agenda - ministry of health nz · 3.1 health and safety, wdhb presentation d mazey 25 3.2 advisory...

Wairarapa District Health Board JUNE 2016

AGENDAHeld on Tuesday 21 June 2016Lecture Room, CSSB Building, Wairarapa DHB, MastertonCommencing at 11:00 am

BOARD PUBLIC SESSION

1. PROCEDURAL BUSINESS 20

1.1 Karakia R Karaitiana

1.2 ApologiesHelen Kjestrup ACCEPT D Milne

1.3 Continuous DisclosureInterest Register/Conflict of Interest

ACCEPT / CONFIRM D Milne

1.4 Minutes of previous meeting ADOPT D Milne

1.5 Matters Arising from Previous Meeting D Milne

1.6 Action Items Register D Milne2. REPORTS 11:20

2.1 Chair Report VERBAL D Milne 5

2.2 Inwards/Outwards Correspondence NOTE D Milne 10

2.3 C E Report NOTE A Isbister 15

2.3.1 OIA / Media Report

2.4 Finance Reporting May 2016 NOTE K Sheridan 15

Verbal update re savings in Maori Health and variance March to April 2016

2.5 Iwi Kainga Report NOTE Y Grace 15

3. HEALTH & SAFETY 12:20

3.1 Health and Safety, WDHB Presentation D Mazey 25

3.2 Advisory Committee Exec Summary NOTE

Advisory Committee Minutes NOTE

3.3 Ratified Health & Safety Policy Statement NOTE

LUNCH – 30 minute break 12:45

4. DECISION PAPERS

4.1 CPHAC/DSAC Recommendations AGREE S Williams 5 1:15

4.2 WDHB Position on donated funds AGREE J Stringer 5 1:20

5. DISCUSSION PAPERS

5.1 Orthopaedic Prioritisation Tool NOTE T Gibson 15 1:25

6. INFORMATION PAPERS 10 1:40

6.1 Dementia Care Response to Queries NOTE S Williams

6.2 Director Maori Health Services Report NOTE J Kerehi

Wairarapa Board Public 21 June 2016 - PROCEDURAL BUSINESS

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Wairarapa District Health Board JUNE 2016

7. MEETING REPORTS AND MINUTES 1:50pm

7.1 Verbal Report from HAC NOTE J Vollebregt 10

7.2 ALT Draft Minutes NOTE

8. PRESENTATION 2:00pm

Rachel Haggerty

9. RESOLUTION TO EXCLUDE THE PUBLIC

Meeting to Close 3:00pm. Proceed to Public Excluded session


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WAIRARAPA DISTRICT HEALTH BOARD

Wairarapa Board INTEREST REGISTERLAST AMENDED: FEBRUARY 2016

Name InterestMr Derek MilneChair

∑ Chair, Wairarapa District Health Board∑ Deputy Chair, Capital & Coast District Health Board∑ Deputy Chair, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, Hutt Valley and CCDHB Finance Risk & Audit Committees∑ Ex Officio Member, WDHB Finance Risk & Audit Committee (30 March 2016)∑ Ex Officio Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Member, WDHB CPHAC/DSAC (30 March 2016)∑ Brother-in-law is on the Board of Healthcare Ltd

Mrs Leanne SoutheyDeputy Chair

∑ Chair, Wairarapa District Health Board, Finance Risk & Audit Committee∑ Deputy Chair, Wairarapa District Health Board∑ Chair of Lands Trust Masterton (15 February 2016)∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees∑ Director, Southey Sayer Limited

∑ Chartered Accountant to Health Professionals including Selina Sutherland Hospital and Selina Sutherland Trust

∑ Trustee, Wairarapa Community Health Trust

∑ Sister-in-Law is employed by WDHB

∑ Shareholder of Mangan Graphics Ltd

∑ Member of UCOL Council

Ms Liz FalknerMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Retired General Practitioner with Masterton Medical Limited∑ Medical Advisor – Post Polio Support Society NZ Inc∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Dr Rob Irwin Member

∑ Member, Wairarapa District Health Board∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Trustee Wairarapa Community Health Trust∑ Member, South Masterton Rotary∑ Chair, Wairarapa Trails Trust (30 March 2016)

Ms Helen KjestrupMember

∑ Member, Wairarapa District Health Board∑ Member, WDHB Finance Risk and Audit Committee (30 March 2016)∑ Works for Central TAS as an Auditor∑ Shareholder, Property Investment Company – Kjestrup Properties∑ Assessor for Royal College of GPs for Cornerstones Programme

Mr Rick Long Member

∑ Member, Wairarapa District Health Board

∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee

∑ Chairman of Wairarapa Community Transport Services Inc

∑ Chairman of Tolley Educational Trust

∑ Trustee for Sport and Vintage Aviation Society

∑ Biomedical Services New Zealand Limited


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∑ Member of Masterton Lands Trust

∑ Director, Longs Properties Limited (1 February 2016)

Mr Alan ShirleyMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Surgeon at Wairarapa Hospital∑ Technical Advisory for Ministry of Health∑ Wairarapa Community Health Board Member∑ Technical Expert Advisor∑ Subregional Endoscopy Steering Group∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory

Committees & Disability Support Advisory Committees (30 March 2016)

Ms Fiona SamuelMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB Hospital Advisory Committees∑ Member, WDHB Hospital Advisory Committee (30 March 2016)∑ Casual Nurse, at Wairarapa Hospital∑ Duty Nurse Manager, at Wairarapa Hospital∑ Contractor Auditor for TAS∑ Member of Clinical Board Wairarapa District Health Board

Ms Janine VollebregtMember

∑ Member, Wairarapa District Health Board∑ Chair, WDHB Hospital Advisory Committee (30 March 2016)∑ DHB Nurse Educator for the UCOL Undergraduate Maori Students. This 0.4 FTE position is

effective from 30 April 2008 to 30 June 2010.

∑ Community Health Clinic establishment∑ Sister in Law works part time at Wairarapa District Health Board (23 February 2016)

Mr Ronald KaraitianaMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa Te Iwi Kainga Committee∑ Member, Wairarapa District Health Board, Finance Risk & Audit Committee∑ ACC Manager in Claims Management∑ Wife Kylie Smith is currently the DHB liaison from Child Youth & Family∑ Maori relationships with staff vary from a number of cousins working at DHB∑ Occasionally plays in a band (potential no risk to the board)∑ Trust Chairman Akura Lands Trust

Ms Jane HopkirkMember

∑ Member, Wairarapa District Health Board∑ Member, Wairarapa, Hutt Valley and CCDHB, Community Public Health Advisory Committees

& Disability Support Advisory Committees (30 March 2016)∑ Member, Wairarapa Te Iwi Kainga Committee∑ Kaiarahi, Takiri Mai Te Ata, Kokiri Hauora∑ Member, Occupational Therapy Board of New Zealand (23 February 2016)


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Wairarapa District Health Board Page 1 Page | 1

Minutes: Anna Cardno, Board Secretary

Held on Tuesday 24 May 2016Lecture Room, CSSB Building, Wairarapa Hospital, Masterton

Commencing at 9:00am

BOARD PUBLIC SECTION

PRESENT

Derek Milne Board ChairLeanne Southey Deputy ChairJanine Vollebregt MemberRick Long MemberRob Irwin MemberAlan Shirley MemberFiona Samuel MemberJane Hopkirk MemberRon Karaitiana MemberHelen Kjestrup MemberLiz Faulkner Member

IN ATTENDANCEAdri Isbister Chief Executive (CE)Anna Cardno Board Secretary/Executive Assistant to CE Tom Gibson Chief Medical Officer (CMO)Jill Stringer Interim Director Wairarapa Health Services (IDWHS)Sandra Williams Acting GM, SIDU (GM SIDU)Jason Kerehi Director, Maori Health Services (DMHS)Catherine Sheridan Senior Finance Manager (SFM)Tofa Suafole Gush Director, Pacific People’s Health (DPPH)

APOLOGIESJustine Thorpe General Manager, Compass Health (GM CH)

1.0 PROCEDURAL

INTRODUCTIONS

1.1 KARAKIAMeeting opened at 9:10am with a karakia by Ron Karaitiana.

1.2 APOLOGIESAs above.

1.3 CONTINUOUS DISCLOSURE1.3.1 INTEREST REGISTER

The Board CONFIRMED that it was not aware of any other matters (including matters reported to/decisions made by the Board at this meeting) which would require disclosure.


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1.4 MINUTES OF THE PREVIOUS MEETINGAPPROVEDThe Board resolved to approve the minutes of the Public meeting held on 19 April 2016 as a true and accurate record of the meeting (pending correction of spelling Justine Thorpe p9).

MOVED: Leanne Southey SECONDED: Janine VollebregtCARRIED

1.5 MATTERS ARISINGItem 4.1 Minuted report on Concerto includes a statement that 60% errors were detected in prescriptions presented at Pharmacy. The Board challenges this statement.

ELT to investigate and report back to the June Board meeting.

The Board feels that 1/7/16 is premature timeframe unless it can be better informed. How will the patient be informed?

The Board supports the sharing of information to improve outcomes for the patient, but seeks full assurance that patient safety and informed consent is properly addressed.

Item 2.3.1 CT Scanner. Ron Karaitiana questioned the IDF plan for the higher spec scanner in CCDHB. The CMO noted that the WDHB CT Scanner is very fit for purpose, and anything higher spec’d would not have staffing expertise here to utilise – so IDF would be required regardless.

1.6 ACTION ITEMS REGISTERNoted.

2.0 REPORTS

2.1 CHAIR REPORT Noted.

2.2 INWARDS / OUTWARDS CORRESPONDENCE

1. The Chair spoke to the letter from the Director-General, MoH on the disestablishment of the NHC and NHB.

2. Audit Management Letter 30 June 2015 outlined the financial information systems complications, which is being addressed and is currently out of the Board’s influence.

Board requests a programme of action over the next 24 months – SFM to provide a report for June meeting.

Correspondence Noted.


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2.3 CHIEF EXECUTIVES REPORTPoints of specific note:

Item 1. Opposition Party visitThe CE advised of a visit on by Labour Party Health and Wellbeing Caucus on 16th of May, including representatives, Trevor Mallard, Ruth Dyson and Annette King who had previously met with Compass Health.

Item 3. Annual Plan 2016/17The CE advised she has read through the full draft plan, which has been a solid team effort by the ELT and their management staff to prepare. The CE is to meet with Alan Shirley, Tom Gibson and Jill Stringer on 25 May 2016 to review. Clinical input has been received.

Item 8: Orthopaedic referralsThe graph provided shows a dip in the referral numbers reflecting the trial of the National Scoring Tool. Now WDHB is referring people on the same basis as the rest of the country. More investigation is required into needs assessment – ongoing issue. (WDHB had been providing more operations than funded). Public health service cannot afford to provide all treatments people could benefit from. A scoring tool has been implemented to justify the level of affordable treatment. WDHB needs to follow National Guidelines – but the aging rural population demographic is high need.

Board to receive a full report on the scoring system for the June meeting - CMO

2.3.2 DashboardAn SLA with HVDHB is being progressed. ASH figures are looking good, but coding is being assessed.

Board wishes to congratulate Maternity on improvements – IDWHS to pass on.Board to have a presentation on Qual’s - CMO

Fiona Samuels noted the IDF figures were trending well. Good work being achieved by Managers with regard Annual Leave liability – high priority focus. Winter planning better managed this year, with bed protocols and planning in place. Bed capacity modelling work is in place to ensure WDHB can manage within its footprint this season.

The Board RECEIVED the report.

2.4 FINANCE REPORTINGThe Board congratulated the CE on the trending budget. Key results year to date were: ∑ Funder $523k favourable∑ Governance $186k favourable ∑ Provider ($67k) unfavourable

Material variances year to date to 30 April 2016The key variances to budget were: ∑ Total Revenue is $1,411k favourable to budget; Devolved MoH revenue is $671k favourable due to MoH

sub contracts unbudgeted which is offset against matching expenditure. ACC revenue is favourable to budget by $125k and Other Revenue $517k, due to $424k of donations received including $306k from the Wairarapa Community Health Trust for the acute monitoring system. $40k additional revenue received from Whanganui DHB for the “Walking in another’s Shoes” program, and $79k of additional Pharmacy rebates partly relating to last year.


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∑ Total personnel expenses (employed and outsourced) are ($216k) unfavourable year to date. Total Medical personnel expenses (employed and outsourced) exceeds budget YTD by ($858k) and the composition of the workforce is continually being reviewed. The total nursing personnel (employed and outsourced) is $109k favourable year to date.

∑ Treatment related costs are ($1,083k) unfavourable to budget. The main areas are Air Ambulance ($251k), Implants and Prostheses ($601k) and Pharmaceuticals ($172k). The $159k YTD savings target is also impacting this result.

∑ External provider costs are favourable $2,491k mostly due to the provision for IDF outflow $344k, Other HOP $96k, Mental Health $150k, Lab Costs $1,531k and Pharmaceuticals $621k and offset by additional payments to the PHO for under 13’s ($221k) covered by additional revenue and higher volumes in ARC facilities ($144k). Offset by small underspends in other lines.

∑ Overall IDF Outflows are a net of ($2,283k) unfavourable against a budget provision of $382k. The result includes total wash-ups of ($784k) including ($403k) for inpatient volumes, ($183k) for outpatient volumes and ($198k) for community pharmaceutical costs. The remainder of the IDF outflows includes ($1,536k) for the WSCL Ltd for the lab contract and other IDF changes of $37k.

Year-end forecast deficit is ($1,946k) which is favourable to budget by $13k. IT includes provisions for a spike spend in IDFs over winter. Tracking on budget.

Allied Health vacancies are being progressed and advertised.

The Board queried bullet point 3 on page 9 of the April Report “Other costs are $47k favourable for the year to date; this is because of some savings being realised on a Maori health services contract”. March report only $4k favourable.

SFM to investigate what the savings are in Maori Health, and why the significant difference month to month.

PharamceuticalsRob Irwin queried the pharmaceutical expenditure i.e MABs, which are under budgeted in terms of volume. Identified and monitoring volumes to budget.

Patient transport and lodging is difficult to budget – there is a significant area of focus to manage costs ($82K unfavourable). The call to require an Air Ambulance is a clinical decision based on patient need. The CCDHB ICU Consultants are included in the clinical decision making.

2.4.1 NZHP ProcurementThe CFM is the nominated Procurement Lead. Rick Long questioned why this is a better approach than HBL. Page 19 of the strategy outlines what will be provided differently. The CE noted the very capable leadership of the CE, Megan Main.


2.5 IWI KAINGA REPORTApologies received from both Yvette Grace (on bereavement leave) and, in her absence, also Kim Smith. A letter was presented to the Board Chair on the morning of the Board Meeting, too late for inclusion at the table. Concern was raised again by Iwi Kainga with regard to Public Excluded papers. The Chair noted


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that the maximum of information must sit within the Public Meeting. Board Chair to table the Iwi Kainga letter at the June Board meeting, along with his response, in Inwards/Outwards correspondence.Chair and CE to meet together at Iwi Kainga meetings, rather than separately.

3.0 HEALTH & SAFETYBoard heard the planned Health and Safety and Governance training to year end, as follows:

PLANNED FORWARDJUN 2016 Health & Safety Co-ordinator, WDHB

20 minute overview of WDHB’s Health and Safety systems, including:∑ Auditing∑ Training & Education∑ Electronic systems∑ H&S annual plans∑ Event Statistics

JULY 2016 Training session in Health & Safety Governance (new legislation etc) Worksafe / ACC

SEP 2016 Two hour workshop: Health Quality & Safety Commission

Board members to undertake the audit in the Governing for Quality Guide. Leanne Southey to provide Board Secretary with information regarding the shared H&S training at WBS.

4.0 DECISION PAPERS

4.1 WDHB actions to address Health and Safety

The Board:NOTES The Health and Safety at Work Act 2015 key changes and WDHB’s responses to these changes and has read this in conjunction with the Health and Safety Report of Strategic Risk submitted to the board in August 2015

NOTES The Health and Safety at Work Act 2015 key changes and WDHB’s responses to these changesAPPROVES that governance training be provided to all Board MembersAPPROVES that Directors shall receive basic training in incident investigation methodology sufficient to ensure that they are able to distinguish between adequate and inadequate investigations

MOVED: Derek Milne SECONDED: Ron Karaitiana CARRIED

5.0 DISCUSSION PAPERS

5.1 Primary Care and Tehei Wairarapa Quarterly Report (Bob Francis/Lisa Burch presenting)After Hours/Urgent Care Compass-led work on Urgent Care – two options considered to date:1. A&E developed further, and 2. MML have radiology added. Further options being investigated. Acute Care Communication Plan – After Hours: Primary Care after hours advertising – Acute Care Working Group wanted smarter communications for the public. The new plan is better targeted and coordinated.


