Agenda

AGED & DISABILITY SUPPORT ADVISORY COMMITTEE

Tuesday, 12 February 2019, Boardroom, Corporate Offices Hauora Tairāwhiti

10.00am Meeting starts

Page

APOLOGIES

1.1. As notified verbal

INTERESTS

2.1. Committee Members’ schedule of interests for review 3 2.2. Conflicts in relation to Agenda items

PREVIOUS MEETING

3.1 Previous Minutes for approval: 04/12/2018 4

ACTION ITEMS

4.1. Actions from previous meeting 6

CORRESPONDENCE

5.1. Nil n/a

INFORMATION ITEMS

6.1. Government Inquiry into Mental Health & Addictions 7 6.2. Falls Prevention 12

DECISION ITEMS

7.0 Nil n/a

GENERAL BUSINESS

8.0 Nil n/a

RESOLUTION TO EXCLUDE THE PUBLIC RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting. The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows:

10.1-2 As shown on resolution to exclude the public in Minutes.

Hauora Tairāwhiti ADSAC Agenda 2019 02 12 .docx

12.1 Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]

Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)]

PREVIOUS IN COMMITTEE MEETING

10.1. Previous In Committee Minutes for approval 04/12/2018 21 10.2. Action Items (Nil) n/a

IN COMMITTEE INFORMATION ITEMS

11.1 Home & Community Support Services Procurement Process 22 112. Hauora Tairāwhiti Annual Plan 2019/20 – draft Guidance 27

IN COMMITTEE DECISION ITEMS

12.0 Nil n/a

PUBLIC RELEASE OF IN COMMITTEE ITEMS

DATE OF NEXT MEETING: Tuesday, 9 April 2019

Hauora Tairāwhiti ADSAC Agenda 2019 02 12 .docx

Member Interest Declared RoleDavid Scott Three Rivers Medical Centre Wife an employee

Treescape Farm Partnership Partner in BusinessTreescape Consultancy Business ConsultantTe Kuri a Tuatae Marae TrusteeEast Coast Rural Support Trust Rural Support Co-ordinatorGisborne District Council Civil Defence Shift Volunteer/Media Liaison OfficerGisborne Herald Casual non-paid columnistMiddle Mount Company Ltd DirectorCONNEXT Charitable Trust Trustee

Prudence Younger Forest Industry Contractors Assoc Chief ExecutivePublic Impressions Limited Director

Na Raihania Whanau Trusts TrusteeHawkes’ Bay DHB Iwi Relationship Board MemberTRONPnui Board Trustee

Josh Wharehinga Gisborne District Council CouncillorTe Wananga o Aotearoa Board memberGisborne Intermediate School Board memberMother employed by Hauora Tairāwhiti Maraea Cookson (Cultural Response Team)Ex Partner employed by Hauora Tairāwhiti Richelle Tarsau (Children’s Ward)Aotearoa Scholarships Trust TrusteeHorouta Waka Hoe Waka Ama Club Board member

Meredith Akuhata-Brown Gisborne District Council CouncillorCampion College Board memberTairawhiti Youth Workers Collective MemberPapawhariki Inc Board memberGisborne Herald Casual unpaid columnistGisborne East Coast Cancer Society TrusteeTe Ara Tika (Tairawhiti Problem Gambling) TrusteeNgati Porou Hauora Charitable Trust Member Tawhiti Maori Womens’ Welfare League Member

Roimata Waihi Te Kupenga Net Trust Board MemberKa Pai Kaiti Volunteer

Jim Green (Chief Executive) Health Partnerships Limited (CE Sponsor – Food Services Programme)

Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the national programme.

Chief Executive Representative, Midland Alliance Leadership Team (Midland Health Network Trust)

Potential conflict exists in relation to decisions made by the Midland ALT which conflict with the interests of Hauora Tairāwhiti.

Interim Chair/Director, HealthShare Limited First responsibility is to Hauora Tairāwhiti but there may be an occasion where this conflicts with the needs of HSL.

Wife employed by Tūranga Health as Tamariki Ora Nurse and Team Coordinator for Tamariki Ora

Potential conflict exists over decisions related to funding of services provided by Tūranga Health affecting the employment status of his wife.

Son is employed as a Medical Registrar at Waikato DHB. Potential conflict regarding decisions on terms and conditions of employment for Medical Registrars.

