Agenda

Combined Community & Public Health Advisory and Disability Services Advisory Committee Meeting

Venue: Kawakawa Room, Education Centre,889 Cameron Road, Tauranga Date and time: Wednesday 28 November 2012 at 10:30am

Our Vision: Healthy Thriving Communities

Our Values: Compassion Attitude Responsiveness Excellence

Item No.

Item

Page

1

Apologies – Nil

2

Interests Register

3 Minutes of Meeting – 26 September 2012

1

4

Matters Arising

4

5 Presentations

6

Reports requiring Decision 6.1 Board Position Statements 6.2 2013 Work Plan

5

14

7

Reports for Noting 7.1 Work Plan

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Item No.

Item

Page

7.2 New Zealand Health Summit Auckland 3 & 4 October 2012 7.3 Health of Older People Strategy 2012/2017 Implementation Update 7.4 Implementation of the InterRAI Long Term Care Tool in Aged

Residential Care

7.5 Mental Health Update 7.6 Planning and Funding Monthly Report

17

19

29

31

38

8

General Business

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Next Meeting – Wednesday 27 March 2013.

Minutes

Combined Community & Public Health Advisory and Disability Services Advisory Committee Meeting

Venue: Conference Hall, Clinical School, Whakatane Date and Time: Wednesday 26 September 2012 at 01:00pm

Committee: Ron Scott (Chair), Marion Guy, Sally Webb, Matua Parkinson, Yvonne Boyes, Mogens Poppe, Bronwen Foxx, Punohu McCausland (Runanga Rep), Mark Arundel.

Attendees: Sarah Davey (Portfolio Manager), Helen Mason (GM Planning and Funding), Janet McLean (GM Maori Health), Gail Bingham (G M Governance and Quality).

Item No.

Item Action Who

1

Apologies Apologies were received from Pauline McQuoid. Resolved that the apology from P McQuoid be received.

Moved: R ScottSeconded: M Parkinson

2

Interests Register The Board was asked if there were any conflicts in relation to items on the agenda. No conflicts were identified.

3

Minutes and Chair report Back Resolved that the minutes of the meeting held 25 July 2012 be confirmed as a true and correct record.

Moved: R ScottSeconded: M Guy

4

Matters Arising As per report circulated with agenda.

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Page 2 of 3

Item No.

Item Action Who

5

Presentation 5.1 SmartGrowth Strategy Plan

A presentation on SmartGrowth Strategy Plan was given by Justine Brennan, Programme Manager.

5.2 Productive Community

A presentation on Productive Community was given by Fiona Burns, Change Manager – Service Improvement.

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Reports Requiring Decision 6.1 Local Diabetes Annual report 2011/12

The Committee discussed the report as circulated with the agenda. The fact that diabetes is reversible is not addressed in the report. Resolved that CPHAC/DSAC note and endorse the recommendations in the Local Diabetes Team.

Moved: B FoxxSeconded: P McCausland

6.2 SmartGrowth Strategy Review

The Committee discussed the report as circulated with the agenda. Resolved That CPHAC/DSAC 1. Notes this paper and provides

feedback to SmartGrowth on the Strategy review relevant to the health service delivery in the western Bay of Plenty.

2. Receives a presentation by Justine Brennan, Project Manager, SmartGrowth Strategy Review

Moved: R Scott

Seconded: Y Boyes

2

Page 3 of 3

Item No.

Item Action Who

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Reports for Noting 7.1 Work Plan

The Committee noted the information

7.2 Bay Navigator Update

The Committee noted the information. 7.3 Communications Project Update

The Committee noted the information.

7.4 Summary Releasing Time to Care – Productive Community BOPDHB The Committee noted the information.

7.5 Planning & Funding Monthly Report

The Committee noted the information.

8

General Business

9

Next Meeting – Wednesday 28 November 2012.

There being no further business the meeting closed at 2:30pm. The minutes will be confirmed as a true and correct record at the next meeting.

3

Combined Community & Public Health Advisory and Disability Services Advisory Committee

Matters Arising (open) – 28 November 2012

Meeting Date

Item Action required Action Taken

23 May 12 5 Hepatitis C presentation – Draft full report on implications of the Hepatitis C project. Due Date: 14 September 2012

25 July 12 7.3

Disability Responsiveness Provider Arm GMPS and Disability Awareness Co-ordinator to meet with Bronwen Foxx regarding disability access at Whakatane. Due Date: 16 November 2012

25 July 12 7.4

Pharmacy Co-Payment – COO to confirm that all hospital sites are considered as part of the Health and Disability Standards audit.Due Date: 16 November 2012

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Board Position Statements

SUBMITTED TO: Combined Community & Public Health Advisory & Disability Services Advisory

Committee Date: 28 November 2012 Prepared by: Brian Pointon, Portfolio Manager, Health Equity Submitted by: Helen Mason, GM, Planning and Funding RECOMMENDED RESOLUTIONS:

1. That CPHAC/DSAC endorses the draft Board position statements on Physical Activity and Nutrition, and Living Environments, and with any amendments, forward to the Board for its approval at their December meeting.

2. That CPHAC/DSAC confirms that Board position statements should be prepared for Child Health, and Climate Change.

ATTACHMENTS:

• Board position statement on Physical Activity and Nutrition • Board position statement on Living Environments

BACKGROUND: These two Board position statements are the seventh and eighth ones to be prepared in a series of perhaps ten statements. Others yet to be written that have been signalled by CPHAC/DSAC for preparation are:

• Child health • Climate change including impacts of global warming on health and emergency

management from adverse weather events

CPHAC/DSAC may wish to consider whether there are any other key issues that it would like statements prepared on in 2013. ANALYSIS:

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Describe how the service relates to the current Annual Plan, and how it will progress the current Annual Plan. Physical Activity and Nutrition is featured in the Annual Plan 2012/13 under section 2.5.3 People have healthier diets on page 43 and section 2.5.6 People are better at managing their long term conditions on page 46. While the national Healthy Eating Health Action programme is no longer funded through DHBs, there is an expectation that weight management, increased physical activity and better diets are part of the range of programmes to prevent or minimise the impact of long term conditions such as diabetes, cardiovascular disease and some cancers. Promotion of healthy living environments is not specifically included in the Annual Plan, but is a precursor for a range of service outcomes, including prevention and minimisation of long term conditions, older people maintaining functional independence in their communities, reduction of smoking rates, and prevention of Ambulatory Sensitive Hospitalisations from respiratory conditions and acute rheumatic fever caused by poor and overcrowded housing. Highlight/ identify any differences in outcomes resulting from initiatives for our AP, and other stakeholders. Both these Board position statements relate to improving integration of services with other government agencies (local, regional and central) and within the health sector. Provide comment on any issues that unless addressed will make it likely that there will be variances between expectations and actual outcomes. i.e. identify if/where we are at risk. Many of the outcomes expected under these two position statements will come from interagency work and integration. Because of the high priority placed on service integration within the health sector, no risk is identified here. Other work requires close relationships and support from local and regional government. SmartGrowth in the western BOP is placing a greater emphasis on social outcomes in its current review which should be seen as a positive influence. There is a risk that the proposed removal of the four well beings from the local government legislation may result in a more limited focus on the benefits from living environments promoting health and social outcomes. Identify if there are any gaps in provision that were not forecast which we need to consider for the next AP. *include draft Annual Plan key section references It is still unclear what the government is expecting from DHBs in the 2013/14 Annual Plan in relation to weight management, preventing obesity, physical activity and nutrition. These terms are not mentioned in the current planning guidelines. The Public Health issues update for Public Health Units to consider when preparing their 2013/14 annual plan states: • The Ministry is currently considering the advice of the Prime Minister’s Chief Science Advisor,

Professor Sir Peter Gluckman, on how best to improve our impact on obesity. • Professor Gluckman suggests that pre-conditions for obesity are set very early and there is an

opportunity to do more to improve women’s pre-conception health and nutrition for babies, infants and pre-schoolers.

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• We will be in touch with you to discuss how your nutrition and physical activity services might be

refocused towards these priority areas when any new decisions are made.

