85 6.79 37.851.70 2.20 0.50 Support Personnel 2.08 2.20 0.12 2.20

24.75 24.27 (0.48) Management & admin Personnel 23.75 24.27 0.52 24.27165.88 173.61 7.73 Total Personnel 164.93 173.62 8.69 173.61

Month Year to Date

The women and children’s division is reporting a year to date (YTD) favourable variance of $135k against budget, with a movement of $175k favourable in October 2009. FTEs are 7.73 under budget for the month and 8.69 under plan YTD. Revenue is $27k unfavourable for October 2009; YTD is $197k unfavourable. The key variance is against the operational portion of the oral health business case. Expenditure is $202k favourable for October 2009; YTD is $333k favourable.

• personnel costs are $132k favourable for October 2009, YTD $324k favourable. The FTEs are 7.73 under budget for the month

• outsourced services are $38k favourable for October 2009, YTD $40k unfavourable. This variance relates to locum cover for senior medical staff

• infrastructure and non-clinical supplies are $10k favourable for October, YTD $32k favourable

• clinical supplies are $22k favourable for October 2009, YTD $17k favourable

6. Risks and Mitigation Risk Mitigation A current shortage of obstetric and gynaecology consultants

Ongoing recruitment

Predicted vacancies in junior doctor staffing in obstetrics, gynaecology and paediatric services

Ongoing recruitment. However contingency planning will be implemented for O&G as there has been limited response to advertising and very few locums making themselves available


SDHB HAC Meeting – 9 December 2009 Human Resources Report

HUMAN RESOURCES (HR) REPORT

HAC Meeting Date: 9 December 2009 Report Prepared By: Karyn Penno Regional GM Human Resources Date Prepared: 23 November 2009

Recommendation That the Committee receives and notes this report.

1. Service Summary

Human Resources Information Systems / Payroll Scoping is underway to determine the requirements and costs to utilise the recruitment and some associated modules including electronic filing within Employee Connect. Work has also started on the planned payroll upgrade. The existing Datacom PeopleManager system will be replaced next year with a web-based payroll system, also supplied by Datacom. This is at no additional cost but will increase functionality. Recruitment Key work for recruitment during October 2009 included the following: • centralised and regionalised recruitment agency database project underway in conjunction

with procurement • industry project fund approved by the Dunedin City Council. We are now progressing to hire

an external resource with Otago University and Mercy Hospital to research senior medical officer (SMO) recruitment issues. Although this funding is specific to Otago (as it is provided via the Otago Economic Development Unit) we anticipate that the findings from this project will have equal validity and applicability for SMO recruitment activity in Southland

• talent-pool, Alumni and Employee Referral programmes now scoped and awaiting approvals. Alumni newsletter being produced for SMO level as initial trial

Southland Otago

Allied 3 6

Support/Management/Corporate/Admin 8 16

Nursing 7 23

New vacancies actively being recruited for

SMO 0 4

Total 18 49

Allied 7 3


Nursing 16 6

New vacancies from pre-October still actively being recruited SMO 0 12

Total 23 24

Allied 4 4


Nursing 20 39

Vacancies filled in October

SMO 0 1

Total 30 49



Learning and Development HR management series pilot programme delivery continues with the following modules having been facilitated this month:

• Southland DHB: Occupational Health and Safety; recruitment practice; leave management Leadership and management development activity is continuing in both DHB’s with Southland senior leadership group workshop programme discussions and programme and content definition discussions in Otago. Workforce Information Participation and input into local discussions regarding information and reporting needs. SDHB Incubator Programme Key activity for October 2009 included:

• delivery of session 6 in October 2009, the final classroom session with the students

• site visit to Peacehaven Village in October 2009

• presentation at regional Otago/Southland careers forum on 21 October 2009

• Aurora College teacher and student meetings held on 30th October 2009

• preparation and development of end of programme evaluation activity and report

• 2010 planning activity continues

• preliminary discussions held regarding a proposed approach for an Otago pilot Regional Policy and Procedure Development Work continues on development of a regional human resources policy platform. Harassment, performance appraisal and management and leave management policies are currently being worked on and scoped up for consultation. Regional change management guidelines are now complete and awaiting final sign off. This work will now form part of the agreed South Island DHB approach to policy and procedure development, with scoping commencing on how to approach policy development from a South Island region perspective. Potential policies identified for regionalisation at this level include recruitment, disciplinary, performance management; leave management, management of change and continuing medical education (CME) management.

2. Employment Relations

South Island Clerical MECA PSA The parties met with assistance from the mediation service on 2 October 2009. Despite a minor amendment to the union’s position the claim remains unaffordable for the DHBs. Notice of industrial action has been received. Contingency planning is well under way. Service and Food Workers MECA SFWU The union conducted stop work meetings (not industrial action) at DHBs across the country on 16 October 2009, as part of a wider campaign. There have been no further dates scheduled for negotiations at this time. Although this does not directly affect SDHB (as we have no SFWU employees); Spotless employees are affected. Southland DHB Clerical and Administrative CEA NZNO Negotiations are tentatively scheduled to continue on 23 November 2009.



MRT MECA APEX The parties met again to progress discussions on 15 and 16 October 2009. The union claims remain significantly outside the DHB parameters for affordability. There is a high risk of industrial action, and contingency planning is accordingly under way. Negotiations are continuing. Southland Managers’ CEA APEX The parties met in October to commence negotiations. Further dates are to be set to continue discussions.


October 2009

2009-2012 STRATEGIC GOALS:

1.0 Establish a recruitment infrastructure that enables and supports delivery of a strategic and proactive approach to recruitment, including improved efficiency, more effective selection outcomes and enhanced budget control

2.0 Cultivate and promote a positive, safe and healthy working environment

3.0 Develop an overarching regional framework for workforce development

4.0 Deliver human resources services that support managers in their management of workforce

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2009/2010

Sco

pin

g

Beh

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Tra

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Co

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lete

d

COMMENT

1.0 RECRUITMENT

1.1 Implement regional centralised recruitment model

√ Some projects finished and awaiting approvals. Advertising rules established. Education for hiring managers is ongoing.

1.1.6 Recruitment metrics reported √ Baseline data collection continues. HRIS scoping ongoing. Reporting function via Adcorp now underway.

1.1.8 Implement e-recruitment platform module of Human Resources Information System (HRIS)

√ Employee Connect currently scoping to provide a quote. Priorities now established regarding need.

1.2 Establish targeted sourcing strategy √ Sourcing strategy development continues. Alumni, talent pool and employee referral programmes scoped.

2.0 SAFE AND HEALTHY WORKING ENVIRONMENT

2.1 Why staff work at OSDHBs: Drivers of Engagement

√ Linked with culture project.

2.1 Engagement Survey √ Linked with culture project.

2.1 Review Exit interview √ IT has completed electronic document; trialling of workflow process will commence in Otago Allied Health unit.

2.3 Policy, Procedure Alignment √ Draft health and safety (H&S) policy revised following advice from HSNO audit. Draft H&S Management policies also under revision.

2.3 HSNO Compliance √ Compliance audit completed, results awaited.

3.0 WORKFORCE DEVELOPMENT

3.1.1 Workforce Development Discussions √ Activity continues, deliverable timing under review.

3.1.2 Workforce Committee √ Activity continues, deliverable timing under review.

3.1.3 Community Engagement √

3.2.1 Incubator Pilot Programme √ Pilot programme activity to conclude 02/11/09.

3.2.2 Scholarship Programme Not yet commenced.

3.2.3 Workforce Information √ Scoping activity as part of HRIS project.

3.4.1 Management and Leadership development

√ Activity continues, deliverable timing under review.

3.4.2 Clinical Governance √

3.4.3 Regional Framework √

4.0 HUMAN RESOURCES SERVICES

4.2 Complete Regional Policies √ Regional Change Management guidelines complete. Harassment and leave management policies being worked on.

HUMAN RESOURCES INFORMATION SYSTEMS

Implement Employee Connect in SDHB √

Introduce Electronic Filing √ Scoping underway with Employee Connect.

Payroll system upgrade √ Childcare centre upgrade to ‘DataPay’ scheduled for November 2009.

Please note: the numbers in the left hand column correspond to the HR Strategic Plan

Human Resources Dashboard


SDHB HAC Meeting – 9 December 2009 Information Group Update

INFORMATION GROUP UPDATE

HAC Meeting Date: 9 December 2009 Report Prepared By: Grant Taylor Regional Chief Information Officer (RCIO) Date Prepared: 25 November 2009

Recommendation

That the committee receives and notes this report.

