6 June 2013 (PDF 2.4MB) - Taranaki District Health Board

3 ResolutionThat the Taranaki District Health Board note and receive the report andattachments of the Chief Executive.Bourke/BallantyneCarried ResolutionThat the Taranaki District Health Board note and receive the report andattachments of the General Manager Finance & Corporate ServicesCatt/LockettCarried 3

4 4

5 ResolutionThat the Hospital Advisory Committee resolve to accept the minutes of themeeting held 11 April 2013 as a true and correct record.Catt/BallantyneCarried 5

6 o o o o o o 6

7 7

8 8

9 ResolutionThat the Hospital & Specialist Services Advisory Committee recommendthat a recommendation be made to HQSC that national thresholds in theformulation of the Quality Accounts framework be set at 100%.Catt/BallantyneCarried 9

10ResolutionThat the Hospital Advisory Committee exclude the public from the meeting onthe basis of the following matters:1. To present Hospital Advisory Committee Minutes pursuant to an earlierresolution publicly excluding the item.Catt/RumballCarried ResolutionThat the Hospital Advisory Committee resolve to accept the minutes of themeeting held 11 April 2013 as a true and correct record.Catt/LockettCarried 10

11COMMUNITY & PUBLIC HEALTH / DISABIITY SUPPORTCOMMITTEESMINUTES – PUBLIC (Unconfirmed)Tuesday, 30 April 201312.30 pmTaranaki Disability Information Centre28 Young StreetNew PlymouthPresentFlora Gilkison (Chairperson), Mary Bourke (late), Peter Catt, Karen Eagles,Alison Rumball, David Tamatea, Colleen TuutaIn AttendanceTony Foulkes, (Chief Executive), Sandra Boardman (General Manager Planning,Funding & Population Health), Ngawai Henare (Chief Advisor Maori Health),Sue Carrington (Communications Advisor), Greg Simmons (Chief Medical OfficerFran Davey (Minute Secretary).Channa Perry (Portfolio Manager Older People & Cancer Services TDHB).719.0 ApologiesResolutionThat the apologies from Alex Ballantyne, Mary Bourke (lateness) Ella Borrows,Kura Denness, Brian Jeffares, and Pauline Lockett be received and noted.Catt/RumballCarried720.0 WelcomeChairman welcomed all present and outlined the purpose of the Community PublicHealth Advisory and Disability Support Advisory Committees. It is a means ofcollecting information from the community to bring to the Board of the DistrictHealth Board for discussion and resolution.721.0 Conflict of InterestThe Register was circulated for signing by members.registered.No new conflicts were722.0 Public CommentEsther Tan, Te Hauora Pou Heretanga, Maori Disability Coordinator, NationalMaori Disability Coalition, Te Piringa, representative (National Collective of MaoriDisability).Esther extended an invitation to a seminar on Thursday, 2 May 2013 offeringworkshops in Ngahere Rongoa (medicinal medicine), Rongoa Raranga (Weaving)CPHAC DSAC 30 April 201311

12and Rongoa Mirimiri (deep therapeutic massaging) and to profile Te Piringa (theNational Collective of Maori Disability).Esther advised these workshops are considered taonga (gifts) and stand alongsideand complement conventional medical practises. It is anticipated these taonga willbe promoted at a national level and will address the wairua (spiritual) aspect of theperson.723.0 PresentationsMembers of the Disability Action Group made presentations as follows723.1 Mr John MajorJohn Major, Chair, Disability Action Group for the DHB, Vice Chair New PlymouthPositive Aging Trust, Vice Chair for the Taranaki Disability Information Trust,member of the New Plymouth District Council Disabilities Working Party andBarrier Free Advisory for Disability Information Centre.Mr Major reported the Disability Action Group of the Taranaki DHB has beeninvolved in a number of projects including the improved wheel chair access to thehospital, input into the planning of the new hospital building around disability andthe use of the Omega hearing apparatus in some departments of the hospital.As a patient, Mr Major complimented the DHB around the exemplary services andtreatment he received at Taranaki Base hospital. Mr Major offered thanks to theBoard for their support and acceptance of the Disability Strategy, and praised thevery positive DHB relationship with the disability community.Chairman thanked Mr Major for his presentation.723.2 Mr Lance Girling ButcherLance Girling-Butcher, New Plymouth District Councillor with his guide dog Yogi;member of the Disability Action Group for the DHB, Disabilities Working Groupparty for the New Plymouth District Council, Chair of the New Plymouth DistrictCouncil’s “Let’s Go” Working Party; Council representative for the Positive AgingTrust and will be leading the political aspect of drafting an Aging Strategy for NewPlymouth;Mr Girling-Butcher praised the staff of Base Hospital for the outstanding andprofessional service he received as a patient on a number of occasions. He notedthe service offered by the hospital Chaplain was commendable and highlighted theimportance this role plays for patients within the hospital environment. Mr Girling-Butcher complimented committee members for their work in association with thecommunity. The retention of the older aged worker at the Taranaki DHB is also tobe complimented, for within these workers is the repository of knowledge to beshared with the younger employees.Chairman thanked Mr Girling-Butcher for his presentation.723.3 Mrs Sue YoungSue Young, Volunteer Deaf Aotearoa 2012, Volunteer Recognition Award for herservices to the Hearing Impaired Community, Committee member of the NewPlymouth Hearing Assn for 26 years, 2001 New Plymouth Hearing Impaired SocialGroup. Worked for Deaf Aotearoa in the Taranaki Office as the Hearing ImpairedSupport Person.CPHAC DSAC 30 April 201312

13Mrs Young was involved in the implementation of the “Front Row to Go” hearingsystem for Base Hospital, the New Plymouth District Council, Puke Ariki, GovettBrewster Art Gallery and the Disability Information Centre.Mrs Young’s passion is in education and awareness around hearing loss. Beingborn with moderate hearing loss she has 20% hearing with the assistance ofhearing aids. Mrs Young acknowledged hearing disability is hereditary in herfamily of which her mother, herself and her son have a hearing impairment.With the closure of the Hearing Association in 2001 and the sale of the LemonStreet property, proceeds from the sale were invested in hearing dogs and theDisability Hearing Centre in Deaf Aotearoa. The dogs are trained for four monthswith sounds around the home ie the doorbell, timer, phone, alarm clock and smokealarm.Mrs Young assisted with the training of staff at Base and Hawera hospitals in theuse of the Omega hearing system. Eight Omega hearing systems are in BaseHospital and two in Hawera Hospital.Chairman thanked Mrs Young for her presentation723.4 Mr Brian EriksenBrian Eriksen, Manager, Taranaki District Information Centre. His role provides acommunity connection for the 50 affiliated disability groups; a member of theDisability Action Group; Coordinator of the Taranaki Disability Strategy CoalitionGroup; Chairman Apepsi Trust, Chairman Kindred Trust; member of Cook for LessTrust, Chairman Community Housing Action Taranaki, Member of the TransportOfficers Group Regional Council New Plymouth District Council, Media Assessorand Coordinator of the Social Services Group Health and Disabilities.Mr Eriksen advised the Taranaki Disability Information Centre was set up in 1984to provide accessible resources to empower people with disabilities to makepersonal choices about their quality of life.Mr Erikson thanked the committee for holding the meeting at the InformationCentre and was very pleased with the DHB relationship with the communitythrough the Disability Action Group.In 2001 the New Zealand Disability Strategy was launched. Strategy 1 was toeducate and inform people around disabilities. The Disability AwarenessWorkshops have been designed to give each individual, group or organisation abetter insight into life with a disability. Mr Erikisen advised the workshop could beadapted to run at the hospital.Discussion• Mrs Rumball who has done the workshop through the New Plymouth DistrictCouncil, noted the time and motion factor changes completely for peoplewith disabilities.• Ms Tuuta recommended Board members and the Management Team attendthese workshops.CPHAC DSAC 30 April 201313

14Chairman thanked Mr Erikisen for his presentation noting how the practicalexperience of the workshop would be beneficial to understanding disability.724.0 Public Comment Cont’d724.1 Mr Joe RodriguesJoe Rodrigues, who has been involved with the health sector for 48 years, reportedresearch by Canterbury University in England showed positive health benefits fromgroup singing for people with dementia, strokes and for the community at large.Linda Cox YMCA New Plymouth implemented a “Singalong” programme one yearago which is showing positive outcomes. Senior Care have imported acomputerised karaoke device for use for people with dementia. The device is onloan to the Riverside Bupa care facility who will monitor and measure thehappiness value.724.2 Te Ara Hikoi Swim GroupTe Ara Hikoi Swim Group (Te Pou Heretanga) provide pool programmes andexercises to help alleviate pain for patients waiting for joints and hip replacements.With the closure of the CCS pool, clarification was sought on public access tohospital hydrotherapy pool.725.0 Minutes of Previous MeetingResolutionThat the Community and Public Health Advisory Committee and the DisabilitySupport Advisory Committee resolve to accept the minutes of the meeting held on26 February 2013 as a true record.Tuuta/CattCarried726.0 Management Reports726.1 Maori Health ReportChief Advisor took her report as read highlight the following:• Kia Ora Hauora – Te Atiawa ranked amongst the top five iwi registrants on thewebsite along side much larger iwi such as Ngati Porou, Tainui, Tuhoe and TeArawa. Work being done through Whakatipuranga Rima Rau in thesecondary schools has contributed to this ranking.• The Maori Health Plan 2012/13 – a full report on Quarter 3 results will bepresented at the joint Board and Te Whare Punanga Korero meeting on 21May 2013. Dedicated Maori Health team resource has now been allocated tosupport the provider arm services to accelerate progress with regards to localpriorities Children’s Oral Health and SUDI.• Whakatipuranga Rima Rau has 163 year 12 and 13 secondary schoolstudents enrolled this year• Gloria Campbell, Regional Commissioner will replace Mark Poppelwell on theWRR board.• He Ritenga Cultural Audits – a request that the Audit report of Paediatrics andDental Health services be circulated to the Board.• Te Reo O Taranaki an iwi representative body would be providing advice andsupport regarding signage and artwork for the new hospital building.Ms Tuuta did not feel it should be necessary to seek additional funding.CPHAC DSAC 30 April 201314