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BOPDHB Position Statement

Physical Activity and Nutrition

Introduction

The Bay of Plenty District Health Board (BOPDHB) is required under legislation:

• to improve, promote, and protect the health of people and communities;

• to promote the inclusion and participation in society and independence of people with disabilities;

• to reduce health disparities by improving health outcomes for Maori and other population groups;

• to exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services;

• to exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations.

The BOPDHB has prepared a series of position statements which demonstrate its commitment to these objectives, and outlines its viewpoint on different health issues. This position statement on Physical Activity and Nutrition aligns with other position statements, including those on Health Inequalities, Disability Responsiveness and Living Environments, and is implemented through the DHB’s Annual Plan.

1. The Bay of Plenty DHB affirms the following:

1.1 The DHB will provide leadership and set an example for other health and non-health agencies in providing a health promoting environment for its employees, patients/clients, visitors and contractors. It will adopt policies for the promotion of healthy physical activity and nutrition, including policies for breastfeeding, physical activity (including the use of active transport to and from work), and the provision of healthy food options at DHB cafeterias, and the support of social club activities such as on-site staff gymnasia.

1.2 The promotion of physical activity and good nutrition should occur in all settings. Depending on the availability of Ministry funding, the DHB will support the delivery of healthy eating and healthy action in community settings through programmes such as health promoting schools and pre-schools, WorkWell, oral health education, breastfeeding friendly environments, Green Prescription and Active Families, and diabetes and cardiovascular disease self-management groups.

1.3 The modern dependence on the private motor vehicle as the primary transport means has contributed to the current high rates of obesity and lack of physical activity. The DHB supports the use of active transport (buses, cycling and walking) as a means to commute to and from work, and for other travel, to increase the uptake of physical activity. The BOPDHB will work through the BOP Regional Transport Committee and BOP Regional Council to increase the provision of public transport, cycleways and walkways for commuting and recreation, particularly in those neighbourhoods where there are more people who do not have access to private transport. It supports good urban design and the provision of infill housing and urban growth areas close to core facilities to reduce urban sprawl.

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1.4 Evidence suggests that adults should engage in at least 30 minutes of physical activity at a moderate intensity on most, if not all, days of the week. If possible, vigorous exercise should be added for extra benefits and fitness. For children, the daily physical activity levels should exceed 60 minutes per day. The DHB will work with Sport Bay of Plenty and other physical activity providers to ensure that physical activity opportunities are accessible to all, including people with disabilities.

1.5 Breast milk is the best first food for babies for optimal growth, development and health. The BOPDHB encourages mothers to exclusively breastfeed their babies for the first six months and then continue to breastfeed along with the introduction of solid foods. It will participate in the Baby Friendly Hospitals programme, and work with other maternity and well child providers to increase breastfeeding rates.

1.6 Evidence shows that food insecurity amongst lower-income families is a significant contributor to poor health outcomes for children in particular. The DHB supports local initiatives such as the development of community and marae gardens, the growing of vegetables and fruit in backyards, and farmers markets so that there is increased food security, and greater consumption of fresh fruit and vegetables.

1.7 It will make submissions where relevant to central, regional and local government on legislation, bylaws, strategies, and plans that will promote the DHB’s physical activity and nutrition objectives.

2. The Bay of Plenty DHB notes that:

2.1 There is an increasing burden in non-communicable chronic diseases such as obesity, diabetes, cardiovascular disease and cancer arising from lack of physical activity and poor nutrition1. While DHBs have the primary role in the treatment of these diseases, and limiting the advancement of disease through screening programmes and early interventions, it also plays an important role in prevention.

2.2 There is growing evidence that the patterns for obesity and later chronic conditions are set in the pre-conception, ante-natal and post-natal phases of the life course. It is still to be determined how the health sector can deliver effective programmes at this early stage in life, which will have a population-based positive health effect.

2.3 At all stages in the life course, there are opportunities for reducing the risks of chronic diseases through a range of physical activity and nutrition programmes. These are best undertaken as a part of normal daily living, rather than through an add-on special effort such as dieting. Nutrition and physical activity programmes are therefore best instilled in childhood to develop healthy lifestyles as long-term habits. It is acknowledged that physical activity and nutrition programmes show benefits at all ages.

2.4 A woman has the right to breastfeed and is protected from discrimination for breastfeeding under the Human Rights Act 1993 and international law. The BOPDHB supports this right through education, increasing the number of breastfeeding friendly public spaces and implementing the national breastfeeding guidelines. The BOPDHB also recognises that some women are unable to breastfeed and will support those women with information and advice.

2.5 There is considerable international and national evidence linking poor urban design that creates urban sprawl as a contributor to the increasing rates of obesity. Cities that have higher levels of inner city living, cycle-friendly transport corridors, and linked walkways encourage greater levels of physical activity as part of daily living, and therefore lower levels of obesity. Lower use of motor vehicles also helps to reduce air pollution and therefore respiratory and other chronic diseases. There are also positive links between regular physical activity and mental health wellbeing.

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1 It has been estimated that in 1997poor diet contributed to about 8,500 deaths in NZ, (including inadequate vegetable and fruit consumption 1,600 deaths) and insufficient physical activity about 2,600 deaths. Health and Participation: An Active Agenda

Advice to the Incoming Minister of Health October 2005 ©2005 Ministry of Health

Adopted by the BOPDHB Board at its meeting on ……………….2013 Review This position statement will be reviewed in three years, or as necessary.

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BOPDHB Position Statement

Living Environments

Introduction

The Bay of Plenty District Health Board (BOPDHB) is required under legislation:

• to improve, promote, and protect the health of people and communities;

• to promote the inclusion and participation in society and independence of people with disabilities;

• to reduce health disparities by improving health outcomes for Maori and other population groups;

• to exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services;

• to exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations.

The BOPDHB has prepared a series of position statements which demonstrate its commitment to these objectives, and outlines its viewpoint on different health issues. This position statement on Living Environments also aligns to other position statements, including Health Inequalities and Physical Activity and Nutrition, and is implemented through the DHB’s Annual Plan.

1. The Bay of Plenty DHB affirms the following:

1.1 Being able to live, work, learn and play in safe and healthy environments is one of the key social determinants of health. This is equally important across all phases of the life course. A safe and healthy living environment is a necessary base on which health services can be delivered by public and private agencies.

1.2 The DHB cannot achieve safe and healthy living environments alone. It will work in a collaborative manner with central, regional and local government agencies, both at governance and operational levels, to enhance interior and exterior living environments. It will actively participate in inter-agency forums and planning groups including:

• SmartGrowth;

• Bay of Plenty Regional Council and the five local authorities in the BOPDHB district;

• Bay of Plenty Regional Transport Committee;

• WHO forums such as Healthy Communities, Safe Communities; Age-Friendly Communities;

• Collaboration Bay of Plenty (CoBoP) and its work streams such as the Social Wellbeing Cluster and Bay of Connections.

• Whanau Ora Regional Leadership Group

• Settlement Support Network Group

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1.3 The achievement of safe and healthy living environments begins with strong public health

legislation and national policy settings. The BOPDHB employed statutory officers (Medical Officers of Health, Health Protection Officers, Smokefree Officers) will administer public health legislation that leads to safe and healthy living environments e.g. Health Act 1956 and regulations, Smoke-free Environments Act 1990, Sale of Liquor Act 1989, Resource Management Act 1991.

1.4 The population expect to be protected from one-off disasters. The DHB will meet its statutory

obligations under the Civil Defence Emergency Management Act 2002, and support other agencies in the health sector to plan for and mitigate the harms from natural and man-made disasters.

1.5 The public expect that their living environment is safe and healthy wherever they go about

their daily activities. The DHB will support programmes such as health promoting schools and pre-schools, workplace programmes such as WorkWell, healthy marae and home-based support care programmes to improve the living environments in education facilities, workplaces, cultural bases and homes.