Project Highlights

iPM Upgrade A significant upgrade of iPM to version 5002 was completed on 10 November 2009. This upgrade changed workflows and had significant bug fixes and the process of upgrading the system went smoothly and was well managed by the information technology (IT) team. Documentation on how this was achieved and build documents of the application servers was generated and will be of use for future upgrades to ensure we continue to implement change to this standard. IT Restructure A restructure of the IT team has been proposed to better align roles and functions and to better support regionalisation and national strategies. Gore iPM/iSoft A project plan has been developed to get Gore hospital onto the same patient management system as Southland. The project plan sees the system going live prior to January 2010 and the first phase is to establish connectivity. We have worked through costing this project but the work to implement is on hold now until questions on funding and the outcome from the hospital capacity review is known. Video Conferencing A need for improved clinical video conferencing for multi disciplinary team meetings as well as improved imaging systems for sharing this information while in these meetings is becoming increasingly necessary. The main driver for this is sharing skills across multiple sites (mainly Dunedin). A review of the requirements has been completed and we are waiting on pricing and how we can secure funding to achieve it. As an interim solution audio conferencing has been put in place. Two vendors have been short listed as the preferred approach and sessions on what they can deliver scheduled with key stakeholders for the end of November 2009. Wireless Infrastructure Work is underway to scope and design the installation of wireless infrastructure in Southland Hospital. This will be an enabler to allow more mobile access and devices and implementation is scheduled in the first quarter of 2010.


October 2009

STRATEGIC GOALS:

An IS informed organisation

IS alignment to the clinical needs of the organisation

Efficiency gains through technology

PROGRESS

PROJECT

Beh

ind

On

targ

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COMMENT

MOH Extract Compliance All MOH extract compliance achieved for 08/09 and 09/10.

iPM Upgrade The Upgrade to iPM version 5002 was successful.

E-texting The trial of e-texting reminders for outpatient appointments concluded in October 2009.

Gore iPM/iSoft This work is currently on hold and pending the funding and the outcome from the hospital capacity review.

E-referrals Southland is looking at how best to achieve this and is closely reviewing three options.

Regional Service Desk Scaling up activity to the Regional Service Desk. This will link to cutting over the Domain.

Video Conferencing A project manager has been assigned and requirements for a vendor agnostic solution sought.

Public Records Act (PRA) Compliance

A working group has been formed and a stock take and roadmap are being drafted.

Licensing Review Stock take complete and reviewing the options.

Server Virtualization A roll out plan for servers has been developed and the project has started. We are progressing well with this and will be replicating systems on completion of the Otago Data Centre.

Application Audit All applications are being audited and assigned to analysts to manage. An audit document has been completed.

Network Audit We are auditing, changing and documenting the configuration of the DHB’s switching environment.

Wireless Design and scoping underway. Scheduled for early 2010.

Thin Desktop Decision on technology has been made and a rollout schedule planned.

Vocera A proof of concept is being investigated for ED and Surgery out of Otago but with SDHB input. Dependent on the wireless network going in.

Disaster Recovery and Business Continuity Planning

Crash kit documentation completed.

RISKS:

• The PABX is old and the hardware intermittently has issues.

Information Group Dashboard October 2009


October 2009 Appendix 8

STRATEGIC GOALS: Promotion of a “Quality Culture” within the organisation Maintenance of a Continuous Quality Improvement Programme Risk Management process implementation throughout all levels of the organisation

PROGRESS

PROJECT

Beh

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On

ta

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COMMENT

Quality Improvement Programme

Accreditation Survey and Certification Audit

Organisation wide accreditation survey and certification audit completed 5-9 October 2009.

Accreditation Programme – Evaluation and Quality Improvement Programme version 4 (EQuIP4)

As above.

Accreditation Quality Action Plan

Await accreditation report.

Certification Corrective Action Plan (Hospital Services)

Await certification report.

Clinical Practice Manual – Policy and Procedure updating

There are currently 26 overdue policies and procedures in the clinical practice manual.

Patient Satisfaction Survey Timely quarterly reporting to Ministry of Health occurring.

Organisation Quality and Risk Framework

Progressing with the view to have a structure for quality and safety in post by November 2009.

Projects

Sharepoint The Public Records Act project is proposing a new version of Sharepoint for policies and procedures. Therefore MIDAS will not be progressed until Sharepoint has been fully assessed for its capability and a decision is made.

National Quality Improvement Project – Incident Management

SDHB reporting SAC 1 and SAC 2 events to National Central Repository as they occur.

National Quality Improvement Project’s –Hand Hygiene

Further baseline auditing to occur to ensure sufficient sample size. One further staff member has attended Gold Auditor training.

Reportable Events

Review of Reportable Events Panel

Meeting scheduled to discuss objectives of the panel.

Compliments and Complaints

Review of Complaints Review Committee

Terms of reference review completed, awaiting review by Senior Management Group.

Resolved complaints for September

Fourteen complaints were received in October 2009.

Risk Management (RM)

Risk Management policy and procedure review

Regional risk management policy consultation completed. Tabled at the November SDHB meeting and ODHB meeting December for sign-off. Regional (SDHB/ODHB) procedure consultation completed and changes being incorporated into document.

Organisational RM Programme

The alignment of ODHB risk register for use in Southland testing is completed in preparation for finalisation of the policy and procedure review and role out of the risk management programme.

Quality and Risk Dashboard 2009/10


SDHB HAC Meeting – 9 December 2009 Nursing Productivity Update

NURSING/MIDWIFERY/ALLIED HEALTH UPDATE

HAC Meeting Date: 9 December 2009 Report Prepared By: Leanne Samuel, Regional Chief Nursing and

Midwifery Officer Date Prepared: 24 November 2009

Recommendation That the Committee receives and notes this report. 1. Performance Indicators • occupancy for October 2009 remains in the main high over the optimal 85%. Maternity

occupancy was 88%, the neonatal unit at 105%, children’s ward was 67% occupancy, and the mental health inpatient unit was at 65%. The medical ward was busy at 96% occupied, the surgical ward was 91% and the rehab unit 93%

• Lakes District Hospital (LDH) occupancy was 63% for the month for the rural inpatient beds

• budget results with regard nursing full time equivalent (FTE) are covered in the financial report for your information

• there was a reduced number (62) of patient watches for October 2009 that necessitated one-to-one nursing to ensure safety of patients. This equates to additional FTE of 3.10 in October 2009. The majority of patients necessitating the watches were psycho-geriatric, mental health act or falls/awol patient risks

2. Clinical Practice • in the process of appointing clinical nurse co-ordinators for after hours medical/surgical -

80 beds following recommendations from the medical ward nursing review. Also recruiting for a clinical midwife manager for maternity

• roll out of new uniforms for mental health teams is underway

• unfortunately, the new associate charge nurse manager from the UK for the rehabilitation unit has withdrawn and we are back to the recruitment drawing board again

• Clinical Training Agency (CTA) funding for post graduate education opportunities currently open for applications across all nursing areas ie includes primary health care

• exploring productive ward opportunities with the Ministry of Health tools for a ward in Southland (yet to be decided)

• attached as per the HAC committees request is birthing data for the last three years and year to date information that reflects rural, home and secondary care birthing numbers and length of stay in hours. Overall, whilst the births are up (on prior to 2007 birthing numbers), for the last three years they have remained reasonably static, as has the length of stay postnatally at Southland Hospital

Please find attached the dashboard reflecting OSDHBs nursing/midwifery activity for your information (appendix 1)



3. Birthing Numbers Number of births calendar year 2007 2008 2009 10mths 2009 ExtrapSouthland Hospital 1296 1326 1104 1325Lakes District Hospital 55 33 56 67Rural Units 182 173 175 210Homebirths 34 45 39 47Regional Total 1567 1577 1374 1649

Length of Stay in hours postpartum for women discharged home from Southland Hospital 2007 2008 2009 10mthsNormal Births Southland Hospital 53.66 53.81 53.29Caesarean Section Southland Hospital 92.09 93.87 92.98Lakes District Hospital 47.06 39.38 47.52

Transfers to Rural Units 2007 2008 2009 10mths 2009 ExtrapFrom Southland Hospital 149 187 180 216



OCTOBER 2009 NURSING PERFORMANCE INDICATORS

NURSING SALARY AND LEAVE COSTS

Total Nursing Salaries Actual/FTE

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Dol

lars

(000

's)