Daughter in-law is currently working in a community Pharmacy in the Waikato.

Potential conflict regarding my involvement with the national Community Pharmacy Agreement which could impact on her employment.

Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may conflict with those in my role as CE of Hauora Tairāwhiti. The management is that decisions around funding are required to come back to Hauora Tairāwhiti.

National Oracle Solution Executive Steering Committee as CE representative

A possible conflict of interest arises for me in this role as opposed to my role as CE of Hauora Tairāwhiti. Management of the possible

Member, National BiPartite Action Group Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the group programme.

Pay Equity Workstream Co-Lead, Employment Relations Strategy Group (ERSG),

Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the work programme.

National CE Lead, Holidays Act Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the work programme.

Nicola Ehau (Planning, Funding & Population Health)

Husband an employee of the Health Quality & Safety Commission

Low likelihood of conflict.

Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may interest with those in my role as GM Planning & Funding in Hauora Tairāwhiti. The management is that decisions around funding require to come back to Hauora Tairāwhiti.

Fraser Hopkins (Communications) Wife is employed by Hauora Tairāwhiti as Team Leader Community Services Admin.

Possible conflict depending on decisions made at leadership and committee level regarding community services administration.

ADSAC Members' Interest Register

Management Attendees

Lois McCarthy Robinson

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Minutes

Aged & Disability Support Advisory Committee

Tuesday 4 December 2018

Present

David Scott (Chair) Na Raihania Roimata Waihi Meredith Akuhata-Brown Prue Younger Josh Wharehinga

Attending Jim Green (Chief Executive) Nicola Ehau (Group Manager, Planning, Funding & Population Health) Claire Campbell (Portfolio Manager, Health of Older People and Disability Support Services) Nicholette Pomana (Portfolio Manager, Child, Youth & Population Health) Joyce O’Donnell (Minutes)

Karakia Welcome from the Chair

Item 1: Apologies Lois McCarthy Robinson Item 2: Interests 2.1 Changes to Register Nil 2.2 Conflicts Related to Agenda items Nil Item 3: Minutes of the Previous ADSAC meeting ADOPTED

The public minutes of the ADSAC meeting held on 14 August 2018. ADOPTED The notes from the ADSAC/CPHAC Open Forum 12 October 2018. The Portfolio Manager advised the deadline for final submissions to the Future Model of Care for Home and Community Support Services (HCSS) Request for Interest (RoI) is this week for evaluation the following. The Group Manager advised a more stable workforce is the expected outcome of the changes in model of care and funding of that service.

Matters Arising Nil

Item 4: Action Items Noted

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Item 5: Correspondence Nil Item 6: Information Items 6.1 NASC Quarter 4 report 2017/18

Noted and discussed in particular the number of referrals vs residential placements; and the need to support initiatives (e.g. socialisation, co-sharing, situated closer to younger populations) that support the elderly remaining longer in the home.

6.2 Te Puna Waiora Group Manager’s update report Noted

Item 7: Decision Items Nil

Item 8: General Business 2019 ADSAC Meeting dates.

• 10.00am start as a trial. • Speakers invited to meetings • June 11 meeting – speaker/forum profile for ADSAC (given the Open Forum is for

CPHAC)

Item 9: Resolution to Exclude the Public RESOLVED that:

In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the following part of the of the proceedings of this, meeting namely:

10.1 Previous In Committee Minutes for Approval 10.2 Action Items

Information Items 11.0 Nil

Decision Items 12.1 Nil

Meeting Ended: 9.57am

Next Meeting:

12 February 2019

________________________________ ____________________ Chair Date

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Action Items Aged & Disability Support Advisory Committee

# Subject Narration Action Due

Carried Over 1. Nil December 2019 2. Nil

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Community & Public Health Advisory Committee

Title: Government Inquiry into Mental Health & Addiction services

Prepared By: Nicola Ehau GM Planning, Funding and Population Health

Date: Saturday, 2 February 2019

Information Item

EXECUTIVE SUMMARY

The Government Inquiry into Mental Health and Addiction was announced early in 2018. The catalyst for the inquiry was widespread concern about mental health services, within the mental health sector and the broader community, and calls for a wide-ranging inquiry from service users, their families and whānau, people affected by suicide, people working in health, media, Iwi and advocacy groups. The purpose of this Inquiry was to: • hear the voices of the community, people with lived experience of mental health and addiction

problems, people affected by suicide, and people involved in preventing and responding to mental health and addiction problems, on New Zealand’s current approach to mental health and addiction and what needs to change

• report on how New Zealand is preventing mental health and addiction problems and responding to the needs of people with those problems

• recommend specific changes to improve New Zealand’s approach to mental health, with a particular focus on equity of access, community confidence in the mental health system and better outcomes, particularly for Māori and other groups with disproportionately poorer outcomes.