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(Janine Vollebregt noted dissatisfaction with information provided by MML telephone after hours, did not state open hours. Bob Francis will follow up). Urgent care clinic/A&M contract requirements are being considered. GP service is paid for on call care at all times for medical intervention as required. Noted that people will always go to ED – need to be smarter at ED to manage this. National issue to address. One option may be to withdraw the GP A/H on call funding and change funding stream.

Primary Care will investigate the use of the Healthline phone answering mechanism at MML.

Youth KinexOne year anniversary of the Youth Kinex programme. Great work has been done – adding some wrap around services. Almost a regional service now, with increased opening hours. Excellent location of Lands Trust, Queen Street. Caters for ages 13-35.Social Sector Trials work has been discontinued, some youth focused services will continue.

ASH RatesOngoing challenge for WDHB. Some changes in how it is measured. Respiratory and Skin work is being undertaken.

Childrens Dental Wait ListHigh wait list for extractions. CE looking to resource the dental bus at WDHB – possibly run an extra 2-3 weekends per year to help reduce the waits.

High needs familiesSupporting high needs families to access services is a key priority for Whaiora.

Board requests more information from South Wairarapa and Whaiora in reporting, and noted that the funding cuts on Maori Health Providers will have a significant effect. How can Whaiora be best supported locally? Report required.

ObesityPlans to set up an Intersectorial Group to look into child obesity are being led by MoH, with Lisa Burch to coordinate. Important to extend the good outcomes of the SST (community resilience, intersectorial work, working together).

Primary and community health integrationPHASE 1:Healthcare Home initiative by MML. Unfunded. Good traction happening in this space. Mobile technology is progressing. Three community nurses are working with Carterton practice –will roll out to other practices – lots of GP liaison. Change of people and culture – well supported. The strategic view will be visible in the Annual Plan.

Accessible prescriptionsThere is a widespread issue of people not collecting scripts due to not being able to afford to pay for them – trial in Hutt is under review.

Health Pathways – 3D workAgreement to adopt the Health Navigator


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Health Point - directory of information. Advanced Care PlanningPalliative Care Strategy – Managed Clinical Network (Adri Isbister Lead CE)Framework for Self Management (8 Community people have been trained)Mental Health

The Board RECEIVED the report and thanked presenters for their time and clarity on matters addressed.

6.0 INFORMATION PAPERS

6.1 Central Region Service Plan Q3 ReportThe CE noted the error in ESPI reporting on p6 – should be yellow coded, not red.

Board requested that relevant parts of the report be extracted and forwarded to appropriate managers.


6.2 Information on FluorideLikely to become political. Need a one pager of scientific evidence with references etc.

Localised information with statistical relevance is being sought from RPH and will be made available to the Board when it is to hand.


6.3 Aged Residential Care (ARC) Examination of Costs within Wairarapa DHBThe Board RECEIVED the report, and noted it was a good, well presented paper.

6.4 EDoNM ReportThe Board queried how the Nurse Practitioner was being received. CMO advised the introduction has so far been extremely positive.


6.5 H R Data ReportBoard queried the HR data regarding performance appraisals. Stats are still very low. CE noted work is under way to address and simplify the process, which is currently cumbersome.

The Board RECEIVED the report, and noted the value of the paper.


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7.0 MEETING REPORTS

7.1 Draft HAC Public Minutes.Noted.

8.0 RESOLUTION TO EXCLUDE THE PUBLICThe Board AGREED that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table. The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the 16 June 2015 Board Agendas

Financial matters; Change proposals; Annual Planning; HDC process reporting, Suicide prevention

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations.

Section 9(2)(i)(j)*

*Official Information Act

MOVED: Derek Milne SECONDED: Janine VollebregtCARRIED

MEETING ADJOURNED: 12:30pm

DATE OF NEXT MEETING: 21 June 2016

CONFIRMED that these minutes constitute a true and accurate record.Dated this day of 2016

Derek MilneChair, Wairarapa District Health Board


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WAIRARAPA DISTRICT HEALTH BOARD PUBLIC BOARD MEETING : ACTION ITEMS

Wairarapa District Health Board MAY 2016 Page 1

MAY 2016 – ALLOCATED TASKSPUBLIC MEETING

Chair Table the Iwi Kainga Letter and response in correspondence in JuneDeputy Chair Provide Board Secretary with information on the WBS Health & Safety TrainingAll Board Undertake the audit in the Governing for Quality Guide Board Secretary Advise Iwi Kainga Secretary that CE and Board Chair wish to meet together at Iwi Kainga meetings, not separatelyPrimary Care Via Bob Francis – to investigate the Healthline phone answering system at Masterton Medical Limited

Board requests more South Wairarapa and Whaiora information in the quarterly reportsSFO Investigate what savings are in Maori Health discussed point 3, p9 April Report and explain the significant difference

reported March to April 2016IDWHS Congratulate Maternity on behalf of Board for the improvements reflected in the April Dashboard

Central Region Service Plan Q3 Report – relevant information to get out to appropriate Managers/StaffActing GM, SIDU Investigate the opportunity for OT hours to be included in the national ARC contracts (Note: this relates to a National

Programme, not local. Requested defer until June: Sandra Williams).

ACTION ITEMS

Action Responsible Meeting date

How Dealt with

Delivery date

Date Completed

PUBLIC BOARD MEETING

12/15.6 Suicide prevention Report on current Wairarapa services for suicide prevention

Sandra Williams

17/11/15 Update 19/4/16deferred

24/5/16

Red Text

Carried over Requested Quarterly Future Completed


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4/16.1 Health & Safety Governance

Provide a paper to the Board on Governance in Health & Safety for the May meeting

Adri Isbister

19/4/16 Report 24/5/16 24/5/16

4/16.2 Dementia Care Questions raised by Fiona Samuel to be answered in a report for the June 2016 meeting

Sandra Williams

19/4/16 Report 21/6/16

12/15.7 Progress on HCSS tender

Any lessons from CC and Hutt DHBs from Home and Community Support Services joint tender process (HCSS)

Sandra Williams

18/8/15 Report Request defer until July

5/16.1 Prescription errors (60%)

Decision Paper Item 4.1 Minutes 19/4/16 page 4 noted 60% errors in prescriptions presenting at Pharmacy. Board requests further explanation

Justine Thorpe

24/5/16 Report Request defer until July

5/16.2 Concerto – patient safety and informed consent

The Board seeks full assurance that patient safety and informed consent is properly addressed before access to Concerto is widened

3D ICT 24/5/16 Report June

5/16.3 Financial Information Systems

Programme of Action Report required to map planning process over next 24 months

Kate Sheridan

24/5/16 Report Will go to FRAC

5/16.4 National Scoring Tool -Orthopaedics

Board requests a full report on the scoring system

Tom Gibson

24/5/16 Report June

5/16.5 Quals presentation Board requests a presentation on Quals Tom Gibson

24/5/16 Discussion paper

June

5/16.6 Supporting Whaiora

Board noted funding cuts in Maori Health will affect Whaiora – how can the Maori Provider best be supported locally?

DMHS 24/5/16 Report June

5/16.7 Fluoride – local data / science

Localised information on fluoride with statistical relevance is to be provided by RPH for Board

RPH 24/5/16 Report When it is to hand

QUARTERLY REPORTS REQUIRED/

Nursing & Midwifery Report Quarterly Report to the Board Helen Pocknall

Report August

Human Resources Quarterly Annual Leave Management Report including advice on any pay out period policies

Donna Hickey /

Report August


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and management of staff well-being. Gretchen Dean

Pacific Community Health Report

Quarterly Report to the Board Tofa Suafole Gush

Report October

FUTURE ACTIONS

12/15.10 Service Level Agreements

Service Level Agreements are required as standard arrangements, following best model approach

18/8/15 July


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Wairarapa Board Public 21 June 2016 - REPORTS

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Wairarapa District Health Board

BOARD DISCUSSION PAPER

Date: June 2016

Author Adri Isbister, Chief Executive

Subject CHIEF EXECUTIVE’S REPORT TO THE BOARD

RECOMMENDATION It is recommended that the Board:

NOTES this paper and discusses as appropriate

APPENDICES:

1. Occupational Therapy Hours in ARC contracts.At the May Board meeting, the Board asked SIDU to consider the inclusion of OT hours in the National ARC contracts. A brief report is attached.2. INSITE article on the consultation for organisational change.3: Wig Wednesday for Child Cancer

1. Executive Summary

Change Process The Board has received the change management proposal which is out with staff for consultation. Some very positive and constructive feedback is being received; staff appear to be actively engaged in the process with some very useful suggestions coming forward. Consultation closes at the end of this month. A one-page bulletin to staff is included in the appendices to this report that provides more detail.

Bowel Screening ProgrammeBackground:The roll-out of a national bowel screening programme is on track to begin in 2017. Budget 2016 invests $39.3 million over four years for national bowel screening – starting with Hutt Valley and Wairarapa DHBs. This will be followed by a progressive roll-out across the country. Additional funding has also been set aside in contingency to enable the IT support needed for a national screening programme. Once fully implemented, the programme is expected to screen over 700,000 people every two years. This investment builds on the successful Waitemata DHB bowel screening pilot, which has been running since 2012. WaiDHB is in the process of developing a business case with financials to the Ministry of Health.Action:Both WaiDHB and HVDHB leads have met with MoH and the Project Manager Waitemata who proved very willing to share information. A paper is being prepared to outline the project structure – then a clinical team will go to Waitemata once Wairarapa has a Project Lead in place.CEs WaiDHB and HVDHB are holding a Bowel Screening Forum for key staff 15 June.

Kahungunu WairarapaDirector Maori Health Services and I met with Kahungunu Wairarapa to discuss their strategic plan and how their objectives coincide with the objectives we have in the Annual and Maori Health plan.

Draft Annual PlanThe plan is now at the MoH and we are about to insert the Budget. More in Finance.


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MIFThe Chair, Senior Finance Manager and I attended the regular MIF meeting with the MoH. We discussed budget expectations and will still be in a tight deficit forecast position FY16/17.

JCC meetingWe had the quarterly JCC meeting this month. Good discussion on SMO recruitment, SMO involvement in strategic and business planning, plus the assurance that we have an independent audit of payroll underway.

Wig Wednesday – 3D ICT supporting Child Cancer 3DHB ICT are supporting Child Cancer this year and are calling out to the wider WDHB to get in behind this wonderful cause. Our IT Team will be wearing wigs and collecting money on WIG WEDNESDAY 22 June and I am sure they would appreciate your support. Poster attached in appendices.

Subregional Disability ForumAlan Shirley, Liz Falkner and I attended this forum in Silverstream. I facilitated the leadership in partnership workshop. About 150 people attended the day. We will have some good feedback to assist with the disability action plan going forward.

Regional Chairs and CE’s meetingDue to have this meeting on 13th 14th June. The Regional CE’s have all undergone a psychometric test to assess EQ and how we work together as a team. The 13th June will be a workshop with the CE’s and a strategic planning day.

Financials The month of May had a favourable variance to budget of $420k and year to date favourable variance of $1,062k. The bottom line result year to date was a deficit of ($1,063k) compared to a budget deficit of ($2,125). The year end forecast deficit has now been revised to ($1,523), being $437k favourable to budget.

The areas of continuous monitoring and review include medical personnel, treatment related costs and IDF’s

2. Maori Health Directorate There is a full Maori Health Services report within the Board papers.

3. Allied Health

3 DHB Allied Health Scientific & Technical Awards 2016Thursday 8 September 2016 Horne Lecture Theatre, Wellington Regional HospitalThese awards are a celebration and acknowledgement of achievements and contribution of Allied Health, Scientific & Technical staff in improving the health and wellbeing for individuals, whānau and the widercommunity. Awards are open to Allied Health, Scientific & Technical staff working across Wairarapa, Hutt Valley, and Capital & Coast DHBs.

Recommendation

That the Board RECEIVES the report.


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Appendix 1: Occupational Therapy Hours in ARC contracts.

There is no stipulation for any staffing hours in the national ARC contract. Instead, the focus is meeting the residents’ assessed needs:

D16.5 Support and Care Intervention

a. Support and care provided by you must be focused on the Resident and delivered in a timely and

competent manner. Your routines and practices within the Facility must reflect as much as possible

community norms, encourage each Resident’s autonomy, respect their dignity and privacy, meet their

cultural requirements, and be documented in the Care Plan.

b. Your staff must be available at all times to meet the needs of each Resident, as identified in the

Resident's Care Plan and when necessary.

c. You must provide the following support and care intervention services to all Residents:

i. supervision and/or assistance with activities of daily living and personal care as determined by the

individual needs of each Resident;

ii. a designated staff member who is skilled in and accountable for assessment, implementation and

evaluation of social, diversional and motivational recreation programmes for each Resident;

iii. for each Resident, a written and implemented social and recreational programme of activities

planned to meet the identified interests, stated preferences and level of ability/disability of the

Resident. You must ensure that this activity programme is evaluated and reviewed each time the

Care Plan is reviewed.

d. The programme referred to in clause D16.5(c)(iii) shall include group and individual activities and

involvement with the wider community. Information related to the preferred activities and level of

involvement will be documented in the Resident’s records.

e. Primary Medical Treatment

iv You must provide the treatment programme prescribed by a Medical Practitioner or Nurse

Practitioner to assist the Resident to develop and maintain functional ability. This may include

such goal and outcome orientated treatment as physiotherapy, respiratory therapy, occupational

therapy, speech therapy, dietetics and podiatry. The treatment programme must be reviewed by

a Registered Nurse at such regular intervals as are specified by the Medical Practitioner or Nurse

Practitioner.

Each year, DHBs have the opportunity to recommend changes to the ARC agreement through their annual contract

variation. These recommendations are forwarded to the national HOP Steering Group from Central Region HOP

Portfolio Managers. The recommendations need to be specific and accompanied by contractual logic. Any DHB could

forward a recommendation relating to stipulation of OT hours, but would need to be clear as to how those hours

should be determined.

It needs to be noted that, to date, no agreement has been able to be reached or included in the ARC contract

regarding stipulated nursing hours so it is doubtful whether stipulated OT hours would have much more success.


32

PUBLIC

Appendix 2: Wairarapa DHB change proposalsMESSAGE TO STAFF

Proposals for changes to our organisation structure were released on 31 May, followed by a four week staff consultation period. The proposals mostly affect senior leadership and management positions and also some 2DHB and 3DHB functions.

You can now go to our dedicated 3DHB consultation site on the intranet to view the proposals being made in each of the three DHBs on their future organisational changes. The consultation documents are posted on a shared site, accessible via the intranet home page, where you’ll be able to read the full proposals, give your feedback on them and ask questions. Click on the red icon which sits under Links on the right of the intranet’s Home page to take you to the consultation documents.

These documents are being released as proposals only at this stage and no decisions will be made until after we have considered all submissions received during the consultation period ending 28 June.

BackgroundDuring the past year we’ve been working to review the organisational structures of Wairarapa, Hutt Valley and Capital&Coast DHBs, with a focus on ensuring strong clinical governance and operational leadership. We’ve been doing this together because some of the areas we have been looking at are 2DHB and 3DHB. We have released proposals for all three DHBs at the same time so you will be able to see what the changes might look like across the DHBs.

We acknowledge the practical, sustainable and valued services created with the 2DHB and 3DHB integration and we intend to continue working closely together. However, it’s also appropriate to review our current organisational structures and working arrangements to ensure we are best placed to address wider health sector changes and challenges.

FeedbackPlease make sure to have your say on the proposals that affect you, so we get as broad a range of feedback as possible from you all. If you have a question, please use the site to ask it. We will do our best to answer questions as quickly as possible as we know that you will need these answers before you make a submission.

I want to reiterate that these proposals for change are proposals at this point, and I do welcome your thoughts for changes and improvements. Please take the time to access the document and give us your input. There is opportunity for you to choose to make public or private comment and I can assure you that ALL constructive feedback will be considered.