1.6 The basis for family life is a safe and healthy home. The DHB will work with other funders

such as the Energy Efficiency and Conservation Authority (EECA), third party funders and approved insulation and heating providers to improve the indoor living environments for families living in cold and damp homes. In addition, the BOPDHB will work with local authorities and the Building and Housing Group within the Ministry of Business, Innovation and Employment to reduce the numbers of unsafe and insanitary houses, and reduce over-crowding in homes, a major contributor to infectious disease spread such as acute rheumatic fever.

1.7 Communities have the right to have a voice on how their neighbourhoods can be shaped to

promote safe and healthy lifestyles. The DHB will support place-based community development initiatives such as the Welcome Bay Community Plan to determine the safe and healthy neighbourhoods that residents wish to live, work, play and learn in.

1.8 The DHB will make submissions where relevant to central, regional and local government on

legislation, bylaws, strategies, and plans that will promote the development of safe and healthy living environments.

2. The Bay of Plenty DHB notes that: 2.1 The pursuit of safe and healthy living environments requires contributions from a number of

government sectors and the community itself. Many health conditions arise from poor management and the unequal distribution of the social determinants of health and tangata whenua determinants of health. The BOPDHB is well-suited through its Planning and Funding teams and Toi Te Ora-Public Health Service to contribute itself through its own funded service delivery, and to support other sectors, to achieve population health goals in community settings.

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2.2 The BOPDHB may play a leadership or supportive role, depending on different circumstances. The BOPDHB may be able to contribute through advocacy, funding, planning, health expertise, statutory roles, data/information or engagement skills. Which role the BOPDHB takes in each circumstance will depend on its immediate applicability in achieving DHB priorities and health outcomes.

2.3 The use of evaluation tools such as Health Impact Assessment and Whanau Ora Health

Impact Assessment to review draft strategies, policies and plans in the wider government sector can improve the safety and health qualities of living environments.

2.4 Healthy living environments can be promoted through good urban planning, leading to increased uptake of physical activity, greater social connectedness, and improved access to services for people who have disabilities or do not own a private motor vehicle.

Adopted by the BOPDHB Board at its meeting on ……………….2013 Review This position statement will be reviewed in three years, or as necessary.

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CPHAC/DSAC Work Plan – 2013 SUBMITTED TO: CPHAC/DSAC 28 November 2012 Submitted by: Helen Mason, GM Planning and Funding RECOMMENDED RESOLUTION: That the Committee endorses the work plan for 2013. ATTACHMENTS: 2013 CPHAC/DSAC Work Plan

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Updated 25 October 2012

Combined CPHAC/DSAC Committee Work Plan - 2013

Month Activity Documentation Source

January No meeting February No Meeting March Planning and Funding Focus Area:

Mental Health – Service Development Plan

Planning and Funding Monthly Report

April No Meeting May Planning and Funding Focus Area:

Regionalisation Planning and Funding Monthly

Report

June No meeting July Planning and Funding Focus Area:

Health of Older People Midland Regional Services Plan

Progress Report Planning and Funding Monthly

Report

August No meeting September Planning and Funding Focus Area:

Maori Health and Primary Care and Integration

Midland Regional Services Plan Progress Report

Planning and Funding Monthly Report

October No meeting November Planning and Funding Focus Area:

Population Health and Child and Youth

Midland Regional Services Plan Progress Report

Planning and Funding Monthly Report

December No meeting

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Combined CPHAC/DSAC Committee Work Plan - 2012

Month Activity Documentation Source

January No meeting February No Meeting March Planning and Funding Focus Area:

Primary Care, including interface with Secondary Care

Planning and Funding Monthly Report

April No Meeting May Planning and Funding Focus Area:

Regionalisation Planning and Funding Monthly

Report

June No meeting July Planning and Funding Focus Area:

Health of Older People Midland Regional Services Plan

Progress Report Planning and Funding Monthly

Report

August No meeting September Planning and Funding Focus Area:

Maori Health and Mental Health Midland Regional Services Plan

Progress Report Planning and Funding Monthly

Report

October No meeting November Planning and Funding Focus Area:

Population Health and Child and Youth

Midland Regional Services Plan Progress Report

Planning and Funding Monthly Report

December No meeting

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New Zealand Health Summit Auckland 3/4 October 2012 

SUBMITTED TO:

CHAC/DSAC

Prepared by: Yvonne Boyes, Board Member

RECOMMENDED RESOLUTION:

That the Board notes the information

BACKGROUND:

The seminar was run over two days and speakers came from Government, DHBs, Aged Care, PHO, Private Surgery and General Practice. A wide variety of topics covered, people from all parts of the health sector attended and many different DHBs represented by board members, CEOs, planning and funding.

Website for all papers presented is www.abcevents.co.nz/healthcare Login :healthcare12, Password: summit 

Some thoughts from the seminar October 2012

Many of the topics discussed were very topical in health at the present time and the message was (sustainable collaborative healthcare).

Understanding the key issues facing the healthcare industry

•Rising costs of health care (managing budget) – new technologies

•Ageing population

•Chronic non-communicable diseases

•Work force

•Equitable access, lifting provision for all

•Evidence based system (Cochrane)

•Integration primary and secondary care – primary care must focus on keeping people out of hospital – health promotion, disease prevention •Best start for children •Efficiency, effectiveness, productivity – outcome focussed.

•Communications. IT – complete patient record. Aged Care and Integration paper presented The sentence “Integrated care” has become the new “holy grail”

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Most of the integrated care discussions have been on the relationship between secondary care (hospitals) and primary care (GPs) Limited systematic discussion on aged residential or community care despite the huge cost of acute care versus community based care Many of the early integrated care initiatives focussed on a single disease, e.g. diabetes or chronic heart failure Experience now from the Kings Fund and others researchers suggest that a more generic approach, e.g. frail elderly or those with chronic disease generally might be more cost effective and avoid “programmatic” Integration is a coherent set of methods and models within the funding,

administrative, organisational, service delivery and clinical levels designed to create… connectivity, alignment and collaboration within and between the cure and care sectors… in order to enhance quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex problems cutting across multiple providers, services and settings… where the result of such efforts to promote integration is called “integrated care” Kodner & Spreewenberg, 2002

Key Message

Rehabilitation care for older people as an example of an opportunity for integrated care Context Rapidly ageing population with increasing rates of chronic disease

Most older people are “ageing in place” in their own homes

Often after a significant illness, older people may not return to their previous level of functional ability and independence

If the decrease in functional ability is too great and/or there is not enough social and community support then older people may no longer be able to manage in their own home and could require continuing residential care

Rehabilitation could improve their functional ability and thus avert this permanent decline

Being in an acute hospital bed is seldom a good place to rehabilitate

The question is – how could models of rehabilitation be better organised within the current system utilising a variety of settings An excellent quote from Professor Mason Durie finished the Seminar “Health is not something that can be prescribed by the doctor, but something which should arise from within communities and the leaders of health are not doctors or nurses but community leaders who can use their influence and wisdom to alter lifestyles and living conditions.

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Health of Older People Strategy 2012-2017

Implementation Update SUBMITTED TO: Combined Community & Public Health Advisory & Disability Services Advisory

Committee Date: 28 November 2012 Prepared by: Sarah Davey, Portfolio Manager, Health of Older People Submitted by: Helen Mason, General Manager, Planning and Funding RECOMMENDED RESOLUTION: That CPHAC/DSAC notes this report. ATTACHMENTS: Nil

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BOPDHB Health of Older People Strategy 2012-2017

Implementation Update The purpose of this report is to update the Committee on our progress towards implementation of the BOPDHB Health of Older People Strategy 2012-2017 (HOP Strategy). Priorities for 12/13 The following areas have been identified by Planning and Funding for progression during the 2012/13 year with associated work streams: Promote Active Ageing Home Based Support Services Redesign Organised Stroke Services Dementia Care Advance Care Planning An update on each work stream is provided below.