15• Ms Tuuta commended the work being done to induct the new Senior MedicalOfficers (SMO’s) on Maori Health inequalities and strategy in Taranaki. Inresponse to a query about how this same information is shared with longerserving SMO’s, Ms Henare acknowledged this as an area that needed furtherwork and to this end, advised of the development of a cultural competencyframework under which the board and all managers, staff and contractorswould be required to demonstrate specified cultural competencies includingknowledge of Maori health inequalities, and strategy to address them.ResolutionThat the Community and Public Health Advisory Committee and Disability SupportAdvisory Committee receive the Maori Health report as tabled.Eagles/CattCarried726.2 Planning Funding and Population Health ReportMrs Boardman took her report as read noting:• Dr Jonathan Jarman has joined the Public Health Unit as Medical Officer ofHealth and acknowledged the work Dr Greg Simmons had done over manyyears.• The Te Kawau Maro contract relates to community contracts as a forerunner forTDHB to look at health outcomes from intervention logic approach ie MamaPepe Tamariki. This will contribute to improved outcomes rather than services.• Referring to the Midland Region Services Plan Q3 performance report, withregard to Maori health, ‘MIRB’ relates to the Midland Iwi Relationship Board,and the Accountability Framework ‘He Raranga-A-Tira’ has been integrated intothe workplans of each regional workstream. The framework sets out minimumexpectations each workstream needs to do to improve responsive to the needsof Maori, including for example ensuring there is appropriate Maorirepresentation on the workstream, and ensuring that specific training takesplace to upskill the Maori workforce in the particular clinical area.ResolutionThat the Community and Public Health Advisory Committee and the DisabilitySupport Advisory Committee receive and note the Management Report of theGeneral Manager Planning Funding and Population HealthEagles/BorrowsCarried727.0 March 2013 Funder Financial ResultsGeneral Manager Planning, Funding and Population Health took her report asread.ResolutionThat the Community and Public Health Advisory Committee and the DisabilitySupport Advisory Committee receive and note the March 2013 Funder FinancialResults.Eagles/TamateaCarriedCPHAC DSAC 30 April 201315

16728.0 Proposed Themes for 2013 Committee MeetingsCommittee received paper for noting.729.0 Terms of ReferenceIt was noted that Terms of Reference would be reviewed in conjunction with thereview of reporting format.732.0 Next MeetingChairperson offered thanks to Channa Perry for organising the presentation and toall presenters and closed the meetingIt was noted the next meeting date is 25 June 2013The meeting concluded at 2.30 pm.Chairman……………………………………….Date ………………………….CPHAC DSAC 30 April 201316

17 17

18 Open forbetter care 18

19 Open for better care 19

20 20

21 21

22 Receive and note the Chief Executive’s Report and associated managementreports. 22

23 23

24Hon Tony Ryall 24

25o o o o o o o o o 25

26 Ministry of Health v Atkinsonand others 26

2727

2828

2929

3030

3131

3232

3333

3434

3535

3636

3737

3838

3939

4040

4141

4242

4343

4444

4545

4646

4747

4848

4949

5050

5151

5252

5353

5454

My DistrictHealth Board2012/13 QUARTER THREE (JANUARY–MARCH) RESULTSHow to read the graphs00 District Health Board 00% –RankingQuarter threeperformance55DHB current performanceGOALProgressShorterstays inEmergencyDepartmentsShorter stays in EmergencyDepartmentsThe target is 95 percent ofpatients will be admitted,discharged, or transferred froman Emergency Department (ED)within six hours. The target isa measure of the efficiency offlow of acute (urgent) patientsthrough public hospitals, andhome again.IncreasedImmunisationIncreased ImmunisationThe national immunisationtarget is 85 percent ofeight-month-olds have theirprimary course of immunisationat six weeks, three months andfive months on time by July 2013,90 percent by July 2014 and95 percent by December 2014.This quarterly progress resultincludes children who turnedeight-months between Januaryand March 2013 and who werefully immunised at that stage.Quarterthreeperformance (%)1 West Coast 100 –1 Northland 121 1 Northland 100 –2 Waitemata 98 –2 Lakes 117 1 Waitemata 100 –3 Wairarapa 97 3 Waikato 116 1 Auckland 100 –4 South Canterbury 97 –4 Taranaki 114 1 Counties Manukau 100 –5 Whanganui 97 –5 Hawke’s Bay 112 1 Lakes 100 –6 Counties Manukau 97 –Elective Surgery6 Bay of Plenty 111 Cancer Treatment1 Bay of Plenty 100 –7 Taranaki 96 7 Counties Manukau 110 1 Tairawhiti 100 –8 Nelson Marlborough 96 – Improved access to elective8 Canterbury 107 Shorter waits for cancer1 Hawke’s Bay 100 –9 Hutt Valley 95 surgery9 MidCentral 106 treatment1 Taranaki 100 –10 Tairawhiti 95 – The target is an increase in10 South Canterbury 106 The target is all patients, readyfor-treatment,1 MidCentral 100 –wait less than 1 Whanganui 100 –11 Auckland 95 – the volume of elective surgery11 Hutt Valley 103 12 Canterbury 94 – by at least 4000 discharges12 Tairawhiti 102 four weeks for radiotherapy or 1 Capital & Coast 100 –13 Lakes 94 per year. DHBs planned tochemotherapy. Six regional cancer13 Waitemata 101 1 Hutt Valley 100 –deliver 109,293 dischargescentre DHBs provide radiation14 Northland 94 –14 Whanganui 100 1 Wairarapa 100 –for the year to date, and haveoncology services. These centres15 Hawke’s Bay 93 15 Nelson Marlborough 100 1 Nelson Marlborough 100 –delivered 6878 more.are in Auckland, Hamilton,16 Southern 93 16 Auckland 100 Palmerston North, Wellington, 1 West Coast 100 –17 Bay of Plenty 90 17 Wairarapa 99 Christchurch and Dunedin. Medical 1 Canterbury 100 –18 MidCentral 90 oncology services are provided by18 Southern 99 1 South Canterbury 100 –the majority of DHBs.19 Waikato 89 19 Capital & Coast 98 1 Southern 100 –* One patient, who was ready-fortreatment,waited four weeks and two 20 Waikato 99.7 –20 Capital & Coast 88 –20 West Coast 98 All DHBs 94 –Now that the hospitaldays for chemotherapy during quarterAll DHBs 106 three.All DHBs 99.9 *–95%100%100%Quarterthreeperformance (%)Change frompreviousquarter1 Wairarapa 96 2 Hawke’s Bay 94 3 Hutt Valley 94 –4 Southern 93 –5 MidCentral 93 6 Canterbury 93 7 Whanganui 92 8 South Canterbury 92 9 Auckland 91 –10 Capital & Coast 91 11 Waitemata 90 12 Taranaki 88 13 Bay of Plenty 88 14 Nelson Marlborough 87 15 Counties Manukau 86 16 Lakes 85 17 Tairawhiti 85 18 Northland 83 –19 Waikato 81 –20 West Coast 78 This information should be read in conjunction with thedetails on the website www.health.govt.nz/healthtargetsChange frompreviousquarterImprovedaccess totarget has been achieved,we are ranking DHBs againstthe primary care target.Betterhelp forSmokers to QuitBetter help for smokersto quitThe target is 95 percent ofpatients who smoke and areseen by a health practitioner inpublic hospitals, and90 percent of patients whosmoke and are seen by ahealth practitioner in primarycare, are offered brief adviceand support to quit smoking.Change frompreviousquarterHospitalsQuarterthreeperformance (%)Quarter threeperformance (%)Progressagainst plan(discharges)– 99 1 Hawke’s Bay 91 – 98 2 South Canterbury 82 99 3 Bay of Plenty 82 95 4 Taranaki 63 97 5 Wairarapa 63 – 92 6 Southern 61 93 7 Nelson Marlborough 59 – 98 8 Northland 55 – 96 9 Capital & Coast 55 93 10 Lakes 54 91 11 MidCentral 53 91 12 West Coast 53 – 93 13 Waikato 51 91 14 Tairawhiti 47 – 96 15 Counties Manukau 45 95 16 Whanganui 42 96 17 Auckland 41 – 97 18 Waitemata 39 –– 97 19 Hutt Valley 34 – 90 20 Canterbury 31 All DHBs 89 –– 95 All DHBs 51 85% 95% 90%55PrimarycareChange frompreviousquarterShorterwaits forHeart andDiabetes ChecksMore heart and diabeteschecksThis target is 90 percent of theeligible population will havehad their cardiovascular riskassessed in the last five yearsto be achieved in stages by July2014. The current stage is toachieve 75 percent by July 2013.Quarterthreeperformance (%)Quarterthreeperformance (%)Change frompreviousquarterChange frompreviousquarter1 Taranaki 70 2 Northland 69 3 Wairarapa 69 4 Bay of Plenty 68 5 Hawke’s Bay 67 6 Waikato 67 7 Waitemata 65 8 Auckland 64 9 Whanganui 63 10 Tairawhiti 63 11 Lakes 62 12 Counties Manukau 61 13 Capital & Coast 60 14 Southern 59 15 South Canterbury 59 16 West Coast 58 –17 Nelson Marlborough 56 18 MidCentral 55 19 Hutt Valley 42 20 Canterbury 29 All DHBs 59 75%