A new structureChange is a process, and we have now begun a journey towards a structure that will provide us a much improved, locally focused and successful DHB. We are intending, with your input, to have a structure that will have clear lines of accountability and enhance and support clinical engagement and leadership. Please be aware this proposal is about designing a team to support the most effective systems and service – how we can best provide for the community and people we serve. Our priority, as always, is to work towards our Wairarapa DHB Vision – Well Wairarapa, Better Health for All. Change can be an anxious time, especially for those staff affected by the structure that has been proposed. Please do take advantage of the support options available to you, including the EAP programme, and look out for any colleagues that may seem significantly concerned. Your manager is the best point of contact if support is required, and our HR team are always available to you.

I will report back to you at the end of the consultation period with some key themes emerging from your feedback and to confirm the next steps in the process. Many thanks in advance for your contribution.


33

PUBLIC

Appendix 3: Wig Wednesday for Child Cancer


34

Media activity: These are media enquiries and issues that we have dealt with this week – mention does not mean that a story has been published.

Subject Media outlet Details

Winter wellness. WaiNews

Reminder to get flu vaccination. Around 9750 Wairarapa residents have had a flu vacc so far. Also article produced by Compass Health promoting Pacific Health education session and flu vacc clinics.

Health targets WaiNews Each quarter we take out a half page in the Wairarapa News to publish health targets results + editorial.

Wairarapa DHB gets green light for bowel screening pilot

Media Works, Times Age, WaiNews, DomPost

Media release picked up by all local media.

Palliative care funding NZ Doctor

∑ How is palliative care funded in your DHB?∑ If a doctor conducts home visits to a dying patient, how much are they paid per visit and

overall?∑ Is there a cap on the amount of pay a doctor can receive for palliative care, either in the

practice, a hospice or at home?∑ Do patients or families need to fill out any paperwork or sign any paperwork to confirm

the GP has visited them?∑ Are any other healthcare professionals entitled to payments for palliative care?

∑ Has your palliative care funding model changed significantly over the last 10 years? How so?Response being prepared by SIDU

Wairarapa DHB’s weekly Media Update

DATE: Week 3 June 2016

Recipients: Recipients:

Derek Milne, Chair, Wairarapa District Health Board and CE WDHB Adri Isbister, Wairarapa DHB CEO

Helen Pocknall, Executive Director of Nursing and Midwifery, Wairarapa and Hutt Valley DHBs

Dr Tom Gibson, Chief Medical Officer, Wairarapa DHB

Amber O’Callaghan, Executive Director Quality & Risk, Wairarapa and Hutt Valley DHBsAngela Keneally and Kirsty Taylor-Doig , Press Secretaries to Jonathan Coleman, Minister of Health

3DHB Communications team Jill Stringer, Interim Hospital Manager

Anna Mahoney, Comms Manager Hutt Valley


35

mental health waiting lists Fairfax media

Journalist was investigating mental health waiting lists in NZ and asked for a definition of "non-contact time" for mental health workers? What is done in this time?

Response: from Nigel Fairley, General Manager MHAID Services, on behalf of the three DHBs

In February 2015 Capital & Coast, Hutt Valley and Wairarapa DHBs developed an integrated mental health, addictions and intellectual disability (MHAID) service to deliver greater consistency of care across the region. As such, this ‘definition’ is used by all three DHBs. Any time where a mental health professional is not directly seeing, or interacting with, a client can be referred to as “non-contact time”. This time is used for a wide range of activities – including talking to patients’ families, reviewing file notes, preparing treatment plans, attending mental health hearings, discussing client care at multi-disciplinary meetings, and other related duties.

Issues Management and Planning These are upcoming issues that have been raised with the Communications Unit internally or by the Ministry of Health

Subject Date Details

Organisational change31 May Change proposals were released for staff consultation on Tuesday 31 May. The consultation will end on 28 June. Staff

questions and submissions are starting to come in via the Sharepoint consultation site.

Official Information Requests

Wairarapa DHB OIAs as at 3 June 2016 Due

OIA 16-33

R Tuner-WaughTranscriptionz

13.04.16 Any information and data medical transcription services (whether provided in-house or by third party) for the years 2010 to 2015:cost

∑ is any information held that details DHB transcription service costs specifically (either in-house or third-party)

∑ if not, is there a standard accounting category used by DHBs for transcription services (either in-house or third-party)

∑ Has MOH conducted any studies or projects regarding transcription and/or records management costs in general

accuracywhether MOH or any DHB collects any data regarding medical transcription accuracy and/or correction rates

∑ whether MOH or any DHB sets performance standards for medical transcription accuracy and/or correction rates

∑ in adverse events reporting, the number of events where transcription error is a major or contributing cause

13.06.16 Tina Ririnui In Progress


36

∑ whether MOH is aware of any DHBs or medical schools providing clinicians with dictation skills training timelinesswhether MOH or any DHB collects data on medical transcription turnaround times

∑ whether MOH or any DHB sets standards or performance objectives for medical transcription turnaround times

OIA 16-34

R Bollard Parliament Library

16.05.16 I would like to request the following information on translation and interpreters in your DHB. Please feel free to contact should you require clarification on any point.

1) How are translation services and interpreters provided by your DHB? Are they contracted out, or provided in-house?

2) How much has been spent on translation services and interpreters on an annual basis, from 2008/09 to most recent figures?

14.06.16 Tina Ririnui In Progress

OIA 16-35

A McCullochReporter

17.05.16 1. Does WDHB have any funding dedicated to Maternal Mental Health (MMH), if so, how much, and can you provide a breakdown of how that funding is spent? (also see q2)2. Does WDHB have a dedicated MMH service or team? (a) if no, to whom are women at risk of or suffering from PND referred? (b) If yes, can you tell me about the scope of your service/team, that is (i) what is the pathway for referral to that service: (ii) how many women does it see annually, and a demographic breakdown if possible(iii) how many women (or third Parties acting on their behalf) seek MMH team care annually, (iv) and how many are accepted into that care, (v)how long are those women under the MMH service/team’ purview, (vi) what happens to women (or third parties acting on their behalf) who seek but are denied access to your MMH service/team?3. What NGOs provide services for women with or at risk of PND in your catchment area, and how do women access them? Do you provide any funding to these NGOs?4. Are all pregnant women or new mothers within the WDHB’s catchment area screened for PND? (i) if yes, can you provide any details on that screening process and its results? (ii) if no, why not, and are you considering such screening?

15.06.16 Nigel Fairley (3DHBMH)

In Progress

OIA 16-36

A MarettLabour researcher

18.05.16 1. The total number of physical assaults on staff broken down by forensic mental health units and mental health inpatient wards for the following calendar years: 2012, 2013, 2014, 2015 broken down by personnel category (nurse, medical professional, allied etc.) and year.

16.06.16 Nigel Fairley (3DHBMH)

In Progress

OIA 16-37

Filipa Payne Iwi N Aus

19.05.16 Since 26th of Feb 2001 how many Australian Citizens have received medical operations under the NZ public health care?Since 26th of Feb 2001 what has been the total cost of expenditure for public health care spent on Australian Citizens living in NZ?

17.06.16 EB and Leanne D

In Progress

OIA 16-38

A Marett Labour Researcher

19.05.16 Please provide details of the range of lymphedema care provided to women by your DHB who have undergone mastectomy. Please also include the number of appointments that a patient receives per year and the number of compression garments provided/funded per year.

17.06.16 Carolyn B In Progress

OIA 16-39

A MarettLabour Researcher

19.05.16 1. Has your District Health Board undertaking or has undertaken in the past six months, a review of mental health services delivery or funding (community and/or inpatient units)2. If so, please provide:• Terms of reference or documents that outline the scope of the review• any reports or briefings as a result of the review• Copies of any papers presented to your Board members in regards to the reviewThis includes contract reviews with NGO providers of community mental health services.

17.06.16 N Fairley(3DHBMH)

In progress


37

OIA16-40

David & Paul Boomert

23.05.16 Can I please have all correspondence and file notes from the Needs Assessment and Coordination Service (NASC) in the Wairarapa in relation to assessment of my needs from the time they first undertook responsibility for this role. I need this for a complaint my family is making to the Health and Disability Commissioner on my behalf. Because the NASC ignored the needs associated with my Prader-Willi Syndrome (PWS) my quality of life has deteriorated severely over many years and I am living with serious health problems directly related to my disability that were preventable if the NASC had done its job.Also, I made and earlier OIA request (5/5/15) and was provided with correspondence which included an email to Helene Dore (Wairarapa DHB) on 30/01/2015 at 9.07am. The senders email address and several other sections were redacted. I would like to be provided with a copy of this email without the redactions. The email is by someone discussing my needs, my disability, my health problems and what funding should be provided to address them. I want to know what role this person, who describes weight management for someone with PWS as a ‘lifestyle choice’ played in my assessment.I would also like to be provided with any correspondence or file notes that show what steps the DHB took to

correct that person’s understanding of PWS, given they agree it is not a lifestyle choice, (according to Russel Simpson - then director Allied Health, Scientific & Technical Wairarapa & Hutt Valley DHBs in his statement to the Dominion Post November 26, 2015). I would also like to know whether that person is still providing advice to the DHB about my needs, and if not when this ceased to be the case.

21.06.16 Jill Stringer In Progress

OIA 16-41

Alex Marett Labour Researcher

23.05.16 The number of FTEs who have been employed by your DHB who are currently waiting for police vetting broken down by personnel category and whether they have been waiting one month, two months, 3 months, greater than 3 months, greater than 6 months.

21.06.16 HR Gretchen

In Progress

OIA 16-42

Alani VailahiNZ First

25.05.16 •Copies of all internal correspondence within the Wairarapa District Health Board regarding Multi Employer Collective Agreement (MECA) negotiations in the past 6 months; and an updated timeline of the pay increase offers by the Wairarapa District Health Board since 2008? •What is the total number of graduate nurses that have gained full-time employment for each year since 2008, broken down by the country each employee gained his/her qualification?


In Progress

OIA 16-43

A Marett Labour Researcher

1. How many neurologists, if any, are employed by the DHB, please provide a breakdown by FTE each year for the past three financial years and the year to date.

2. Does the number meet the need for services for MS patients?3. Please provide copies of any reports, correspondence, advice, briefings where a key item discussed is

pressures (if any) in neurology since June 20154. What is the average waiting time for a sufferer of multiple sclerosis to access an appointment with a

neurologist at your DHB, and how does this compare to 2013/14 and 2014/15?5. How many multiple sclerosis patients, if any, are waiting for a neurologist appointment at your DHB for the

past two financial years and the year to date, broken down by month?


In Progress


38

Adri Isbister Catherine Sheridan

Chief Executive Senior Finance Manager


FINANCIAL REPORT

MAY 2016


39

1

1. FINANCIAL PERFORMANCE OVERVIEW

The month of May has a favourable variance to budget of $420k and year to date favourable $1,062k.

Key results year to date were:

Funder $556k favourable

Governance $194k favourable

Provider $312k favourable Material variances year to date (YTD) to 31 May 2016

The key variances to budget were:

Total Revenue is $1,753k favourable to budget; Devolved MoH revenue is $767k favourable due to MoH sub contracts unbudgeted which is offset against matching expenditure. ACC revenue is favourable to budget by $205k and Other Revenue $682k, due to $442k of donations received including $306k from the Wairarapa Community Health Trust for the acute monitoring system. $40k additional revenue received from Whanganui DHB for the “Walking in another’s Shoes” program, $80k Biomedical Dividend received and $155k of additional Pharmacy rebates partly relating to last year offset by lower interest income.

Total personnel expenses (employed and outsourced) are ($268k) unfavourable YTD. Total Medical personnel expenses (employed and outsourced)

exceeds budget YTD by ($975k); the composition of the workforce is continually being reviewed. The total nursing personnel (employed and outsourced) is $119k favourable YTD and total management & admin personnel (employed and outsourced) is $338k favourable YTD.

Treatment related costs are ($1,191k) unfavourable to budget. The main areas are Air Ambulance ($283k), Implants and Prostheses ($616k) and

Pharmaceuticals ($202k). The $175k YTD savings target is also impacting this result. The key areas where savings appear to be being made are treatment disposables and minor instrument purchases.

External provider costs are favourable $2,817k mostly due to the provision for IDF outflow $420k, Other HOP $75k, Mental Health $153k, Lab Costs $1,794k and Pharmaceuticals $658k and offset by additional payments to the PHO for under 13’s ($347k) covered by additional revenue and higher volumes in ARC facilities ($194k). Offset by small underspends in other lines.

Overall IDF Outflows are a net of ($784k) unfavourable against a budget provision of $420k. The result includes total wash-ups of ($821k) including ($425k) for inpatient volumes, ($180k) for outpatient volumes and ($167k) for community pharmaceutical costs. The remainder of the IDF outflows includes ($1,791k) for the WSCL Ltd for the lab contract and other IDF service changes of $37k.

Year-end forecast

The year-end forecast deficit is ($1,523k) which is favourable to budget by $437k. The following table provides a summary of the financial performance of the DHB at the end May 2016.


40

2

Wairarapa DHB

Operating Report for the month of May 2016

Month $000s Year to Date Annual

Actual Budget Variance Last Year Variance Actual Budget Variance Last Year Variance Forecast Budget Variance Last Year Variance

Revenue

11,125 11,028 96 10,614 511 Devolved MoH Revenue 122,476 121,709 767 117,301 5,175 133,798 133,147 651 128,098 5,700

155 118 37 116 39 Non Devolved MoH Revenue 1,403 1,300 104 1,367 36 1,532 1,418 114 1,493 38

258 178 80 195 63 ACC Revenue 2,165 1,960 205 1,720 445 2,358 2,138 220 1,944 414

470 304 166 316 153 Other Revenue 4,030 3,348 682 3,513 517 4,384 3,776 608 3,808 576

225 276 (51) 280 (55) IDF Inflow 2,971 3,039 (67) 3,085 (114) 3,247 3,315 (67) 3,345 (97)

39 24 15 26 13 Inter DHB Provider Revenue 332 268 63 317 14 360 293 68 371 (10)

12,272 11,930 343 11,548 724 Total Revenue 133,377 131,624 1,753 127,303 6,074 145,680 144,087 1,593 139,059 6,621

Expenditure

Employee Expenses

901 833 (68) 785 (116) Medical Employees 9,704 9,083 (621) 8,596 (1,108) 10,537 9,916 (621) 9,599 (938)

1,523 1,536 12 1,488 (35) Nursing Employees 16,314 16,547 233 15,457 (856) 17,859 18,084 224 17,015 (844)

440 468 28 424 (16) Allied Health Employees 4,630 5,086 456 4,639 9 5,098 5,555 456 5,104 5

81 55 (25) 60 (21) Support Employees 734 605 (129) 614 (119) 806 661 (145) 688 (118)

479 493 14 431 (48) Management and Admin Employees 5,264 5,339 75 4,386 (877) 5,776 5,832 57 4,876 (899)

3,424 3,385 (39) 3,188 (236) Total Employee Expenses 36,645 36,660 15 33,693 (2,952) 40,076 40,047 (29) 37,283 (2,793)

Outsourced Personnel Expenses

221 172 (49) 271 51 Medical Personnel 2,245 1,891 (354) 2,514 269 2,483 2,063 (420) 2,692 210

12 11 (2) 26 14 Nursing Personnel 230 117 (114) 107 (123) 257 127 (130) 132 (125)

11 2 (9) (6) (17) Allied Health Personnel 98 27 (70) 20 (78) 100 30 (70) 36 (64)

0 0 0 0 0 Support Personnel 8 0 (8) 0 (8) 8 0 (8) 7 (1)

100 147 46 89 (11) Management and Admin Personnel 1,350 1,613 263 1,332 (18) 1,466 1,760 294 1,459 (7)

344 332 (12) 380 36 Total Outsourced Personnel Expenses 3,931 3,648 (283) 3,973 42 4,314 3,980 (334) 4,326 12

269 340 72 336 67 Outsourced Other Expenses 3,630 3,725 95 3,909 280 3,839 4,065 227 4,428 589

842 734 (108) 812 (30) Treatment Related Costs 9,239 8,048 (1,191) 8,437 (802) 10,098 8,782 (1,317) 9,376 (723)

640 737 97 664 24 Non Treatment Related Costs 7,557 8,006 449 7,475 (82) 8,340 8,745 406 8,143 (197)

2,865 2,553 (312) 2,699 (165) IDF Outflow 30,874 28,083 (2,791) 27,954 (2,920) 33,297 30,636 (2,661) 29,819 (3,478)

3,512 3,838 326 3,593 81 Other External Provider Costs 39,810 42,628 2,817 41,717 1,907 44,191 46,553 2,362 45,571 1,380

232 287 54 287 54 Interest, Depreciation & Capital Charge 2,755 2,952 197 3,252 498 3,047 3,238 191 3,468 421

12,128 12,206 78 11,959 (169) Total Expenditure 134,440 133,749 (691) 130,411 (4,030) 147,202 146,047 (1,156) 142,414 (4,789)

144 (276) 420 (411) 555 Net Result (1,063) (2,125) 1,062 (3,107) 2,044 (1,523) (1,960) 437 (3,355) 1,832

Result by Output Class

312 280 33 (28) 341 Funder 3,596 3,040 556 354 3,242 3,757 3,642 114 1,088 2,669

8 (0) 9 22 (14) Governance 195 1 194 399 (203) 196 1 196 354 (158)

(176) (556) 379 (405) 228 Provider (4,854) (5,167) 312 (3,860) (994) (5,475) (5,602) 127 (4,796) (679)

144 (276) 420 (411) 555 Net Result (1,063) (2,125) 1,062 (3,107) 2,044 (1,523) (1,960) 437 (3,355) 1,832


41

3

Financial Commentary

1 Revenue

Revenue is favourable to budget by $343k for the month and favourable year to date by $1,753k. The year to date favourable position is mostly due to $767k MoH sub contracts not budgeted however there is a corresponding offset in expenditure. ACC revenue is favourable $205k, Inter DHB revenue favourable $63k and other revenue favourable $682k mostly due to donations and bequests, pharmaceutical rebates and dividends received.

