The theory and the practice - Bpac.org.nz

WHĀNAU ORA:The theory and the practice10 | BPJ | Issue 37

Message from Minister Responsible forWhānau Ora – Hon Tariana TuriaIf there is one thing that we have learnt out of thedevastation, the suffering and the chaos associated withthe Christchurch earthquakes, it has been to reacquaintourselves with our neighbours, to come together ascommunities, and most of all, to reach within our familiesto find the greatest source of strength.Whānau Ora is that source – a source of comfort, ofmotivation, of encouragement.Whānau Ora is about whānau being empowered to developa plan for our future; and to trust in our own solutions.It is about restoring to ourselves, our confidence in ourown capacity to provide for our own – to take collectiveresponsibility to support those who need it most.I believe that Whānau Ora represents a majortransformation in the way services are designed anddelivered, contracts arranged and the way providers worktogether.Whānau Ora taskforceIt has been close to two years (June 2009) since Cabinetapproved the establishment of the Whānau Ora Taskforce,chaired by Professor Sir Mason Durie.The Taskforce held 22 regional hui with a range of urbanand rural whānau, iwi and service providers during Octoberand November 2009. Approximately 600 people attendedthese hui. The Taskforce also received more than 100written submissions on its document, “Whānau Ora: Awhānau-centred approach to Māori wellbeing”.Government has appointed a Governance Group to overseeimplementation of Whānau Ora. The Governance Group iscomprised of three community representatives and threeagency Chief Executives.Over the past year, I have watched Whānau Ora gainconsiderable momentum and I have been overwhelmedby the enthusiasm of stakeholders, whānau, communities,providers, practitioners, government departments and myown ministerial colleagues. What could be more inspiringthan witnessing whānau being empowered to take controlof their future?Selection of Whānau Ora collectivesIn October 2010, Government announced the selectionof 25 Whānau Ora provider collectives, which betweenthem bring together 158 providers across Aotearoa(including four Pacific providers in Auckland, Wellingtonand Christchurch).It has been wonderful to see the high number of providercollectives which in itself expresses Government’s desirefor providers to be more effective and efficient by workingcollaboratively.BPJ | Issue 37 | 11

I have heard it described as moving from “five cars upthe driveway” to one car containing a navigator and fourpassengers. The shift in mindset is a shift from multipleagencies working with individual family members often inisolation of each other, to instead a bold and innovativeapproach which places the aspirations of whānau at thecentre of service planning and delivery. Everyone is facingthe same direction; the focus firmly fixed on outcomes.For whānau – the outcomes we seek are that whānau willbe:▪▪ Self-managing▪▪ Living healthy lifestyles▪▪ Participating fully in society▪▪ Confidently participating in Te Ao Māori▪▪ Economically secure and successfully involved inwealth creation▪▪ Cohesive, resilient and nurturingProgrammes of actionProvider collectives must therefore align all of theirinteractions to best support whānau wellbeing.Programmes of Action outline a planned approach byprovider collectives to respond to whānau aspirations,and, where necessary, to provide whānau-centredservices.Officials from Te Puni Kōkiri, Ministry of Health and Ministryof Social Development are working with the Whānau Oraprovider collectives to progress their Programmes of Action.These Programmes serve to inform the “business cases”that identify the resources required by provider collectives.They include a focus on relationship management,infrastructure, integrated contracting, workforce andpractice development, monitoring and evaluation andaction research.Regional leadership groupsAlongside these collectives, there are ten RegionalLeadership Groups which are championing Whānau Orawithin their respective regions. Each Regional LeadershipGroup comprises community representatives and officialsfrom the three lead agencies. Their existence serves toremind us that local solutions are determined at the locallevel through collaboration and cooperation of whānau,hapū and iwi.Integrated contractingCentral to the development of more holistic service deliveryto whānau is the concept of integrated contracting. TheMinistry of Social Development is currently leading workwith 22 providers and their funders with the aim of having20 signed integrated contract agreements this year.Essentially, we envisage the transitioning of existingservice delivery contracts into an integrated contractwithin the Whānau Ora framework. These outcomes-basedintegrated contracts will bring funding currently receivedfrom government funders together into a single contract.Action researchI have always believed that Whānau Ora needed aframework to measure progress toward achievingoutcomes for whānau. The last thing I would want is forbean-counting, silo by silo: how many meetings had; howmany people served; how many booklets distributed. SoWhānau Ora will be underpinned by a comprehensiveresearch, evaluation and monitoring programme that willmeasure the success of the approach for whānau, forproviders, and in terms of value gained for governmentinvestment. It is about outcomes that are influenced bythe needs that whānau identify and choose.Developing providersIn Budget 2011, Government invested another $30 millionin Whānau Ora. The emphasis of this new investment willgo towards developing providers in regions of high needand where there are currently no provider collectives.These locations include; Kaipara, Hauraki, South Waikato,Taupō/Tūrangi, Palmerston North, Wairarapa, Levin/KapitiCoast and Murihiku.12 | BPJ | Issue 37