Promote Active Ageing HOP Strategy Recommendations: A. Community health, prevention and information A6. Promote development of programmes and policies across government agencies and local

government that promote active ageing including the WHO Global Age-Friendly Cities Guidelines. Provide advice and expertise on population ageing through representation on the Population Ageing Technical Advisory Group, the Population Health Advisory Group, Strategic Partners forum and Collaboration Bay of Plenty, and other mechanisms that may from time to time be required.

A7. Actively contribute to the review of the SmartGrowth Strategy1 in the Western Bay of Plenty and make advice available to local government in the Eastern Bay of Plenty.

This work stream is being led by the Population Ageing Technical Advisory Group (PATAG) and activity has been focussed on two areas: 1. Input to the SmartGrowth Strategy Review 2. Active participation in Tauranga City Council’s Age Friendly Cities Project.

1 SmartGrowth is a programme aimed at implementing a plan for managing growth in the Western Bay of Plenty.  The programme is being led 

by  Bay  of  Plenty  Regional  Council,  Tauranga  City  Council, Western  Bay  of  Plenty  District  Council,  and  Tangata Whenua  who  work  with community groups and government agencies such as the NZ Transport Agency.   The context for the Strategy  is a sub‐region facing  long term growth pressure while  at  the  same  time many  sectors of  the  community  are demanding  greater  consideration of quality of  life  issues  and protection of the core values that make the sub‐region such a desirable place to  live, work and play.   A review of the SmartGrowth Strategy commenced in 2011.  

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1. The SmartGrowth Strategy Review commenced earlier this year and the community

engagement phase was undertaken between July and October. PATAG has provided consultation and input to the SmartGrowth Issues and Discussion paper which informed the issues that the Review project team took to the community and recommended that some local population ageing research be undertaken. This was taken up by SmartGrowth along with several other research projects to inform the Review. The impacts and opportunities of an ageing population including recommendations for alternative housing models, economic development, transport, and social cohesion are key themes that SmartGrowth are being asked to consider in the Strategy review.

2. Earlier in the year, following a series of submissions to Council’s long term plan,

Tauranga City Council agreed to undertake an Age-Friendly City (AFC) project in line with the World Health Organisation’s (WHO) Age Friendly Cities Guidelines. The AFC project group has representatives from Age Concern, Toi Te Ora, DHB Planning and Funding, The Elder Forum, and disability services. The objectives include development of actions and policies that aim to make Tauranga age-friendly. A series of community engagement workshops are planned commencing in February 2013. Participants will be asked to consider a series of questions based on the WHO framework. The workshops will be undertaken in a ‘world café’ style. Feedback from the workshops will inform the recommended actions and policy recommendations.

Home Based Support Services Redesign HOP Strategy Recommendations: C. Integrated care and community services C5. Implement a redesign of home and community support services in conjunction with the Midland Region DHBs as part of a regional project to a restorative model of care. Consider changes the current funding model from an uncapped demand driven model to a capped bulk funding model with adjustments for demographic growth in future years where appropriate.

In addition to a recommendation in our local HOP Strategy, this work stream is part of a Midland region collaborative project initiated by the Health of Older People portfolio managers and links to actions in the Midland Regional Services Plan 2012/13. The work stream lead for BOPDHB is the Portfolio Manager, Planning and Funding. The Midland Project team currently includes: Portfolio Managers of Health of Older People services from the 5 Midland DHBs Professor Matthew Parsons, Auckland University - Gerontology Department and consultant WDHB Planning & Funding Analyst - WDHB Support is also sought from HOP medical specialists and clinicians and NASC teams across the region. Background

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Within Midland region, more than $60 million is spent annually on the provision of home based support service which for 85 - 90% of older people they receive a task based service relating to housework and / or showering / dressing / personal care within hourly allocations of time over a week. This approach no longer adequately meets the needs of older people. It is well recognised that a person’s mobility, strength, balance, cognitive ability and / or social isolation impacts on their ability to maintain their nutrition, hydration, skin integrity, physical ability, continence or managing medication and treatment. Older people require services that can be flexible to need, be provided by well trained, supervised workforce and that focuses on helping older people to retain as much independence for as possible for longer. The medical needs of older people can be complex and home support services staff are well placed to recognise changes in wellbeing and raising concerns and involving health professionals when required. In association with this service type, there also needs to be an increased use of other health disciplines, such as allied health, medical specialists, specialist nurses and well informed general practice team. NZ now also has a national comprehensive geriatric assessment tool - interRai that is expected to be used in many areas of services for older people - to better inform clinicians and providers, to reduce unnecessary duplication of assessments and to assure older people that there is clear communication between the people who provide assessment, treatment and support for them and their family. This information is stored electronically and therefore can be readily shared with the person’s permission. Nationally, two documents developed in 2012 - 13 also support the change in the way home based supports are provided: Every provider must be certified and audited against a mandatory standard - Home &

Community Support Sector Standard irrespective of whether they are funded by ACC, MOH DSS or DHB.

An updated Home & Community Support Service specification that outlines the DHB contract requirements is due for completion within six months.

In addition, it is expected that DHBs will select and contract with providers who can meet both the standard and the new service specification. The regional service changes proposed include: Providers being responsible for:

- ongoing assessment and review of clients’ needs - using interRai geriatric assessment tools

- maximising clients ability to stay at home - improving strength, balance & mobility, increasing social interaction using structured outcome based processes

- increasing interaction with other health professionals - including general practitioners, pharmacists, allied health

- increasing the percentage of staff that are trained - increasing and / or decreasing service delivery depending on the changing needs of the

older person. - Managing services within more flexible funding models - Improved reporting on client group, service needs, service delivery and service gaps

The Midland project involves:

- Implementation of the mandatory standard and national service specifications

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- Development of a purchasing and reporting framework that links service delivery to client

need - using interRai data. - Current models used by Auckland, Capital & Coast, Canterbury DHBs are being

considered along with resource allocation tools within interRai. (See further below *) - Education of current providers on the new service model, as part of a provider selection

process - Education of NASCs, general practice, allied health, specialist services for older people,

older people advocacy services on new model - Potentially a provider selection process with an aim that new agreements will be in place

mid - late 2013. * Note: BOPDHB NASC has developed a level of expertise in the use of interRAI having being one of the DHBs that was an early adopter. Relatively little is understood in NZ about the potential of the resource allocation tools within interRAI as a means of informing a purchasing framework although the tools are used overseas where interRAI is used. BOPDHB staff at the NASC have been leading research and analysis of the interRAI resource allocation tools to inform the Midland project. A meeting with all BOP providers was held in October 2012. Providers were updated on the progress of the project, the development of the Service Specifications, the requirements for compliance with the Standards by September 2013 and the new auditing framework. There was an opportunity to discuss concerns or raise issues. Most providers were supportive of changes and signalled their willingness to move towards the new model. The significant cost of staff training to move to a restorative model and be compliant with Standards was highlighted as a concern for all providers. Next steps: There are 2 key milestones to be achieved which will influence the timing and direction of recommendations for the redesign project to General Managers of Planning and Funding across the region:

Finalising the national service specifications. A final draft has been developed but approval by DHBs has been delayed until consultation with the sector on a funding model has been completed. An anticipated date for final adoption has not been given.

An analysis of the 2 main case mix models being proposed to inform a funding/purchasing model being the Auckland University case mix model and the resource allocation tools within interRAI . Analysis is currently being undertaken on the 2 systems and expected to be finished by early December 2012.

Organised Stroke Services HOP Strategy Recommendations: G. Stroke and TIA G1. Complete the development of a TIA pathway through Bay Navigator. G2. Establish an organised stroke service – see Section D on the development of an acute geriatric ward.

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The Organised Stroke Services work stream is being led by the Provider Arm. It also has links to actions in the Midland Regional Services Plan 2012/13. Background The MOH has identified establishment of organised stroke services in each DHB as a priority for the 2012-13 year. In the Bay of Plenty work was initiated in 2009 on the priority areas as outlined in the “Diabetes and Cardiovascular Disease”: Quality improvement plan published in 2008 by the Ministry of Health. The key focus within the BOPDHB has been:

Better identification of at risk people and streamlining of referral for Transient Ischaemic Attack (TIA) patients from primary to secondary service diagnosis and treatment.