2 Workforce expenses

Employed Workforce expenses were ($39k) unfavourable to budget for the month and are $15k favourable year to date.

Medical workforce costs were ($68k) unfavourable for the month and ($621k) unfavourable year to date. Tax provision of ($96k) to the IRD, fixed term DHB employed locums in Acute, Orthopaedics and Mental Health. Sabbatical cover in General Medicine and Orthopaedics and a transition from an SMO starting and another fixed term SMO leaving.

Nursing costs were favourable to budget by $12k for the month and $233k favourable year to date due to vacancies.

Allied Health costs are $28k favourable for the month and $456k favourable to budget year to date due to vacancies, some of which are being covered by nursing staff.

Support staff costs are ($25k) unfavourable for the month and ($129k) unfavourable year to date due to additional staff required for sick leave.

Management and Administration costs are favourable to budget by $14k for the month and year to date $75k favourable.

3 Outsourced Personnel

Outsourced personnel costs are ($12k) unfavourable to budget for the month and ($283k) unfavourable year to date.

Medical is unfavourable ($49k) for the month and ($354k) unfavourable year to date. Locums were required in most specialities to cover CME, annual leave and a vacancy in Anaesthetics. The new Chief Medical Officer has started and 1.0 FTE vacancy in Anaesthetics has been recruited to with an expected start date of June/July 2016. An offer has been made, pending acceptance for 0.8 FTE in Orthopaedics to recruit for a future retirement.

Nursing outsourced is unfavourable ($2k) for the month and ($114k) unfavourable year to date due to agency health care assistants being required for patient watches. This is in line with the high acuity in the hospital.

4 Outsourced Other Expenses

Outsourced clinical services are $72k favourable to budget for the month and $95k favourable year to date. Orthopaedic procedures were outsourced to Selina Sutherland in November and April in order to comply with MoH requirements for ESPI5 (surgical wait times). Outsourced Radiology is $173k favourable year to date due to less than expected budget volumes and pricing adjustments. Mental Health Bed nights are on


42

4

budget for the month and unfavourable ($132k) year to date. 37 bed nights were required in May which includes some bed nights that are recovered via the IDF process. A project is underway to determine presenting issues for acute mental health presentations.

5 Treatment related costs

Treatment related costs were ($108k) unfavourable for the month and are ($1,191k) unfavourable year to date. Key areas contributing to the unfavourable variance year to date are:

Implants & prostheses are ($616k) unfavourable to budget year to date. There have been 3 more hips and 26 more knees than the same period last year.

Pharmaceuticals are ($202k) unfavourable to budget year to date. Rituximab ($79k) and Infliximab and Tocilizumab ($129k) are unfavourable year to date. Infliximab can in part be offset by a higher than budget Pharmac rebate estimate of $43k.

Patient Transport & Lodging is ($98k) unfavourable to budget year to date.

Air Ambulance is ($283k) unfavourable to budget year to date with a peak in transports from/to the Wairarapa in July and August. Air transport has peaks so we will continue to monitor for a possible trend. The decision to transport patients is a clinical one and can be made by other DHBs.

0

1

2

3

4

5

6

7

8

9

0

20

40

60

80

100

120

140

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Mental Health Bed Nights

Bed Night Usage (LHS) Budget No. of individuals (RHS)


43

5

Planned procurement efficiencies of $175k YTD are partially achieved and reflected in other lines. Work continues in this area.

6 Non Treatment related costs

Non-clinical supply costs were $97k favourable to budget for the month and are $449k favourable year to date. ITC expenses are $414k favourable year to date due to a $138k reduction in IT leased equipment costs and $183k of budgeted national projects that are on hold. Transport costs are favourable $79k year to date due to a new lease arrangement and cheaper fuel prices than budgeted. The budget required efficiency savings of $58k year to date in this area are being achieved.

7 Interest, Depreciation & Capital Charge

Interest, Depreciation & Capital Charge costs were favourable to plan by $54k for the month and are favourable by $197k year to date. A summary of these costs actual versus budget is shown in the table below:

0

2

4

6

8

10

12

14

16

18

20

Jan

Feb

Mar

ch

Ap

ril

May

Jun

e

July

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

ch

Ap

ril

May

Jun

e

July

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

ch

Ap

ril

May

2014 2015 2016

Air (Fixed Wing and Helicopter) transports from/to the Wairarapa (Wairarapa domicilied)

Year Month

Count of NHI

Mode Domicile Comments


44

6

Breakdown of

Interest, Depreciation & Capital Charge Actual Budget Budget Var Last Year Actual Budget Budget Var Last Year

$000 $000 $000 $000 $000 $000 $000 $000

Interest 77 89 12 90 955 981 26 1,101

Depreciation 137 159 21 137 1,476 1,541 65 1,524

Capita l Charge 19 39 20 60 329 430 100 631

233 287 54 287 2,761 2,952 191 3,256

Year To DateMonth


45

7

WAIRARAPA DHB FUNDER SUMMARY

Financial Statement of Performance

Overall the result for Wairarapa DHB Funder for the month of May is ($33k) adverse and $556k favourable for the year to date which is principally due to lower than expected pharmaceutical costs. The main reasons for variances are explained below:

Wairarapa DHB

Funder Result

Actual Budget Last year

Actual vs

Budget

Actual vs

Last year

May-16


Actual vs

Budget

Actual vs

Last year

Year End

Forecast

Annual

Budget

Last year

Actual

Forecast vs

Annual

Budget

Forecast vs

Last year

10,637 10,637 10,151 (0) 486 Base Funding 117,008 117,012 111,661 (3) 5,347 127,925 127,925 121,812 0 6,112

486 391 463 95 23 Other MOH Revenue 5,421 4,698 5,672 723 (251) 5,826 5,223 6,318 603 (492)

10 10 (23) 0 34 Other Revenue 194 114 397 80 (202) 204 124 401 80 (196)

225 276 280 (51) (55) IDF Inflows 2,971 3,039 3,085 (67) (114) 3,248 3,315 3,343 (67) (96)

11,359 11,315 10,871 44 488 Total Revenue 125,594 124,862 120,815 732 4,780 137,203 136,587 131,874 616 5,328

222 222 217 0 (6) DHB Governance & Administration 2,447 2,447 2,383 0 (63) 2,669 2,669 2,600 0 (69)

4,448 4,422 4,390 (26) (58) DHB Provider Arm 48,867 48,665 48,406 (203) (461) 53,290 53,087 52,834 (203) (455)

External Provider Payments: 0

918 955 790 37 (128) - Pharmaceuticals 9,817 10,475 10,408 658 591 10,794 11,486 11,267 692 473

3 266 327 263 324 - Laboratory 1,329 3,123 3,414 1,794 2,085 1,330 3,389 3,771 2,058 2,441

693 665 623 (27) (70) - Capitation 7,722 7,474 7,231 (248) (491) 8,480 8,201 8,250 (279) (230)

571 541 504 (30) (67) - ARC-Rest Home Level 5,971 5,869 5,610 (102) (361) 6,495 6,393 6,189 (102) (306)

468 448 444 (20) (25) - ARC-Hospital Level 4,953 4,861 4,769 (92) (184) 5,407 5,295 5,181 (112) (226)

308 285 307 (22) (0) - Other HoP 3,143 3,219 3,139 75 (4) 3,470 3,511 3,423 41 (47)

291 295 260 3 (31) - Mental Health 3,246 3,399 3,339 153 93 3,541 3,694 3,669 153 128

0 (17) (6) (17) (6) - Savings Plan 0 (183) (73) (183) (73) 0 (200) 0 (200) 0

260 340 343 80 84 - Other 3,628 3,755 3,878 127 250 3,980 4,091 3,782 111 (198)

2,610 2,573 2,699 (37) 90 IDF Outflows 29,083 28,299 27,954 (784) (1,129) 30,835 30,872 29,819 37 (1,016)

255 0 0 (255) (255) - Hutt DHB - Lab Contract 1,791 0 0 (1,791) (1,791) 2,046 0 0 (2,046) (2,046)

0 38 0 38 0 - Provision for IDF Wash-ups 0 420 0 420 0 1,110 458 0 (652) (1,110)

11,047 11,035 10,899 (12) (147) Total Expenditure 121,998 121,822 120,461 (176) (1,538) 133,447 132,944 130,787 (502) (2,660)

312 280 (28) 33 341 Net Result 3,596 3,040 354 556 3,242 3,756 3,642 1,088 114 2,668

Month Year to Date Annual

Variance Variance Variance


46

8

Year to Date Variances

Revenue

Other MOH revenue is $95k favourable for the month and $723k year to date. The variance for the month is made up of $34k for ‘In Between Travel’, $9k additional electives revenue, $32k relating to the funding for Free Under 13’s services, $12k additional funding for Hospice Community Palliative Care, and $8k other minor variances. The year to date variance of $723k is made up of $347k relating to the funding for Free Under 13’s services, $133k additional funding for Hospice Community Palliative Care, $95k of additional electives revenue for 2015/16 and $20k for 2014/15, $50k of additional Care Plus revenue, $102k of ‘In Between Travel’ revenue and ($24k) relating to other small variances.

Other Revenue is $80k favourable because of $40k additional revenue received in July from Whanganui DHB for the “Walking In Another’s Shoes” program which has been passed to the Provider Arm, and $40k is the net favourable gain on IDF wash-ups for 2014/15 including a further $30k recognised for oncology volumes with CCDHB.

Expenditure

Provider Arm payments are ($26k) adverse for the month and ($203k) year to date. A monthly adjustment of ($9k) relating to additional palliative care funding from the Ministry brings the year to date adjustment to ($108k). A monthly adjustment of ($9k) for additional electives revenue brings the year to date total to ($95k). A monthly adjustment of $3k relating to the GP liaison position brings the year to date adjustment to $26k. Included this month was an adjustment of ($10k) which is for the period February to May for home based support services provided to a specific patient The year to date variance includes a transfer of ($40k) made in July for the “Walking In Another’s Shoes” program which is covered by additional revenue from Whanganui DHB, and $25k for AnteNatal HIV Screening as the Ministry has discontinued the funding for this service.

External Provider Payments:

Pharmaceuticals expenses are $37k favourable for the month because of $34k of additional rebates for 2015/16, ($30k) additional National Haemophilia costs, and $33k from lower than budgeted demand driven costs. The variance for the year to date is $658k favourable because of $82k additional Pharmac rebates received for the 2014/15 year, $372k of additional rebates for 2015/16 based on the latest Pharmac forecast, $57k from GST claimed in relation to deductions from Pharmac rebates, ($30k) additional National Haemophilia costs and $177k from lower than budgeted demand driven costs.

Lab costs are $263k favourable for the month and $1,794k year to date because of the new contract costs now being included as IDF outflows as Hutt DHB is the lead DHB for this contract.

Capitation expenses are ($27k) adverse for the month and ($248k) year to date relating to additional Ministry revenue for free under 13’s and other funded programmes.

Aged residential care costs are a net ($194k) adverse for the year to date (rest home & hospital level) because of higher volumes of clients receiving rest home and hospital level care.

Other HOP costs are $75k favourable year to date with $74k from lower than expected costs for home based support services, $97k of recoveries from Focus and ($64k) additional costs for other demand driven services including respite care and day programmes.


47

9

Mental Health savings of $3k has been recognised this month and $153k year to date which relate to savings achieved in 2014/15 and 2015/16 on a reallocation of funding between providers. The negotiations for a new service have recently been concluded which has confirmed the amount of savings achieved.

The Savings line shows ($17k) adverse for the month and ($183k) for the year to date because no actual savings have been recognised against this budget provision.

Other costs are $127k favourable for the year to date and this is because of some savings being realised on a Maori health services contract and some costs now recognised as IDF outflows. For the month of May the costs are $80k favourable with $42k from the release or reduction of accruals relating to primary mental health and suicide prevention costs, $12k from lower dental and immunisation costs, $12k from lower travel and accommodation costs and $14k from other small variances.

Overall IDF Outflows, excluding the lab contract, are ($37k) adverse for the month against a budgeted wash-up of $38k, and ($784k) year to date against a budget provision of $420k. The year to date result includes total wash-ups of ($821k) including ($425k) for inpatient volumes, ($180k) for outpatient volumes, ($49k) for PCT costs and ($167k) for community pharmaceutical costs. The remainder of the year to date variance in IDF outflows is because of agreed IDF service changes of $37k, and additional costs of ($1,791k) relating to the lab contract which is shown separately. Refer to the tables below for further details.

Year End Forecast

We are forecasting a surplus of $3,756k which is $114k favourable to the budgeted surplus of $3,642k and the detailed breakdown of this is shown in the Financial Statement of Performance above.

Forecast Revenue:

The MOH revenue is $603k favourable which is the year to date position of $723k plus an adjustment of $31k for June for under 13s services, $34k for ‘In Between Travel’, and an adverse adjustment of ($185k) which relates to a funding adjustment by the Ministry of Health related to ‘Reprioritisation of DHB PHARMAC Drug Savings’.

Other Revenue is expected to be unchanged from the current $80k favourable position which was from one-off amounts.

Forecast Expenditure:

Provider Arm variance of ($203k) is unchanged from the current year to date position.

Pharmaceuticals are $692k favourable based on the latest Pharmac forecast (February 2016) and includes an adjustment for GST claimed on deductions from the rebates and the expected DFP payout.

Laboratory costs are forecast to be $2,058k favourable as the contract costs for the new laboratory service is now reflected in IDF outflows.

Capitation costs are ($279k) adverse which relates to the expenditure of the additional funding received for under 13 services.

Aged residential care costs are a total adverse variance of ($214k) (rest home & hospital level) because of higher volumes.

Other HOP costs are forecast to be $41k favourable which is the year to date variance of $75k less $34k of additional ‘In Between Travel’ costs associated with the additional revenue recognised.


48

10

Mental Health savings of $153k are forecast which is the current year to date savings.

Other costs are expected to be $111k favourable which is the year to date position of $127k plus an adjustment for June for after hours services for under 13s covered by additional MOH funding.

IDF Outflows – the wash-ups are forecast to be ($1,100k) adverse against the budgeted provision of $458k, and includes ($655k) for inpatient volumes, ($200k) for outpatients, ($60k) for PCT costs and ($185k) for pharmaceutical costs.

IDF Outflows – Lab costs are forecast to be $2,046k favourable – refer to the table below.