The Inquiry commenced work in February 2018 and reported to the Minister of Health in November 2018. The Government will be providing their view on the contents of the inquiry in March 2019.

BACKGROUND

This paper provides the committee with the key recommendations of the inquiry findings and further provides you with the full Inquiry document. There are 16 themes and 40 recommendations as follows: Expand access

1. Agree to significantly increase access to publicly funded mental health and addiction services for people with mild to moderate and moderate to severe mental health and addiction needs.

2. Set a new target for access to mental health and addiction services that covers the full spectrum of need.

3. Direct the Ministry of Health, with input from the new Mental Health and Wellbeing Commission, to report back on a new target for mental health and addiction services.

4. Agree that access to mental health and addiction services should be based on need so: o access to all services is broad-based and prioritised according to need, as occurs with other

core health services o people with the highest needs continue to be the priority.

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Increase choice of services 5. Commit to increased choice by broadening the types of mental health and addiction services

available. 6. Direct the Ministry of Health to urgently develop a proposal for Budget 2019 to make talk

therapies, alcohol and other drug services and culturally aligned therapies much more widely available, informed by workforce modelling, the New Zealand context and approaches in other countries.

Facilitate co-design and implementation

7. Direct the Ministry of Health, in partnership with the new Mental Health and Wellbeing Commission (or an interim establishment body) to:

o facilitate a national co-designed service transformation process with people with lived experience of mental health and addiction challenges, DHBs, primary care, NGOs, Kaupapa Māori services, Pacific health services, Whānau Ora services, other providers, advocacy and representative organisations, professional bodies, families and whānau, employers and key government agencies

o produce a cross-government investment strategy for mental health and addiction services.

8. Commit to adequately fund the national co-design and ongoing change process, including funding for the new Mental Health and Wellbeing Commission to provide backbone support for national, regional and local implementation.

9. Direct the State Services Commission to work with the Ministry of Health to establish the most appropriate mechanisms for cross-government involvement and leadership to support the national co-design process for mental health and addiction services.

Enablers to support expanded access and choice

10. Agree that the work to support expanded access and choice will include reviewing and establishing:

o workforce development and worker wellbeing priorities o information, evaluation and monitoring priorities (including monitoring outcomes) o funding rules and expectations, including DHB and primary mental health service

specifications and the mental health and addiction ring fence, to align them with and support the strategic direction of transforming mental health and addiction services.

11. Agree to undertake and regularly update a comprehensive mental health and addiction survey. 12. Commit to a staged funding path to give effect to the recommendations to improve access and

choice, including: o expanding access to services for significantly more people with mild to moderate

and moderate to severe mental health and addiction needs o more options for talk therapies, alcohol and other drug services and culturally

aligned services o designing and implementing improvements to create more people-centred and

integrated services, with significantly increased access and choice. Transform primary health care

13. Note that this Inquiry fully supports the focus on primary care in the Health and Disability Sector Review, seeing it as a critical foundation for the development of mental health and addiction responses and for more accessible and affordable health services.

14. Agree that future strategies for the primary health care sector have an explicit focus on addressing mental health and addiction needs in primary and community settings, in alignment with the vision and direction set out in this Inquiry.

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Strengthen the NGO sector 15. Identify a lead agency to:

o provide a stewardship role in relation to the development and sustainability of the NGO sector, including those NGOs and Kaupapa Māori services working in mental health and addiction

o take a lead role in improving commissioning of health and social services with NGOs. Enhance wellbeing, promotion and prevention Take a whole-of-government approach to wellbeing, prevention and social determinants

16. Establish a clear locus of responsibility for social wellbeing within central government to provide strategic and policy advice and to oversee and coordinate cross-government responses to social wellbeing, including:

o tackling social determinants that impact on multiple outcomes and that lead to inequities within society

o enhancing cross-government investment in prevention and resilience-building activities.