Early identification of acute stroke or TIA on presentation – with identification of ischaemic stroke and thrombolysis in ED

Access to specialist nursing supervision and care by colocation of identified stroke/ TIA patients

Earlier access to allied services with a focus on stroke rehabilitation. Reduction in length of time from acute admission to rehabilitation care being instigated

by early referral and assessment by rehabilitation physician. Progress to date: 1. Bay Navigator – TIA pathway: Primary and secondary services have worked together in a Bay Navigator project to establish a clear pathway for people with suspected TIA / Stroke diagnosis and referral processes. The pathway is a web based resource able to be accessed across primary and secondary services. The tool contains background information around TIA/ Stroke incidence along with resources, which may be provided by primary health care providers to patients. The key role of the pathway is to provide assessment, referral and diagnostic pathway resources for GPs. The pathway stratifies risk and prioritizes access to diagnostic procedures, e.g. carotid Doppler, CT or MRI. In addition dedicated TIA clinics are delivered weekly with the tool outlining grading criteria and process for rapid referral of suspected or high risk patients. Resources include links to validated screening tools along with advice around management. A triage question tool for GPs has been developed. The pathway has been launched and education for GPs commenced.

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2. Clearly defined pathway for management of stroke

Earlier work on stroke pathway (above) has allowed for the following initiatives to be put in place. 3. Establishment of named ward for co-location of patients with Stroke /TIA One acute medical ward has been identified as the lead site for acute patient location. The process is for patients to be referred either directly from ED or Admission planning unit for admission to 2B; or for patients with less definitive diagnosis to be assessed by CNS – Stroke and Neurology within 48 hours of presentation and referred into ward. Identification of a home ward for acute stroke has allowed for improved resourcing from allied health service and focused education for nursing staff within the ward. 4. Appointment of CNS – Stroke: A senior nurse was appointed to act as lead in identification of patients who are admitted with TIA/ Stroke in June 2010. This role has focused on the provision of education to nursing staff in both ED and acute medical ward – along with a series of education within the HIA rehabilitation service. In addition the CNS identifies and transfers stroke patients from within other wards to the acute stroke designated ward and fast tracks referral and assessment by specialist SMOs from HIA . The role also provides direct specialist nursing input into care management within the acute services and case manager’s patients to rehabilitation or discharge. The CNS now also provides outpatient follow up for complex patients and families who have ongoing care requirements. In addition the CNS ensures that all patients and families receive both acute education and are linked to available ongoing support from Stroke Foundation. 5. HIA In reach In October 2011 we were able to recruit to vacant SMO positions in Health in Ageing service, increasing the number of geriatricians to 3. This allowed for the establishment of an in reach service to acute services with a particular focus on orthogeriatrics, stroke and admission planning unit (acute presentation). All diagnosed stroke patients are referred to SMO and assessed within 3 days of presentation (allowing for weekend presentations). Depending on the level of functional injury an individualised management plan is established at this time. This has contributed to a reduced LOS, discharges directly from acute service for low disability strokes

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(with community and outpatient based follow up) and earlier instigation of rehabilitation therapy during acute phase of stroke. The net result of the above initiatives is demonstrated in acute LOS data.

Next Steps: 1. Acute Stroke Unit The next initiative to contribute to outcomes for people with acute Stroke/ TIA is to further develop the location for acute stroke admission or transfer. The current clinical area is less than ideal due to the lack of dedicated rehabilitation resources. A proposal is being developed to move acute stroke patients into a dedicated area within the 39 bed Health in Ageing unit. 2. Lead Physician for Acute Stroke care It is anticipated by the Stroke team that in addition to the CNS role that a named physician will be identified to lead the ongoing development of stroke services at BOPDHB. This role will also provide a resource to establish more dedicated stroke specialist input for patients at Whakatane Hospital. 3. Midland Regional Stroke Service work The Midland Regional Stroke Network has been established with SMO, CNS and Planning and Funding engagement in the work which will result in more standardised process and access across the Midland region. This will inform how services develop across the region and will inform development of services going forward. 4. Development of in –hospital navigator (Stroke Pathway) This work will be undertaken as part of the Midland Regional service work.

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Dementia Care HOP Strategy Recommendations: C. Integrated care and community services C2. Develop specific Bay Navigator pathways that are relevant to older people e.g. falls prevention, osteoporosis, dementia, Transient Ischemic Attack (TIA), ie stroke. F. Dementia and Mental Health in Older People F1. Promote recognition and assessment of mental health status of the older people by all

health care providers as central to supporting healthy ageing. This includes depression, underlying mental illnesses or dementia.

F2. Provide greater accessibility and seamless clinical service delivery for people with dementia through establishment of a coordinated, integrated dementia service including an early detection and management service for people with dementia in all settings, including acute inpatient services, community and residential care facilities.

F6. Develop a dementia pathway for people with behavioural support needs through Midland Region Dementia Advisory Service, specialist health services for the older person, MHSOP and Bay Navigator.

This work stream is being led by Mental Health Services for Older People in conjunction with Bay Navigator. The activity is currently focussed on development of a Dementia Pathway. A Dementia Pathway for diagnosis and treatment of uncomplicated dementia has been developed. The pathway group is led by a nurse practitioner working in primary care and includes secondary care clinicians, geriatricians, psychogeriatricians, CNS, GPs, community providers, Planning and Funding and a client representative. The pathway includes resources with links to validated diagnosis and screening tools along with advice around management. A triage question tool for GPs has been developed. Sessions in EBOP and WBOP for GPs to trial the pathway are scheduled for late November in anticipation of the formal launch in February 2013. The pathway group has identified a need for a primary care education process to implement and support primary care diagnosis, and for increased capacity of our community providers for advice, advocacy, support and respite. Dedicated Ministry funding will be directed to these identified needs.

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Advance Care Planning HOP Strategy Recommendations: B9. Promote training for health professionals in Advance Care Planning in accordance with

the Advance Care Planning Co-operative Guidelines and training programme. The BOP Palliative Care Network were initially asked to lead the Advance Care Planning (ACP) work stream but declined to do so on the basis that it is ethically inappropriate for the work to be led from a palliative care viewpoint. Currently the work is being led by Planning and Funding. In addition to the Advance Care Co-operative Guidelines, which focuses on training clinicians in a secondary care setting, a number of other options to progress ACP can be considered. There is a high level of interest in ACP from primary and community care providers, however our discussions reflect an awareness for ACP to be handled with care, and a level of reservation about how ACP can be implemented. Planning and Funding has commissioned a paper to be developed which explores the various options to implement ACP with a focus on community settings. The paper will be developed by the end of December 2012.

Annual Plan 2012/13 In addition to the above, a number of other activities that we have committed to in the Annual Plan 2012/13 have also been progressed.

Annual Plan 2013/14 Planning and budgeting for our 2013/14 Annual Plan has commenced. For Health of Older People the planning guidelines expect a continuing focus on priorities identified in 2012/13, including integration with primary care, ‘wrap around services for HOP’ and reducing readmissions for people over the age of 75. Additional expectations include:

Development of fracture liaison services (which links to Recommendations in the HOP Strategy under Section H - Falls and Bone Health). A Bay Navigator pathway for Falls Prevention is commencing early in 2013 which will support this work.

Developing policies to prevent Elder Abuse (links to Recommendations under Section A – Community Health, Prevention and Information.)

Budget permitting, we would like to see development of transitional care services (including supported discharge as recommended in the Strategy) prioritised for 2013/14 which supports improvement in the target for reducing admissions for people over 75 target, preventing avoidable admissions and organised stroke services.

