hospital advisory committee respect nelson …section 6: presentation the gm maori health &...

HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN AGENDA

23 June 2015 1

HOSPITAL ADVISORY COMMITTEE

NOTICE OF MEETING

OPEN MEETING

A meeting of the Advisory Committee Members of Nelson Marlborough District Health Board will be

held on Tuesday 23 June 2015 at 9.30am

Support Services Room 1 Wairau Hospital

Blenheim

Our VISION is: “leading the way to healthy families”

Our MISSION is to: “work with the people of our community to promote, encourage and enable their health, wellbeing and independence.”

Our VALUES are:

RespectWe care about and will be responsive to the needs of our diverse people, communities and staff

InnovationWe will provide an environment where people can challenge current processes and generate new ways of working and learning

TeamworkWe create an environment where teams flourish and connect across the organisation for the best possible outcome

IntegrityWe support an environment which expects openness and honesty in all our dealings and maintains the highest integrity at all times

HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN AGENDA

23 June 2015 2

HAC MEETING AGENDA

Section Agenda Item Time Attached Action

PUBLIC FORUM 9.30am

1 Welcome, Karakia, Apologies, Registration of Interests

9.40am Attached Resolution

2 Confirmation of previous Meeting Minutes, Correspondence

9.45am

Attached Resolution

2.1 Action Points Attached Resolution

3 Clinical Services Report Attached Resolution

4 PRESENTATION: - Top of the South Service Review by Peter Bramley

11.00am As

Presented Note

5 Glossary Attached Note

Meeting finish 12.30pm

There are no items for the Public Excluded section of this meeting.

HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN MEETING

Welcome, Apologies, Registrations of Interest 1-1

WELCOME, KARAKIA AND APOLOGIES

Apologies



REGISTRATIONS OF INTEREST – HAC MEMBERS

Name Existing – Health Existing – Other Interest Relates To Possible Future Conflicts

Gerald Hope (Chair)

CE Marlborough Research Centre

Director Maryport Investments Ltd

CE at MRC landlord to Hill laboratory services Blenheim

Landlord to Hills Laboratory Services Blenheim

Russell Wilson

Member of NZ National

Party (Regional Office holder)

Managing Director of Carat Investments

Principal Consultant at Wilson Consultants (HR and Business Management consultancy)

NZ National Party

Carat Investments

Wilson Consultants

Jessica Bagge Save our Services/Hands Off Wairau

Marlborough District Council

Marlborough Signs & Design Ltd

Was a spokesperson and co-leader

District Councillor

Signwriter

Jenny Black (ex-officio)

Chair of South Island Alliance Board

Life Member of Diabetes NZ

Chair of National Chairs



Patricia O’Brien Member of the ANZCA PS08 Expert Advisory Group

Life member of the NZ Anaesthetic Technician’s Society Inc

Providing information relevant to the review of the ANZCA professional document PS08 Statement on the Assistant to the Anaesthetist

Dana Wensley

Mother receives home care through the DHB

Spokesperson for PEN

International human rights organisation that represents the rights / interests of writers. Being the NZ spokesperson means that I am committed to advocate for the right to freedom of speech and freedom of expression. This covers writing and the spoken word, whether it is in fiction, non-fiction, satirical, workplace setting etc.

Dawn McConnell Te Atiawa representative and Chair of Iwi Health Board

Director Te Hauora O Ngati Rarua

Trustee, Waikawa Marae

Regional Iwi representative, Internal Affairs

MOH contract

As at 17 June 2015


Minutes – 28 April 2015 2-1

MINUTES OF MEETING

MINUTES OF A MEETING OF THE HOSPITAL ADVISORY COMMITTEE OF NELSON MARLBOROUGH DISTRICT HEALTH BOARD HELD AT SEMINAR CENTRE ROOM 1, BRAEMAR CAMPUS, WAIMEA ROAD, NELSON ON TUESDAY 28 APRIL 2015 AT 9.30 AM. Present: Gerald Hope (Chair), Dana Wensley, Dawn McConnell, Luke Katu, Jessica Bagge, Russell Wilson, Jenny Black (ex officio) Apologies: Patricia O’Brien, Judy Crowe, Jenny Black (Marlb), Peter Bramley In Attendance: Brigid Forrest, Alan Hinton, Chris Fleming (CE), Hilary Exton (Acting GM Clinical Services / Director Allied Health), Eric Sinclair (GM Finance & Performance), Harold Wereta (GM Maori Health & Whanau Ora), Ros Gellatly (CMA Primary), Nick Baker (Chief Medical Officer), Vienna Richards (Communications Manager), Gaylene Corlett (Minute Secretary) Karakia: Luke Katu

SECTION 1: MEMBERS OF THE PUBLIC Nil

SECTION 2: APOLOGIES AND REGISTRATIONS OF INTEREST Noted.

SECTION 3: MINUTES OF PREVIOUS MEETING AND CORRESPONDENCE 3.1 Minutes of the Committee Meeting 24 February 2015 Noted 3.2 Correspondence Noted.