56Taranaki District Health BoardPrivate Bag 2016New Plymouth 4620New ZealandTelephone 06 753 6139Facsimile 06 753 7770Email corporate@tdhb.org.nzWebsite www.tdhb.org.nzHealth Targets, Quarter Three 2012/1328 May 2013The health targets results for the third quarter of 2012/13 have been released by the Ministry ofHealth.The Taranaki health sector continues to work towards the targets, which are indicative of a widerrange of services and efforts in priority areas.This Quarter Taranaki DHB has improved in all six national health targets. Taranaki is top of all theDHBs for the More Heart and Diabetes Checks Target.Nationally across all DHBs four Health Targets have been met:• Improved access to elective surgery target (106.3 percent)• Shorter waits for cancer treatment (99.9 percent)• Increased immunisation (88.9 percent)• Better help for smokers to quit hospital target (94.8 percent).All other national Health Target results have improved compared with quarter two 2012/13.Planning and Funding, and Population Health General Manger Sandra Boardman said a focus on thesix key areas is important to continue to improve health, reduce inequalities and improve the qualityof health services for Taranaki people. “The targets provide a useful indication of how we are doing”.The health targets for Taranaki DHB are:1) Shorter Stays in ED. Target 95%, Achieved 96%The team continues to focus on improving the flow of patients in our acute pathway work. This hasbeen an enormous effort by the Emergency Department and the whole hospital approach.We are very pleased to have achieved the target with 96% of patients seen in ED admitted ortransferred from the ED within six hours. Nationally the target has continued the trend of increasedperformance this quarter, reaching 94%; the highest result yet.2) Improved Access to Elective Surgery: Target 100%, Achieved 114%Quarter three results for the elective surgery target show the national target has been achieved with116,171elective surgical discharges provided, against a target of 109,293 discharges.Taranaki DHB is one of 15 DHBs to achieve this target and one of 10 to be 5% or more ahead ofplan.3) Shorter Waits for Cancer Treatment: Target 100%, Achieved 100%Nationally, 99.9 percent of patients, who were ready-for-treatment, received their radiotherapy andchemotherapy within four weeks of the decision to treat. We plan to continue this strongperformance and our collaborative relationship with MidCentral DHB to maintain the 100% cancerwaiting time target.4) Increased Immunisation: Target 85%, Achieved 88%Taranaki DHB was one of 17 DHBs to reach the target - 85 percent of eight-month olds are fullyimmunised. Increasing immunisation rates are a priority in order to reduce the incidence ofpreventable disease in our community. We are working closely with PHOs, Hospital Services,outreach immunisation services, National Immunisation Register and Well Child Providers on56

57strategies to improve immunisation uptake including early enrolment of newborns with a generalpractice.5) Better Help for Smokers to Quit (Hospital Target): Target 95%, Achieved 95%This quarter, the hospital Better Help for Smokers to Quit target was 94.8 percent nationally. We areworking hard to ensure patients and visitors to our hospitals are given advice about quitting and arepleased to have exceeded the target this quarter. This is important to us as Taranaki DHB groundsand buildings are now fully Smokefree/Auahi Kore.Better Help for Smokers to Quit (Primary Care Target): Target 90%, Achieved 63%National performance for the primary care target was 51 percent, an 8.4 percent improvement onquarter two with Taranaki achieving 63%, a 5% increase from last quarter.6) More Heart and Diabetes Checks: Target 75%, Achieved 70 %Taranaki DHB will continue to work with the PHOs in developing their Diabetes Care ImprovementPackages and Long Term Conditions programmes to meet this new target. We are pleased to see anincrease of 3% this quarter, making Taranaki DHB one of the top three performers in this target andone of seven DHB within 10 percent of the target.Diabetes and cardiovascular disease continue to be among the main causes of ill health in Taranaki.57

58 There is potential for HaweraInpatient and ED services ascurrently configured to providesuboptimal careMeet with St John regarding clinical direction/emergencyresponse against clinical pathways/inter-hospital transfers. This is a major piece of work involving internal and external COO/CNA June 2014players that will be progressed over the next 18 months.Clinical pathways identified for discussion and evaluation withHawera medical and nursing teams.CMA, COO/CNA From31/01/12 Ongoing evaluation of clinical pathways occurs ensuring riskmitigation is acceptable. Ongoing evaluation of DVT and Cellulitis primary-secondarycare protocols are Taranaki DHB wide and require coordinationwith Hauora Coalition and Midland HealthNetwork PHOs. Map of Medicine to prioritise pathways for DVY, Cellulitisand Stroke Thrombolysis Monitor impact on Outpatient Clinics of physicians roundingin Hawera. There has been a reduction in the ability for theCOO/CNAFrom19/09/11visiting Physician to see all outpatients booked – monitoringcontinues. Daily operation meeting reviews patient flows for HaweraInpatient Ward.COO/CAN,Clinical ServicesMgr, CNM EDHawera, SupportServices CoordinatorHaweraFrom3/10/11Continuing Evaluation/review of actions taken to be undertaken CMA, COO/CAN, 15/08/13Clinical ServicesMgr158

59 Limited capacity to fill medicalRecruitment of permanent medical staff with appropriate scopesrosters with staff appropriatelyqualified in scopes of practice towork in Hawera ED and InpatientWard.of practice.3-5 year timeframe for Rural Medicine Hospitalaccreditation programme to deliver the number ofpermanent medical staff aimed for ie 5 or 6 vocationallyregistered rural medicine specialists based in Hawera.Recruitment strategy for Rural Medicine Hospital doctorsrequired.Consideration to be given to credentialing the HaweraHospital ED and inpatient medical service earlier than theplanned date in 2017 as a Rural Hospital MedicalDepartment. One permanent vocationally registered RuralMedicine Specialist is working in Hawera ED, another isnearing the end of vocational trainingCMA, COO/CNA& GMFinance/Commercial/HR & ODCredentialingCommitteeOngoing Evaluation/review of actions taken to be undertaken CMA, COO/CAN,Clinical ServicesMgr15/8/13Ability of DHB to continue to meetsupervision and Medical Council ofNew Zealand (MCNZ) requirementswith respect to Hawera HospitalMOSS.Strengthen supervision of Hawera Inpatient MOSS by theDepartment of Medicine and Older People’s Health throughweekly ward rounding in Hawera by both Departments andMOSS spending one day a week attached to the Departmentof Medicine at Taranaki Base Hospital.CMA, COO/CNARecruitment of permanent medical staff with appropriate scopesof practice. 3-5 year timeframe for Rural Medicine Hospitalaccreditation programme to deliver the number ofpermanent medical staff aimed for ie 5 or 6 vocationallyregistered rural medicine specialists based in Hawera. Recruitment strategy for Rural Medicine Hospital doctorsrequired.CMA, COO/CNA& GMFinance/Commercial/HR & ODFrom31/01/122017259

60 Consideration to be given to credentialing the HaweraHospital ED and inpatient medical service as a Rural HospitalMedical Department. One permanent vocationally registeredRural Medicine Specialist is working in Hawera EDTransporting emergency surgicalpatient to Hawera Hospital leads todelays in reaching definitivesurgical care which has resulted inpoor outcomesCare of older persons issuboptimal. Patients’ safety can becompromised by lack of experience,lack of focus on identification &treatment of potentially reversibledisease in tandem with good Evaluation/review of actions taken to be undertaken CMA, COO/CAN, 15/8/13Clinical ServicesMgrMeet with St John regarding clinical direction/emergencyresponse against clinical pathways/inter-hospital transfers. This is a major piece of work involving internal and external COO/CNA Sept 2013players that will be progressed over the next 18 months.Clinical pathways identified for discussion and evaluation withHawera medical and nursing teams.CMA, COO/CNA From31/01/12 Ongoing evaluation of clinical pathways occurs ensuring riskmitigation is acceptable. Compliance with the policies and procedures of the MidlandRegional Trauma Service. Compliance with Taranaki DHB policies on patient transfers Evaluation/review of actions taken to be undertaken CMA, COO/CAN, 15/8/13Clinical ServicesMgr Monitor impact on Outpatient Clinics of physicians rounding COO/CNAin Hawera. There has been a reduction in the ability for thevisiting Physician to see all outpatients booked – monitoringFrom19/09/11continues. Regular inpatient ward rounds are undertaken by Older COO/CAN, ClinicalPeople’s Health Service and the General PhysiciansServices Mgr, CMA360