450

455

460

465

470

475

480

485

490

FTE

Dollars 3057 2466 2766 2869 2600 2818 3184 2943 3270 2913 3061 2884 2941

FTE 469.12 468.04 465.31 468.55 466.97 481.30 478.86 474.79 475.52 469.11 488.09 469.68 470.07

Oct -08 Nov-08 Dec-08 Jan-09 Feb-09 M ar-09 Apr-09 M ay-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09

Nursing Annual Leave

-

10

20

30

40

50

60

70

80

FTE

Actual 44.33 29.22 28.32 73.17 45.1 45.86 41.04 32.19 26.42 39.23 39.93 33.94 40.83

Budgeted 40.63 40.63 49.71 40.63 40.63 40.63 40.63 40.63 41.35 34.35 34.35 34.35 34.35

Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar -09 Apr -09 May-09 Jun-09 Jul -09 Aug-09 Sep-09 Oct-09

Average cost of Nursing Overtime per day

-200400600800

1,0001,2001,4001,6001,8002,0002,2002,4002,6002,8003,000

Dol

lars

A c tual / day 1, 371 1, 915 1, 228 1, 502 2,436 2, 638 1, 442 1,861 2, 336 2, 776 2, 480 2,107 1, 829

B udget/ day 1, 833 1, 833 1, 833 1, 833 1,833 1, 833 1, 833 1,833 1, 833 1, 673 1, 673 1,673 1, 673

Oc t-08 Nov -08 Dec -08 Jan-09 Feb-09 M ar -09 Apr -09 M ay -09 Jun-09 Jul -09 A ug-09 Sep-09 Oc t -09

Nursing Sick Leave

-

5

10

15

20

25

30

FTE

Actual 12.48 12 14.44 8.65 10.04 13.19 12.88 15.4 16.71 15.092 25.09 15.76 12.99

Budgeted 11.48 11.48 11.48 11.48 11.48 11.48 11.48 11.48 11.48 11.22 11.22 11.22 11.22

Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar -09 Apr -09 May-09 Jun-09 Jul -09 Aug-09 Sep-09 Oct-09



MATERNITY SERVICES Service Occupancy

Maternity Services Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 81% 88% 89% 88% 0% 0% 0% 0% 0% 0% 0% 0% 87%

2008/09 95% 92% 95% 79% 79% 80% 81% 73% 76% 82% 79% 81% 83%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunAvg YTD

Non Clinical vs. Clinical Nursing FTE (Excludes Health Assistants)

Maternity Non Clinical vs Clinical Nursing FTE

02468

101214161820

FTE

Total Actual 17.80 19.49 16.93 17.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 71.96

Product ive 14.39 13.93 14.20 15.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.42

Unproduct ive 3.41 5.56 2.73 2.58 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.57

Total Budget 19.09 19.09 19.09 19.13 19.09 19.18 19.31 19.09 19.14 19.18 19.09 19.14 19.14

Budget Product ive 16.23 16.23 16.23 16.11 16.23 15.60 13.22 16.07 16.10 15.18 16.23 16.10 15.79

Budget Unproduct ive 2.86 2.86 2.86 3.02 2.86 3.58 6.09 3.02 3.04 4.00 2.86 3.04 3.34

Jul-09 Aug-09 Sep-09 Oct -09 Nov-09 Dec-09 Jan-10 Feb-10 M ar-10 Apr-10 M ay-10 Jun-10 YTD

Nursing Hours Per Patient Bed Day

Maternity

-

2

4

6

8

10

Maternity 7.04 6.49 6.73 7.01 - - - - - - - -

Benchmark 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55

Bissetts assessed average 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02

Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10



MEDICAL SERVICES Service Occupancy

Medical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 89% 96% 93% 96% 0% 0% 0% 0% 0% 0% 0% 0% 93%

2008/09 98% 95% 93% 90% 92% 90% 88% 95% 99% 92% 94% 98% 94%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Avg YTD


Medical Ward Non Clinical vs Clinical Nursing FTE

048

1216202428323640

FTE

Total Actual 35.86 33.84 33.57 34.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 137.92

Clinical 28.56 29.05 29.74 29.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29.28

Non Clinical 7.30 4.79 3.83 4.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.21

Total Budget 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45

Budget Clinical 31.95 31.95 31.95 31.84 31.95 30.90 26.14 31.60 31.84 29.95 31.95 31.84 31.16

Budget Non Clinical 5.50 5.50 5.50 5.61 5.50 6.55 11.31 5.85 5.61 7.50 5.50 5.61 6.30



Medical Ward

-

1

2

3

4

5

6

Medical 5.11 4.57 4.99 4.66 - - - - - - - -

Benchmark 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40

Bissetts assessed Average 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53




SURGICAL SERVICES Service Occupancy

Surgical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 91% 89% 89% 91% 0% 0% 0% 0% 0% 0% 0% 0% 90%

2008/09 90% 89% 89% 77% 85% 81% 88% 89% 91% 92% 89% 94% 88%



Surgical Ward Non Clinical vs Clinical Nursing FTE

048

121620242832364044

FTE

Total Actual 39.06 38.81 37.71 37.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 153.33

Clinical 31.94 31.62 31.74 32.94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 32.06

Non Clinical 7.12 7.19 5.97 4.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.27

Total Budget 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95

Budget Clinical 34.93 34.93 34.93 34.82 34.93 33.79 28.58 34.56 34.82 32.75 34.93 34.82 34.07



Nursing Hours Per Patient Bed Day Surgical Ward

-

1

2

3

4

5

6

Surgical 4.84 4.85 5.02 4.90 - - - - - - - -

Benchmark 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70





CHILDREN’S WARD Service Occupancy

Children's Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 60% 69% 87% 67% 0% 0% 0% 0% 0% 0% 0% 0% 71%

2008/09 73% 74% 84% 56% 53% 51% 49% 67% 67% 66% 54% 68% 63%

Jul Aug Sep Oct No v Dec Jan Feb M ar Apr M ay JunAvg YTD


Children's Ward Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

FTE

Total Actual 14.15 15.03 15.06 14.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 58.97

Clinical 12.66 12.65 12.83 12.31 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.61

Non Clinical 1.49 2.38 2.23 2.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.13

Total Budget 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65

Budget Clinical 12.53 12.53 12.53 12.45 12.53 12.06 10.20 12.41 12.44 11.72 12.53 12.44 12.20

Budget Non Clinical 2.12 2.12 2.12 2.20 2.12 2.59 4.45 2.24 2.21 2.93 2.12 2.21 -

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 M ar-10 Apr-10 M ay-10 Jun-10 YTD


Children's Ward

-

2

4

6

8

10

Childrens 8.78 8.03 6.69 8.02 - - - - - - - -

Benchmark 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93

Bissett assessed average 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54




REHABILITATION UNIT Service Occupancy

Rehabilitation Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 90% 87% 90% 93% 0% 0% 0% 0% 0% 0% 0% 0% 90%

2008/09 94% 92% 92% 71% 81% 80% 82% 83% 89% 87% 91% 83% 85%



AT&R Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

FTE

Total Actual 24.00 25.65 24.84 20.80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 95.29

Clinical 19.54 20.37 20.97 17.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.49

Non Clinical 4.46 5.28 3.87 3.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.34

Total Budget 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75

Budget Clinical 20.27 20.27 20.27 20.16 20.27 19.54 16.53 20.06 20.15 18.97 20.27 20.15 19.74




AT & R

-

1

2

3

4

5

AT&R 4.68 4.48 4.56 3.48 - - - - - - - -

Benchmark 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40





NEO NATAL UNIT Service Occupancy

Neo Natal Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 111% 139% 155% 105% 0% 0% 0% 0% 0% 0% 0% 0% 127%

2008/09 125% 191% 180% 181% 65% 123% 169% 118% 150% 164% 148% 105% 143%



Neo Natal Non Clinical vs Clinical Nursing FTE

0123456789

1011121314

FTE

Total Actual 11.66 12.53 12.36 10.56 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 47.11

Clinical 8.84 9.56 9.07 9.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.12

Non Clinical 2.82 2.97 3.29 1.56 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.66

Total Budget 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75

Budget Clinical 9.19 9.19 9.19 9.12 9.19 8.82 7.46 9.10 9.11 8.58 9.19 9.11 8.94




Neo Natal Unit

-

2

4

6

8

10

12

Neo Natal 8.97 7.88 6.90 9.85 - - - - - - - -

Benchmark 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00





CRITICAL CARE UNIT Service Occupancy

Critical Care Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 61% 61% 62% 45% 0% 0% 0% 0% 0% 0% 0% 0% 57%