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Implementation of the interRAI Long Term Care Tool in Aged Residential Care

SUBMITTED TO: Combined Community & Public Health Advisory & Disability Services Advisory

Committee Date: 28 November 2012 Prepared by: Sarah Davey, Portfolio Manager, Health of Older People Submitted by: Helen Mason, General Manager, Planning and Funding RECOMMENDED RESOLUTION: That the Committee notes this report ATTACHMENTS: Nil BACKGROUND: This report provides an update to the Committee on the progress towards implementing the Comprehensive Clinical Assessment tool - interRAI LTCF, currently being rolled out in Aged Residential Care (ARC). interRAI LTCF supports an improvement in quality in aged residential care. Over the past few months the Associate Minister of Health has been engaging with the Ministry of Health and the sponsors of the rollout of interRAI LTCF with a view towards speeding up the implementation pathway. Originally the plan for the rollout of interRAI into ARC facilities was to have 90% of facilities utilising the tool by 30 June 2015. The project has had a challenging start including interoperability issues, software upgrades requiring staff to be retrained and the approach to training being less than ideal. This resulted in the 2011/12 budget being underutilised. In a letter of advice to DHBs dated 18 October 2012, the Government has made a number of key decisions with the following being the key messages:

1. The Government has decided to bring forward the implementation date of the interRAI comprehensive clinical assessment tool for residential care facilities

2. All facilities are expected to be using the comprehensive clinical assessment tool, or for their nurses to be undergoing training in the use of the tool, by June 2014

3. From July 2015, use of the tool in all aged residential care facilities will be a requirement for aged residential care providers

4. Funding carried forward from 2011/12 will be used to accelerate training in the use of the assessment tool during 2012/13

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5. DHB CEs are expected to support re-budgeting to ensure that resources planned for

2014/15 are available for the year 2013/14 6. Training for nurses in aged residential care facilities will continue to be provided at no

charge to aged residential care providers.

District Health Boards previously committed to funding the rollout over the period July 2011 to June 2015. Re-phasing the budget means the BOPDHBs commitment will essentially double in 2013/14 to approximately $286,000 A number of commitments have been made by the project team and sponsors to ensure the fast-tracking is a success. We have supported fast-tracking the project with a strong expectation that the commitments are delivered on. Eight ARC facilities in BOP are currently implementing the tool. ANALYSIS: Describe how the service relates to the current Annual Plan, and how it will progress the current Annual Plan. *include current Annual Plan key section references Implementation of interRAI LTCF is an action in the 2012/13 Annual Plan resulting from approval of the national business case by DHBs and the New Zealand Aged Care Association. References: Pg 35 – Improving quality in aged residential care Pg 60 – 3.2.1 Managing acute and unplanned care Pg 92 - 3.2.9 – Undertaking Comprehensive Clinical Assessment in Aged Residential Care. Highlight/ identify any differences in outcomes resulting from initiatives for our AP, and other stakeholders. Nil Provide comment on any issues that unless addressed will make it likely that there will be variances between expectations and actual outcomes. i.e. identify if/where we are at risk. Risk with fast-tracking the roll out are outlined above. Identify if there are any gaps in provision that were not forecast which we need to consider for the next AP. *include draft Annual Plan key section references

Nil

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Mental Health update

(Confidential Section) SUBMITTED TO: Combined Community & Public Health Advisory & Disability Services Advisory

Committee Date: 28 November 2012 Prepared by: Lesley Watkins Portfolio Manager Mental Health & Addiction Submitted by: Helen Mason General Manager, Planning & Funding RECOMMENDED RESOLUTION: That CPHAC/DSAC note the Mental Health, Alcohol and Drug Sector Performance Monitoring and Improvement Report (January 2011 to December 2011). The finalised Rising to the Challenge The Mental Health and Addiction Service Development Plan 2012 – 2017 will be presented at the February 2013 meeting. ATTACHMENTS:

• Letter from Memo Musa, Senior Advisor, Mental Health Improvement • Mental Health Alcohol and Drug Sector Performance Monitoring and Improvement

Report Executive Summary BACKGROUND: The purpose of the Mental Health Alcohol and Drug Sector Performance Monitoring and Improvement Report is to provide details on key mental health and addiction measures in order to build an overall performance picture for the period ending 31 December 2011. The report provides a picture of how the sector has performed on a quarterly and year-to-date basis. The full report is available at http://www.nsfl.health.govt.nz ANALYSIS: BOPDHB has the highest HONOS (The Health of the Nations Outcomes Scale) compliance rate in the country for inpatient admissions and inpatient discharge at 95.4% and 94.2% respectively. This achievement is due to the focus put on HONOS compliance by the project leader in the Provider Arm services. Under section 7: Maori Mental Health it is noted that a demonstration Substance Misuse Prevention Service for Maori Taitamariki (targeting taitamariki aged 10 -13 years whose parents

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have a substance abuse or mental health problem and who are identified as being at risk of developing substance use and mental health problems) was established in Maketu in 2010. It is now being evaluated with two other prevention services in West Auckland and Invercargill. A suicide prevention package was delivered to the Kawerau community by Te Rau Matatini. This includes a suicide prevention workshop for community members and whanau who have had to deal with a suicide. Describe how the service relates to the current Annual Plan, and how it will progress the current Annual Plan. Access rate targets (PP6) are included in the current Annual Plan and BOPDHB is exceeding its targets. PP7 Improving mental health services targets relapse prevention planning and features in the current Annual Plan. BOPDHB is meeting its targets. PP8: Alcohol and other Drug (AOD) services waiting times features in the current Annual Plan and targets increasing percentages of people being seen within 3 weeks and 8 weeks leading to a target of 80% within 3 weeks and 95% within in 8 weeks in the 14/15 year. BOPDHB is currently meeting its 12/13 targets. Highlight/ identify any differences in outcomes resulting from initiatives for our AP, and other stakeholders. The impact of the rollout of the PRIMHD reporting system to NGOs across the BOPDHB area was only just being evidenced in the 2011 year. It is now clear that access rates are rising due to the more accurate collection of data from NGOs as well as BOPDHB Provider Arm services. Provide comment on any issues that unless addressed will make it likely that there will be variances between expectations and actual outcomes. i.e. identify if/where we are at risk. PRIMHD data is not currently organised to be user friendly for Planning & Funding however there is a review occuring which will hopefully make changes. Identify if there are any gaps in provision that were not forecast which we need to consider for the next AP. The nationalization of forensic beds will lead to pressure for medium secure (also known as inpatient high and complex beds) in the Midland region. A sub regional approach with Lakes DHB is being considered.

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35

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Planning & Funding Monthly Report to CE – October 2012 

Newsflash – Good News Stories 

Presbyterian Support (Northern) who run the Enliven programme that provides restorative home based support and day services for elderly people in Tauranga and Whakatane, were recently recognised for their commitment to providing quality education and training for their staff. The Adult Learners’ Week Awards ceremony was held for the Tauranga Moana region last month at the Tauranga City Council Mayoral Chambers. Enliven Tauranga was delighted when they won the overall supreme award for Innovative Provider award that was presented by Kuku Wawatai – Director Education and Maori Development, BOP Polytechnic. Enliven Tauranga have recently released an integrated training programme for a national certificate level 2 training for the health & disability sector that involves the entire organisation to actively participate in support workers educational and learning achievements, including welcoming clients contributions. Entwined in the learning is a strong literacy focus and the entire programme has been approved and endorsed by the industry training organisation, Careerforce.

Child & Youth Health 

Immunisation: The BOPDHB’s unofficial October 2012 immunisation results (up until 20 October 2012) are at 89% for total and 90% for Maori populations. This is an increase of 4% in the coverage rate for total and a 9% increase for Maori populations over the September 2012 results with a decline rate of only 3.9%. The rolling quarterly figures from 21 July 2012 to 20 October 2012 are at 86% Total and 80% for Maori populations. This is a 3% increase for total and a 5% increase for Maori populations over the previous rolling quarter. This represents a continuation of the steady improvement towards the 8 month target overall, and an elimination of the gap between Total and Maori rates. The Ministry is now working towards achieving 90% nationally by 30 June 2013 rather than 85%, but without formally changing the target figures.

Detailed actions to increase performance are outlined in the report to the BOPDHB Board.