61 rehabilitation practice andmaximisation of function Many patients in South Taranaki are“transport disadvantaged” and findit difficult to attend appointmentsat Hawera and Taranaki BaseHospitals Daily operational meeting reviews patient flows for HaweraInpatient Ward.COO/CAN, ClinicalServices Mgr, CNMED Haw, SupportServices CoordinatorHaweraFrom3/10/11Continuing Evaluation/review of actions taken to be undertaken CMA, COO/CAN, 15/8/13Clinical ServicesMgrWork with the Taranaki Regional Council on South TaranakiCOO/CNA 1/1/14transport issues via the Taranaki DHB representative. Working with commercial operations, Councils, St John andsome smaller single providers with the aim being to enhanceaccess for South Taranaki residents to North Taranaki healthservices. As above, this is a major piece of work that will progressover the next year. Communication re the nature of the clinical risks to Hawera Inpatient Doctors CMA 29/09/11 Meet with St John regarding clinical direction/emergency response against clinical pathways/inter-hospitaltransfers.GM H&SSGM H&SS28/09/1131/01/12 Further meeting to be scheduled with St John Regional Mgr once St John have completed their preparatory GM H&SS 30/04/12work. St John presentation received and is being considered including funding implications. Clinician review anddiscussion occurring. All patients transferred from Base to Hawera Hospital for inpatient care will be reviewed by the Dept ofOlder Peoples Health before transfer.CMAFrom3/10/11461

62 Presentations requiring a surgical intervention will be transferred to Base Hospital - agreed with medicalCMA, 31/12/11/staff in Hawera.GM H&SS, DON Inpatients of more than 72 hour status, not under the Older Persons Health service, will be discussed with aphysician and there will be consideration of a transfer to base hospital – discussed with and agreed to byphysicians and raised at HOD meeting. Specific clinical pathways (listed below) have been discussed with medical staff in Hawera and they haveagreed to follow TDHB protocols.o Deep vein thrombosis clinical pathwayo Cellulitis clinical pathwayo Stroke clinical pathwayo Myocardial Infarction clinical pathwayo Asthma clinical pathwayo Other identified clinical pathways Explore shared IT systems, including e-referrals, discharge summaries, diagnostic requests and resultsCMA, 30/06/12dependent.GM H&SS, DON Joint access between Southcare and Hawera Hospital. Weekly ward rounds by visiting specialists from the Dept of Medicine and Older Peoples Health. CMA From19/09/11 Communication strategy developed. CMA, GM H&SS,DON & CommsFrom30/09/11 Hawera ED Service reviewed in consultation with the HOD ED. Agreed that the Hawera ED Service hasCMA 29/11/11appropriate clinical oversight and accountability and therefore the associated clinical risk is acceptable.Review the recruitment strategy Review the job descriptions for rural hospital medicine practitioners at the next Hawera Drs meeting –CMA, GM H&SS 31/12/11completed – now in final draft.Med Off. Hawera Investigate establishment of a rural medicine hospital specialist programme.CMA, GM H&SS 31/12/11 Information from the College of GPs has been received. CMA & Medical Recruitment Manager to progressonce resource/support implications resolved.Med Off. Hawera Awaiting visit from the college. Accreditation has been granted. Will work towards advertising for a trainee recruit to start in 2013.Reviewing Hawera training programmes to obtain vocational specialty. Base ED and Specialist runs at Baseare also accredited for rural medical training.562

63Clinical pathways defined, including supervision and treatment between Base Hospital Specialists and SouthTaranaki services.CMA 30/9/11663

64Taranaki District Health Board Health Target Monitoring 2012-2013 - Q3 2013 Result100%90%80%70%60%50%40%30%20%10%0%2010-2011Shorter Stays in emergency departmentsQ1 11-12Q2 11-12Q3 11-12Q4 11-Jul-1212Aug-12Total 89% 88% 91% 90% 90% 92% 91% 93% 93% 93% 94% 95% 97% 96%Maori 91% 93% 95% 94% 94% 95% 95% 95% 96% 96% 96% 97% 97% 97%Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%Sep-12Oct-12 Nov-12Dec-12Jan-13Feb-13Mar-13130%120%110%100%90%80%70%60%50%40%30%20%10%0%Q1 11-12Q2 11-12Improved Access to Elective SurgeryQ3 11-12Q4 11-12Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13Total 110% 111% 121% 120% 109% 111% 113% 114% 115% 114% 115% 115% 114%Target 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%Mar-13100%90%80%70%60%50%40%30%20%10%0%2010-2011Q1 11-12Shorter Waits for Cancer TreatmentQ2 11-12Q3 11-12Q4 11-Jul-1212Aug-12Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%Maori 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%Target 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%Sep-12Oct-12 Nov-12Dec-12Jan-13Feb-13Mar-13100%90%80%70%60%50%40%30%20%10%0%2010-2011Better Help for Smokers to Quit - SecondaryQ1 11-12Q2 11-12Q3 11- Q4 11-Jul-1212 12Aug-12Total 83% 88% 91% 87% 90% 89% 85% 87% 91% 95% 94% 91% 96% 95%Maori 84% 93% 90% 91% 91% 91% 86% 87% 91% 94% 93% 90% 97% 95%Target 90% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%Sep-12Oct-12 Nov-12Dec-12Jan-13Feb-13Mar-13Better Help for Smokers to Quit - Primary100%90%80%70%60%50%40%30%20%10%0%2010-2011 Q1 11-12 Q2 11-12 Q3 11-12 Q4 11-12 Sep-12 Dec-12 Mar-13Total 30% 35% 39% 42% 45% 53% 58% 63%MaoriTarget 90% 90% 90% 90% 90% 90% 90% 90%100%90%80%70%60%50%40%30%20%10%0%More Heart and Diabetes Checks - CVD RiskAssessmentsQ3 11-12 Q4 11-12 Sep-12 Dec-12 Mar-13Total 55% 59% 63% 67% 70%Maori 50% 54% 54% 58% 61%Target 60% 60% 75% 75% 75%Increased Immunisation 8 months100%90%80%70%60%50%40%30%20%10%0%Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13Total 83% 84% 87% 88% 87% 87% 86% 88% 88%Maori 79% 81% 81% 86% 85% 83% 79% 77% 74%Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%64

Taranaki District Health Board - Progress on our Annual Plan 2012-13May-1365Priority Area Objective Project Annual Plan Status Measure Measure Status Target Progress Progress CommentsEmergency Departments (ED) – UnplannedCareElective Services – Planned CareImproved access to the most appropriate urgentcare and meeting the Health TargetAcute PathwayProject WhakapaiOn TrackOn TrackA sustainable after-hours service Primary Care On TrackBetter emergency care co-ordinationRegional collaboration - Midland Regional TraumaSystemImproved access to elective services and meetingthe Health TargetEmergency Care Coordination Team/RegionalEmergency Department ServiceMidland Regional Trauma SystemElective ServicesMidland Regional Elective Services Action GroupPre Admission Project; Enhanced Recovery AfterSurgery; The Productive Operating TheatreNot StartedOn TrackOn TrackNot StartedOn TrackHealth target ED - All patients treated oradmitted within 6 hoursPolicy Priority 2 - 50% reduction in EDgrowth ☺ PrimarySystem Integration 1 - AmbulatorySensitive Hospitalisations 0-4 yrs Maori ☺ ASH 0-4yrs Other☺ ASH 45-64 yrs Maori☺ ASH 45-64 yrs Other☺ ASH 0-74 yrs Maori☺ ASH 0-74 yrs Other☺ Health Target - Improved access toelective surgery ☺ SIRs - Total Major Joints per 10,000☹ SIRs - Cataract per 10,000☺ SIRs - Cardiac per 10,000☺ SIRs - Percutaneous revascularization per10,000 ☹ SIRs - Coronary angiography per 10,000☺ ESPI 8 - The proportion of patientstreated who were prioritised usingnationally recognised processes or tools ☺ Ownership Dimension 7 - Elective andarranged day of surgery admission☺☹The acute pathway project continues to analyse, plan and implement changes for patients presenting to the ED, being admitted to the ward and then through to discharge. We continue to achievethe shorter stays target after reaching the 95% in Q3. Current work is focusing on length of stay and delay reasons, internal ED monitoring and flow co-ordinationOptions has been agreed in principle by TALT . Further investigation is underway to identify the most appropriate model of care for the Taranaki population. MDT and the CommunityReferral Hub implementation is in progress. Map of Medicine clinical pathways will be implemented in Taranaki.TDHB continues to work with the Midland Region in the delivery of the Regional Trauma Service. Locally scenario training is ongoing with positive response from all clinical depts involved.All waiting lists are being managed within 5 months, planning beginning to work towards the 4 month target for 14/15.Significant progress has been made within the Elective projects as per the project manager status report. Ongoing focus on these areas will continue to impact on performance measures.Implement the Government’s new expectations onimproving waiting times for diagnostic servicesDiagnosticsNot StartedTDHB is contributing data to the Ministry monthly regarding the new waiting times targets for Colonoscopy and Angiography. New waiting time targets have been introduced to the services andcompliance is being monitored. Fulford radiology is contributing the data for CT MRIRegional collaboration Midland Regional Elective Services Action Group Not StartedDevelopmental Measure 2 - Improvingwaiting times for diagnostic servicesBaseline SettingTDHB is working with the Midland Region on key elective projects. These include Ophthalmology, Orthopaedics and Pain. There is discussion currently regarding the introduction of General Surgeryinto this planning and latterly vascular and plastics. TDHB led a planning session for orthopaedics presenting the orthopaedic production model. Other midland DHBs will be adopting this model toplan their service delivery.Cancer ServicesImproved access to cancer services and meetingthe Health TargetCancerDiagnosticsNot StartedNot StartedHealth Targets - Shorter Waits for CancerTreatment☺TDHB is contributing data to the Ministry monthly regarding the new waiting times targets for Colonoscopy and Angiography. New waiting time targets have been introduced to the services andcompliance is being monitored. Fulford radiology is contributing the data for CT MRIPalliative Care Plan On Track SIRs Not AvailableDraft Palliative Care Plan consultation completed Feb 2013. Finalised Plan signed off by TDHB Board March 2013. Detailed implementation Plan being developed and a number of projects alreadyunderwayCancer On Track Faster Cancer Treatment project at TDHB is closely aligned to the central cancer network project.Regional collaborationFaster Cancer TreatmentOn TrackDevelopmental Measure 1 - Fastercancer treatmentBaseline SettingWorking with the Central Cancer Network to establish data collection process appropriate for TDHB service delivery models. Data collection commenced and quality of information improving. Weare identifying process changes to enhance the pathway for patients. The cancer nurse co-ordinator has commenced and is focusing on pathways for patients and referral processes to ensure thosemost in need of support are seen. this role has been utilised across a number of services.Cardiac ServicesImproved access to cardiac services and reducedwaiting timesRegional collaboration – Acute CoronarySyndrome (ACS) ProjectCardiacOn TrackDevelopmental Measure 2SIRs - Cardiac per 10,000☺SIRs - Percutaneous revascularization per10,000 ☹SIRs - Coronary angiography per 10,000☺Baseline SettingTDHB is working with the midland region on cardiology projects (ACS). A local project to look at acute and elective cardiology service delivery has-been undertaken with recommendations currentlyin draft format65