2008/09 58% 48% 57% 54% 55% 49% 48% 63% 51% 52% 62% 72% 56%



Critical Care Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

18

FTE

Total Actual 15.88 17.39 15.51 15.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 64.17

Clinical 13.77 14.96 13.13 11.87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.43

Non Clinical 2.11 2.43 2.38 3.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.61

Total Budget 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15

Budget Clinical 12.95 12.95 12.95 12.87 12.95 12.47 10.56 12.82 12.86 12.11 12.95 12.86 12.61




Critical Care Unit

-

5

10

15

20

25

30

Critical Care 23.02 23.46 20.95 25.04 - - - - - - - -

Benchmark 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00





MENTAL HEALTH UNIT Service Occupancy

Mental Health Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 78% 81% 65% 0% 0% 0% 0% 0% 0% 0% 0% 73%

2008/09 81% 78% 64% 40% 63% 65% 51% 65% 69% 76% 96% 70% 68%



Mental Health Unit Non Clinical vs Clinical Nursing FTE

02468

101214161820222426283032

FTE

Total Actual 23.71 26.21 23.90 24.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 98.23

Clinical 20.07 20.22 19.79 18.56 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.66

Non Clinical 3.64 5.99 4.11 5.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.90

Total Budget 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45

Budget Clinical 21.78 21.78 21.78 21.59 21.78 20.90 17.65 21.58 21.58 20.33 21.78 21.58 21.18




Mental Health Unit

-

2

4

6

8

Mental Health 7.17 6.47 6.25 7.07 - - - - - - - -

Benchmark 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01





PERIOPERATIVE SERVICES (NON WARD) Non Clinical vs. Clinical Nursing FTE (Excludes Health Assistants)

Perioperative Non Clinical vs Clinical Nursing FTE

048

121620242832364044

FTE

Total Actual 40.47 42.94 40.17 39.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 163.37

Clinical 33.24 35.06 34.67 34.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 34.35

Non Clinical 7.23 7.88 5.50 5.38 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.50

Total Budget 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80

Budget Clinical 34.03 34.03 34.03 33.82 34.03 32.78 27.74 33.70 33.81 31.84 34.03 33.81 33.14



LAKES HOSPITAL Service Occupancy

Lakes Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 65% 56% 63% 0% 0% 0% 0% 0% 0% 0% 0% 63%

2008/09 53% 46% 60% 51% 55% 34% 53% 60% 56% 57% 54% 49% 52%



October 2009

STRATEGIC GOALS:

1.0 Nursing and Midwifery Workforce High performing nursing and midwifery workforce able to effectively contributes to meeting the health needs of the community.

2.0 Nursing and Midwifery Practice/Professional Standards Professional excellence and safety in Nursing and Midwifery practice delivering optimal frontline care and maximising the potential of the nursing workforce.

3.0 Nursing and Midwifery Resource Utilisation Effectively deployed, managed and supported Nursing and Midwifery Resource able to meet the service needs.

4.0 Nursing and Midwifery Governance and Leadership Clinical governance and leadership roles and responsibilities are upheld professionally and within the wider organisations structures and functions within the multidisciplinary and management teams

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2009/2010

Sco

pin

g

Beh

ind

On

Tra

ck

Co

mp

lete

d

COMMENT

1.0 Workforce development

1.1 NETP and NETP expansion and MFYOP

Ongoing

1.2 PDRP uptake

1.3 CTA program access/uptake

1.4 Nurse Practitioner development program

Workshops planned for November in Otago and Southland DHB’s

1.5 Access to course conference support

1.6 Unregulated worker orientation/ education

O

S

1.7 Management and Leadership development

Aligns to HR program and possibly CTA funding for nursing and midwifery

2.0 Nursing and Midwifery Practice

2.1 Clearly demonstrated integration of Evidenced based practice

Needs ongoing evaluation

2.2 Contemporaneous models of care are delivered and evaluated continuously

As above

2.3 Quality and HR processes and Policy, Procedure Alignment

Recruitment and retention strategies aligned, gaps identified; and approval processes complied with

2.4 Regulatory Compliance

Compliance Nursing and Midwifery councils of New Zealand re APCs, education programs etc

3.0 Nursing and Midwifery Resource Utilisation – this is in the context of production, planning, value for money initiatives, models of care development, clinical leadership, expert opinion, audit, culture, organisational systems/relationships, District Annual Plan delivery

3.1 Safe Staffing and Healthy Workplace

3.1.1 Patient Forecasting -how many? -what type? -when? -specific needs? -required outcomes? -cost?

Project briefing and scoping yet to be undertaken, nor project management resource identified. Aligns to national SSHW demonstration site pilot work due for completion in April 2010

Nursing and Midwifery Dashboard-OSDHBs


3.1.2 Matching resources -how many staff? -what skill set required? -where? -with what resources? -what is the available budget?

As above

3.1.3 Resource provision -Right number of staff? -Right type? -Right skill mix? -Right skills -Right environment -Right time? -Right resources?

As above

3.1.4 Service Delivery -Safe -Effective -Appropriate -Timely -Sustainable -Flexible -Responsive

Establishing targeted tool kit sourcing strategy for senior nurses use on a shift by shift basis -Capacity planning tools (prospective) -Integrated roster and bed management alignment electronically -Business Intelligence reporting platform-live time

4.0 Nursing and Midwifery Governance and Leadership

4.1 Clinical Governance, clinical leadership on the ground

O

S

Clinical Governance review and structure in place SDHB Putting the patient first, OPJ, value for money related projects for ODHB

Projects/Practice Development Initiatives

Falls S

O

Early Warning Scores (Otago)/ Ups (Southland)

Clinical –Key performance indicators

Failure to rescue EWS (Otago) UPS (Southland) project being audited for improved rescue rates

Falls S

O

Being rolled out on 6th floor at Dunedin Hospital. Yet to be scoped for Southland Hospital

Pressure Injuries Not yet commenced

Health care associated infection

HAI data captured and reported via infection prevention and control


SDHB HAC Meeting – 9 December 2009 Financial Report

FINANCIAL REPORT

HAC Meeting Date: 9 December 2009 Financial Report as at: 31 October 2009 Report Prepared by: Bron Anderson, Senior Business Analyst Date: 18 November 2009

1. DHB Provider Summary Results

Annual

Actual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

11,292 11,367 (75) Revenue 45,418 45,467 (49) 138,636 (6,795) (7,371) 576 Less Personnel Costs (27,960) (28,905) 945 (86,463) (4,893) (4,682) (211) Less Other Costs (19,110) (18,831) (279) (56,006)

(396) (686) 290 Net Surplus / (Deficit) (1,651) (2,269) 617 (3,834)

Month Year to Date

Summary Comment:

• October 2009 result is an operating deficit of $396k, this is a favourable variance against plan by $290k

• the YTD position is $617k within plan this position arises from a YTD operating deficit

of $1,651k compared against a budgeted defi cit of $2,269k

2. Emerging Trends

• personal health funding related to Oral Health Business Case • other revenue kiwi saver tax credits (favourable variance) • Accident Leave and Other Leave within salary groups, in particular nursing • treatment disposables costs, in particular dressings (related to vac wound care

machines), protective clothing (related to H1N1) and patient consumables • clinical equipment minor purchases (favourable variance) • oncology pharmaceuticals • external storage services • coal costs • domestic staff travel (favourable prediction) • fuel costs (favourable prediction) • data network and internet fees



3. Revenue

AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

402 310 92 Accident Insurance 1,447 1,241 206 3,724 108 103 5 Clinical Training Agency 311 413 (102) 1,238

10,418 10,576 (158) Funder Arm revenue 42,021 42,305 (285) 129,149 53 53 - MOH Disability Support Services 211 212 (2) 637 36 46 (10) MOH Personal Health 56 184 (128) 553 14 19 (5) MOH Public Health 33 77 (44) 231

- 2 (2) Non DHB's - 9 (9) 26 17 26 (9) Other DHB's 98 105 (6) 314

136 120 16 Other Income 684 480 205 1,439 104 105 - Patient/Consumer Sourced 553 419 134 1,257

2 6 (3) Training Fees & Subsidies 4 23 (18) 68 11,292 11,367 (75) Total Revenue 45,418 45,467 (49) 138,636

Month Year to Date

• YTD Clinical Training Agency (CTA) is unfavourable against budget this is due to gaps in the rosters and therefore posts not being able to be filled