Oral health: The Royal Society of NZ has issued a statement on community water fluoridation. Its position is that no new evidence has come to light in recent years so that its original stance that it supports the Ministry of Health advice that fluoridation is a safe and effective practice to improve oral health is maintained. Staff from the National Fluoridation Information Service are visiting the BOP on 16 November to engage with key public health and oral health professionals in the BOPDHB and the wider health sector.

Planning and Funding is working closely with Provider Arm considering a proposal for development of a hospital based dental service.

Examination arrears in BOP DHB Community Dental Service

Planning and Funding is working closely with Regional Community Services to put in place improvement processes including routine reporting for staff and setting an annual service delivery plan that ensures all schools receive services in a 12 month period.

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There have been a number of improvements in our process’s including a 7% improvement in arrears in the last 12 months moving from 22% to our current rate of 15% in September 2012. The implementation of the Titanium system has taken longer than expected and impacted on productivity in the initial stages. We are now gaining the benefits of the electronic record which allow the therapists easy access to the client rolls and appointment processes. Based on the current performance we are forecasting the likely arrears by December 2012 to be 13% and are confident of achieving the 10% target in 2013.

Other (Child Wellness/Sexual Health/Breastfeeding etc):

The Ministry of Health is undertaking a Value for money project on Sexual and Reproductive Health with components contracted to KPMG. To date, KPMG has collected information from the DHB on services it funds and delivers in the BOP. A series of consultation workshops are being held for DHBs and Maori and Pacific providers. Planning and Funding will be represented at the DHB specific workshop on 5 November in Auckland.

PoPAG has received from Toi Te Ora-Public Health Service a first draft of a Health Needs Assessment (HNA) of Sexually Transmitted Infections in the BOP and Lakes DHBs. This work will be progressed into a discussion document for the wider sector to comment on suggested actions arising from the HNA.

B4SC BOPDHB are on track to achieve the high needs population target.

Long Term Conditions

Diabetes/CVD:

CVD

A teleconference was convened by the Ministry of Health to discuss reporting on CVD risk assessment. The key issue with reporting is the timeliness of information with data not available until well after due reporting dates. As an interim step, the Ministry have sought narrative reports from the PHOs on efforts to improve performance.

Diabetes

Data sharing between the PHOs and the provider arm will be explored in the management of patients receiving diabetes care improvement packages. The aim is to ensure that patients do not unnecessarily cross over into the secondary service, thereby using up resource meant for patients with a real need for secondary level intervention.

The diabetes self-management service has commenced in the Eastern region. Based on results in the Western Bay, course completion may be an issue to monitor. The agreement makes provision for analysis to understand why patients fail to complete the program and what role support services could play to ensure completion rates improve.

Smoking:

The secondary health target was achieved with 95% of all smokers being provided with brief advice. The continual achievement of this target is closely monitored

The primary health target information will not be available till 5th November. However, the BOPDHB is one of the forerunning DHBs and we strive to continue this with our continued partnerships with Primary Care.

Planning and Funding delegates attended the Midland Smokefree Vision Workshop held on 18-19th October in Rotorua. The key actions arising were to develop a regional tobacco control plan that will segue into local DHB plans.

The regional plan shall be formed by a Midland Smokefree Project Steering Group.

The representatives on this group will come from the five DHBs, Public Health Units,

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National NGOs, PHOs and Aukati Kaipaipa Providers across the Midland region. Members will be invited for their expertise in strategy in tobacco control. Healthshare will be the facilitator of this work

Cancer (radiotherapy):

Funding advice and associated service specifications for Cancer Care Coordinator have been received and will be actioned in November.

For the Multidisciplinary Meeting intiative (MDM) funding is in place but a recording issue associated with the purchase unit needs to be worked through. The Midland region is currently working towards a common set of definitions.

Electives (including IDF’s):

Elective volumes are ahead of target. A review of individual DHB and surgical specialty will be undertaken in November to determine whether given current production, revised year-end targets need to be issued to providers. The aim is to avoid affordability issues arising, noting that there is no guarantee now that the MoH will fund any over delivery.

Primary Care

Business case implementation:

The Alliance Leadership Team (ALT) met in October. Feedback following the meeting with the Minister and the Director General was discussed and a framework for a further letter to the Minister was agreed. The ALT is confident there is good evidence of improved and innovative activity that is able to be included within the letter. Summary activity from Eastern Bay Primary Health Alliance (EBPHA), DHB service redesign and the projects under the business case will be illustrated with specific data.

Discussion around establishing larger innovation projects, with joint funding of area wide contracts and the potential for a Bay of Plenty ALT in conjunction with the Bay Navigator Governance Group was tabled for consideration and discussion.

An agreed process for the After Hours Service Alliance Leadership Team (SALT) and its membership were confirmed following the successful After Hours workshop. An options document is to be circulated to stakeholders by the end of November 2012 with collation of feedback by end of December 2012. Both Whanau Ora and Te Whiringa Ora will be reviewed with the DHB evaluation template and process whilst awaiting the outcome of the Request for Proposal (RFP) for evaluation of the business cases currently under consideration by the Ministry.

EBPHA will reactivate the workforce study that had been postponed during the deliberations around the Peak practice register transfer to the National Hauora Coalition.

A summary document on the outstanding Year 2 deliverables will be developed and closed off.

PHOs:

After the potential movement of General Practices to the National Hauora Coalition, the BOPDHB Board agreed to no additional PHOs in the Bay of Plenty. The Board has also approved the exploration of strengthening/building on the existing PHO configuration. This work is underway with a PHO and Planning & Funding meeting to be held in November 2012. The meeting will look to generate ideas on how to build on what we have now.

Ambulatory sensitive (avoidable) hospital admissions (ASH):

The ASH project group has continued its work examining the 0-4 yr ASH scores and

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hospitalisation data from Tauranga Hospital in particular. This has raised a few issues that are being worked on to ensure that the data is correct, and that it is better understood. Once that work is completed in the next month, we will then be in a position to start discussing ASH more broadly with the primary health sector.

Diagnostics (labs/radiology):

A meeting has been convened for 30 October to discuss future contracting and facility considerations with the provider.

Non PHO treatment & support (incl pharmacy):

Community Pharmacy:

Community Pharmacy group has booked in to present the latest pharmacy service model to the GPs through a CME meeting, and a PHO clinical committee meeting.

Planning and Funding has communicated the new community pharmacy model through the following:

1. Internal DHB communication – Check up Magazine

2. A high level overview pharmacy service for prescriber document has been sent to all PHOs for them to distribute to their GP population and also sent out via the GP Liaison Officer’s regular news letter.

BOPDHB NASC has agreed for BOPDHB Community Pharmacy to have access to the support net system.

Professional support:

Health of Older People

Home & community support:

The Midland Home Based Support Services redesign project team met again this month. The focus of the meeting was to explore the interRAI Case Mix model as an alternative model to the one developed by Auckland Uni. Bay of Plenty’s experienced team at Support Net led the discussion and presentation with support from Andrew Downes, the national interRAI Software Service Manager. interRAI has the ability to categorise people with similar levels of need into different groups called Resource Allocation Groups (RUGs), which can then inform service planning and allocation. RUGs are widely used overseas to allocate care packages and funding. New Zealand’s use of interRAI for this purpose is only emerging but the potential is exciting, particularly now that we are starting to collect good data nationally through the data warehouse which can now inform our planning and policy development. At this stage the interRAI case mix model as a method to base allocation and purchasing for home based support is the preferred approach in Midland, and there is a great opportunity for Bay of Plenty to lead the direction.

Planning and Funding hosted a meeting this week for all our Home Based Support Providers to update them on the progress with the Midland HBSS redesign project and to discuss the new requirements for Certification against the Home and Community Service Standards, required by 1 September 2013. There was a good attendance by all providers who appreciated the opportunity to have an open discussion about their issues, potential changes to the contracting and purchasing framework and the work required to be ready for certification. The general feeling was positive. Many of our larger providers already seek voluntary certification but the smaller ones do not. The main issue identified was the need for staff training and the level of investment that this will require.