Laboratory Costs

The following table provides a breakdown of lab costs included in the table above and also extracts from that table the transactions relating to the new lab contract, including consequential changes to IDF inflows and outflows.

Laboratory Costs Only

Actual Budget Variance May-16 Actual Budget Variance Total Budget

2,630 0 (2,630) Medlab - IDFs removed 18,412 0 (18,412) 21,042 - 21,042

2,630 0 (2,630) IDF Inflows - Labs Component 18,412 0 (18,412) 21,042 - 21,042

0 0 0 MedLab Central Ltd - Base 1,196,976 1,196,976 0 1,196,976 1,196,977 1

0 2,993 2,993 MedLab Central Ltd - Quality 23,939 32,916 8,977 23,939 35,909 11,970

0 261,744 261,744 New Lab Contract 0 1,832,208 1,832,208 - 2,093,954 2,093,954

43 0 (43) Labs Project 71,238 49,689 (21,549) 71,239 49,686 (21,553)

0 0 0 Miscellaneous Tests 13,794 0 (13,794) 13,794 - (13,794)

2,568 1,000 (1,568) NZ Blood Service 22,903 11,000 (11,903) 24,403 12,000 (12,403)

2,611 265,737 263,126 Labs Totals (as above) 1,328,849 3,122,789 1,793,940 1,330,351 3,388,526 2,058,175

Wellington SCL Ltd Contract

253,943 0 (253,943) - Base Amount 1,784,166 0 (1,784,166) 2,038,109 (2,038,109)

6,446 0 (6,446) - Quality Component 45,119 0 (45,119) 51,564 (51,564)

(5,411) 0 5,411 Medlab - IDFs removed (37,877) 0 37,877 (43,288) - 43,288

254,978 0 (254,978) IDF Outflows - Labs Component 1,791,407 0 (1,791,407) 2,046,385 0 (2,046,385)

257,589 265,737 8,148 Totals 3,120,256 3,122,789 2,533 3,397,778 3,388,526 32,832

Month Year to DateTotal Actual /

Forecast

Forecast vs

Annual

Budget


49

11

Pharmaceutical Costs

Community Pharmaceuticals accruals are calculated on a consistent methodology across the 3 SIDU DHBs which takes into account the seasonality of the expenditure, and timing delays between the month of service and the month of payment. In the 2014/15 financial year, on average, 27.19% of the costs were paid in the month of service, 69.15% in the month following, and the remaining 3.66% spread across the 3 months following. The amounts included in the graph below therefore include accruals, as detailed in the following table:

The following graph shows the expenditure on community pharmaceutical costs including the actuals for 2014/15 and 2015/16 and the budget for 2015/16. The budget for 2015/16 has been phased based on the information provided in the Pharmac forecast which was used as the basis for the budgets. The net amount reported as pharmaceutical costs in the accounts includes community pharmaceutical costs, Pharmac rebates, payments for National Haemophilia services and any transactions relating to the Discretionary Pharmaceutical Fund (DPF).

Month of

Service

Cash

Transactions Accrual

Total

Reported

Jan-16 $ 1,027,681 $ 0 $ 1,027,681

Feb-16 $ 989,209 $ 0 $ 989,209

Mar-16 $ 1,052,535 $ 4,000 $ 1,056,535

Apr-16 $ 994,167 $ 20,000 $ 1,014,167

May-16 $ 324,573 $ 768,000 $ 1,092,573

Total Accrual $ 792,000


50

12


51

13

Aged Residential Care

The following tables show the $, volume and price variances for the different aged residential care levels. Overall ARC costs are ($194k) adverse for the year to date which is primarily attributable to backdated claims for last year for rest home and hospital level care being in excess of the provision made at year end.

Wairarapa DHB

Aged Residential Care

to 31 May 2016

$000 Actual Budget Variance Actual Budget Variance Var as %

Expenditure

Dementia Care 131 141 10 1,484 1,526 42 2.8% 1,663 54 (12)

Rest Home Level Care 441 401 (40) 4,486 4,342 (144) -3.3% 4,730 (123) (21)

Hospital Level Care 468 448 (20) 4,953 4,861 (92) -1.9% 5,295 (140) 49

Total Expenditure 1,040 990 (50) 10,923 10,730 (193) -1.8% 11,688 (209) 16

Activity Actual Budget Variance Actual Budget Variance Var as %

Dementia Care 1,546 1,645 99 17,144 17,774 630 3.5% 19,366

Rest Home Level Care 6,276 5,703 (573) 63,372 61,632 (1,740) -2.8% 67,151

Hospital Level Care 3,802 3,640 (162) 40,470 39,335 (1,135) -2.9% 42,857

Total Subsidised Beddays 11,624 10,988 (636) 120,986 118,741 (2,245) -1.9% 129,374

Last Year Price Increase

Per Unit Cost Actual Budget Variance Actual over Last Year

Dementia Care 86.42 85.86 (0.56) 85.52 1.05%

Rest Home Level Care 70.78 70.44 (0.34) 68.35 3.56%

Hospital Level Care 122.43 123.55 1.12 123.36 -0.75%

Year to Date

Volume

Variance

Price

Variance

MonthFull Year

Budget

Full Year

BudgetMonth

Year to Date

Year to Date


52

14


53

15

2 ANALYSIS AND TRENDS (EXCLUDING OUTSOURCED)

Personnel

Medical FTE needs to be looked at in combination with outsourced medical personnel due to vacancies and roster requirements, including leave and CME currently being filled by locums. Vacancies exist in Anaesthetics and Mental Health (both Adult and Child) which are currently being covered by locums. There is 2.0 FTE that has remained in the budget but the cost has been transferred to outsourced medical personnel which are reflected in the average cost per FTE on the budget line.

Nursing FTE is 4.0 FTE favourable YTD and areas that are over budget are offset by vacancies and timing to recruit into those vacancies.

Allied Health is 7.0 FTE favourable YTD due to vacancies during the year in Outpatients, Occupational Therapy, FOCUS, Oral Health, Mental Health and Radiology. Some of the vacancies are currently being filled by nursing or outsourced staff.

Support Staff is on budget YTD.

Management and administration staff is unfavourable to budget by (2.0 FTE) YTD. Implementation of the Administration Review Project commenced in August and this variance is expected to reduce in coming month with some roster changes. In part can be offset by Allied Health.

The following tables provide a summary of the personnel paid through the payroll. Note that all Medical personnel vacancies are filled by outsourced until vacancies are recruited to and are not included in the tables.

Wairarapa DHB

FTE


Actual vs

Budget

Actual vs

Last year

YTD May 2016


Actual vs

Budget

Actual vs

Last year

Year end

forecast

Annual

Budget Last year

Forecast

vs Annual

Budget

Forecast

vs Last

year

FTE

43 44 42 2 (1) Medical 42 44 40 2 (2) 42 44 40 2 (2)

217 231 226 15 9 Nursing 223 227 214 4 (9) 223 228 215 5 (8)

71 76 73 5 2 Allied Health 69 76 71 7 2 69 76 71 7 2

16 15 13 (1) (3) Support 15 15 13 0 (2) 15 15 13 0 (2)

90 91 92 1 1 Management & Administration 93 91 89 (2) (4) 93 91 89 (2) (4)

437 458 445 21 8 Total FTE 443 454 428 11 (15) 443 454 429 11 (14)

$ per FTE ($000)

21,094 18,804 18,853 (2,291) (2,242) Medical 228,491 205,034 214,277 (23,457) (14,214) 248,105 223,837 239,143 (24,267) (8,961)

7,031 6,636 6,586 (396) (445) Nursing 73,115 72,787 72,098 (328) (1,017) 80,039 79,323 79,019 (716) (1,020)

6,224 6,152 5,835 (72) (389) Allied Health 66,792 66,860 64,892 67 (1,900) 73,544 73,025 71,479 (519) (2,065)

5,031 3,618 4,659 (1,413) (372) Support 49,203 39,803 46,827 (9,401) (2,376) 54,030 43,487 52,365 (10,543) (1,665)

5,294 5,417 4,692 123 (602) Management & Administration 56,645 58,918 49,493 2,273 (7,152) 62,155 64,314 54,903 2,159 (7,252)

7,843 7,390 7,164 (453) (678) Cost per FTE all Staff 82,766 80,834 78,771 (1,932) (3,996) 90,513 88,167 86,940 (2,346) (3,573)




54

16

FTE Trend

-

50

100

150

200

250

300

350

400

450

Jun

11

Jun

12

Jun

13

Jun

14

Jun

15

Jul 1

5

Au

g 1

5

Sep

15

Oct

15

No

v 1

5

De

c 1

5

Jan

16

Feb

16

Mar

16

Ap

r 1

6

May

16

Medical Nursing Allied Health Non Health Support Managemt/Admin Budget

Jun 11 Jun 12 Jun 13 Jun 14 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16

Medical 40 38 39 39 40 40 41 42 43 43 45 43 42 43 42 43

Nursing 198 198 204 209 226 228 228 229 226 228 224 212 221 220 221 217

Allied Health 90 89 69 69 71 70 69 69 70 71 68 67 67 71 70 71

Non Health Support 12 13 14 14 13 14 14 14 14 14 15 15 15 15 17 16

Managemt/Admin 104 108 101 89 90 92 93 95 93 93 93 91 95 94 93 90

Actual FTE 443 444 426 421 440 445 445 449 446 450 445 428 441 443 444 437

Budget 453 450 437 428 423 454 450 450 450 451 451 451 458 458 458 458


55

17

Ministerial Cap on Management & Administration Staff

WDHB remains within the cap set by the Minister for management and administration staff.

It is noted that the definition applied to an FTE with the cap differs to that applied to normal FTE reporting and also includes any subsidiaries of a DHB. The definition applied is that one employed FTE is based on one person who works a 40 hour week, a person working more than 40 hours a week is counted as one FTE. The following table shows the current levels:

Actual Budget Variance

Employed FTE 87.6 115.8 28.2

Vacant FTE 1.0 0.0 (1.0)

Outsourced FTE 13.0 0.0 0.0

Contractor FTE 0.0 3.0 3.0

Subs idiary FTE 3.2 4.0 0.8

Total FTEs 104.7 122.8 18.0

Year to Date

Management/Administration Cap

Full Time Equivalent (FTE) Staff NumbersFor the period ended 31 May 2016


56

18

Annual Leave Trend - $’000’s

2,500

2,600

2,700

2,800

2,900

3,000

3,100

3,200

3,300

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

2016 2014 2015

Category

Less than

20 20-30 30-40

Greater

than 40

% >40 of

total staff Total Staff Total $

Medical - Senior 20 7 0 7 21% 34 849,626

Medical - Junior 13 1 0 0 0% 14 51,001

Nursing 187 47 22 19 7% 275 1,405,665

Allied Health 70 7 3 1 1% 81 238,722

Support 9 4 3 0 0% 16 50,846

Mgmt/Admin 75 20 5 5 5% 105 389,569

Total 374 86 33 32 6% 525 2,985,429

Total staff with leave days


57

19

3 INTER DISTRICT FLOWS

The following table shows the components of the IDF changes that are reflected in the variances reported above.


58

20

The following table shows the IDF outflow variances compared to the budgeted provision:

IDF Outflows CCDHB Other DHBs Total

Activity Based Wash-up

- Inpatient IDFs (65,406) (359,604) (425,010)

- Outpatients / Non- DRG (179,921) 0 (179,921)

- Community Pharms / PCTs (196,015) (20,294) (216,309)

Actual Wash-ups (441,342) (379,898) (821,240)

Less YTD Budgeted Provision 419,837 0 419,837

Year to Date Variance on Wash-ups (21,505) (379,898) (401,403)

Other IDF Outflow Changes (82,473) (1,671,205) (1,753,678)

Net YTD Reported Variance (103,978) (2,051,103) (2,155,081)


59

21

-

50.00

100.00

150.00

200.00


IDF CWD Elective Outflow

2015-16 2013-14 2014-15 Budget 15-16

-

10.00

20.00

30.00

40.00

50.00


IDF CWD Acute Inflow

2015-16 2014-15 2013-14 Budget 15-16

-

2.00

4.00

6.00

8.00

10.00

12.00


IDF CWD Elective Inflow

2015-16 2013-14 2014-15 Budget 15-16

-

50.00

100.00

150.00

200.00

250.00

300.00


IDF CWD Acute Outflow

2015-16 2013-14 2014-15 Budget 15-16


60

22

4 HOSPITAL THROUGHPUT

There have been 247 or 3.3% more discharges so far this year than last year. The increase has been in medical discharges with 278 more than last year with a very busy winter last year. MSW bed utilisation figures based on 36 beds being 100% gave an average of 79.93%, with AM duty 87.81%, PM duty 76.70% and Nights 75.27%. There was an average of 21 patient movements every 24 hours during May in MSW.

This is reflected in the total bed days which are 18,695 so far for the year comparable to 18,266 at the same time last year. The average length of stay is very similar to last year and has decreased slightly from 2.44 to 2.41 days this year.

ED attendances are at similar levels to last year with 302 less attendances this year. There have however been 452 less Triage 5 presentations than the same period last year reflecting the on-going projects to address the appropriateness of these presentations. Triage 2 and 3 presentations however have increased by 464 presentations reflecting the acuity and the increasing workload in the Emergency Department and then the flow on higher acuity need in MSW.

Theatre visits are at similar levels to last year and theatre utilisation is at 75% for May.

Wairarapa DHB

Hospital Throughput


Actual vs

Budget

Actual vs

Last year

YTD May 2016


Actual vs

Budget

Actual vs

Last year

Year end

forecast

Annual

Budget Last year

Forecast

vs

Annual

Budget

Forecast

vs Last

year

Discharges

261 240 236 (21) (25) Surgical 2,521 2,635 2,585 114 64 2,874 2,874 2,800 0 74

407 398 420 (9) 13 Medical 4,681 4,376 4,403 (305) (278) 4,774 4,774 4,804 0 (30)

48 61 42 13 (6) Other 543 669 510 126 (33) 729 729 558 0 171

716 698 698 (18) (18) Total 7,745 7,679 7,498 (66) (247) 8,377 8,377 8,162 0 (215)

CWD

261 257 261 (4) 0 Surgical 2,730 2,370 2,737 (360) 7 3,087 3,087 2,990 0 97

233 215 227 (18) (6) Medical 2,687 2,830 2,395 143 (292) 2,585 2,585 2,607 0 (22)

45 45 38 1 (7) Other 509 498 493 (10) (16) 544 544 544 0 (1)

539 518 527 (21) (12) Total 5,926 5,698 5,625 (228) (301) 6,216 6,216 6,141 0 (75)

Other

963 1,059 901 96 (62) ED Attendances 9,827 11,654 10,129 1,827 302 12,714 12,714 10,968 0 1,746

478 472 472 (6) (6) ED Admissions 5,464 5,090 5,090 (374) (374) 5,538 5,538 5,538 0 0

346 310 310 (36) (36) Theatre Visits 3,509 3,611 3,611 102 102 3,931 3,931 3,931 0 0

1,626 1,792 1,708 166 82 Bed Days 18,695 18,381 18,266 (314) (429) 19,814 19,814 20,057 0 (243)

2.86 3.10 3.10 0.24 0.24 ALOS Inpatient 3.01 3.05 3.05 0.04 0.04 3.06 3.06 3.06 0.00 0.00

2.27 2.57 2.45 0.30 0.18 ALOS Total 2.41 2.39 2.44 (0.02) 0.02 2.39 2.39 2.46 0.00 (0.06)




61

23

STATEMENT OF FINANCIAL POSITION

`

Actual

$000's

Budget

$000's

June 15

$000's

Actual vs

Budget

Actual vs

Last year

Bank 0 0 0 0 0

Accounts receivable & Prepayments 4,370 3,350 3,350 1,020 1,020

Stock 860 797 797 63 63

Total current assets 5,230 4,147 4,147 1,083 1,083

Fixed assets 41,284 43,697 41,652 (2,413) (368)

Work in progress 4,896 3,816 797 1,080 4,099

Total fixed assets 46,180 47,513 42,449 (1,333) 3,731

Investments in associates 644 643 3,349 1 (2,705)

Trust funds invested 300 266 266 34 34

Total Investments 944 909 3,615 35 (2,671)

Total Assets 52,354 52,569 50,211 (215) 2,143

Bank 1,645 3,362 1,499 1,717 (146)

Accounts payable and accruals 9,283 9,494 9,912 211 629

Crown loans and other loans 5,069 1,319 5,069 (3,750) 0

Capital charge payable 101 195 0 94 (101)

Current employee provisions 6,319 6,280 5,702 (39) (617)

Total current liabilities 22,417 20,651 22,182 (1,766) (235)

Crown loans 20,750 24,500 20,750 3,750 0

Other loans 313 313 376 0 63

Long term employee provisions 562 563 562 1 0

Trust funds 300 266 266 (34) (34)

Total non-current liabilities 21,925 25,642 21,954 3,717 29

Total Liabilities 44,342 46,293 44,136 1,951 (206)

Net Assets 8,012 6,276 6,075 1,736 1,937

Crown Equity 42,037 39,037 39,037 3,000 3,000

Revaluation Reserve 5,558 5,558 5,558 0 0

Opening Retained earnings (38,520) (36,194) (35,165) (2,326) (3,355)

Surplus/(deficit) (1,063) (2,125) (3,355) 1,062 2,292

Total retained earnings (39,583) (38,319) (38,520) (1,264) (1,063)

Total Equity 8,012 6,276 6,075 1,736 1,937

Variance

Wairarapa DHB

Statement of Financial Position

May-2016


62

24

5 CASHFLOW FORECAST

The cash flow forecast is based on cash flow expectations as at 13 June 2016 including the agreed $3m equity injection received in January 2016. The borrowing limit for Wairarapa DHB is $5.09 million.

Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

$000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000

Operating Cash Flows

Operating receipts 14,483 13,674 13,564 13,484 14,034 13,784 26,179 4,544 13,819 13,524 13,494 13,754

Operating payments -12,962 -14,011 -13,864 -13,910 -13,990 -13,250 -13,650 -16,900 -13,095 -14,610 -13,539 -13,746

Capital charge paid -228 0 0 0 0 0 -225 0 0 0 0 0

Total operating cash flows 1,294 -337 -300 -426 44 534 12,304 -12,356 724 -1,086 -45 8

Investing Cash Flows

Interest Receipts 6 6 6 6 6 6 6 6 6 6 6 6

Sale of assets 0 0 0 0 0 0 0 0 0 0 0 0

Purchase of Fixed Assets -150 -80 -80 -80 -127 -116 -81 -119 -119 -122 -122 -122

Increase in Investments & Trust Funds 0 0 0 0 0 0 0 0 0 0 0 0

CRISP investment -267 -79 -79 -79 -79 -79 -79 -79 -79 -79 -79 -79

FPSC investment -20 -18 -18 -18 -18 -46 -92 -139 -139 -176 -65 -65

Total investing cash flows -431 -171 -171 -171 -218 -235 -246 -331 -331 -371 -260 -260

Financing Cash Flows

Capital Injections 0 0 0 0 0 0 0 3,000 0 0 0 0

Equity repaid 0 0 0 0 0 0 0 0 0 0 0 0

Loans drawn 0 0 0 0 0 0 0 0 0 0 0 0

Debt repaid -6 -6 -6 -6 -6 -6 -6 -6 -6 -6 -6 -6

Net interest expense (Loans) -225 0 0 -44 -197 0 -225 0 0 -44 -197 0

Total financing cash flows -231 -6 -6 -50 -203 -6 -231 2,994 -6 -50 -203 -6

Net Cash Flows 632 -514 -478 -647 -377 292 11,826 -9,693 387 -1,507 -508 -258

Opening cash balance -1,645 -1,013 -1,527 -2,005 -2,652 -3,029 -2,737 9,090 -603 -215 -1,722 -2,230

Closing cash balance -1,013 -1,527 -2,005 -2,652 -3,029 -2,737 9,090 -603 -215 -1,722 -2,230 -2,488


Forecast Statement of Cash Flows

For period June 2016 to May 2017


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-6,000

-4,000

-2,000

0

2,000

4,000

6,000

8,000

10,000

12,000

1/0

7/2

01

5

8/0

7/2

01

5

15

/07

/20

15

22

/07

/20

15

29

/07

/20

15

5/0

8/2

01

5

12

/08

/20

15

19

/08

/20

15

26

/08

/20

15

2/0

9/2

01

5

9/0

9/2

01

5

16

/09

/20

15

23

/09

/20

15

30

/09

/20

15

7/1

0/2

01

5

14

/10

/20

15

21

/10

/20

15

28

/10

/20

15

4/1

1/2

01

5

11

/11

/20

15

18

/11

/20

15

25

/11

/20

15

2/1

2/2

01

5

9/1

2/2

01

5

16

/12

/20

15

23

/12

/20

15

30

/12

/20

15

6/0

1/2

01

6

13

/01

/20

16

20

/01

/20

16

27

/01

/20

16

3/0

2/2

01

6

10

/02

/20

16

17

/02

/20

16

24

/02

/20

16

2/0

3/2

01

6

9/0

3/2

01

6

16

/03

/20

16

23

/03

/20

16

30

/03

/20

16

6/0

4/2

01

6

13

/04

/20

16

20

/04

/20

16

27

/04

/20

16

4/0

5/2

01

6

11

/05

/20

16

18

/05

/20

16

25

/05

/20

16

Weekly Cash Balances

Cash balance

Overdraft limit


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6 TREASURY MANAGEMENT

a. Key Financial Ratios

The following table shows the four key financial ratios used to assess the financial performance by the National Health Board Business Unit (NHB)

within the Ministry of Health.

Actual Budget Variance

Net Surplus / (Defici t) $000 (1,063) (2,125) 1,062

Working Capita l Ratio 0.23 0.31 (0.08)

Interest Coverage 1.45 0.39 1.06

Gearing 78% 83% 5%


Key Financial RatiosFor the period ended 31 May 2016

Year to Date


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b. Borrowing Schedule

The following table shows the borrowing facilities currently available to the DHB and the amounts drawn against each facility.

Facility

Limit

Maturity

DateAmount

$000 $000

Working Capital

NZ Health Partnerships Sweep arrangement 5,000 1,658 3.66% Floating

Selina Sutherland 700 08-Dec-20 382 7.00% Fixed margin plus OCR

Term Borrowing (National Health Board Business Unit)

Core 25,750

15-Oct-16 5,000 2.21% Fixed

15-Apr-17 1,250 2.93% Fixed

15-Dec-17 1,000 4.31% Fixed

15-Dec-17 4,500 4.85% Fixed

15-Dec-18 3,000 3.08% Fixed

15-Mar-19 2,000 4.42% Fixed

15-Dec-19 3,000 3.20% Fixed

15-Apr-20 6,000 3.25% Fixed

25,750

Total Borrowing 30,850 27,790

For the period ended 31 May 2016

Interest Rate

Borrowing Schedule



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7 CAPITAL EXPENDITURE

The following table shows the Capital Expenditure Actual versus Budget to 31 May 2016

.

Variance

Project description

2014-15

bought

forward

Current

year

2015-16

Total 2014-15

bought

forward

Current

year

Total

Spent

to date

Estimated

Spend

this Fyr

Estimate

to

completion

- Future

Fyrs

Forecast To Total

Budget

Status

($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000)

STRATEGIC CAPEX

Prior Year Projects b/f:

National Oracle Solution (NOS) 541 880 1,421 962 163 1,125 15 281 1,421 - Project Delayed

CRISP/RHIP 1,318 1,124 2,442 371 1,406 1,777 - 665 2,442 -

Disaster Recovery - 175 175 - - - - - - 175 Deferred to 2016/17 FY

3D Labs Integration - 93 93 - - - - 120 120 (27)

Colposcopy (MOH Requirement) - 20 20 - 20 20 - - 20 -

Provation - - - - 26 26 34 - 60 (60)

TOTAL STRATEGIC PROJECTS 1,859 2,292 4,151 1,333 1,615 2,948 49 1,066 4,063 88

BASELINE CAPEX

Buildings & Plant 18 50 68 - 33 33 21 - 54 14

Clinical Equipment 68 430 498 - 785 785 179 - 964 (466)

Other Equipment 34 50 84 - 30 30 6 - 36 48

Information Technology - 50 50 - 29 29 21 - 50 -

Intangible Assets (Software) 4 - 4 - - - 4 - 4 -

TOTAL BASELINE PROJECTS 124 580 704 - 877 877 231 - 1,108 (404)

Less Additional Funding - (3) (3) - - (3) 3

Less Donations received - WCHT - (369) (369) (49) - (418) 418

Less Donations received - SSH - (22) (22) - - (22) 22

Less Donations received - Other - (7) (7) (50) - (57) 57

Less Funded by Donated Funds - (23) (23) (25) - (48) 48

TOTAL CAPEX 1,983 2,872 4,855 1,333 2,068 3,401 156 1,066 4,623 232

Budget Actual


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INFORMATION PAPER

Date: 13 June 2016

Author Dianne Mazey, Health, Safety & Preparedness Coordinator

Subject Health and Safety Advisory Committee Meeting – Executive Summary

Executive Summary The attached Health and Safety Advisory Committee minutes provide a summary of health and safety performance across the organisation in the preceding two months.

In addition to new business brought to the table by individual areas the committee covers a broad range of standing agenda items:

∑ Health and safety successes

∑ Reportable event Statistical data analysis

∑ Health and safety representative training topics

∑ Health and safety promotional material

∑ Updates on the Health and safety annual plan

Wairarapa Board Public 21 June 2016 - HEALTH AND SAFETY

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C:\Users\BB2SER~1\AppData\Local\Temp\BCL Technologies\easyPDF 7\@BCL@200EAB83\@[email protected]

Present: Kerrie French, Lesley Pond, Julie Dennison, Tonianne Bainbridge, Margie Lawton, Gabe Wickens, Megan Futter, Linda Tatton, Robyn Mills, Judy Knox, Pat Collins, Sharon McArthur, Janet Hodge, Julie Worthington, Colleen Daniels, Jenny Clarke, Dianne Mazey, Clare Matthews

Apologies: Amber O’Callaghan, Tina Te Tau, John Brock, Michele Halford, Michelle Carbin, Jill Stringer, Sandra Loveday, Sarah Robbins

Copies to: Chief Executive [26], HR/ Bipartite meeting via Gretchen Dean [1], Lizzie Daniell [28], Tam Wootton [14], Departmental Managers

Minutes of previous meeting accepted as accurate record.

Health And Safety Success Stories

New Reps nominated as follows:ÿ Robyn Mills CSSDÿ Tonianne Bainbridge Spotlessÿ Gabe Wickens as lead Orderlyÿ Jenny Burt will represent the DNM Groupÿ Janet Hodge has kindly returned as Rep for Outpatients.

∑ Free financial wellbeing seminars for staff - Rival Wealth have offered to come in to provide some sessions

∑ Standing desk trials have been hugely popular and is currently booked out.

∑ Security at old hospital has been tightened up with involvement now from Police and dog Handlers, Fire Service and Colliers property management company.

∑ Proposal for generic naming of buildings on site has been approved by Jill Stringer.

∑ Hepatitis B screening check for OCS staff have been initiated, to ensure all staff surveyed.

∑ Smaller linen bags are to be rolled out. It will take time to replace all bags given the volume. This should alleviate the manual handling issues that over filled large linen bags have caused.

TOPIC DISCUSSION Actions Responsibility of:Standing Agenda Items

Reportable Events YTD

Department Agendas

Reportable Event Data Overview. Unfortunately no graphed data available dueto the lack of training around reports on the new SQUARE system for system administrators in Quality.

Reports to be set up and available for following meeting as a priority

Clare Matthews

Reminder to all reps to include H&S as a standing agenda items at all team meetings.

All Reps All Reps

Minutes of Meeting of Health & Safety Advisory Committee1st June 2016

11.30am


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H&S Rep training topic

Annual Plan 2015-2016

Video presentation shown to group from ‘WorkSafe’ regarding the new Health and Safety Legislation.

Draft annual plan to be distributed to Reps, all feedback to Di Mazey.

Health and Safety Plan 2016-2017.docx

All Reps to open embedded annual plan and review and feedback. No response will be taken as general acceptance.

All Reps

Business arising from previous minutes:

The free on-line Rep transition training session via ‘Safety N Action’ appears to be slightly incompatible with our computer system as some reps report not being able to get past module 4, some staff have been completing the rest of the modules at home which Managers have been advised must be claimed back. Training has taken up to 4hrs to complete. Reps have three chances to correctly pass the modules.

Reps to advise any difficulties in completing to Di Mazey

Manual handling - over filled laundry bags: Feedback from Linen Meeting that smaller bags have been commenced. It will take time to replace all bags due to volume however this should reduces manual handling events.

Staff parking – after dark: Request for increased lighting in main staff car park outside Mental Health has been approved and signed off. Awaiting the contractor to submit their Health and Safety paperwork. Work should commence shortly.

Additionally lighting out the back of the hospital by CSSD and the Mail room was raised as not working – assured this is due to daylight saving timer adjustments which Len is working through.

H&S reps to remind staff they can ask to be escorted to their vehicles after dark if security team.

All Staff

DHB Recycling Query: Query raised if the DHB recycles everyday items such as milk bottles. Many areas of the DHB are throwing away in main rubbish or taking home to recycle. Advised by Quality that Jill Stringer is already looking into this as part of a wider waste management issue.

To be followed up with Jill Stringer by Clare Matthews

C Matthews

Walk way on Blair Street and Taka Wahi. Safety concerns regarding the lack of walkway. Dianne Mazey will follow up.

Di Mazey to follow-up. Di Mazey

Hazardous Home Visit: Community Nursing Rep Colleen Daniells raised concerns regarding a client visited by District Nursing who presents an array of health and safety risks to staff. A lot of work has been done around this particular case with external agency involvement, multi-disciplinary meetings and trial of a new plan that involves a limited time plan on visits etc.

This situation will continue to be monitored.

Di Mazey


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Shingles Vaccine: The DHB are looking into the possibility of subsidising a shingles vaccination, which would be particularly relevant to our aging workforce. Occ Health is progressing this.

Dianne will keep Reps informed

Di Mazey

Slip -overshoes: A Midwife slipped in theatre whilst wearing overshoes. There was water on the floor at the time. Dianne Mazey will contact Procurement to see if there are any other alternatives on the market.

Di to Dianne Mazey will contact Procurement.

Di Mazey

Volunteer’s desk: Request made to Karen Haines to re-site desk to its previous position. Di Mazey to follow up.

Di awaiting response to follow up.

Di Mazey

Flu vac: vaccinations still available from the Occupational Health Clinic held each Monday morning in Outpatients or via the ward based vaccinator, probably through until August at this stage.

All reps to be aware the Flu Vaccination is still available

All

Technical Advisory Service Audit February 2016: Feedback very good on our existing Health and Safety management systems in placer. Only significant recommendations were for the Board and the due diligence aspects of their duties. Big thank you again to all Reps involved in the audit process.

H&S Intranet page upgrade: Upgrade completed covering the overall presentation of the page, terminology and alignment with new Health & Safety legislation.

Linen bags in Paeds play room: Issue with full linen bags being left in the Paeds playroom reported. RE not received into Quality however informed this has been followed up by CNM of Paeds and Linen Ladies.

No further action

Concerns with traffic turning at the top of Blair Street and Te Ore Ore road: Increased traffic making the turn into Blair Street is of concern as many observed drivers do not appear to know the road code at this junction. Concern that it is an accident waiting to happen. Diane Mazey has raised these concerns with the Council with no response. This will now be chased up.

Nothing from Council –Di will see them in person.

Di Mazey

SQUARE Electronic reportable events system: No major issues, some staff finding it time consuming to complete.

Staff to contact Quality Dept if any issues

All Reps

NEW BUSINESS

Health and Safety Policy statement 2016.docx

Health & Safety Policy Statement for ratification: positive feedback received from members of HSAC. Formally ratified through HSAC.

Reps to print off embedded document (far left hand column) and put in flyer holder in bathroom areas.


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Free Training Course – Self Care in Healthcare 18th June: Self-care and Health Care flyer handed out. A very useful course specifically tailored forhealthcare personnel. This is a free course and comes highly recommended.

All Reps to consider attending and make staff aware.

All Reps

Employee Participation and Rep ElectionsInformation on employee participation and rep elections distributed widely across the organization. All existing reps have remained on in their roles with the addition of the following additional Reps in work groups not previously represented: Robyn Mills CSSD, Tonianne Bainbridge Spotless, Gabe Wickens as lead Orderly and Jenny Burt will represent the DNM group. Additionally Janet Hodge has kindly returned to the Rep role in Out Patients department.