• Internal Revenue The following variances exist within the internal revenue line

ContractsMonthly Variance

YTD Variance Comment

Fee For Service contracts (1) (6)

Dental Contracts over plan, Aged care behind plan

Mental Health wash up back to funder arm (62) (276)

Positions that remain unfilled

Mental Health internal error (100) 0

Correct YTD position now reflected

Pharmaceutical Lines; PCT & Community (10) (28)

PCT revenue over plan, Community Pharms under budget

Various other contracts 15 25

B4 Schools check, Additional herceptin funding, one contract now delivered in primary care

Total (158) (285)

• accident compensation corporation (ACC) revenue is above budget for the month and YTD; areas where this is the case include orthopaedics, occupational therapy, physiotherapy and imaging

• the operational portion of the Oral Health Business Case is budgeted under the Ministry of Health personal health line. The project is moving ahead well but a misalignment in the timing of the project costs shows as an unfavourable monthly and yearly result

• the favourable YTD outcome against patient/consumer sourced revenue is due to non resident activity



• under the other income category kiwi saver credits, training fees and accommodation rentals are favourable to budget, donations received and interest revenue offset part of this positive variance as these income lines are below plan

4. Salaries

Monthly Salary Total Costs The following table summarises the overall salary position. Annual

Actual Budget Variance Actual Budget Variance Budget

Costs $' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Medical (1,745) (2,202) 457 (7,874) (8,685) 811 (25,589) Nursing (2,941) (3,034) 93 (11,799) (11,712) (86) (35,802) Allied Health (990) (1,012) 22 (3,926) (4,029) 103 (11,882) Support (51) (48) (4) (194) (191) (3) (563) Management/Administration (1,067) (1,074) 7 (4,166) (4,288) 121 (12,628) Total Salaries (6,795) (7,371) 576 (27,960) (28,905) 945 (86,463)

Month Year to Date

Annual

FTEs Actual Budget Variance Actual Budget Variance Budget

Medical 105.25 114.07 8.82 110.24 112.86 2.62 112.25 Nursing 477.01 472.59 (4.42) 482.32 472.59 (9.73) 472.59 Allied Health 187.14 179.88 (7.26) 184.80 179.88 (4.91) 179.88 Support 13.80 13.09 (0.71) 13.80 13.09 (0.71) 13.09 Management/Administration 225.18 223.77 (1.41) 221.30 223.77 2.47 223.96 Total FTEs 1,008.38 1,003.40 (4.98) 1,012.44 1,002.19 (10.26) 1,001.77

Month Year to Date

YTD costs are $945k under budget. FTEs are over budget by a total of 10.26 YTD. Further explanation for different vocational groups is shown below. Medical Salaries Medical salaries have a favourable variance of $457k for the month and $811k YTD. Key reasons for this favourable result include

• lower FTE against plan • high annual leave taken therefore a reduction in leave liability • non direct salary items are very favourable against plan • monthly accrual for unpaid days assumes high leave also taken

Please refer to the table below for sub category breakdown within the medical salaries.



Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000 FTES FTES FTES

Ordinary (856) (1,071) 216 79.26 85.53 6.27 (3,874) (4,397) 523 82.25 87.83 5.59 Accident Leave - - - - - - - - - - - - Annual Leave Taken (147) (244) 97 12.36 11.22 (1.14) (706) (965) 259 10.90 11.61 0.71 Other Leave 2 - 2 0.38 - (0.38) (22) - (22) 0.45 - (0.45) Sick Leave (17) (44) 27 1.76 3.46 1.70 (94) (176) 82 2.01 3.44 1.43 Statutory (incl Time in Lieu) (38) (65) 26 0.35 5.16 4.81 (35) (65) 30 0.60 1.29 0.69 Training (incl CME)/ Study Lve (30) (78) 47 2.05 4.57 2.52 (139) (312) 172 2.65 4.55 1.90 Long Service Leave - - - - - - - - - - - - Back Pays (1) - (1) - - - (28) - (28) - - - Allowances (399) (389) (10) - - - (1,534) (1,548) 14 - - - Penal - (2) 2 - - - - (2) 2 - - - Base Medical Salaries (1,486) (1,893) 406 96.16 109.94 13.78 (6,432) (7,465) 1,032 98.87 108.73 9.86

Overtime (93) (51) (41) 9.09 4.13 (4.96) (637) (198) (439) 11.37 4.13 (7.24) ACC Levy (4) (8) 4 - - - (28) (30) 2 - - - Meals (11) (10) (2) - - - (44) (38) (5) - - - Superannuation (46) (65) 19 - - - (192) (254) 62 - - - Course Fees, Conferences, Study Grants (76) (92) 16 - - - (279) (367) 88 - - - External Clinical Supervision (1) - (1) - - - (1) - (1) - - - Professional Membership Fees and Costs (12) (28) 16 - - - (69) (112) 43 - - - Recruitment Expenses & Advertising (15) (35) 20 - - - (178) (142) (36) - - - Relocation - (20) 20 - - - (3) (80) 77 - - - Parental Leave - - - - - - (12) - (12) - - - Total Medical Salaries (1,745) (2,202) 457 105.25 114.07 8.82 (7,874) (8,685) 811 110.24 112.86 2.62

Month Month Year to Date Year to Date

The bulk of the above YTD favourable result is in the junior doctor area $627k. FTEs levels for the month are within plan. There is a favourable variance in junior medical staffing of 6.87 FTE and a 1.95 favourable FTE variance within the senior staffing section. The FTE calculation includes medical overtime. A budget was only allocated against the junior doctor area for the additional duties incurred to cover roster gaps. Senior doctors are also undertaking extra shifts, so the bulk of the variance against overtime relates to extra duties by senior doctor. The budget includes a vacancy factor which reduces the salary budget and therefore FTEs but increases the outsourced budget. The 2009/2010 split will be monitored carefully to ensure accurate modelling and potential areas where locum use can be modified. Direct salary cost lines against both the senior and junior areas are favourable to plan; allowance and overtime costs are unfavourable against plan across both medical areas, this aligns with the FTEs being above the overtime budget. Of note some of the non direct salary items are favourable to budget

• superannuation $19k for the month, $62k YTD • course fees and conference $16k monthly variance, $88k YTD • professional membership fees $16k for the month, $43k YTD • recruitment and relocation are $40k over for the month, $41k YTD

In most cases the favourable variances will not continue. The budget is phased on a monthly basis but in terms of expenditure it is managed to the annual budget. Outsourced medical costs must be considered as well when reviewing the medical salary costs. As noted above the way the budget is compiled means that part of the staffing establishment is now allocated against the outsourced line. The budget has tried to reflect the reality of the permanent and locum split. The variance to budget is favourable $411k for the month and $892k YTD when considering the two components of medical costs (salaries and outsourced costs). October 09 reflects high locum/ fee for service charges, $828k but with the modelling of the budget the variance of the two medical cost lines (salaries and outsourced) against that budgeted is better than that reported in past months in previous financial years.



The table below shows the last 16 month trend of medical outsourcing charges, October is up approximately $92k higher compared to the previous month, which was the lowest for the past 15 months.

The table below shows the variance in categories between salaries and outsourced.