The Dementia Pathway through Bay Navigator is complete with the group preparing to launch the pathway with primary care in February next year. A pre-launch workshop with General Practitioners is scheduled for late November to test the pathway and work through any outstanding issues.

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Secondary services for older people:

Development of organised stroke services continues to be the main focus for service development. As stock take of service delivery against the Midland Dashboard has shown that we are delivering a good level of service and much progress has been made. We are continuing to progress towards co-locating acute and rehab patients together in HIA.

Residential care:

We have developed a process to streamline complex discharges to residential care for patients who come into hospital and are assessed as eligible for residential care but have no capacity to consent to their entry to residential care (and consequent income and asset testing to determine liability for payment), no enduring power of attorney in place, nor any family members or welfare guardian identified. These vulnerable patients are often safe to be discharged but cannot without the legal matters in place, which can take up to six months to sort through. We have worked with a willing residential care provider to agree on a process whereby they are happy to accept the admission based on certain terms and conditions, while the legal matters are sorted out, thereby freeing up an acute or rehab hospital bed.

Palliative care:

The BOPDHB Palliative Care Network has a meeting scheduled for late October. The focus of the meeting is a workshop on home support services.

The hospital consult liaison service is finding its feet slowly. Fortnightly meetings have been continuing to work though implementation issues.

Other

The Population Ageing Technical Advisory Group has been continuing its focus on input to the SmartGrowth Strategy review, including the research project on population ageing in the BOP. We are pleased to see that population ageing has been picked up as a key focus for the review.

We are also contributing to the Tauranga City Council’s Age Friendly City project. A series of public workshops is planned for early 2013 to have feedback from elderly people in the community about how age-friendly they find the city and what could be done to improve. The workshops will be conducted in a ‘world café’ style with questions for focus areas designed on the World Health Organisations model.

Health Equity (Public health)

Health promotion and education (including HEHA):

There is still no word from the Ministry as to what priorities will be established for physical activity and nutrition in 2012/13 (or 2013/14) and what funding will be available to local providers or programmes. The Public Health Issues Update in the PHU Annual Plan Guidance for 2013/14 states that they are still considering Sir Peter Gluckman’s advice on how best to improve the impact on obesity, with a suggestion that it will be more about women’s pre-conception health and nutrition for babies, infants and pre-schoolers.

Planning and Funding are working with Te Kupenga Hauora to see how a small HEHA underspend can be utilised to carry out a cooking demonstration and nutrition programme in the 17 kohanga reo in the western BOP. This one-off project would align with any likely initiative (see para above), and maintains some continuity of the Kai Ora programme successfully run by Stephen Cameron since 2008.

Screening:

Te Teo Herenga Waka staff met with the Ministry of Health contract lead and National Rheumatic Fever Prevention Programme Coordinator to better understand the requirements of the two Maori providers in eastern (NASH) and western (NMOPHO)

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Bay of Plenty under the Ministry contracts. This clarified a number of issues. The work will be primarily around Maori community awareness raising in those areas currently not involved with school-based throat swabbing programmes. The “opportunistic” throat swabbing in the community is in fact restricted to limited set clinic times for parents to bring in a child with a sore throat for a free swab and antibiotics. The providers have been provided with all the relevant resources and programmes that Toi Te Ora has developed, and will be participants in the BOP/Lakes Rheumatic Fever Steering Group to ensure they are well linked in.

Other:

The Pregnancy and Parenting Education services evaluation is near completion. The recommendations are likely to increase contractual requirements, with appropriate supports, for education on breastfeeding, immunisation, and smokefree/alcohol free pregnancies. We have offered our input into the Ministry-led review of the service specification for pregnancy and parenting education services which will begin in the next couple of months, once a consultant’s report is received.

Mental health and addiction services

Addiction services:

A community meeting was held in Tauranga with ACC, Police and other community organisations to look at how to reduce the harm caused by alcohol particularly in youth. There is a desire to implement a system whereby those who injure themselves and present to the Emergency Department (ED) will be referred for a Brief Intervention to the SORTED team (Youth Alcohol & Other Drugs (AOD) service within the Provider Arm) similar to a pilot being rolled out in the Wellington Regional Hospital ED.

A regional Child Adolescent Mental Health & Addiction Service (CAMHS) training day in Rotorua was attended at which the Tauranga-based SORTED team presented on their service which is funded out of additional funding secured to work with clients of the Youth Justice system who have identified AOD issues.

Specialist mental health & addiction services:

Development of Youth Mental Health & Addiction System of Care to support the rollout of the Prime Minister’s Youth Mental Health project is underway. A draft Terms of Reference has been developed and a stocktake of DHB-contracted services in underway.

The contracting process is underway for a jointly funded (with Ministry of Health) Dual Disability Service for one individual which raises the usual issues around the interface with Disability Services where Mental Health Services often become the default provider of services because there is a paucity of funded disability services in the BOP and also because of philosophies driving services which are often alike in content but not in operationalizing.

Community mental health services:

Completion of the process to move the contract for Peer Support Services for Adults in the Opotiki area from Tirohia te Kopere Trust to Recovery Solutions Services (RSS) following several meetings with trustees and representatives of RSS. Funding paper to follow.

Capacity & capability:

Engagement around the consultation process for the Service Development Plan (SDP) 2012 – 2017 (which has arisen from Blueprint II) is taking place across the month of October at a national level (Portfolio Managers/Clinical Directors/General managers) and at a regional level where providers are invited. The draft SDP has been sent out to all mainstream providers with the option to meet to discuss the draft and formulate feedback. Two providers only expressed an interest to attend such a meeting.

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P&F is involved in Gateway Assessment primary mental health RFP process which is being led by Child Youth & Family Services nationally and will be part of the panel which decides on the successful Bay of Plenty-wide provider of around 86 packages of evidence-based interventions being made available to those identified through the Gateway Assessment process.

BOP provides the Midland Regional representative on the review of the Eating Disorders continuum of services being undertaken by the NDSA on behalf of the Ministry of health.

BOP provides the Midland Regional representative on the E-therapy Beating the Blues project rollout which is looking to increase the use of the E-therapy tool as part of the stepped care approach to primary mental health issues. Looking to publicise this tool within the BOP and identify areas that need additional training.

Planning

Annual Planning (AP):

We are expecting the planning guidelines for the 2013/14 AP shortly. Early indications are that there will be a focus on reducing violence against children. In addition:

The AP Steering Group (APSG) is about to be reconvened.

Exec briefing is scheduled for 6 November.

A brief presentation will be given at the staff forums on 14 and 15 November in Whakatane and Tauranga respectively.

A half day workshop for the Board has been scheduled for 21 November.

P&F has developed a stakeholder engagement register, with workshops scheduled for Bay Navigator, the Primary Health Organisations (PHOs) and the Alliance Leadership Team (ALT).

Regional activity – a PID (project implementation document) has been prepared by the planners across the region to build on the regional consistency from last year, to ensure greater alignment with the RSP (regional services plan) and to give GMs P&F across the region the “what” and “when”. Waikato DHB is resourcing the development of a template document, consistently themed cover page and project plan, all of which should give the Minister greater confidence that we are working well regionally. Mary Smith, GM Lakes, has been appointed to provide GM P&F support for the regional group.

Performance results:

The auditors have drafted their constructive report to management, which includes two observations in regard to the Annual Plan and Annual Report. Planning & Funding are pleased with that they have noted significant improvement in both, and have offered minor recommendations which can be implemented. Planning & Funding have met with Corporate and Provider Arm Executive (and key accounting or analytical leads) to discuss the key issues and high level strategies in regard to Budget 2013/14. This meeting has allowed early budget issues, principles and assumptions around BOPDHB revenue and expenditure to be tabled in advance of Price-Volume Schedule negotiations.

The second quarterly Regional Analytical meeting is scheduled for Tuesday 30 October. Our Finance & Performance team are advancing our goal of greater regional collaboration within the analytical teams, with a view to create efficiencies and promote best work practices across the region.

General

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CARE

A Board annual review document has been prepared in draft, framed by CARE values, and was approved by the Board, subject to a reference to the Board’s Code of Conduct.

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