17. Direct the State Services Commission to report back with options for a locus of responsibility for social wellbeing, including:

o its form and location (a new social wellbeing agency, a unit within an existing agency or reconfiguring an existing agency)

o its functions (as proposed in Figure 3 in section 7.1.3). Facilitate mental health promotion and prevention

18. Agree that mental health promotion and prevention will be a key area of oversight of the new Mental Health and Wellbeing Commission, including working closely with key agencies and being responsive to community innovation.

19. Direct the new Mental Health and Wellbeing Commission to develop an investment and quality assurance strategy for mental health promotion and prevention, working closely with key agencies.

Place people at the centre Strengthen consumer voice and experience in mental health and addiction services

20. Direct DHBs to report to the Ministry of Health on how they are including people with lived experience and consumer advisory groups in mental health and addiction governance, planning, policy and service development decisions.

21. Direct the Ministry of Health to work with people with lived experience, the Health Quality and Safety Commission and DHBs on how the consumer voice and role can be strengthened in DHBs, primary care and NGOs, including through the development of national resources, guidance and support, and accountability requirements.

22. Direct the Health and Disability Commissioner to undertake specific initiatives to promote respect for and observance of the Code of Health and Disability Services Consumers’ Rights by providers, and awareness of their rights on the part of consumers, in relation to mental health and addiction services.

Support families and whānau to be active participants in the care and treatment of their family member

23. Direct the Ministry of Health to lead the development and communication of consolidated and updated guidance on sharing information and partnering with families and whānau.

24. Direct the Ministry of Health to ensure the updated information-sharing and partnering guidance is integrated into:

o training across the mental health and addiction workforce o all relevant contracts, standards, specifications, guidelines, quality improvement

processes and accountability arrangements.

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Support the wellbeing of families and whānau 25. Direct the Ministry of Health, working with other agencies, including the Ministry of Education,

Te Puni Kōkiri and the Ministry of Social Development, to: o lead a review of the support provided to families and whānau of people with mental

health and addiction needs and where gaps exist o report to the Government with firm proposals to fill any gaps identified in the review

with supports that enhance access, affordability and options for families and whānau. Take strong action on alcohol and other drugs

26. Take a stricter regulatory approach to the sale and supply of alcohol, informed by the recommendations from the 2010 Law Commission review, the 2014 Ministerial Forum on Alcohol Advertising and Sponsorship and the 2014 Ministry of Justice report on alcohol pricing.

27. Replace criminal sanctions for the possession for personal use of controlled drugs with civil responses (for example, a fine, a referral to a drug awareness session run by a public health body or a referral to a drug treatment programme).

28. Support the replacement of criminal sanctions for the possession for personal use of controlled drugs with a full range of treatment and detox services.

29. Establish clear cross-sector leadership and coordination within central government for policy in relation to alcohol and other drugs.

Prevent suicide

30. Urgently complete the national suicide prevention strategy and implementation plan and ensure the strategy is supported by significantly increased resources for suicide prevention and postvention.

31. Set a target of 20% reduction in suicide rates by 2030. 32. Establish a suicide prevention office to provide stronger and sustained leadership on action to

prevent suicide. 33. Direct the Ministries of Justice and Health, with advice from the Health Quality and Safety

Commission and in consultation with families and whānau, to review processes for investigating deaths by suicide, including the interface of the coronial process with DHB and Health and Disability Commissioner reviews.

Reform the Mental Health Act

34. Repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 so that it reflects a human rights–based approach, promotes supported decision-making, aligns with the recovery and wellbeing model of mental health, and provides measures to minimise compulsory or coercive treatment.

35. Encourage mental health advocacy groups and sector leaders, people with lived experience, families and whānau, professional colleges, DHB chief executive officers, coroners, the Health and Disability Commissioner, New Zealand Police and the Health Quality and Safety Commission to engage in a national discussion to reconsider beliefs, evidence and attitudes about mental health and risk.

Establish a new Mental Health and Wellbeing Commission

36. Establish an independent commission – the Mental Health and Wellbeing Commission (with the functions and powers set out in Figure 4 in section 12.2.2) – to provide leadership and oversight of mental health and addiction in New Zealand.