Actual Budget Variance Actual Budget Variance Actual Budget Variance$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000

Specialist Medical Officer - Employees (998) (1,199) 201 46.82 47.59 0.77 (4,547) (4,778) 231 - Outsourced (518) (511) (7) (2,054) (2,044) (10)

(1,516) (1,710) 194 (6,601) (6,822) 221 MO - Employees (195) (235) 40 12.17 13.35 1.18 (945) (898) (47) - Outsourced (1) (94) 93 (38) (421) 383

(196) (329) 133 (983) (1,319) 336 Total SMO (1,712) (2,039) 327 58.99 60.94 1.95 (7,584) (8,141) 557 Registrar - Employees (411) (520) 109 28.25 29.93 1.68 (1,640) (2,033) 393 - Outsourced (164) (25) (139) (526) (101) (425)

(575) (545) (30) (2,166) (2,134) (32)

House Officer - Employees (141) (248) 107 18.01 23.20 5.19 (741) (976) 235 - Outsourced (145) (152) 7 (501) (633) 132

(286) (400) 114 (1,242) (1,609) 367 Total RMO (861) (945) 84 105.25 114.07 8.82 (3,408) (3,743) 335

Month Month Year to Date

RMO costs are $335k within budget YTD. Total Senior Medical Officer (SMO and Medical Officer) costs sit within plan YTD by $557k. Nursing Salaries Nursing salaries have a favourable variance of $93k for the month. YTD the variance is unfavourable by $86k. The following table provides the breakdown of the variance by sub categories:


Ordinary (1,991) (2,086) 95 394.93 393.92 (1.01) (8,089) (8,412) 323 397.67 399.07 1.40 Accident Leave (10) - (10) 1.66 - (1.66) (32) - (32) 1.55 - (1.55) Annual Leave Taken (272) (241) (31) 40.83 34.35 (6.48) (1,056) (950) (106) 38.48 34.35 (4.13) Other Leave (8) - (8) 1.72 - (1.72) (36) - (36) 1.75 - (1.75) Sick Leave (62) (60) (2) 12.99 11.22 (1.77) (334) (238) (95) 17.24 11.22 (6.02) Statutory (incl Time in Lieu) (51) (109) 58 7.21 14.71 7.50 (47) (109) 62 8.59 9.56 0.97 Training (incl CME)/ Study Lve (52) (64) 12 10.28 11.70 1.42 (170) (254) 84 8.44 11.70 3.26 Long Service Leave (3) (4) - 0.45 0.73 0.28 (35) (15) (20) 0.52 0.73 0.22 Back Pays 2 - 2 - - - (5) - (5) - - - Allowances (277) (274) (3) - - - (1,116) (1,094) (22) 0.00 - (0.00) Penal (46) (36) (10) - - - (46) (36) (10) - - - Base Nursing Salaries (2,770) (2,874) 103 470.07 466.63 (3.44) (10,966) (11,108) 143 474.24 466.63 (7.61)

Overtime (57) (52) (4) 6.94 5.96 (0.98) (283) (206) (76) 8.07 5.96 (2.11) ACC Levy (28) (20) (7) - - - (107) (78) (29) - - - Superannuation (32) (49) 17 - - - (130) (162) 32 - - - Course Fees, Conferences, Study Grants (27) (23) (4) - - - (128) (91) (36) - - - Rural Retention Training - - - - - - (3) - (3) - - - Professional Membership Fees and Costs (5) (5) - - - - (18) (18) - - - - Recruitment Expenses & Advertising (13) (3) (10) - - - (24) (12) (12) - - - Relocation (4) (3) (1) - - - (64) (13) (51) - - - Parental Leave (6) (6) - - - - (55) (22) (33) - - - Gratuities - - - - - - (21) - (21) - - - Total Nursing Salaries (2,941) (3,034) 93 477.01 472.59 (4.42) (11,799) (11,712) (86) 482.32 472.59 (9.73)


Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09

Total Medical Outsourced (567) (942) (808) (749) (762) (984) (761) (825) (1,069) (922) (833) (813) (808) (747) (736) (828)



FTEs are tracking above YTD budgeted levels 9.73 FTE. This month 4.42 FTE’s have been used higher than budget. The over run in FTE relates to;

• the over run of sick leave 1.77 for the month, 6.03 YTD • a number of patient watches being required for confused patients • FTEs attributed to accident leave where there is no budget al location • FTEs aligned with other leave (e.g. bereavement and jury) where there is no budget

allocation • extra work related with H1N1 activity • there are some nursing positions being filled in mental health but are budgeted as an

allied position • overtime payments are being incurred over and above budget, over runs are

happening in the ward areas and perioperative The FTE overrun would be expected to be driving the fiscal position of the direct salary costs over plan, however this is not the case as those employed currently have a lower average salary than those budgeted. YTD the real drivers over budget are some non FTE related costs. These costs include

• course fees YTD unfavourable against plan $36k • recruitment and advertising YTD unfavourable against plan $12k • relocation YTD unfavourable against budget $51k • gratuities YTD position is $21k unfavourable against plan

The above costs (apart from gratuities because there is no budget apportioned) should be viewed with an annual budget perspective in mind as the budget phasing is a best approximation. Parental leave costs are over running budget expectation, the budget is set on historical data but in reality this often does not align, the fiscal position is $33k above plan YTD Long service leave entitlements have increased over time as employment agreements have been settled. This is reflective above with the unfavourable fiscal variance due to these entitlement changes. Allied Health FTEs are above budgeted pa rameters for the month by 7.26 The FTE variance is impacting on the monthly result as the following areas are above budget

• 0.73 FTE against accident leave • 1.10 FTE against other leave • 1.44 FTE over and above plan within the overtime section • 0.64 FTE long service leave cost code

The fiscal result however stays within plan for the month and YTD, this misalignment with the FTE variance is because currently there are lower average salaries than that budgeted. Also some non direct salary items are tracking behind plan which is maintaining the favourable result against plan; items lines include superannuation, course and conference fees, professional membership fees, recruitment and relocation costs. A vacancy factor has been maintained within allied health for a number of years, and has been set in the 2009/2010 budget to be 31.51FTE.



The current non mental health vacancy factor is 25, which is over budget. When mental health vacancies are accounted for the vacancy factor remains at 15, suggesting the factor may have been set too high. The unfilled positions in mental health will be affecting service delivery.

Other items impacting the YTD fiscal result include

• the difference with the treatment of statutory days accrual between the old payroll system and the ne w payroll system

• additional leave for those working on call during weekend being actioned in September 09 for the 12 month period ended 30 June 2009

• $33k charge for parental leave incurred during July 09 and $2k during October 09 The table below shows both the financial and FTE status of the different allied groups in the provider arm.

Month Month Year to Date Year to DateActual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000 FTES FTES FTES

Audiologists - (5) 5 - 1.00 1.00 (1) (22) 21 - 1.00 1.00 Child Therapists (1) - (1) - - - (2) - (2) - - - Dental Therapists (60) (86) 26 11.60 15.22 3.62 (246) (342) 96 11.69 15.22 3.53 Occupational Therapists (74) (83) 10 14.16 16.00 1.84 (301) (332) 31 14.13 16.00 1.87 Physiotherapists (78) (76) (2) 13.83 13.39 (0.44) (296) (305) 9 13.85 13.39 (0.46) Speech Therapists (10) (12) 3 1.60 2.20 0.60 (36) (49) 13 1.60 2.20 0.60 Therapist Aids/Assistants (70) (89) 20 23.59 24.27 0.68 (310) (356) 46 23.32 24.27 0.95 Other Therapists - (19) 19 - 3.30 3.30 - (76) 76 - 3.30 3.30 Case Managers (56) (76) 21 10.75 14.19 3.44 (199) (306) 106 9.89 14.19 4.30 Community Support Workers (88) (95) 6 21.69 20.80 (0.89) (373) (379) 6 21.64 20.80 (0.84) Cultural Workers (38) (34) (4) 6.44 6.61 0.17 (148) (136) (12) 6.16 6.61 0.45 Health Education Workers - (14) 14 - 2.40 2.40 - (58) 58 - 2.40 2.40 Health Promotion Officers (5) (6) 1 0.80 1.00 0.20 (18) (25) 7 0.79 1.00 0.21 Psychologists (64) (101) 37 9.00 14.11 5.11 (246) (405) 159 8.02 14.11 6.10 Recreation/Training/Welfare Officers (7) (4) (3) 1.30 1.00 (0.30) (29) (16) (13) 1.51 1.00 (0.51) Social Workers (105) (108) 3 19.66 19.51 (0.15) (438) (432) (6) 19.18 19.51 0.33 Trainee Psychologists - (4) 4 - 1.00 1.00 - (18) 18 - 1.00 1.00 Pharmacists (28) (29) - 4.66 4.57 (0.09) (119) (114) (4) 4.75 4.57 (0.18) Pharmacist Interns - (4) 4 - 1.00 1.00 - (17) 17 - 1.00 1.00 Pharmacist Technicians (16) (13) (3) 4.58 3.53 (1.05) (67) (51) (17) 4.59 3.53 (1.06) MRT's & Sonographers (167) (155) (12) 20.69 23.25 2.56 (606) (608) 2 20.79 23.25 2.47 MRT & Sonographer Students (13) (5) (7) 3.03 1.00 (2.03) (54) (21) (33) 3.26 1.00 (2.26) Paramedics - 107 (107) - (25.51) (25.51) - 426 (426) - (25.51) (25.51) Technicians (75) (84) 9 13.54 16.01 2.47 (284) (333) 49 13.50 16.01 2.51 Dietitians (16) (14) (2) 2.70 2.65 (0.05) (65) (54) (10) 2.64 2.65 0.01 Hearing / Vision Testers (8) (9) - 1.94 2.00 0.06 (36) (35) (1) 1.96 2.00 0.04 Scientific Officers & Researchers (1) 16 (17) - (6.00) (6.00) (11) 63 (74) - (6.00) (6.00) Other Allied Health Staff (10) (7) (3) 1.58 1.38 (0.20) (40) (29) (11) 1.57 1.38 (0.19) Health Protection Officers - - - - - - (1) - (1) - - - Total Allied Health Salaries (990) (1,012) 22 187.14 179.88 (7.26) (3,926) (4,029) 103 184.80 179.88 (4.92) Management Administration YTD costs and FTEs are within plan. The under run of FTEs against budget explains the favourable fiscal variance along with the no provisioning for expired Multi Employer Collective Agreements (MECAs) One item of note relating to this cost category includes the YTD unfavourable variance against allowances of $69k. This variance includes a budget mistake where all allowance payments against some clinical areas have not been accounted for, some acting up allowances have been incurred with no budget attached and some regional roles that now have allowances that were not known during budget preparation time.