Moved: Gerald Hope Seconded: Brigid Forrest RECOMMENDATION:



THAT THE MINUTES OF THE MEETING 24 FEBRUARY 2015 BE ADOPTED AS A TRUE AND CORRECT RECORD AND THE CORRESPONDENCE BE NOTED. AGREED

SECTION 4: ACTION POINTS Item 1 – Discharge Planning: a Charter is in place. Basic data has been collected looking at admissions and readmissions for the development of three key workstreams going forward. Item 2 – Overview of Maori Access to Services: Presentation during meeting. Completed. Item 3 – Referral Letters: noted some services send copies of letters and others do not. More information will be available at the next meeting. Carried forward. Item 4 – Acknowledgement re Electives: to be noted in the DHB Connections Apr/May. Communications Manager to follow up. Item 5 – Theatre Cancellation Information: Completed Item 6 – Workforce Development: GM HR working with team looking at retirement and different ages. Carried forward.

SECTION 5: REPORTS 5.1 Clinical Services Noted commissioning of new MRI delayed until June 2015. Discussion held on opportunity of Wairau patients attending MRI appointments in Nelson to reduce backlog. Discussion held on mammography scans for women in Blenheim noting they are offered the opportunity to attend in Nelson. It was requested that when items, like the Calderdale Framework, are mentioned in the Clinical Services report, that a brief explanation be given to ensure Committee members understand what it is. Noted the Calderdale Framework is a transformational tool used to improve the way people work. It aims to provide a clear and systematic method of reviewing skill mix roles and service design to en sure safe and effective patient centred care. The framework was first developed and implemented within the Clinical Therapy and Rehabilitation Directorate of Calderdale and Huddersfield NHS Foundation Trust. It has also been used in Australia. Discussion was held on the Code of Practice for Fluoridation of Drinking Water Supplies, noting a government subsidy of at least 50% is still available from the MOH for installation of new fluoridation plant. It was noted that NMDHB, through Public Health, have put forward submissions to two of the local authorities, and the Marlborough District Council submission will be sent early May. Noted there has been interest in the setting up of a Shisha (flavoured tobacco) Hookah (smoking pipe) bar in Nelson. The Committee believes this would be a step in the wrong direction. It was agreed that advice be requested from the Medical Officer on where this venture sits in relation to the Smoke Free Act.



Noted the strengthening work of the Arthur Wicks building in Wairau will be delayed as a second engineering opinion is being sought due to the rising costs of the original estimate. Discussion held on the Emergency Preparedness Plan, and it was agreed that the Emergency Coordinator be asked to give a presentation on emergency preparedness at the next combined workshop. Noted the St John’s daily service for non urgent road transfer between Nelson and Wairau with a dedicated vehicle will start on 1 May. This is for hospital based transfers and other cases as deemed appropriate. Noted the Director of Allied Health and the CE met with Walter Scott about the transport shuttle for patients travelling from Wairau to Nelson for hospital appointments. This work is progressing. Financials Whilst the financials for Clinical Services are adverse, there are mitigating factors which should bring it back into line next month. Noted RMOs arrive in Nelson with high leave balances which is a cost to the organisation. It was agreed that this issue be raised at a national level and a report brought back to the Committee at the next meeting.

Moved: Jessica Bagge Seconded: Russell Wilson

RECOMMENDATION:

THAT THE CLINICAL SERVICES REPORT BE RECEIVED. AGREED

SECTION 6: PRESENTATION The GM Maori Health & Whanau Ora presented on Selected Population and Health Measure Comparisons of Maori and Non-Maori. The presentation was to give some perspective and an overview of how the Maori population is being serviced in the way of hospital services, noting the data records information to October 2014, the start and end points for the graphs may simply mean the period in which the data was available, and that categories where Maori data was numerically small have been aggregated to show statistical significance to trends. Noted in 2015 there are 711,960 Maori, and it is estimated that by 2030 there will be 827,230. Inpatient activity shows 8% of Maori in Nelson and 10 % in Wairau have access to services. This mirrors the population across the DHB for Maori, but is not an indicator of utilisation. 36% of Maori utilise hospital services between the ages of 0 – 9 years. The factors driving this may include costs, complications or locality access.