37. Establish a ministerial advisory committee as an interim commission to undertake priority work in key areas (such as the national co-designed service transformation process).

38. Direct the Mental Health and Wellbeing Commission (or interim commission) to regularly report publicly on implementation of the Government’s response to the Inquiry’s recommendations, with the first report released one year after the Government’s response.

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Wider issues and collective commitment 39. Ensure the Health and Disability Sector Review:

o assesses how any of its proposed system, structural or service commissioning changes will improve both mental health and addiction services and mental health and wellbeing

o considers the possible establishment of a Māori health ministry or commission. 40. Establish a cross-party working group on mental health and wellbeing in the House of

Representatives, supported by a secretariat, as a tangible demonstration of collective and enduring political commitment to improved mental health and wellbeing in New Zealand.

NEXT STEPS

We are working closely with the MoH to be prepared for the next tranche of activity that will come from the Government direction. The inquiry recommendations also align well to our own local review and the timing of this review will work well with the government’s response to the inquiry recommendations as we respond to the recommendations on settings in society, as well as through the mental health and addictions services Hauora Tairāwhiti both funds and provides. Regular updates on the inquiry next steps and our own review will be provided.

RECOMMENDATION

Note the report and the addition links below: You Tube link to summary: https://www.youtube.com/watch?v=uBvx526ZTnc&feature=youtu.be Link to Full report: https://mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/

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Aged & Disability Support Advisory Committee Title: Tairāwhiti Falls Prevention report

Prepared By: Heather Robertson, Nurse Leader - Primary and Community, Kat Ngatai Falls CNS

Date: Friday, 1 February 2019

Information Item

EXECUTIVE SUMMARY

Falls in older people are common and cause considerable pain, injury, loss of confidence, loss of independence and mortality. People over 65 years of age have the highest risk of falling with those over 80 falling at least once a year. Most falls happen in the community but a significant number of falls also occur in rest-homes and hospitals. The majority of falls are preventable, or the severity of the resulting injury reduced, if the environment were safer and individual risk-taking and personal fall risk factors were minimised. Due to the ageing population the economic impact of falls will continue to grow and will become a significant challenge to local health system; ACC costs will rise steeply and the capacity for hospital services, residential care and rehabilitation services will be impacted. Tairāwhiti has a long history and association with the provision of falls prevention services, and benefits from a relationship with ACC. This paper provides an update on the falls prevention activities in Tairāwhiti for the 6 months from 1 July-31 December 2018, through the co-funding arrangement between ACC and Hauora Tairāwhiti.

BACKGROUND

In New Zealand falls represent a high proportion of reported serious and sentinel events. The definition of a fall is any unintentional change in position where the person ends up on the floor, ground, or other lower level. It includes falls that occur while being assisted by others (WHO, 2012). It also includes ‘borderline cases’ such as when an older person feels faint or that their legs are giving way and where someone has been able to safely lessen the impact or distance of the fall. Trends in improved health and more effective healthcare have seen an increase in the number of older people, a group which ranges from those who are generally healthy and active to those who are very frail or debilitated; the older person population in Tairāwhiti is increasing and set to rise further. Further, people with co-morbidities are at increased risk of falling; as the number of co-morbidities increases, the risk of falling also increases, co-morbidities increase with age. “Falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays” (Institute for Clinical Systems Improvement, 2010, p7). Data ascertains that in 2016, 216,000 New Zealand people aged 50 and over had one or more ACC claims for a fall-related injury accepted. In addition, in people aged 85 and over, 25 percent had at least one ACC claim due to a fall in 2016 which equated to 56 ACC claims per day among those aged 85+ and 27,000 people aged over 50 were admitted to hospital with a fall in 2016. Older people and women had higher admission rates with 77 percent of all people attending hospital after a fall (Health Quality Safety Commission). A recently published 2017/18 trauma snapshot identified on the $284,159 spent on trauma in this DHB, 68.2% of this trauma was due to falls.