Ordinary (835) (858) 23 199.85 186.05 (13.80) (3,369) (3,570) 201 197.19 193.35 (3.84) Accident Leave (1) - (1) 0.07 - (0.07) (5) - (5) 0.23 - (0.23) Annual Leave Taken (88) (92) 5 16.66 17.42 0.76 (334) (369) 35 13.82 17.42 3.60 Other Leave (1) - (1) 0.31 - (0.31) (8) - (8) 0.53 - (0.53) Sick Leave (14) (40) 26 5.63 8.76 3.13 (124) (159) 36 7.37 8.76 1.39 Statutory (incl Time in Lieu) (37) (47) 10 0.78 9.73 8.95 (39) (47) 8 0.56 2.43 1.88 Training (incl CME)/ Study Lve (6) (8) 2 1.28 1.77 0.49 (26) (32) 6 1.11 1.77 0.67 Long Service Leave 2 - 2 - - - (11) - (11) 0.03 - (0.03) Back Pays (31) - (31) - - - (51) - (51) - - - Allowances (25) (2) (23) - - - (78) (9) (69) (0.00) - 0.00 Penal - - - - - - - - - - - - Base Management Admin Salaries (1,036) (1,047) 12 225 224 (1) (4,045) (4,186) 142 221 224 3

Overtime (2) (4) 2 0.60 0.04 (0.56) (8) (15) 7 0.48 0.04 (0.44) ACC Levy (7) (8) 1 - - - (32) (29) (3) - - - FBT (9) - (9) - - - (14) - (14) - - - Meals - - - - - - (1) - (1) - - - Superannuation (10) (8) (1) - - - (37) (32) (5) - - - Course Fees, Conferences, Study Grants (2) (3) 1 - - - (19) (10) (8) - - - External Clinical Supervision - - - - - - - - - - - - Professional Membership Fees and Costs - - - - - - (3) (1) (2) - - - Recruitment Expenses & Advertising - (2) 2 - - - (7) (9) 2 - - - Relocation - - - - - - - - - - - - Parental Leave - (1) 1 - - - - (4) 4 - - - Total Management Admin Salaries (1,067) (1,074) 7 225.18 223.77 (1.41) (4,166) (4,288) 121 221.30 223.77 2.47


The ministry has required that a cap be put on management administration FTE so that there is no growth in this area. The capped level against this group has been maintained for YTD October 09. The over run against the month is due to a correction relating to the past 4 months where a position was incorrectly coded against nursing.

5. Expenditure

Outsourced Outsourced costs are outside plan $140k for the month and $9k YTD. As noted above in the salary section the medical budget was phased and adjusted for locum use (which in most cases is paid at a premium when compared to salaried staff) therefore the fee for service budget lines have increased compared to last year. This approach has resulted in a favourable variance to plan in the medical outsourced cost category. Outsourced management administration costs lines have no material variance to report. Outsourced allied costs reside over budget for the month and YTD. Extra activity has been undertaken against the therapists, psychologists and social workers lines Outsourced clinical services are over plan. These costs relate to Southern Blood and Cancer and other outsourced services, for example lithotripsy and MRI scans. The over run this month relates to the outsourc ing of some ACC activity. Clinical Supplies Total clinical supplies expenditure for the month of October 09 is $1,893k against a budget of $1,803k, a $90k unfavourable variance to plan. YTD this variance is $212k outside budget parameters. The phasing of the budget can impact on the monthly result. This year the clinical supplies budget has been phased on days of the month. Within the reported variance various lines have over and under runs which require some explanation.



Line Item Monthly Variance YTD Variance CommentBlood Products (24) (51) Patient VolumesContinence & Hygiene supplies (14) (40) Patient RequirementsDrapes (9) (20)

Dressings (5) (33)VAC wound care machines; benefit of keeping patients out of hospital

Protective Clothing (12) (55) H1N1Medical Gases (3) (16) Patient VolumesSutures (5) (12) Patient VolumesStaples & Accessories (18) (20) Patient MixSyringe, Needle and Sharpe Bins (6) (18) Patient VolumesTubes, drainage & suction (6) (9)Customised Procedure packs (2) (10)

Patient Consumables (49) (122)

Activity related, some of the variance is offset below against Operating Leases

Other (8) (21)Total Treatment Disposables (161) (427)

Sterilising Consumables (11) (8)Other (1) (1)Total Diagnostic Supplies & Other clinical equipment (12) (9)

Clinical Equipment -Minor Purchases 8 35 Expenditure is being closely monitoredClinical Equipment - Repairs & maintenance 8 16Clinical Equipment - Depreciation 14 53 Timing of expenditure

Clinical Equipment - Operating Leases 10 30In part a change in coding which actuals (Patient Consumables)

Clinical Equipment - Service Contracts 5 13Other 1 5Total Instruments & Equipment 46 152

Ostomy Supplies 28 53 Patient demandOther 2 (7)Total Patient Appliances 30 46

Total Implant and Prosthesis 57 86 Volume delivery

Total Pharmaceuticals (36) (42)

Patient mix, Oncology which includes medical day stay has the highest variance

Total Other Clinical & Client Costs (14) (19) Air ambulance & ambulance

Total Clinical supplies (90) (212)

The table below shows the past 16 months of expenditure against the total clinical supplies line. Predominately the bulk of this cost category is driven by patient volumes and patient mix.

Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09

Total Clinical Supplies(1,688) (1,497) (1,731) (1,835) (1,600) (1,767) (1,684) (1,629) (1,911) (2,024) (1,964) (2,178) (1,847) (1,837) (1,790) (1,893)



Infrastructure and Non Clinical Supplies Total infrastructure and non clinical supplies costs were $1,747k for the month compared to a budget of $1,767k therefore generating a favourable variance to plan of $19k for October 09. YTD the variance compared to budget is unfavourable by $58k Hotel service costs are $7k over budget for the month and $67k YTD. YTD the items driving this variation include laundry charges. Part of the higher cost against budget is related to volume (including activity related to H1N1) but also there has been an associated cost with lost property. Also there is an unfavourable variance against patient meals $20k this is related to the variable portion of the contract, more meals than planned. $9k relates to food and groceries costs. There is also an over run against orderlies outsourced ($18k); cleaning charges offset some of the YTD variance by sitting $8k under budget. Facilities costs are $57k within budget for the month and $102k YTD. Within this cost section, maintenance expenditure resides within plan by $23k for the month but above plan by $25k YTD. The adverse YTD result is driven by the upgrading of some of the staff accommodation. The budget for electricity and coal expenditure needs to be looked at on an YTD basis as the phasing of the budget is creating artificial variances during this period of the year. There has been an increase in the price of coal over and above the budget allocation; the prediction is that the variance will be approximately $30k higher than budget. Waste removal charges are $11k outside the YTD budget. Building and plant depreciation is above plan for the month the budget setting is accurate but an error has been discovered once the accounts were closed off relating to the depreciation amount on the revalued assets balance last year. This error will be corrected in November accounts and will have a favourable impact to the bottom line. External storage charges reside $21k over YTD, this variance relates to last financial year some charges were missed during the year end accrual process. Transport costs are within budget for the month and YTD. YTD the staff travel expense line is maintaining this positive variance along with fuel charges being under plan. Information systems and telecommunication costs are on plan for the month and within budget YTD. Depreciation charges, IT leases and hardware minor purchases are favourable to budget but are offset with an over run against bureau and outsourcing fees ($12k), software maintenance fees ($22k) and direct telecommunication charges ($43k). Interest and financing costs are below plan by $51k YTD. This variance is driven by the capital charge cost being under budget by $50k. Total professional fees and expenses rest within YTD budget allocation by $72k. YTD all line items have been managed to planned parameters apart from insurance. Total other operating expense includes the one liner of savings. This saving initiative is on top of the vacancy factors included in the salary lines. Each area in the hospital has been tasked with contributing to this savings initiative in various ways.