66Taranaki District Health Board - Progress on our Annual Plan 2012-13May-13Priority Area Objective Project Annual Plan Status Measure Measure Status Target Progress Progress CommentsTobacco ControlLong Term Chronic Conditions -Cardiovascular Disease (CVD) / DiabetesService Integration – Primary CareDevelopment and DeliveryWhānau OraBetter Support for Smokers to Quit in Secondary CareBetter Support to Quit in Primary Care (PHOs) GeneralPracticeRegional collaboration – implement the 2012-13actions in the Midland Smokefree 2025 Five YearProgramme of Action 2010-15Meeting the Health TargetUse of Integrated Care model to effectively manage theinterface between primary and secondary care.Organised Stroke servicesRegional collaborationOn TrackOn TrackHealth Target - Better Helpfor smokers to quitSecondary ☺Health Target - More Heartand Diabetes Checks ☹Detection☹ Policy Priority 20 - DiabetesPolicy Priority 20 - DiabetesManagement☹TDHB is working with the midland region for renal service delivery. Progress being made with agreed regional alert system for renalpatients attending ED. Ongoing progress with data collection and clinical guidlinesTDHB continues to participate in the Midlands Regional Stroke Network comprising representation from Waikato, Lakes, Bay of Plentyand Tarawhiti.Better after hours care for children under 6 Primary Care Complete GP Free After-Hours service for under sixes has been implemented in TaranakiImproved access to Primary Care, better integrationbetween Primary and Secondary Care and better use ofresourcesRegional collaborationTobacco Action PlanLong Term Chronic ConditionsStroke ServicesLong Term Chronic ConditionsPrimary CareTaranaki Immunisation StrategyGroupTobacco Action PlanWhanau OraMDM - POACPrimary CareBehind PlanOn TrackOn TrackOn TrackOn TrackBehind PlanOn TrackOn TrackOn TrackHealth Target - Better Helpfor smokers to quit PrimaryPolicy Priority 20 - StrokeServicesHealth Target More Heartand Diabetes ChecksManagement☹☹Policy Priority 20 - DiabetesHealth Target - IncreasedImmunisation☺Health Target - Better Helpfor smokers to quit Primary☹Not Available☹System Integration 1 -Ambulatory SensitiveHospitalisations 0-4 yrs ☺ MaoriASH 0-4yrs Other☺ ASH 45-64 yrs Maori☺ ASH 45-64 yrs Other☺ ASH 0-74 yrs Maori☺ ASH 0-74 yrs Other☺ The Secondary Care Tobacco Health Target monthly performance for March 2013 was 98.44% and for the second month in a rowTDHB has achieved the Tobacco Target. Midland Health Network continue to improve with target results currently delivering themeasures required on the service specification however not yet acheiving the target of 90%MDT on track contract under development. TALT agreed a Primary Options model will be developed that meets the needs of theTaranaki population.MDT on track contract under development. TALT agreed a Primary Options model will be developed that meets the needs of theTaranaki population.The uptake for Maori children with completed immunisations at 8 months decreased for the second month while uptake for Maori at24 months remained static. The uptake for total population is has not decreased. We continue to work with the OIS providers to lookat ways of improving the statistics and looking at more detailed analysis on where the babies are geographically located. The TaranakiImmunsiation Steering Group reviewed the Strategic Action Plan and a number of initiatives are being followed up.The Secondary Care Tobacco Health Target monthly performance for March 2013 was 98.44% and for the second month in a rowTDHB has achieved the Tobacco Target. Midland Health Network continue to improve with target results currently delivering themeasures required on the service specification however not yet acheiving the target of 90%Te Kawau Maro is on track. Tui Ora Ltd consolidation of providers is complete. TDHB is working with TKM to develop the ResultsBased Accountability outcomes framework. The population health outcomes have been agreed and the performace measures andpopulation health indicators are being finalised. On track for an RBA Framework contract from 1 July 2013.Taranaki Primary Options has been discussed at TALT and has been agreed in principle. The Waikato model of service deliveryproposed by the Midlands Health Network is to be reassessed and a model of care develped that meets the needs of the Taranakipopulation.Primary Options has been agreed in principle by TALT . Further investigation is underway to identify the most appropriate model ofcare for the Taranaki population. MDT and the Community Referral Hub implementation is is progress. Map of Medicine clinicalpathways will be implemented in Taranaki.Establish Whānau Ora ProgrammeWhanau OraOn TrackTe Kawau Maro is on track. Tui Ora Ltd consolidation of providers is complete. TDHB is working with TKM to develop the ResultsBased Accountability outcomes framework. The population health outcomes have been agreed and the performace measures andpopulation health indicators are being finalised. On track for an RBA Framework contract from 1 July 2013.Introduce a sustainable service delivery model - using awhole of system view to determine the most efficientservice delivery models for whānauImplementation of theResults BasedAccountability FrameworkNot AvailableWhanau Ora On Track TDHB continues to support the collective through capacity building of Tui Ora and Te Kawau Maro alliance.66