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Fortuitously, effective health care systems directed at prevention and early intervention can considerably impact on the reduction of health disparities and the severity of illness (WHO, 2008). In 2017, Hauora Tairāwhiti partnered up with ACC and received $201,000 per annum over a three year period as part of a national falls prevention business case. A falls prevention model was developed by the Tairāwhiti Falls prevention Group; a cross-sector forum formed in 2014 to reduce the incidence and severity of injury from falls. At the end of the three years (June 2020) ACC will review its contribution and ongoing funding should not be assumed. The model relies on collaboration between ACC and Hauora Tairāwhiti as funders as well as local primary, community and secondary health and well-being providers. There is alignment with fracture liaison standards and osteoporosis guidelines with clear contributory measures. REPORT ON ACTIVITIES (1 JULY 2018-30 DECEMBER 2018) 1. Promotional activities The Hauora communication team is supporting the falls prevention programme and have developed a health promotion plan. Planned is a series of posts that will educate and inform families about what they can do to help their loved ones to prevent them from falling, facts and figures about falls, promoting the free falls assessment and in-home strength and balance programme and success stories. This includes Identifying five Falls Champions who are willing to participate in the falls campaign. These champions will be people who have had a fall and have been through the falls assessment and in-home strength and balance programme and will be able to vouch for the programme. The first article is based on the experience of one of these champions was launched in early January, link enclosed (http://gisborneherald.co.nz/localnews/3879286-135/falls-prevention-key-to-independence. 2. The Australian and New Zealand Hip Fracture Registry (ANZHFR) The ANZHFR is a bi-national audit of hip fracture care and secondary fracture prevention in Australia and New Zealand. Its objective is to use patient level and facility level data to enable improvements to hip fracture care across both countries. Hauora Tairāwhiti went live in New Zealand December 2017. The Registry evaluates care against the Hip Fracture Care Clinical Care Standard and its seven quality statements: care at presentation; pain management; orthogeriatric model of care; timing of surgery; mobilisation and weight-bearing; minimising the risk of another fracture; and transition from hospital care. As at the end of December 2018 there were 34 people added to the registry. We are below the national standard for length of stay; survival rates are good, with a slight improvement in bone medications on discharge.

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3. Fracture liaison service The established Fracture Liaison Service (FLS) commenced June 2018; since then 89 people have met the FLS criteria. The FLS is available for people who have had an initial fracture and are at risk of a second or subsequent fracture if an intervention is not put in place to minimise risk. This may include bone density diagnostic screening, prescribing of bone strengthening medication, referral to a strength and balance programme and education and advice to primary care teams. People who meet the criteria are over 50 years old and have sustained a fracture from a standing height but exclude those of the hands, feet and scull. As well as case management of secondary prevention in the acute setting, the falls nurse Clinical Nurse Specialist (CNS) collaborates with nurses in other specialties, and the broader multi-professional team, to promote and develop the service. This function is a key integrator across primary and secondary care (including supported hospital discharge), to provide seamless pathways in the falls and fracture system. Although some decline the FLS, these people all received fracture prevention advice or further follow up with their GP for bone healthcare. Report the number of older people (65 and over, or younger if identified as a falls risk) that have been seen by the Fracture Liaison Service or similar fracture prevention service

(Q1 & Q2) Annual Target

39 121

4. Aged Residential Care Aged care has made a concerted effort to reduce the number of falls in their facilities with positive effect. There are a couple of facilities that are doing extremely well in their reduction of falls as indicated by their rate of falls. The area where it has decreased the most is at dementia level. As the graph below indicates the rate is variable but the number of falls resulting in injuries has significantly decreased. Conversely there has been an increase in the number of people with a fractured neck of femurs in the past four months. It needs to be understood that aged care have the frailest of our population in their facilities. Some of the people who fall are the same people and aged care providers do not have the capacity to provide the full time supervision that some of these people require. Additionally, those at dementia level do not have an understanding of their limitations.

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5. Hospital The number of falls in the hospital appears to be increasing but could also means there is better reporting

There has been a marked improvement in the hospital falls data with a positive increase in both the percentage of people aged 75+ (55+ Māori and Pacific) who received a falls risk assessment and the percentage of people with an individualised care plan. Falls audit data for hospital as part of the HQSC markers

6. Falls risk assessments – General Practice The model sought to strengthen the local falls pathway by providing proactive screening of older people enrolled within Primary Care. The target group are Māori or Pacific people over 65 and all others over 75

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years of age. A flexible and inclusive, rather than prescriptive, approach will be taken to this aspect of the programme, with screening being undertaken by all members of the Primary Care team. Primary Care Teams were trained to ensure that they are using robust basic screening tools, coding appropriately and referring the identified person to the correct service in the pathway. There is also the option for a funded extended GP consult to review medication and any emerging conditions that might contribute to falls. Assessments in general practice volumes are increasing but volumes remain below that expected for this cohort. Ongoing encouragement needs to be given to the practices to perform falls assessments. Under consideration is the feasibility of pharmacies undertaking theses assessments.