But if I was to be asked, I would say Whānau Ora is notabout the funding. It is about all of us picking up on ourresponsibilities, rather than picking up the phone toask the health provider or CYF to take up a role which isrightfully ours.Whānau Ora is possibly the first time in which Governmenthas been able to measure value for money against acultural construct.It is about our transformation; celebrating the power andpotential of a whānau-centred approach which will enableour people to flourish.Waipareira has also opened a one-stop frontline WhānauOra hub integrating health, social, justice and educationservices. The Whānau House – a four-storey complex inthe central business district of Henderson – is the home ofthe trust’s new-look workforce: kaimahi (service workers),kaiārahi (navigators) and kaiwhakahaere (leaders).NUMA is the parent body for the Whānau Ora providercollective that includes; Waipareira, Manukau UrbanMāori Authority (South Auckland), Te Rūnanga o Kirikiriroa(Hamilton) with approved affiliate Te Kohao Health andTe Roopu Awhina ki Porirua (Wellington) which is indevelopment.Whānau Ora is the ultimate expression of our survival.Tēnā tātou katoa.How is Whānau Ora being delivered?Te Whānau o Waipareira - AucklandTe Whānau o Waipareira in west Auckland – part of theNational Urban Māori Authority (NUMA) – has beenoperating a “Whānau Ora, Whānau Tahi” approach toservice delivery since January 2011.The collective has an enrolled health population of95,000 and provides whānau residing in the five mainurban centres with nearly 300 individual services acrosseducation, health, housing, justice and social services.Services include public health; mental health; primarycare; drug and alcohol addiction; Strengthening Families;Family Start; Parents as First Teachers (PAFT); breastscreening; nutrition; smoking cessation; 24/7 accidentand medical; ACC support; whānau housing; mentoring;holiday programmes; kaumātua support; child advocacy;restorative justice; violence prevention; funeral; housinginitiatives; diabetes; Māori men’s health; budget advice;financial literacy; youth services; youth justice; socialwork support; day activities and life skills programmes foradolescents; and tikanga Māori.As a specialist Whānau Ora provider, Waipareira is offeringfamilies wrap-around services tailored to their needs. Akaiārahi, or navigator, will work with whānau to identifythe aspirations and outcomes they seek, develop anoutcomes focused plan to achieve them and then brokertheir access to a range of services available both internallyand externally in the wider community.More than 200 staff have taken part in training anddevelopmental workshops focused on understandingoutcomes, whānau-centred practice and understandingthe requirements of privacy and confidentiality whenworking with whānau.For more information about NUMA, visit:www.numa.org.nz.Kōtahitanga – Whānau Ora inspired innovationKōtahitanga is a Whānau Ora collective of four Māorihealth and social service providers in South Auckland:Turuki Health Care Trust, Papakura Marae Trust, HuakinaDevelopment Trust and Te Kaha o Te Rangatahi Trust.The collective employs more than 285 staff and providesservices to over 22,000 multi-ethnic whānau including16,000 Māori.BPJ | Issue 37 | 13