Thank you to all Reps remaining in roles and welcome to new Reps.Health & Safety Representative identification: Committee discussed the option of some form of identification for our Health and Safety Reps. This increases the visibility of reps and supports the further promotion of health and safety within our organization. Preferred option is a badge that can be placed on security card lanyards or on clothing in a bright colour.

Di Mazey will investigate options and pricing.

Di Mazey

GENERAL BUSINESS

Infection control: signage & PPE: Query over the actual requirement to change curtains in patient areas. Appears curtains are being taken down and replaced unnecessarily. This was reviewed in 2015 by Lizzie Daniell, Infection Prevention and Control with a query if this has been implemented in all wards. There is a limited amount of curtains within the DHB with turnaround taking 4 days. More curtains are being arranged by Tina Ririnui.

To be followed up with Anna McGregor.

Di Mazey

Radio coverage: Still issues with coverage. Sign off required by Amber O’Callaghan. Videre the radio provider has suggested moving of the aerial or possibly a repeater might be needed to address.

Di Mazey to follow-up directly with Videre

Di Mazey

Spinal board attachment : Not available in the hospital. A reportable event has been submitted. Linda Tatton will look into this. The lack of attachment in Selina Sutherland poses a risk to staff given their low staffing numbers.

Linda Tatton will investigate the Spinal Board attachment for Selina Sutherland.

Linda Tatton

Infectious Isolation: No notification that patients are coming to theatre from isolation. Infection Prevention Control to be advised.

Di to notify infection prevention and control team

Di Mazey

NEXT MEETING: 3rd August 2016, 11.30am, CSSB Lecture Room


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Health and Safety Policy StatementOur Health and Safety Vision:

“We will all have a safe workplace”

We believe that:∑ No business objective will take priority over health and safety

∑ All incidents are preventable

∑ Whilst management has ultimate accountability, we all have responsibility for health and safety

∑ All personnel have the responsibility to stop any job they believe is unsafe or cannot be continued in a safe manner

To achieve this we will:∑ Maintain and continually improve our Health, Safety and Environmental Management System

∑ Proactively identify hazards and unsafe behaviours and take all steps to manage these to as low as reasonably practicable

∑ Set targets for improvement and measure, appraise and report on our performance

∑ Assess and recognise the health and safety performance of employees and contractors

∑ Consult and actively promote participation with employees and contractors to ensure they have the training, skills, knowledge and resources to maintain a healthy and safe workplace

∑ Accurately report and learn from our incidents

∑ Support the safe and early return to work of injured employees

∑ Design, construct, operate and maintain our assets so that they safeguard people and property

∑ Require our contractors to demonstrate the same commitment to achieving excellence in health and safety performance

∑ Comply with relevant legislation, regulations, codes of practice and industry standards

Adri Isbister Dated: 1 June 2016Chief ExecutiveWairarapa District Health Board__________________________________________________________________________________

This health and safety policy statement is made under the Health and Safety at Work Act 2015 and places duties upon both Employers and Employees.

Document No: 000102 Page 1 of 1 Version: 7Prepared by: Health, Safety & Preparedness Coordinator Review Date: 1/06/2016Authorised by: Chief Executive G:\QUALITY\HEALTH & SAFETY\Policies, Procedures\Health and Safety Policy statement 2016.docx Class Code: OPO-C

„ Wairarapa DHB. CONTROLLED DOCUMENT. The electronic version is the most up-to-date version. WDHB will NOT take any responsibility in case of any outdated paper copy being used and leading to any undesirable consequence.


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Wairarapa, Hutt Valley and Capital & Coast District Health Boards

DECISION PAPER

Date: 1 June 2016

From Sandra Williams, Acting Director, SIDU

Endorsed By CPHAC DSAC Committee

Subject CPHAC DSAC Recommendations

RECOMMENDATION

It is recommended that the Wairarapa District Health Board:

Approves the recommendations as discussed and endorsed at the May 2016 CPAHC DSAC committee meeting.

1 PURPOSE

To seek approval from the Wairarapa District Health Board for the recommendation discussed and endorsed at the May 2016 CPAHC DSAC committee meeting as outlined below.

2 MEETING RECOMMENDATIONS

Sub Regional Disability Implementation Plan

The Senior Disability Advisor provided a progress report on the disability implementation plan 15/16, and the planning for the Sub Regional Disability Forum on 3 June 2016.

The Committee ENDORSED to the Board that it approve:

a) The development of a five year action plan for improved access to health services for deaf and hard to hearing people

b) The development of a clear policy based on emerging themes and findings from the sub regional review in consultation with health staff, deaf community and chosen allies.

Moved: Nick Leggett Seconded: Katy Austin CARRIED

Equity Indicator Report

The Committee discussed the report which laid out the updated performance data for the equity monitoring indicators, a narrative report on activity planned, or currently underway, to improve performance. The Committee had also asked for a review of the indicator set.

The Committee:

a. NOTED The review of the set of indicators;

b. ENDORSED the proposed set of local equity monitoring indicators;

c. Agreed to RECOMMEND to the three District Health Boards that they accept the set of equity monitoring indicators to be monitored for the next twelve months:

∑ breastfeeding rates; ∑ immunisation rates; ∑ preschool oral health enrolment, arrears, caries free at 5 years, decayed, missing or filled

teeth (DMFT) at 12 years;

Wairarapa Board Public 21 June 2016 - DECISION PAPERS

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Wairarapa, Hutt Valley and Capital & Coast District Health Boards

∑ breast and cervical screening; ∑ brief advice to quit smoking; ∑ cardiovascular disease risk assessment (CVDRA); ∑ new born enrolment in General Practice at three months; ∑ ambulatory sensitive hospitalisations (ASH); ∑ did not attends (DNAs); ∑ access to primary care by long term users of mental health and addictions (MH&A) services;

access to specialist mental health services; MH&A DNAs; acute inpatient seclusion rates; and acute inpatient readmission rates.

d. NOTED the indicators will be reviewed again in twelve months' time;

e. NOTED the most recent performance against equity monitoring indicators;

f. NOTED the actions currently planned or underway to improve performance in areas requiring improvement.

Moved: Nick Leggett Seconded: Katy Austin CARRIED


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BOARD DECISION PAPER

Date: 14 06 16

Presented By Jill Stringer

Author Jennie Mitchell and Jill Stringer

Endorsed By Kate Sheridan

Subject Wairarapa DHB position statement on Donated Funds

RECOMMENDATION

It is recommended that the Board:

a. Agrees the Board position statement related to donated funds

b. Notes cementing the relationship with the Wairarapa Community Health Trust as the usual recipient of donated funds.

c. Notes the establishment of a Donated Funds Administration Team to consider future requests for use of Donated Funds

1 PURPOSE

The Board has requested a position statement be developed in relation to donated funds, given the developing relationship with the Wairarapa Community Health Trust, and the advantages to donors from channelling larger donations through a charitable Trust.

2 BACKGROUND

Wairarapa DHB does not actively solicit general donations, though sometimes does for specific purposes. However, grateful members of the public sometimes either donate funds, or leave bequests.

There is scope for working more closely with the Wairarapa Community Health Trust to channel this philanthropy, given their substantive support for the DHB health services, and the ethical dilemma of whether it is appropriate for the DHB to actively solicit donations.

DHB support for the WCHT could include information on our website, distribution of WCHT posters or leaflets, and supporting media awareness of donations to the DHB. The Board has requested that we prepare a ‘position statement’ for the DHB in relation to this.

3 POSITION STATEMENT

Wairarapa District Health Board position statement regarding donated funds.

Wairarapa DHB will ensure that philanthropy from the community to the DHB is appropriately recognized, receipted and disbursed.


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They will work with the Wairarapa Community Health Trust to ensure donors are aware of the advantages of channeling larger donations through this charitable Trust.

All donations made directly to the DHB will be transparently managed and in accordance with the wishes of the donors.

4 CURRENT STATUS

Wairarapa DHB are holding Donated Funds totalling $314,870.05 as at 31st March 2016. These are made up of specific donated funds totalling $43,064.40 and General Donated Funds totalling $271,805.65. These funds are held in a separate bank account to that used for day to day DHB income and expenditure.

Management has formalised the DHB’s procedure for receiving Donated Funds and developed a transparent mechanism for access to funds held for General purposes to benefit the patients and staff of Wairarapa DHB.

There are 24 Donated Funds in total of which 17 are specifically ear marked for a service e.g. Palliative Care Fund, Acute Nurses Education Fund. The balances in the Specific funds range from $103.47 to $21,607.74. Most are being used by that service on a regular basis to pay for appropriate items such as Staff training, new equipment etc. The decision on the use of the Donated Funds is made by the relevant Cost centre Manager. Specific Donated funds totalled $43,064.40 at 31.3.2016.

The remaining Donated Funds are for general use to benefit Patients and Staff of Wairarapa DHB. These totalled $271,805.65 at 31st March 2016, the majority ($170,638.85) is from a Canadian Bequest received in 2009. At the time of this bequest, the Board agreed the Fund would be kept intact and interest used for educational purposes.

In November 2015, the Board agreed to use $10,000 of this Fund as seed funding for the Simon Prior Scholarship to be administered by Masterton Trust Lands Trust.

Most of the Donated funds are on call apart from $150K of the Canadian Donated Fund which was recently moved to a one year Term Deposit to obtain higher interest.

Interest accumulates quarterly to the Donated accounts.

General Donated funds have been used mainly for the purchase of Clinical Capital equipment when this has been needed urgently and there is not sufficient CAPEX budget to cover it. The decision on what Donated Funds will be used for have been made jointly by the Director of Wairarapa Health Services (DWHS) and the Chief Financial Officer (CFO).

For example, a recent bequest for $70K was used to bring forward the purchase of 5 PACU monitors at a total cost of $55K. These were budgeted to be purchased from the 2017 CAPEX budget but with the generous donation of the Cardiac Monitoring System by the Wairarapa Community Health Trust, it was decided to align the PACU monitors with that system as quickly as possible, to improve safety through consistency of equipment, and take advantage of servicing contracts. This will also enable us to start the 2017 financial year with a bigger contingency budget to cover the cost of essential equipment that breaks down and needs to be replaced urgently.

The Donated Funds Administration Team was established in May 2016. The group has developed draft TOR and principles. It will consider applications for use of the Donated funds and recommend the most appropriate use for final approval by the CFO.

It is made up as follows:


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∑ DWHS (Chair)∑ One Doctor∑ One Nurse∑ One Allied Health professional∑ One Admin Team Member∑ Financial Accounting Manager as Finance representative and to provide information regarding

Donated Funds, CAPEX requests pending and to administer the recommendations of the group.

∑ Secretarial support

Requests for use of the General Donated Funds will be made via either the DWHS or the Financial Accounting Manager.

5 WAIRARAPA COMMUNITY HEALTH TRUST

An excellent relationship has been developed between the Wairarapa Community Health Trust and the DHB. The CE or Director Wairarapa Health Services is regularly invited to attend WCHT meetings to discuss areas where the WCHT could best support the health of our population.

In preparation for those meetings the DHB’s CAPEX plan is reviewed, and items of the highest priority that have a good match to the principles of the WCHT’s purpose are presented for their consideration. Items can also include off-plan equipment for which there is an urgent need due to service change or development, unexpected breakdown or new initiative.

In addition, projects which have a direct impact on the health of our community, but which may require support beyond the capacity of the DHB may be presented for consideration.

6 CONCLUSION

Management will review the success of the DFAT once it has been in place for 12 months.

The DFAT will make recommendations on the use of the General Donated Funds. These recommendations with require final sign off by the CFO (and CEO if over the DA of the CFO).

The DFAT Terms of Reference will be presented to ELT for endorsement.

The WCHT will be approached to see if they feel it would be useful to develop an MOU regarding donated funds.


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Wairarapa Board Public 21 June 2016 - DISCUSSION PAPERS

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BOARD INFORMATION PAPER

Date: 10th July 2016

Author Joanne Edwards, Senior Manager Service Integration

From Sandra Williams, Acting Director, SIDU

Endorsed By Adri Isbister, CEO

Subject Wairarapa Dementia Care – response to Board queries

RECOMMENDATION

It is recommended that the Board

a. Notes these responses to their queries about Dementia in Wairarapa

ADDENDUMS

1 INTRODUCTION

This paper is in response to questions posed by Fiona Samuel, Board Member on 13 May 2016.

2 RESPONSES

2.1 What is the current number of people in dementia care?As of 10th June 2016, there are 51 people in secure dementia care in Wairarapa. There are three people in psychogeriatric care out of the area. It is not known how many people with dementia who are in other types of residential care facilities.

2.2 What are the numbers of people with dementia living at home being cared for by families and or carers?

This number is unknown as there is no register of people diagnosed with dementia. Analysis of the interRAI assessment system will indicate the people with cognitive impairment, but not all people with cognitive impairment have dementia. Also, not all the older population have an interRAI assessment, so a definitive number cannot be given.

2.3 What is the waiting list for dementia care placement and how long is the average wait for placement?

There is no waiting list. As of 10th June 2016 there are 7 vacancies in secure dementia care units in Wairarapa for people who need that level of care. There are 59 vacancies in rest home/hospital level care facilities for people who may have dementia but who do not need secure care.

2.4 How many people with dementia are living in non dementia facilities?Cognitive impairment is a continuum – Aged residential care providers estimate 80% of their residents have some degree of dementia. However, these residents may not have been formally diagnosed against clinical criteria.

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2.5 What are the predicted numbers of people with dementia in Wairarapa for the coming years?

To answer this question, how the term “dementia” is being used needs to be defined. The statistics quoted by Alzheimers NZ have not been independently validated. There is no national register of people who have been diagnosed with dementia (e.g. against the criteria in Appendix 1).

As mentioned above, cognitive impairment is a continuum from slight short term memory loss to major loss of cognitive function. Depending on the cause, dementia can also be reversed. So far, specific modelling work has only been done for dementia residential care based on residents in secure care, not the total number of people with dementia.

The following estimations are based on the Ministry of Health demand planner. This data is based on the current volumes of subsidised bed days for dementia and then the estimated population growth has been applied:

Bed days forecast for dementia in 2020/21 are 23,931 bed days – 65 bedsBed days forecast for dementia in 2031/32 are 34,666 bed days – 95 beds

It needs to be noted that the further into the future that modelling extends, the less robust the estimate.

2.6 What are the medium and long term plans for dementia care services including staffing and facilities in Wairarapa bearing in mind the number of people with dementia in NZ is set to triple by the year 2050.

The estimate of increase in dementia is subject to a number of variables. Entry to residential care is not necessarily tightly correlated with an aging population. One would also expect that the systems approach being taken for current strategic planning for 20/30 should have some impact on the numbers needing secure residential care.

Currently the DHB has over capacity with 7 vacancies and 12 secure unit beds closed. If the closed beds were opened for admission again, this would give the DHB a total of 70 secure dementia care beds, which is above the estimate needed for 2020/21.

There are no plans for provision of a local psychogeriatric facility in Wairarapa due to the risk related to clinical and financial sustainability for such a highly specialist unit.

ARC providers are required by their contract to provide appropriate staffing according to their residents’ assessed needs. Residential and Home & Community Support service providers are already strengthening their staffing capability (for all staff) with regard to dementia care and are being supported by the DHB to do so.

The Aged residential Care (ARC) contract for secure dementia care units details the training requirements for staff working in a dementia unit. This is monitored via the National HealthCert process with portfolio managers responsible for monitoring any corrective actions required. The DHB encourages all other residential care facilities to have their staff attend recognised dementia training and all of them have a number of staff trained in dementia care.

2.7 What succession plans are in place for Anthony Duncan? Also bearing in mind it is understood that he works over and above his FTE hours?


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Responsibility for employment of Anthony Duncan sits with the DHB provider arm management. However, contingency planning has already included provision of 0.2 FTE Nurse Practitioner Mental Health to support the DHB medical and nursing staff who have a specialist role with managing dementia patients and their families with complex issues. This support includes assessment and advice for people in all settings and the Nurse Practitioner works closely with Dr Duncan as well as the DHB staff. The Nurse Practitioner Mental Health sits within a highly specialised team at CCDHB and therefore also has that clinical support for her Wairarapa role.