67Taranaki District Health Board - Progress on our Annual Plan 2012-13May-13Priority Area Objective Project Annual Plan Status Measure Measure Status Target Progress Progress CommentsTobacco ControlLong Term Chronic Conditions -Cardiovascular Disease (CVD) / DiabetesBetter Support for Smokers to Quit in Secondary CareBetter Support to Quit in Primary Care (PHOs) GeneralPracticeRegional collaboration – implement the 2012-13actions in the Midland Smokefree 2025 Five YearProgramme of Action 2010-15Meeting the Health TargetUse of Integrated Care model to effectively manage theinterface between primary and secondary care.Tobacco Action PlanLong Term Chronic ConditionsBehind PlanOn TrackHealth Target - Better Helpfor smokers to quitSecondary ☺Health Target - Better Helpfor smokers to quit PrimaryHealth Target - More Heartand Diabetes Checks ☹Detection☹ Policy Priority 20 - DiabetesPolicy Priority 20 - DiabetesManagement☹☹The Secondary Care Tobacco Health Target monthly performance for March 2013 was 98.44% and for the second month in a row TDHB has achieved the TobaccoTarget. Midland Health Network continue to improve with target results currently delivering the measures required on the service specification however not yetachieving the target of 90%MDT on track contract under development. TALT agreed a Primary Options model will be developed that meets the needs of the Taranaki population.TDHB is working with the Midland region for renal service delivery. Progress being made with agreed regional alert system for renal patients attending ED. OngoingOrganised Stroke servicesOn TrackPolicy Priority 20 - Strokeprogress with data collection and clinical guidelinesStroke ServicesNot AvailableServicesRegional collaboration On Track TDHB continues to participate in the Midlands Regional Stroke Network comprising representation from Waikato, Lakes, Bay of Plenty and Tairawhiti.Service Integration – Primary CareDevelopment and DeliveryBetter after hours care for children under 6 Primary Care Complete GP Free After-Hours service for under sixes has been implemented in TaranakiImproved access to Primary Care, better integrationbetween Primary and Secondary Care and better use ofresourcesLong Term Chronic ConditionsPrimary CareTaranaki Immunisation StrategyGroupTobacco Action PlanWhanau OraOn TrackOn TrackOn TrackBehind PlanOn TrackHealth Target More Heartand Diabetes ChecksManagement☹☹Policy Priority 20 - DiabetesHealth Target - IncreasedImmunisation☺Health Target - Better Helpfor smokers to quit Primary☹MDT on track contract under development. TALT agreed a Primary Options model will be developed that meets the needs of the Taranaki population.The uptake for Maori children with completed immunisations at 8 months decreased for the second month while uptake for Maori at 24 months remained static. Theuptake for total population has not decreased. We continue to work with the OIS providers to look at ways of improving the statistics and looking at more detailedanalysis on where the babies are geographically located. The Taranaki Immunisation Steering Group reviewed the Strategic Action Plan and a number of initiatives arebeing followed up.The Secondary Care Tobacco Health Target monthly performance for March 2013 was 98.44% and for the second month in a row TDHB has achieved the TobaccoTarget. Midland Health Network continue to improve with target results currently delivering the measures required on the service specification however not yetachieving the target of 90%Te Kawau Maro is on track. Tui Ora Ltd consolidation of providers is complete. TDHB is working with TKM to develop the Results Based Accountability outcomesframework. The population health outcomes have been agreed and the performance measures and population health indicators are being finalised. On track for an RBAFramework contract from 1 July 2013.Regional collaborationMDM - POACPrimary CareOn TrackOn TrackSystem Integration 1 -Ambulatory SensitiveHospitalisations 0-4 yrs ☺ MaoriASH 0-4yrs Other☺ ASH 45-64 yrs Maori☺ ASH 45-64 yrs Other☺ ASH 0-74 yrs Maori☺ ASH 0-74 yrs Other☺ Taranaki Primary Options has been discussed at TALT and has been agreed in principle. The Waikato model of service delivery proposed by the Midlands HealthNetwork is to be reassessed and a model of care developed that meets the needs of the Taranaki population.Primary Options has been agreed in principle by TALT . Further investigation is underway to identify the most appropriate model of care for the Taranaki population.MDT and the Community Referral Hub implementation is progressing. Map of Medicine clinical pathways will be implemented in Taranaki.Whānau OraEstablish Whānau Ora ProgrammeWhanau OraOn TrackTe Kawau Maro is on track. Tui Ora Ltd consolidation of providers is complete. TDHB is working with TKM to develop the Results Based Accountability outcomesframework. The population health outcomes have been agreed and the performance measures and population health indicators are being finalised. On track for an RBAFramework contract from 1 July 2013.Introduce a sustainable service delivery model - using awhole of system view to determine the most efficientservice delivery models for whānauImplementation of theResults BasedAccountability FrameworkNot AvailableWhanau Ora On Track TDHB continues to support the collective through capacity building of Tui Ora and Te Kawau Maro alliance.67

68Taranaki District Health Board - Progress on our Annual Plan 2012-13May-13Priority Area Objective Project Annual Plan Status Measure Measure Status Target Progress Progress CommentsMental Health and Addiction ServicesImproved access for child and youth to mental healthservicesMH&A - Provider ArmOn TrackPolicy Priority 6 - Improvingthe health status of peoplewith severe mental illness☺TDHB Dementia Pathway has been endorsed as the standard to be implemented by the midland region.Health of Older PeopleDelivery against Implementation Action Plan – MentalHealth and Addictions Adult Continuum Project.Regional collaborationMH&A - Planning and FundingBehind PlanOn TrackPolicy Priority 8 - NonurgentMental Healthreferrals seen

69MEMORANDUMTO:FROM:Taranaki District Health BoardSandra BoardmanGeneral Manager — Planning, Funding & Population HealthDATE: 27 May 2013SUBJECT:Ministry of Health Quarterly ReportingQuarter Three 2013 Feedback1. OVERVIEWThis report provides the Board with an overview of the Ministry of Health’s feedback on theQuarter Three 2013 non-financial report.Of its 40 deliverables, the final ratings for Taranaki District Health Board received were:Outstanding Achievement O 0Achieved A 16Satisfied S 7Partially Achieved P 8Further Work Required B 0Not Achieved N 3Not Applicable NA 62. HEALTH TARGET ACTIVITIESResponses to the Ministry feedback were submitted by the deadline of 22 April 2013.2.1 Quarter Three Feedback1. A HT Better Help for Smokers to Quit — Maternity 12/13 NA2. A HT Better Help for Smokers to Quit — Primary Care 12/13 P3. A HT Better Help for Smokers to Quit — Secondary 12/13 A69

704. A HT Improved Access to Elective Surgery 12/13 A5. A HT Increased Immunisations 12/13 A6. A HT More Heart and Diabetes Checks 12/13 P7. A HT Shorter Stays in Emergency Departments 12/13 A8.A HTShorter Waits for Cancer Treatment Radiotherapy andChemotherapy 12/139. B DV1 Faster Cancer Treatment 12/13 A10. B OP1 Output Delivery Against Plan — Hospitals 12/13 A11.12.B OP1B OS10Output Delivery Against Plan — Personal/Mental Health Services12/13Improving the Quality of Data Provided to National CollectionSystems 12/1313. B OS3 Inpatient Length of Stay 12/13 P14. B OS5 Theatre Productivity 12/13 P15. B OS6 Elective and Arranged Day Surgery 12/13 P16. B OS7 Elective and Arranged Day Surgery Admissions 12/13 A17. B OS8 Acute Re-Admissions to Hospital 12/13 A18. B PP10 Oral Health — Mean DMFT Score at Year 8 12/13 A19. B PP11 Children Caries Free at Five Years of Age 12/13 N20.21.22.23.B PP13B PP18B PP2B PP20Improving the Number of Children Enrolled in DHB FundedDental Services 12/13Improving Community Support to Maintain the Independence ofOlder People 12/13Implementing Better, Sooner, More Convenient Primary HealthCare 12/13Improved Management for Long Term Conditions (CVD,Diabetes and Stroke) 12/1324. B PP21 Immunisation Coverage 12/13 NA25. B PP22 Improving Integration — System 12/13 NA26. B PP22 Improving Integration — Systems (DCIP) 12/13 NA27. B PP22 Improving Integration — Systems (LTC) 12/13 NA28. B PP23 Improving Integration — HOP Wrap-Around Services 12/13 A29. B PP24 Improving Waiting Times — Cancer MDMs 12/13 AAAPPANP30.B PP25Delivery of the Prime Minister’s Youth Mental Health Initiative12/13A70

7131. B S12 Regional Service Planning 12/13 NA32. B S14 Standardised Intervention Rates 12/13 A33. C CFA B4 School Check Funding 2012/13 S34. C CFA Boost Hospice Care Funding S35. C CFA Budget 2011 Funding for Dementia Respite S36. C CFA Electives Initiative and Ambulatory Initiative Variation S37. C CFA Establishment of Green Prescription Initiative N38.C CFAFunding for the Development and Maintenance of PHO Planningand Response Local Regional or National Health Emergencies12/1339. C CFA School Based Health Services 12/13 S40. C CFA Well Child Tamariki Ora Services 12/13 SS2.2 TDHB Responses to FeedbackThe following comments relate to indicators with a Partial rating or less.A HT Better Help for Smokers to Quit — Primary Care 12/13An analysis for training per practice has been completed with 73 practice nurses and 13GPs having completed smoking cessation training to date. In addition, a pregnancypathway has been drafted and TDHB is currently liaising with local midwives at Tui OraLimited, Plunket and general practices to facilitate input and buy-in for the pathwaydocument. This will progress through the quarter and results will be reported on in the 4 thQuarter. An Action and Evaluation Plan for Specialist Smoking Cessation Support hasbeen developed for cessation services within MHN primary care and this has beenapproved by the DHB. One service has already commenced in South Taranaki with 20patients referred and engaged with the smoking cessation service. Two North Taranakipractices with high percentage of Maori clients commence the service from the 1 April2013.PA HT More Heart and Diabetes Checks 12/13CVD Risk Assessment continues to progress toward the 75% target for 1 July 2013 withthe Midland Health Network undertaking a number of steps to ensure target is met,including: Multi-Disciplinary Team approach, investment in nurse education to Level 7,focus on coverage and clinical outcomes, referral pathways in place and moving the DARto a multi—year programme. A strategy currently being implemented by Taranaki DHB isto implement the Results Based Accountability contracting framework through the TeKawau Maro partners to reach high needs and those at high risk.P71