Whānau Ora – A General Practitioners perspectiveDr Glenn Doherty is a General Practitioner and clinicaldirector for specialist Whānau Ora provider Te Whānauo Waipareira in west Auckland. Affiliated to the EastCoast tribe of Ngāti Porou, Dr Doherty has worked at theWai Health Clinic – now known as the Whānau CentreHealth Clinic – for the past three years. He has practisedconsistently as the only Māori male General Practitioner inwest Auckland for the last 11 years and has been workingin health management, policy and research and clinicalmedicine roles for the past 28 years. Dr Doherty has aspecial interest in adolescent and youth health and hasbeen the school doctor at Kelston Boys and Hendersonhigh schools in recent years. He is also on the ClinicalGovernance Board for the Waitemata PHO and a newlydeveloped National Māori Health Advisory Council. Hetalks to Best Practice Journal about his work at the clinic.What is the Whānau Centre Health Clinic?“The new centre has been expanded to include morecomprehensive services than before and in time, will beoperating under a ‘Whānau Ora, Whānau Tahi’ kaupapa.We have expanded to include a dental service and onsitepharmacist and are in the process of co-locatingvarious Waitemata District Health Board services. Weare also negotiating with a radiology service and will beco-locating WINZ, CYF and ACC within the centre. Visitingspecialists and a birthing unit are also in the process ofbeing developed.”What does Whānau Ora mean to communities?“Whānau Ora is about co-ordinating care on behalf ofpatients and ensuring care plans and Whānau Ora planscomprehensively address client needs. It is a whānaucentricmodel of service integration using a Māori kaupapato improve all outcomes for our registered clients. Primarycare practitioners will, over time, have centres in theirneighbourhoods and communities like this one that matrixacross sub-regions to provide services that may have beentraditionally provided under and by mainstream servicesor providers.”What are ”wrap-around services”?“Apart from primary and secondary health care serviceswithin the centre, we have a large amount of education,social services, justice and mental health services,which are known as wrap-around services. This meansthat whānau that access our services are looked atcomprehensively – not just snapshots of care or contact.Over time, we will develop a referral triaging process,clinical and non-clinical, that ranks client priorities basedon needs. Access and socio-economic issues will be takeninto account and care plans and Whānau Ora plans will bedeveloped around those needs. There will be a fosteringof new models of service delivery that will focus aroundusing Whānau Ora and Whānau Tahi models to add valueto client outcomes. We will also be concurrently developinghow we measure our performance to achieve improvedoutcomes for clients.”14 | BPJ | Issue 37

How will General Practitioners be involved?“The primary care strategy set the scene for ‘better,sooner, more convenient services’ so these WhānauOra centres implicitly will be ‘one-stop shops’ withmost services co-locating under one roof. Thisapproach capitalises on critical mass and economiesof scale in communities within the context of primarycare. Ultimately, there should be Whānau Ora clausesin contracts with General Practitioners to ensurethese principles are manifested in clinical pathwaysto these centres. In addition, General PractitionerClinical Networks will be required to work closelywith these centres and ensure they are meaningfullyengaged and aligned with these centres.”What other services does the Whānau CentreHealth Clinic offer?“In addition to core general practice and nursingservices, the centre offers podiatry, midwifery anddietician services. We are about to employ a GeneralPractitioner to run a chronic care clinic and we arelooking at working with an endocrinologist to runvirtual and on-site clinics for our difficult diabeticclients. We also have a family violence service,Māori mobile nursing services, cardiac rehabilitationservices and oral health services integrated with theclinic. The centre offers a suite of ten services underthe ‘Services to Improve Access’ contract. Finally, aMāori mirimiri service (traditional massage) is alsobeing developed. Service navigators will also workto align and engage clients with appropriate andrelevant services.”What is your outlook for the future?“This is an exciting time for this urban Māori authorityin west Auckland, to provide services within theWhānau House and for staff working in the centreand for our community. Waipareira is the only serviceentity of its kind in New Zealand run and operated byMāori for all people wanting new approaches to theirpersonal care and the care of their whānau.”Kōtahitanga has developed a new whānau-centredmodel of practice, Mana Tiaki, to address the unmetneeds of whānau. The model is applied across a networkof providers and is evidence-based, outcomes-drivenand strengths-focused. It is based upon the premise ofsupporting and enabling whānau-centric practice and canbe applied to any whānau who chooses it, although it isnot exclusive to Māori.Mana Tiaki also enhances provider member capacity todeliver high quality services to whānau as it supportsimproved and coordinated access to a range of niche orspecific services that are delivered by the network.As with other Whānau Ora collectives, Kōtahitanga providesa range of health and social services across a continuumof care. The collective also provides innovation acrossareas such as te reo-based rangatahi services, specialistcultural needs assessment for kuia and kaumātua, wahineand pepi services that have world class accreditation,marae-based and integrated services, intersectoralservice delivery, a mix of rural and urban services, iwi andmata waka networks and cultural competency systems.Alliance Health+ Trust – a Whānau Ora Collectivemeeting the needs of Pacific peoplesAlliance Health+ Whānau Ora Collective represents sixproviders including: Auckpac, Bader Drive, HealthstarPacific, Penina Health Trust, Southseas and Tongan HealthSociety.For the past 20 years, members of this provider collectivehave customised services to meet the needs of Pacificpeoples and high needs populations in Auckland. In doingso, the collective have long-established relationships withPacific churches and community interest groups to ensurethe voices of these groups are representedIn 2010, Alliance Health+ was established in responseto the Ministry of Health policy – Better, Sooner, MoreConvenient Health Care in the Community – whichresulted in the consolidation of three Pacific-led PrimaryBPJ | Issue 37 | 15