Practice Nurse Screening and Assessment Quarter: Q1 & Q2 2018 Month July -September October -

December Total

Completed falls risk assessments. 86

50

137

Ethnicity

Māori 30 20 50

Pacific 3 2 5

European 53 28 81

GP Extended Consultations Quarter: Q1 & Q2 2018

12 5 17

7. Community Group Strength & Balance Community Strength and Balance Programmes target large numbers within a population who may be at risk of an initial fall, but for whom acute or specialist intervention is not yet required. The average utilisation of classes is at 48%. Two Tai Chi Train the Trainer workshops for falls prevention have been scheduled for April to increase the number of peer led classes in Tairāwhiti; one workshop will be in Gisborne and one will be held on the East Coast. Currently there are no community strength and balance classes on the east coast. It is hoped this will provide a solution to that gap. The cost of these workshops will be met by Presbyterian Support East Coast. Reporting Requirement

(Regional Total) Definition Quarter

1&2 Lead Agency Quarter

Actual

Number of Classes The total number of classes across the quarter, within your region (usually offering 10-15 places for people to participate).

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Number of Places The total number of offerings per class, for people to attend at any given point in time.

265 250

Number of Attendees (Reach)

The number of unique (the same person counted only once a year) older people participating in the offered class

39 124

Number of Attendees Who Have Completed 10

This information will count the number of unique individuals occupying a place over

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Weeks or more (Super Reach)

a 10-week period in a quarter.

Average utilisation of Classes (%)

The average percentage filled places across a quarter.

44%

8. In-Home Strength & Balance In-Home Strength and Balance Programes are for people who are at an increased risk of falling, and for whom participating in a community programme is clinically inappropriate given their high mobility and balance needs. Sport Gisborne hold the contract for this in Tairāwhiti.

Classification 1 July- 31 December

Annual Target

Commentary / Narrative from DHB

Report the number of older people (65 and over, or younger if identified as a falls risk) that have received in-home strength and balance retraining services:

Number of people that received in-home strength and balance retraining (65-74)

9 Included in the volume below

The contract with ACC does not separate out the age bands

Number of people that received in-home strength and balance retraining (75+)

43 119 In home strength and balance data reported was below the target set by ACC for our region. On closer examination it was discovered there was underreporting by the provider of those that had received in home strength and balance services. This report also captures the missing data from the last quarter

The volumes for this service are tracking nicely. A number of the participants are very frail and it is difficult encouraging them to participate in the programme. The provider has been closely working alongside St John. St John refer people they attend that fall in the community, whether they are injured or not, to the falls nurse who then triages them and refers to In home strength and balance if they meet the criteria. The physiotherapist that has been running this programme has now resigned. Sport Gisborne are actively recruiting a replacement. OUTCOMES TO DATE: According to the ACC Dashboard, gains from this more comprehensive, district-wide response to falls prevention include:

• Fewer falls amongst the older population • More people at risk of falls are identified early and offered appropriate support • Less fractures due to falls, particularly a reduction in hip fracture and associated significant

morbidity • Lower hospital admissions as a result of falls and hence rehabilitation costs • Better levels of support on discharge from hospital for adults with injuries • More timely and equitable services • Better follow up experience for those who do fall

RECOMMENDATION

That the Aged & Disability Support Advisory Committee notes the report.

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APPENDIX A ACC Dashboard https://public.tableau.com/views/LiveStrongerforLongerFallsFracturesOutcomesFramework/Landing?:embed=y&:display_count=yes

References Institute for Clinical Systems Improvement (2010). Health Care Protocol; Prevention of Falls. Retrieved

from: http://www.icsi.org/falls__acute_care___prevention_of__protocol_/falls__acute_careprevention_of__protocol__24255.html

World Health Organisation (WHO). (2008). Primary health care. Now more than ever. Retrieved

from http//www.euro.who.

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