72B OS10 Improving the Quality of Data Provided to National CollectionSystems 12/13In terms of the National Health Index Duplications, our result has improved from 10.57%(Not Achieved) in the previous quarter. The DHB continues to review performance withMaternity and Emergency Departments, with further improvement expected in the nextquarter. Still awaiting addition of late coded February data and once this is completed, itis anticipated that our result will exceed 97%.PB OS3 Inpatient Length of Stay 12/13The Ministry noted that it is pleased to see continued improvement in performance, andacknowledges the DHBs planned initiatives to improve performance which includes:• The use of delay codes• A weekly meeting to review patients with LOS that are above the highboundary point to ensure there is a good management plan in place.• The rolled-out internal measures such as ‘100% of patients to have an EDD’so that the MDT can work towards a shared goal for discharge.PRapid Rounds continue to provide a daily focus for the discussion of discharge plans forpatients, and these are in the process of being implemented across all inpatient wards.B OS5 Theatre Productivity 12/13Taranaki DHB continues to review utilisation at the specialty level in its endeavours toreach target with ongoing discussions and monitoring of theatre utilisation to providerationale for the 4 th Quarter as to why utilisation is only incrementally improving. Changeshave been made around the utilisation and resourcing of the gynaecology lists and thesehave resulted in improved efficiency from 65% in Q1 to 72% in Q2.PB OS6 Elective and Arranged Day Surgery 12/13Whilst the overall percentage day case surgery has decreased in Quarter 3, detailedanalysis shows some improvement in previously problematic Diagnostic Related Groups(DRGs). Of note, procedures that are more frequently performed are mainly showingimprovement in day case rates The total variance days across the top 20 problematicDRGs has reduced by 19 demonstrating that focused efforts around previously reportedunderperforming DRGs are paying off. In addition, five procedures reported as in the top 20most problematic in Quarter 1 now no longer appear.PTo improve performance over the next quarters, detailed information on the top five DRGswill be provided to TDHBs ENT and General Surgeons. Changing the performance ofthese five DRGs alone will lead to improved overall performance.B PP13 Improving the Number of Children Enrolled in DHB Funded DentalServices 12/13This result is only Partially Achieved due to a lack of arrears rates by ‘Maori, Pacific andOther Population Groups’ being provided to the Ministry. It is anticipated that Quarter 4will see this target as achieved.P72

73B PP20 Improved Management for Long Term Conditions (CVD, Diabetes andStroke) 12/13While the DHB was able to provide a report for Diabetes, it was unable to provide a reportfor Stroke figures, and this meant only a Partial rating.PB PP11 Children Caries Free at Five Years of Age 12/13The target for 2012 was not met, therefore a rating of ‘Not Achieved’ was given.NThe Annual Plan target was set at 60% with the DHB only achieving 52%.TDHB is working collaboratively with other health providers to provide greater emphasison early enrolment in Community Oral Health Services to give preventative oral healthmessages to parents and whanau.B PP2 Implementing Better, Sooner, More Convenient Primary Health Care 12/13This was ‘Not Achieved’ due to subsequent figures requested by the Ministry not beingprovided in time. This was largely due to work still being in progress, such as:N• Taranaki DHB working with NHC and Tui Ora Ltd to develop and agree Contributionto Outcomes Mapping with the agreed population health outcomes of;- All pepi and tamariki have the best start in life- All whanau are in control of their health and social wellbeing- Whanau living well with a long term condition- All rangatahi realise their potentialIt is anticipated that more information will be available at the completion of this work.C CFA Establishment of Green Prescription InitiativeOne provider staff member was on annual leave during March which meant less referralsdischarged/completed during the month. Awaiting on Tui Ora Mental Health Services staffto organise logistics for Tai Chi and gentle exercise sessions for clients which will seereferrals/discharged increased.N3. RECOMMENDATIONIt is recommended that the Taranaki District Health Board note and receive the QuarterThree 2013 Reporting Feedback.Sandra BoardmanGeneral Manager Planning, Funding & Population Health73

74Taranaki DHB - Māori Health Plan Indicator Performance 2012/13Access to Care120%100%80%60%40%20%0%N2.1 Percentage of Māori enrolled in PHOs07/08 08/09 09/10 10/11 11/12 12/13 Q1 12/13 Q2 12/13 Q3100806040200N2.2 The % of actual to expected ambulatory sensitivehospitalisations (ASH) 0-4 yrs09/10 10/11 11/12 12/13 Q2140120100806040200N2.2 The % of actual to expected ambulatory sensitivehospitalisations (ASH) 45-64 yrs09/10 10/11 11/12 12/13 Q2120100806040200N2.2 The % of actual to expected ambulatorysensitive hospitalisations (ASH) 0-74 yrs09/10 10/11 11/12 12/13 Q2Māori non-Māori TotalMāoriOtherMāoriOtherMāoriOtherMaternal HealthCardiovascular DiseaseCancer25%20%15%10%5%0%N3 Percentage of infants exclusively breastfed at 6months08/09 09/10 10/11 11/12100%80%60%40%20%0%N4.2 CVD risk assessment in the last five years11/12 12/13 Q1 12/13 Q2 12/13 Q3100%80%60%40%20%0%N6.1 Breast screening rate among the eligiblepopulation (50-69 yrs)07/08 08/09 09/10 10/11 11/12 12/13 Q1 12/13 Q2 12/13 Q3100%80%60%40%20%0%N6.2 Cervical screening rate among the eligiblepopulation (25-69 yrs)09/10 10/11 11/12 12/13 Q1 12/13 Q2Māori non-Māori TotalMāori non-Māori TotalMāori non-Māori TotalMāori non-Māori TotalSmokingImmunisation120%100%80%60%40%20%0%N7.1 Percentage of adults 15+ admitted to hospitalprovided with advice and help to quit09/10 10/11 11/12 12/13 Q1 12/13 Q2 12/13 Q3Māori non-Māori Total70%60%50%40%30%20%10%0%N7.2 Percentage of smokers in primary care who areprovided with advice and help to quit11/12 12/13 Q1 12/13 Q2 12/13 Q3Māori non-Māori Total100%90%80%70%60%50%40%30%20%10%0%N8.1 Percentage of 8 month olds fully immunisied12/13 Q1 12/13 Q2 12/13 Q3Māori non-Māori Total80%70%60%50%40%30%20%10%0%N8.2 Seasonal influenza immunisation rates for Māoriaged 65 years and over11/12 12/13 Q1 12/13 Q2Māori non-Māori TotalDiabetesMāori Health Workforce100%90%80%70%60%50%40%30%20%10%0%L7a Percentage of diabetics who have attended aDiabetes Annual Review (DAR)08/09 09/10 10/11 11/12 12/13 Q1 12/13 Q2 12/13 Q3Māori non-Māori Total100%90%80%70%60%50%40%30%20%10%0%L7b Percentage of diabetics who have completedDAR and are HbA1c < 64mmol/mol08/09 09/10 10/11 11/12 12/13 Q1Māori non-Māori TotalR2 Percentage of Māori staff in Taranaki DHB10%8%6%4%2%0%07/08 08/09 09/10 10/11 11/12 12/13 Q1 12/13 Q2Māori 6.7% 6.5% 6.3% 6.4% 6.7% 6.9% 6.7%200150100500L5 Number of Māori recruited to the Incubatorprogramme09/10 10/11 11/12 12/13 Q1 12/13 Q2Maori 50 111 178 163Access to ServicesOral Health20%15%10%5%0%L1 Did-Not-Attend (DNA) rate for outpatientappointments11/12 12/13 Q1 12/13 Q2 12/13 Q370%60%50%40%30%20%10%0%L2a Percentage of 5 year olds in Taranaki carries-free07/08 08/09 09/10 10/11 11/12 12/132.001.501.000.500.00L2b DMFT scores at year 8 in Taranaki07/08 08/09 09/10 10/11 11/12 12/13Māori non-Māori TotalMāori non-Māori TotalMāori non-Māori Total74

752012-13 Māori Health Plan Status Report - Local PrioritiesMay-13Health PriorityObjectiveReportingResponsibilityAnnualPlan StatusMeasureMeasure StatusTargetProgressProgress CommentsACCESS TO SERVICESReducing the Did-Not-Attend (DNA) rateat outpatient appointmentsClinical ServicesManager, MedicalBehindPlanDid-Not-Attend (DNA) rate foroutpatient appointments ☹ Initial audit completed and working group to address high DNA services. This isan ongoing process. He Ritenga Audit planned for colposcopy and diabetesservicesORAL HEALTHIncreasing the percentage of 5-year oldsin Taranaki caries free and reducing theDMFT scores at year 8 in TaranakiClinical ServiceManager, Child andMaternal HealthBehindPlanPercentage of 5-year olds inTaranaki caries free ☹ DMFT scores at year 8 in Taranaki☹ Auditing the below is an on going process for the COHS staff. No progress onprocess mapping pathways or on developing action plan due to lack of capacity.Maori Health team resource has been allocated to assist the team to gettraction on improving this indicator.RESPIRATORY HEALTHReducing the asthma hospitalisation ratefor those 0-14 years of ageClinical ServiceManager, Child andMaternal HealthNotStartedAsthma hospitalisation rate 0-14years ASR per 100,000Not AvailableNotAvailableThough the priority remains it is being reviewed with a view to reschedulingwhen capacity can be allocated to focus on improving in this area.SUDDEN UNEXPLAINED DEATH OF INFANTSSYNDROMEReducing the rate of SUDIClinical ServicesManager – Child andMaternal HealthBehindPlanSUDI mortality rate per 1,000 livebirths of Māori infantsNot AvailableNotAvailableMaori health team capacity has been allocated to support the development andimplementation of actions to improve this area.MĀORI HEALTH WORKFORCEIncreasing recruitment to the IncubatorprogrammeChief Advisor MāoriHealthOn TrackTotal number of Māori recruited tothe Incubator programme ☺ 178 year 12 and 13 students participated in the Incubator programme in the2012 academic year. 163 students from the 13 schools are enrolled in 2013; 32health professionals involved as mentors in first round of workshops 2013WHANAU ORA DEVELOPMENT ANDIMPLEMENTATIONSupport the development andimplementation of initiatives in Taranakito achieve the ultimate goal of Te KawauMārō Taranaki Māori Health Strategy –Whanau OraChief Advisor MāoriHealth;GM Planning andFunding and team;General Manager,Hospital and SpecialistServices and teamTe Kawau Mārō Strategic Allianceintegrated outcomes-based contractsuccessfully developed and in placeby 30 June 2013;Support the implementation ofTaranaki Ora Provider collectivebusiness plan commenced by 30June 2013An agreed framework forintersectoral planning to address thehealth and socio-economic needs ofTaranaki communitiesNarrativeNarrativeNarrativeMain activity is focussed on supporting Te Kawau Maro Alliance RBA result cardto underpin the new outcomes-based contracting arrangement; Ngati Ruanuiundergoing structural changes including review of NHC membership which mayimpact on these developments.75