It also needs to be noted that there is continuous increasing medical and nursing capability in Wairarapa with regard to managing complex dementia and challenging behaviours through developments such as the Cognitive Impairment Health Pathway, Regional Dementia Behaviour Advisory Support, and professional development in dementia related study.

2.8 Please outline the service provision for dementia care as it currently stands.It is unclear whether this request relates to just residential care or the total service available for people with dementia. In summary the total range of funded service provision includes:

∑ Primary Care teams with Nurse Practitioner and 2 GPs with dementia as a special interest∑ FOCUS interRAI assessment and service coordination∑ Home and Community Support Services (2 funded providers)∑ Carer Support – relief in the home, respite care in residential care (including day respite), day

activity support (provided by Alzheimer’s Wairarapa)∑ Residential care (498 beds rest home/hospital level and 58 secure dementia care beds) ∑ DHB Nurse specialists/ Physician who provides cover for Dr Duncan/ 0.2 FTE Nurse

Practitioner Mental Health/ Psycho-geriatrician input∑ Specialist provision of services in other DHBs – e.g. psycho-geriatric care in Hutt Valley and

CCDHB.

2.9 Is there enough nursing FTE allocated to manage this growing problem? How much extra FTE has been allocated to this service over the past 5 years? Is this service adequate and will it be adequate as we move into the future?

FTE are not allocated specifically to the service. Growth in FTE has been evident as new beds for dementia care have been opened. Over the past five years, there have been 33 new secure dementia care beds in the Wairarapa and by definition these beds demand an increase in FTE in order to provide the service. The exact increase in FTE numbers employed by these providers of secure dementia care are unknown, but there have to be enough to provide the service as contracted for and audited against the Health and Disability standards. With the closure of 12 beds due to lack of demand, there would have been an associated reduction of FTE in that facility.


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APPENDIX 1 DEMENTIA CRITERIA(From the Cognitive Impairment Health pathway – Wairarapa, Hutt Valley and CCDHB)

Dementia: 1 to 3 answered YES

Alzheimer's type dementia: 1 to 6 answered YES

Criteria Yes No

1. There are multiple cognitive deficits including both A and B:

A) Memory impairment (impaired ability to learn new information or to recall previously learned information).

B) One or more of the following:

∑ Aphasia (language disturbance)∑ Apraxia (impaired ability to carry out motor activities despite intact motor function)∑ Agnosia (failure to recognise or identify objects despite intact sensory function)∑ Disturbance in executive function (i.e., planning, organising, sequencing, abstracting)

2. The cognitive deficits (1A and B) each cause significant impairment in social or occupational functioning and represent a significant decline from the previous level of functioning.

3. Delirium has been ruled out.

4. The course is characterised by gradual onset and continuing cognitive decline.

5. The following have been ruled out:

∑ Other central nervous system conditions that cause progressive deficits in memory and cognition e.g., cerebrovascular disease, Parkinson's disease, Huntington’s disease, subdural haematoma, normal pressure hydrocephalus, brain tumour.

∑ Systemic conditions that are known to cause dementia e.g., hypothyroidism, vitamin B12 or Folate deficiency, niacin deficiency, hypercalcaemia, neurosyphilis, HIV infection.

∑ Substance induced conditions.

6. The disturbance is not better accounted for by another Axis 1 disorder e.g., major depressive disorder, schizophrenia.


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Hutt Valley and Wairarapa DHBs APRIL 2016

BOARD NOTING PAPER

Date: 1 June 2016

Author Jason Kerehi, Director Māori Health

Endorsed By Adri Isbister, Chief Executive Officer, Wairarapa DHB

Subject Maori Health Directorate Monthly Update – Wairarapa DHB

RECOMMENDATION

It is recommended that the Boards:

a) NOTE the progress made on the deliverables for the 15/16 Maori Health Plan

b) NOTE the key areas/performance in the Maori Health Indicators

c) NOTE the suggestion to erect carvings in and around the DHB

1. PURPOSE

The Chief Executive has asked that I provide the Board with a monthly update on activities associated with Māori Health in the Wairarapa with specific reference to the Wairarapa District Health Board Māori Health Plan 2015/16.

2. MAORI HEALTH PLAN 15/16 DELIVERABLES

2.1 Maternity

The original objective was to run a pilot tikanga ante-natal class here in the Wairarapa but this has been revised to explore further the options and to look more widely at the needs of whanau across the Pregnancy and Parenting spectrum.

The Maori Health Directorate has met with Maternity to discuss and develop a joint strategy to improve outcomes with whanau. We are looking at ways to increase the numbers of expectant Maori mums and their whanau completing ante-natal training. We are keen to look at a tikanga-based ante-natal model in Waikato which has had considerable success.

We are also discussing workforce opportunities within Maternity. There are two Maori students studying locally to be midwives, one of which is the inaugural recipient of the DHB funded Te Whakawaiora Scholarship. The final part of our strategy is about how we can support the Maternity/Midwives/Lead Maternity Carers in culturally appropriate training.

2.2 DNA Project

We are in the midst of surveying patients who have missed their appointments to understand better the key issues being the DNA. Preliminary results suggest that a great number of patients are receiving their notices after the appointment has occurred. We are looking at three departments; Orthopaedics, Gynacology and Pediatrics. We will have our results for the next monthly report. The next step for us is to then work with the departments to understand their systems and where appropriate make improvements.


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2.3 Te Tohu Whakawaiora

We had twenty-two staff from across the health sector complete this one-year pilot course in December last year which provides a tikanga-based cultural awareness paper focussed on workers within the health sector. CCDHB ran a similar pilot for 15 staff at the same time.

Evaluations have been completed for both pilots but we haven’t collated our results yet or reported back to the Central Region Maori Managers who sponsored the project.

Again, our preliminary feedback suggests that we make improvements to the paper making it more relevant to the health sector before rolling it out again. The draft report also suggests we re-think who we have delivering the paper and/or assessing it.

A wider consideration is that we review all of our cultural training across the Wairarapa District Health Board to determine what would be the most effective mix of training for our staff. We are working with HR to look at what is being offered, what else is available and what would be most appropriate for our DHB.

3. MAORI HEALTH INDICATORS


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3.1 Key Indicator Trends

The above chart is taken from www.trendly.co.nz and shows the available Maori Health data as at June 2016. The key areas to highlight are Maori ASH rates for 0-4 year olds; breastfeeding rates at 3 months and CVRA 35-44 years.

I am not certain if the data for 0-4 year old ASH rates is definitely June 2015 and I may need to just clarify further with SIDU. However, this indicator has always been a problem area for Wairarapa District Health Board. This is certainly an issue which is being highlighted in the review of acute services. We are ranked last out of all 20 DHBs

Our breastfeeding rates at 3 months have tended to jump up and down over the past year. This rate measures babies that are being exclusively breastfed at three months which is why it always rates badly. The Maori Health Directorate is supporting Regional Public Health to get more Maori Peer Counsellors out there in our community supporting mums and breastfeeding. The recently completed Peer Counsellor course had three Maori on the training. We are ranked 8th.

CVRA rates for 35-44 year olds is another area that traditionally rated badly and currently we sit in second-to-last place on the rankings. I have discussed this area with our PHO and Justine is looking at sending a notice to all Maori men in this age group who have not had an assessment to either book themselves in for an appointment and to possibly offer a voucher.

4. OTHER KEY AREAS

4.1 Whaiora

The Board has asked us to consider how we can support Whaiora as it handles the changes to its funding, in particular the dropping of Mana Wahine services and the review of tobacco advice services. Our Chief Executive has met the GM Whaiora to discuss ways in which we can assist and has suggested partnering with other providers as way of maintaining service levels for whanau.

4.2 Maori Carvings at the DHB

The CE and I recently met with Kahungunu ki Wairarapa. One of the discussions we had concerned the carvings that were at the Ministry of Health in Wellington. A recent restructure within the Ministry has led to these carvings being offered back to Wairarapa iwi as the carver – Takirirangi Smith was from here.

The carvings in question are now back in the Wairarapa. One of the conditions of return was that the carvings stay within Health (if possible). Kahungunu have suggested that these carvings be offered to our hospital and erected in the most appropriate places. Both Rangitane and Kahungunu iwi are supportive of this proposal.

The DHB will work closely with iwi to identify where in the hospital these carvings should go. There are a number of carvings so it is possible that there will be multiple sites for them to be put. The locations include

∑ The main front entrance (perhaps a waharoa or entranceway);∑ Emergency Department entrance;∑ The courtyard opposite the Chapel which has a memorial to two past kaumatua; Kuki Rimene

and Taka Panere;∑ Taku Wahi; and∑ The entrance to the CSSB Boardroom where our powhiri are held.


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The CE has also suggested that we time the unveiling of the carvings with a proposed visit by the Minister of Health. We will work with Hospital staff and iwi to determine the most appropriate locations, schedule and process to erect the carvings. This will occur within the next month or two.

This is hugely symbolic for the hospital and our Maori community.

Noho ora mai

naa

Jason KerehiDirector Maori Health


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Wairarapa Alliance Leadership TeamMeeting DRAFT Minutes

Tuesday 17th May 2016, 5.30 pm – 7pmCSSB Lecture Room, DHB Offices, Blair Street, Masterton

Quorum – For a meeting to progress, at least 50% of the ALT membership is required to be present.

Members: Bob Francis (Chair ) Bob Sahakian Sarah MartinHera Edwards Andrea Rutene Dale ColesTony Becker Hamish Duncan Brad MartinAdri Isbister Helen Pocknall Roger MorrisMartin Hefford

Present: Bob Francis Dale Coles Adri Isbister

Roger Morris Helen Pocknall Tony Becker

Bob Sahakian Hera Edwards

Ex-officio: Jill Stringer, Justine Thorpe, Wayne Skipage, Chrissy Shaw (minutes)

Apologies: Yvette Grace, Brad Martin, Hamish Duncan, Andrea Rutene, Annie Lincoln, Sandra Williams, Martin Hefford

Absent Sarah Martin

AGENDA ITEMS ACTION

1. Welcome/ApologiesMeeting opened at 5.00 pm

2. Conflicts of Interest RegisterThere was one change noted on the Conflicts of Interest Register

∑ Add- Tony Becker-Trustee – Wairarapa Children’s Trust

3. Confirmation of Minutes from previous meetingThe Team approved the minutes of the meeting held 2nd February 2016.

Moved: Dale Coles Seconded: Adri Isbister

4. Action register

Justine presented the register to the group.

Note: Once the action list is accepted, ‘requests to close’ will be removed

Updates of Note

1. ID 1 & 3 to be removed from the register

2. ID 2 & 5 are to be followed up with Adrian by Justine

Action- Follow up with Adrian Lumsden on ID 2 & 5 on Actions Register Justine

5. Mental Health and Addictions Leadership Group Presentation

Chair Simon Phillips from SIDU, Louise Ihimaera and Peter Critchley, Chair

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of Wairarapa Mental Health and Addiction Consumer Leadership Group gave their presentation to the group outlining the work that they are doing in the community.

6. Tihei Wairarapa programme progress report

Justine presented this report to the group and taken as read.

In summary, key issues are-

∑ ALT Membership- With most members having actually completed the 3 year term the Expression of Interest process is due to start. After consultation with the DHB it has been decided to stay with the status quo and cut out the long-winded interviews but still ask for Expressions of Interest from the community, if not enough response then informally ask people to join the ALT. With the exception of the Iwi representative, process will remain the same.

Action- Get the Expression of Interest process started

∑ Urgent Care Clinic Business Case- Although significant work has been put into this but there is a lot more work required to go forward with this project. Further report due in November.

Action-

∑ Primary and Community Integration Project- Phase 1 has seen three District Nurses allocated to Carterton Medical, they will be given mobile devices so as they can work out in the community and communicate with the practice.

∑ The Social Sector Trial has been discontinued in the Wairarapa but there is a strong drive to keep the health components of the trial, most of all the Youth focus.

∑ ASH rates- Due to the Ministry changing the definitions the ASH rates are looking worse but this the case nationwide.

There was some discussion around getting Public Health more engaged so the group agreed that TJ (Tessa-Jane Dennis) from Public Health is to be invited to become a member of the ALT.

2.1 Youth Kinex are celebrating their 1st Anniversary and have funding to continue for the next 12 months

Self-management – Kath Tomlinson and Linda Spence have just finished training 14 people over 4 days to become trainers and deliver the Stanford Self-Management programme to others.

Accessible Prescriptions – this has been making frustratingly slow progress and after some discussion, it was agreed that there must be better ways to ensure people do pick up their prescriptions.

Action- Bob and Justine to look at progressing this at a much quicker pace

Health Care Homes-Masterton Medical have been trialling, without funding, some phone consultation appointments and have had a positive response, finding that people are happy to pay for this service. It was suggested by a few out of town patients that a video consult would suit them even better still. Although Practices may need to invest in this to start with, the benefits to the community and GP’s will be well worth it in the long term.

A motion was put to receive and accept the programme update report

Moved – Dale Coles Seconded- Hera Edwards

Justine

Bob/Justine/Adri

Bob/Justine


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7. District Annual Plan

Justine presented this report to the group and taken as read.

∑ A more defined timeline for targets will be added into the plan and some words around investment strategies in regard to the Integration projects funding i.e. Mobile devices

∑ The recommendation is to endorse the plan subject to the budget being approved.

∑ All reference to the Social Sector Trial is to be removed for the document.

∑ In addition, to be added is mention of the Childhood Obesity project, which is not yet confirmed but resource, has been earmarked for this.

Action- Lisa Burch will work with Bob to finalise and sign off the presentation

Moved- Bob Francis Seconded- Dale Coles

Lisa /Bob

8. Patient Information Business Case

This information paper was put forward for noting.

In summary, points of interest:

∑ This has been approved by the Health Pathways governance group

∑ The group met and reviewed three service provider options and consensus was that Health Navigator and Health Point were the preferred options.

Moved- Dale Coles Seconded- Hera Edwards

9. Acute Services Analysis- Roger Morris

Roger presented his report to the group.

In summary, points of interest:

∑ With a work plan now in place, Roger will visit all the practices to get their input into designing an acute triage tool.

Motion was put forward that the group agree to proceed with Rogers work

Moved- Bob Francis Seconded- Adri Isbister

10. Acute Care Programme Coordination Proposal

Justine gave a summary and talked through the recommendations for this report, points of interest were:

∑ That the messages to the public about going to their GP in the first instance need to be consistent and delivered in a coordinated fashion.

Motion was put to recommend and endorse the plan

Moved- Helen Pocknall Seconded- Bob Francis


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11. Access to Concerto Privacy Impact Assessment

Justine presented this paper to the group.

In summary:

∑ This plan has gone to the Board and been endorsed and approved.

This paper was noted

12. Health Promotion and Services to Improve Access Plans

Justine presented this paper to the group.

Points of interest:

∑ This Health Promotion plan is made up of capitation as well as the Self-Management funding and the Tobacco Control budget.

∑ We make a contribution the Red Cross Transport Service and we are waiting to see the results of the SIDU transport review.

Motion to endorse the plan was put forward.

Moved- Roger Morris Seconded- Tony Becker

13. Alliance Executive Team Minutes

These minutes were put forward for noting.

14. General Business

The meeting closed at 7.01 pm.

Next meeting is on Tuesday 16th August 2016

Signed: __________________________ Bob Francis (ALT Chairperson)

Date: ____________________________


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Wairarapa District Health Board June 2016

BOARD DECISION PAPER

Date: June 2016

Author Derek Milne, Wairarapa District Health Board Chair

Subject Resolution to Exclude the Public

RECOMMENDATION

IT IS RECOMMENDED that the Board AGREES that Public be excluded from the following parts of the of the Meeting of the Board in accordance with the NZ Public Health and Disability Act 2000 (“the Act”) where the Board is considering subject matter in the following table.The grounds for the resolution is the Board, relying on Clause 32(a) of Schedule 3 of the Act believes the public conduct of the meeting would be likely to result in the disclosure of information for which good reason exists under the Official Information Act 1982 (OIA), in particular:

SUBJECT REASON REFERENCE

Public Excluded Minutes For the reasons set out in the 16 June 2015 Board Agendas

Financial matters; Change proposals; Annual Planning; Pharmacy Services Contract, Risk Reporting

Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations.

Section 9(2)(i)(j)

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