Turning to Whānau Ora in times of needRenee Muru is the primary health care manager for TurukiHealth Care in South Auckland – part of the Kōtahitangaprovider collective.Renee says that meeting people and home visits are a keypart of their Whānau Ora service approach which aimsto put a complete package of support around people’shealth and social needs.“In simple terms, health problems are often closely relatedto things like housing, income, education, transport,employment, nutrition and smoking cessation,” she says.“It’s important to see the whole individual in the contextof their whānau. By collaborating with other agencies wecan address the factors that contribute to ill health, makea positive difference and get some great outcomes forwhānau.”As part of the Kōtahitanga collective, Turuki worked withmore than 20 individuals who arrived in Auckland afterthe Christchurch earthquake in February.As well as no food or accommodation, and no knowledgeof local support systems, their social and health needswere varied. They underwent needs assessments drivenby their own goals and aspirations with access to servicesacross a network of providers.Turuki helped the whānau in a number of ways, including;enrolling their children in schools, assessing immediatehealth needs as many came without vital medication,providing support with counselling services and helpingto secure accommodation.“A number of these clients have never been beneficiariesand using the services of WINZ and Housing New Zealandwere very foreign to them,” says Renee.“This work is ongoing and we are continuing to support anumber of families with their short term, medium and longterm goals.”16 | BPJ | Issue 37

Health Organisations (PHOs): Ta Pasifika (Bader Driveand Southseas), Auckpac PHO and Tongan Health SocietyPHO.integrated care through the delivery of wrap-aroundservices that meet the needs of the consumer and theirfamily.Whānau Ora is a concept that strongly aligns with Pacificvalues and provides an exciting opportunity to enhanceprimary care. The inclusion of other Pacific non-governmentorganisation (NGO) providers such as Healthstar Pacificand Penina Trust helps achieve the holistic outcomes forwhānau.Within a year, Integrated Family Health Centres (IFHCs) willbe a central hub in which some of the collective’s modelof care activities will occur. The centres will offer a rangeof services for whānau to easily access in one locationacross the health and social sector, and externally with keygovernment agencies and NGOs.The collective has developed O Le Aiga mā le Fanau iaOla Pacific framework for Whānau Ora which describeshealth and wellbeing in the context of relationships, socialenvironments and the wider determinants of health.It takes a long-term perspective of building for futuregenerations.Alliance Health+ is focused on greater co-ordinated andLooking ahead, Alliance Health+ plans to continue tofocus on key areas: structural change by strengtheningthe Alliance Health+ clinical governance programme;establishment of integrated family health centres andnurse-led clinics/networks; development of populationhealth programmes for communities; WhānauOra (enhanced primary care); and acute demandmanagement.Department of General Practice and Rural HealthDunedin School of Medicine, University of OtagoDivision of Health SciencesComplementary Medicine – its place inprimary care – GENX 826Semester Two – 2011Commences with the first residential in Dunedin on August 27 & 28 and finishes with a residential onNovember 26 & 27.Study of this paper will equip GPs with the knowledge base to help their patients make informed healthcare choices in relation to complementary therapies.STUDENTS WILL GAIN:• An overview of non-conventional treatmentoptions available in the primary healthcaresector and of reasons patients give for usingthem.• Understanding of the different health careperspectives that underlie complementarypractices and how they fit with generalmedical practice.• Knowledge about existing research ofcomplementary therapies, how to accessevidence-based information and what thespecific challenges are for research in thisfield.• Understanding of the legal and regulatoryenvironment for complementary practices inNZ.For more information contact:Anita Fogarty, Postgraduate Administrator03 479 7424 or 021 279 7424Email: gp.postgrad@otago.ac.nzwww.otago.ac.nz/dsm/gp