76DIABETESMaintaining attendance at the diabetesmanagement programme in primary carePortfolio Manager,Primary CareOn TrackPercentage of diabetics who haveattended a diabetes managementprogrammes☹ Percentage of the diabetics whohave participated in a diabeticmanagement programme have aHbA1c ≤64 mmol/mol☹On track76

772012-13 Māori Health Plan Status Report - National PrioritiesMay-13Health PriorityDATA QUALITYObjectiveImproving the accuracy of ethnicity data inPHO registersReportingResponsibilityPortfolio Manager,Primary CareAnnual PlanStatusBehind PlanMeasureData accuracy baseline is determinedand performance targets set for PHOregistersMāori MeasureStatusTBCMāoriTargetProgressN/AProgress CommentsPHO's have been contacted regarding this implementing this indicator. TheNational Hauora Coalition have indicated they will implement this indicator.Discussed with MHN at Taranaki Alliance Leadership meeting on 7 May 2013.ACCESS TO CAREIncrease PHO Māori enrolment ratesPortfolio Manager,Primary CareBehind Plan Percentage of Māori enrolled in PHOs☹ PHO's have been contacted regarding this implementing this indicator. TheNational Hauora Coalition have indicated they will implement this indicator.Discussed with the MHN at Taranaki Alliance Leadership meeting on 7 May 2013.MATERNAL HEALTHReduce the ambulatory sensitivehospitalisation (ASH) rateImproving Māori breast feeding ratesClinical ServiceManager - Child &Maternal HealthPortfolio Manager,Primary CareClinical ServicesManager - MH andPortfolio Manager -Population HealthOn TrackBehind PlanOn TrackOn TrackASH 0-4yrs MaoriASH 0-4yrs OtherASH 45-64 yrs MaoriASH 45-64 yrs OtherASH 0-74 yrs MaoriASH 0-74 yrs OtherPercentage of infants exclusivelybreastfed at 6 months☺☺☺Not AvailableNotAvailableThe target is met however on-going monitoring will occur to ensure this ismaintainedPHO's have been contacted regarding this implementing this indicator. TheNational Hauora Coalition have indicated they will implement this indicator.The target is met and there will be on-going monitoring to ensure there is noslippageThe implementation of the Breastfeeding Community Support Service is on track.Taranaki DHB submitted a proposal to the Ministry of Health on behalf of a widerstakeholder group for Services to Support Child and Maternal Nutrition andPhysical Activity. This proposal is one of eight nationally that has been successful.This new service will extend and develop the Breastfeeding Community SupportService and prioritise a maternal and child nutrition and physical activity focus infive community locations from 01 July 2013CARDIOVASCULAR DISEASECANCERMonitoring the number of tertiary cardiacinterventions for Māori and non-Māori inTDHBIncreasing the proportion ofcardiovascular risk assessments (CVRA)performed in the eligible populationImprove breast screening rates among theeligible populationClinical ServicesManager - MedicalServicesPortfolio Manager,Primary CarePortfolio Manager -Population HealthOn TrackOn TrackAt RiskNumber of tertiary cardiacinterventionsProportion of the eligible populationwho have had the blood tests forCVD risk assessment in the last fiveyearTBCN/ABreast screening coverage rates forMāori women aged 50 to 69 ☺ Cardiology project approaching completion including data collection that includesservice delivery ind intervention rates for Maori. This will provide the directionfor the future of the cardiology services for Taranaki including recommendationsfor Maori Health.☹ On TrackTDHB has engaged with the Central Cancer Network as part of theBreastscreening meeting on the central cancer network on Friday 23 November.Taranaki Coverage at May 2012 was 71% overall and 56% for Maori, the MaoriImproved cervical screening ratesPortfolio Manager -Population HealthOn TrackCervical screening coverage rates forMāori women aged 20 to 69 years ☺ Enrolled women (25-69) who have a smear recorded on the register during theprevious three years, shown as percentage of adjusted populationLast available stats Dec 2012-• National Coverage 77.3% • Taranaki Coverage85.5% • National Maori coverage 62.8% • Taranaki Maori coverage 73.3.9%.Noupdate to statistics available from National Screening Unit at this stage.SMOKINGIncreasing the proportion of hospitalisedsmokers who are offered cessation adviceand support to quitClinical ServicesManager - MedicalServicesOn TrackPercentage of adults 15+ admitted tohospital either acutely or for electiveprocedures who are provided withadvice and help to quit☹Focus area for hospital services with improved screening and advice across allunits. We are now a smoke free site. We continue to achieve the requirednational targets for the provider arm.77

Increasing the proportion of smokers whoare seen by a health practitioner inPrimary Care who are offered cessationadvicePortfolio Manager -Population HealthOn Track78Percentage of smokers in primarycare who are provided with adviceand help to quitNot AvailablePrimary Care quarterly report at Jan - March 2013 indicates Brief Advice 63 .1%,an increase of 5.49% and Cessation support 26.0% a slight increase 1.72%. Afocus on Primary Care setting is maintained whilst performance remains belowthe 90% target. A training analysis per practice has been completed. Currently 73Practice Nurses and 13 GPs have completed smoking cessation training to date inMHN. The development of ManTech Outbox document for consistency aroundsmoking cessation referral pathway is in development in Taranaki.IMMUNISATIONIncreasing the proportion of 8 month oldMāori children who have completed theirvaccinationsPortfolio Manager -Population HealthOn TrackPercentage of 8 month old Māorichildren complete their scheduledvaccinations☹ The uptake for Maori at 8 months old for April 2013 decreased for the secondmonth while upake for Maori at 24 months remained statis. We continue to workwith the OIS providers to look at ways of improving the statistics and looking atmore detailed analysis on where the babies are geographically located. TheTaranaki Immunisation Steering Group reviewed the Strategic Action Plan and anumber initiatives are being followed up.Increasing the proportion of eligible Māoriwho have received the seasonal influenzavaccinePortfolio Manager,Primary CareOn TrackPercentage of Māori aged 65 yearsand over immunised for influenzaNot AvailableOn track78

792012-13 Māori Health Plan Status Report - Regional PrioritiesMay-13Health PriorityObjectiveReportingResponsibilityAnnualPlan StatusMeasureMeasure StatusTargetProgressProgress CommentsMĀORI HEALTH INVESTMENT AND PROVIDERCAPACITY DEVELOPMENTBuild Māori capacity and capability toenable Māori participation at all levels ofdecision-making to support a kaupapaMāori focus on wellness, earlyintervention and case management in thecommunity within the context of whānauChief Advisor MaoriHealthOn TrackProtect investment in Māoriprovider funding across MidlandDHB’s to at least the same level asexisted in 2011-2012;Protect the investment in otherMāori-specific services to at leastthe same level as in 2011Not AvailableConfirmed figures to be reported at year end. Weare on track to achieving this result.MĀORI HEALTH WORKFORCEIncrease the recruitment and retention ofMāori into the Taranaki DHB workforceGeneral Manager,Human ResourcesBehindPlanThe total number and percentage ofMāori employed within MidlandDHB☹Maori particpatin in the hospital workforce iscurrently 7.10%. Multi-faceted activities are underway to influence this result including WRR, TDHBrecruitment policy & procedures, scholarshipsawards, ethnicity data recording, programmes toimprove cultural awareness, cultural audits.HE RARANGA-A-TIRA MIDLAND REGIONALSERVICES MĀORI HEALTH ACTION PLANImprove the environment for enablingMāori responsiveness approachesVariousresponsibilities, as perHe Raranga-A-TiraActive participation of Māori indecision-making / Promoting andMonitoring Māori health gainBuild Māori health workforcecapacity within Midland regionEnsure mechanisms are in place toaudit and monitor culturalresponsiveness of NGOs andMidland DHB’sNarrativeNarrativeNarrativeTe Whare Punanga Korero is actively engaged inmonitoring Maori health gainData unavailableHe Ritenga Cultural audit of outpatients isscheduled79

Midland Region Maori Health Plan Performance Monitoring DashboardTaranaki DHB Maori Health Plan DashboardQuarter 3 Update (May 2013)80Priority IndicatorTarget MaoriNon-Maori orTotalCommentaryHealthTarget/IDPRegional Ranking(out of five)Waikato(Maori)Tairawhiti(Maori)Lakes(Maori)BOP (Maori)NATIONAL PRIORITIES & INDICATORS1Data QualityPHO ethnicity data accuracyAudit tool to be impletemented duringfinancial year2Access to CarePercentage of Māori enrolled in PHOs96% 88%99%IDP5th93% 99%99%92%3aAmbulatory SensitiveHospitalisation (ASH) RateASH Rate: 0 - 74 years

8181

8282

8383

8484

8585

8686

8787

8888

8989

9090

9191

9292

9393

9494