6. Forecast

The following table shows a high level forecast predicting that the final fiscal result will be better than plan by $561k. This forecast assumes the same trends that are being currently experienced along with the employment agreements budget assumptions.



YTD YTD YTD Forecast Annual budget VarianceActual Budget variance Jun-10 Jun-10 Jun-10$' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Revenue 45,418 45,467 (49) 138,635 138,636 (1)

Less Personnel CostsMedical (7,874) (8,685) 811 (24,200) (25,589) 1,389 Nursing (11,799) (11,712) (87) (35,627) (35,802) 175 Allied (3,926) (4,029) 103 (12,034) (11,882) (152) Support (194) (191) (3) (584) (563) (21) Management / Admin (4,166) (4,288) 122 (12,498) (12,628) 130

(27,959) (28,905) 946 (84,943) (86,464) 1,521

Less Other CostsOutsourced Cost - Medical (3,119) (3,199) 80 (9,557) (9,897) 340 Outsourced Cost - Other (1,411) (1,322) (89) (4,236) (3,963) (273) Clinical Supplies (7,367) (7,155) (212) (21,804) (21,295) (509) Infrastructure Costs (7,212) (7,154) (58) (21,369) (20,852) (517)

(19,109) (18,830) (279) (56,966) (56,007) (959)

Net Surplus / (Deficit) (1,650) (2,268) 618 (3,274) (3,835) 561

7. Capital Commitments

TOTAL Core IS IS project Buildings Clinical & Other Oral Health

Annual Budget 6,557 823 377 600 2,600 2,157

Carried Forward 2008/09 ( Including those approved and ordered but not paid for )

1,840 461 583 65 731

Total Capital Available 8,397 1,284 960 665 3,331 2,157

Purchased YTD October 09 1,673 603 91 209 693 77 Donated Assets 12 12 WIP 84 81 3 Committed 698 166 224 - 191 117

Remaining Capital 5,930$ 516$ 564$ 456$ 2,435$ 1,960$

Significant purchases October 09 $'000ECG Machine 13$ 13 Omnitrack Thompson W alker 28$ 28 CPAPS 14$ 14 Triad Diathermy Machine 39$ 39 ambulance Bay Doors 8$ 8

TOTAL 102$ -$ -$ 8$ 94$ -$

Capital Expenditure Position as at October 09 ($'000)

The capital budget has to be managed within agreed parameters. Capital affordability will continue to be an issue in this financial year.



Statement of Financial Performance Current Month Year to Date Annual

Part 2: DHB provider Actual Budget Variance Variance Actual Budget Variance Variance Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 2.1: Statement of Financial PerformanceREVENUEMinistry of Health MoH - Personal Health 36 46 (10) U (22%) 56 184 (128) U (69%) 553 MoH - Public Health 14 19 (5) U (26%) 33 77 (44) U (57%) 231 MoH - Disability Support Services 53 53 0 F (1%) 211 212 (2) U (1%) 637 Clinical Training Agency 108 103 5 F 4% 311 413 (102) U (25%) 1,238 Internal - DHB Funder to DHB Provider 10,418 10,576 (158) U (1%) 42,021 42,305 (285) U (1%) 129,149Ministry of Health Total 10,629 10,798 (169) U (2%) 42,631 43,191 (560) U (1%) 131,808Other Government Other DHB's 17 26 (9) U (33%) 98 105 (6) U (6%) 314 Training Fees and Subsidies 2 6 (3) U (60%) 4 23 (18) U (81%) 68 Accident Insurance 402 310 92 F 30% 1,447 1,241 206 F 17% 3,724 Other Government - 2 (2) U (100%) - 9 (9) U (100%) 26Other Government Total 422 344 78 F 23% 1,550 1,377 173 F 13% 4,132

Government and Crown Agency Total 11,051 11,142 (91) U (1%) 44,181 44,569 (388) U (1%) 135,940Other Revenue Patient / Consumer Sourced 104 105 0 F 0% 553 419 134 F 32% 1,257 Other Income 136 120 16 F 14% 684 480 205 F 43% 1,439Other Revenue Total 241 225 16 F 7% 1,237 899 339 F 38% 2,696

REVENUE TOTAL 11,292 11,367 (75) U (1%) 45,418 45,467 (49) U 0% 138,636

EXPENSESPersonnel Expenses Medical Personnel (1,745) (2,202) 457 F 21% (7,874) (8,685) 811 F 9% (25,589) Nursing Personnel (2,941) (3,034) 93 F 3% (11,799) (11,712) (86) U (1%) (35,802) Allied Health Personnel (990) (1,012) 22 F 2% (3,926) (4,029) 103 F 3% (11,882) Support Services Personnel (51) (48) (4) U (7%) (194) (191) (3) U (2%) (563) Management / Admin Personnel (1,067) (1,074) 7 F 1% (4,166) (4,288) 121 F 3% (12,628)Personnel Costs Total (6,795) (7,371) 576 F 8% (27,960) (28,905) 945 F 3% (86,463)

Outsourced Expenses Medical Personnel (828) (782) (46) U (6%) (3,119) (3,199) 81 F 3% (9,897) Allied Health Personnel (22) (13) (9) U (69%) (74) (51) (22) U (44%) (154) Management / Administration Personnel (1) (2) 1 F 66% (1) (7) 7 F 91% (22) Outsourced Clinical Services (380) (291) (89) U (30%) (1,243) (1,163) (80) U (7%) (3,487) Outsourced Corporate / Governance Services (23) (25) 1 F 6% (94) (99) 6 F 6% (298) Outsourced Funder Services - - - n/m - - - n/m -Outsourced Services Total (1,253) (1,113) (140) U (13%) (4,530) (4,521) (9) U (0%) (13,860)

Clinical Supplies Treatment Disposables (710) (548) (161) U (29%) (2,607) (2,180) (427) U (20%) (6,438) Diagnostic Supplies & Other Clinical Supplies (36) (24) (12) U (48%) (106) (97) (9) U (10%) (277) Instruments & Equipment (319) (365) 46 F 13% (1,293) (1,445) 152 F 11% (4,394) Patient Appliances (30) (59) 30 F 50% (190) (236) 46 F 20% (699) Implants & Prosthesis (123) (180) 57 F 32% (629) (715) 86 F 12% (2,114) Pharmaceuticals (557) (521) (36) U (7%) (2,110) (2,069) (42) U (2%) (6,146) Other Clinical Supplies (118) (104) (14) U (13%) (433) (413) (19) U (5%) (1,227)Clinical Supplies Total (1,893) (1,803) (90) U (5%) (7,367) (7,155) (212) U (3%) (21,295)

Infrastructure & Non Clinical Expenses Hotel Services, Laundry & Cleaning (379) (372) (7) U (2%) (1,543) (1,476) (67) U (5%) (4,379) Facilities (484) (541) 57 F 10% (2,190) (2,291) 102 F 4% (6,271) Transport (78) (114) 37 F 32% (348) (454) 106 F 23% (1,355) IT Systems & Telecommunications (257) (257) - (0%) (1,001) (1,013) 12 F 1% (3,066) Interest & Financing Charges (368) (381) 13 F 3% (1,461) (1,512) 51 F 3% (4,566) Professional Fees & Expenses (21) (47) 26 F 55% (113) (185) 72 F 39% (548) Other Operating Expenses (160) (56) (104) U (187%) (556) (223) (334) U (150%) (666) Democracy - - - n/m - - - n/m - Subsidiaries & Joint Ventures - - - n/m - - - n/m -Infrastructure & Non-Clinical Supplies Total (1,747) (1,767) 19 F 1% (7,212) (7,154) (58) U (1%) (20,852)

Total Expenses (11,688) (12,053) 365 F 3% (47,069) (47,736) 667 F 1% (142,470)

Net Surplus/ (Deficit) (396) (686) 290 F 42% (1,651) (2,269) 617 F 27% (3,834)


hospital advisory committee meeting · 1. welcome and apologies mrs katie o ˇconnor, chair,...

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