Pregnancy, child birth and the puerperium followed by newborns and other neo-nates, and diseases and disorders of the ear, nose, mouth and throat are identified as high service usage. Maori women rather than men are more likely to be re-admitted. In comparison, non-Maori have a more dispersed distribution of hospital access across the age categories. Readmission rates for Maori are highest for those aged 0-9 years at 21%. The position does not improve with higher than usual re-admittance rates from ages 10– 59 years. Key disease categories include digestive, respiratory system and circulation. Again Maori women rather than men are more likely to be re-admitted for both Nelson and Wairau. The trend over time suggests an ongoing increase. More work will be required to understand the behaviours behind the increases. In contrast, non-Maori have higher re-admittance rates for those aged between 59 – 79 years. Services accessed are similar to Maori. As expected, higher than usual volumes of those aged 0–1 year (46%) suggesting more newborns and use of other services like Neo-nates. Nelson and Wairau have similar trends for Maori. There appears to be no difference between Maori and non-Maori populations. Highest level of activity is between 20 – 39 years (35% for 20 – 29 years and 20% 30 – 39 years). Pregnancy, childbirth and puerperium are the main registered activity followed by disease/disorders of the digestive system, musculoskeletal and connective tissue. The trend for both Nelson and Wairau is on the increase and may not change over time. In contrast, the non-Maori population shows an even spread of service utilisation from ages 20 – 59 years. This mirrors their population demographics. Service utilisation categories are similar to Maori. Data shows trending for Wairau is on the increase. The reverse is true for Non-Maori. Maori ALOS for Nelson show increases which is against the trend line. Non-Maori are trending downwards. Contributing factors may include high degree of complications when presenting to hospital services. Interestingly, when viewed alongside Maori, All Inpatient Activity and Maori Re-Admit data, there are clear downward trends. In conclusion, Maori pregnancy rates top all inpatient activity. The trends indicate future increases in the use of hospital services. Access to inpatient services across those departments in this report appear to be good. There are areas where further work is needed, eg re-admission, average length of stay and Maori kidney disease. This report gives a first snap shot on activity for Maori. Moving forward, the DHB is open to any further advice HAC may offer. The dashboard will be reviewed and other areas may be included. A map of hospital service access by deprivation, ethnicity and age/gender will be developed and the report will include DNA and FSA (decline) rates for Maori. Discussion: It was agreed to relook at the data for Maori once the pregnancy/child birth information has been removed to gain a better perspective of Maori accessing services. Also consider taking out cervical cancer data as well.



PUBLIC EXCLUDED It was agreed at the Public Excluded meeting on 24 February 2015 that when there are no agenda items to be discussed in the Public Excluded section of the HAC meeting, there is no requirement for the Committee to resolve itself into Public Excluded.

Meeting closed at: 10.56am

NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN MEETING

Action Points – HAC Open 2.1-1

ACTION POINTS - HAC Open Meeting

Held on 28 April 2015

Action Item #

Action Discussed Action Requested Person Responsible

Meeting Raised In

Due Date Status

1 GM Clinical Services Report

Report requested on discharge planning for adult wards, ensuring that consumer representatives have been invited onto the Steering Group. Update to be given at next meeting

Peter Bramley 25 February 2014 Update required 23 June 2015

Completed

2 Minutes of meeting held 25 November 2014

GM Clinical Services to work with GM Maori Health & Whanau Ora, CMO, Director of Allied Health and Director of Nursing & Midwifery to develop a report to give some perspective and an overview of how the Maori population is being serviced in the way of hospital services

Peter Bramley 24 February 2015 28 April 2015 Completed

3 Clinical Services Report

Follow up on whether patients receive a copy of the letter sent to their GP about their referral

Peter Bramley 24 February 2015 23 June 2015 Completed



Action Item #


Meeting Raised In

Due Date Status


Provide an acknowledgement to staff around electives and more data looking at intervention rates, providing certainty etc to be provided in the staff Connections magazine for April/May

Chris Fleming 24 February 2015 23 June 2015 Completed


Look at presenting information on theatre cancellations in a more easy to read manner.

Peter Bramley 24 February 2015 28 April 2015 Completed

6 Presentation Helen Telford, GM HR, DoNM to look at anecdotal data available and compare ages of those that retired last year to those that left.

Heather Smith 24 February 2015 23 June 2015 Completed


Requested that when items, like Calderdale Framework are mentioned an explanation be given to the Committee about who or what they are

Peter Bramley 28 April 2015 Noted



Action Item #


Meeting Raised In

Due Date Status


It was requested advice from the Medical Officer be sought on where the setting up of a Shisha Hookah bar in Nelson sits in relation to the Smoke Free Act

Peter Bramley 28 April 2015 23 June 2015 Completed


It was requested that the Emergency Coordinator be asked to give a presentation on emergency preparedness at the next combined workshop

Peter Bramley/ Andrew Lesperance

28 April 2015 To be confirmed


GM Finance & Performance to raise at the national CFO meeting the issue of RMOs being employed with high leave balances which are a cost to the new DHB

Eric Sinclair 28 April 2015 23 June 2015 Completed

11 Presentation: selected population and health measure comparisons of Maori and non Maori

Relook at data for Maori once the pregnancy/child birth and cervical cancer data has been removed to gain a better perspective of Maori accessing services

Harold Wereta 28 April 2015 23 June 2015 Ongoing and to be reported at August HAC meeting.


Clinical Services Report 3-1

Status This report contains: For decision Update Regular report For information

MEMO

To: HAC Members

From: Peter Bramley, GM Clinical Services

Date: 17 June 2015

Subject: Clinical Services Report

1. GENERAL Clinical Services has delivered 1,837 caseweights in May (102% of plan). The NMDHB, under the new four month rule that no one waits longer than four months, has nine patients waiting longer than four months for a FSA and eleven patients waiting longer than four months for an elective procedure. Clinical Services has delivered a year to date position of $26.127m compared to a budgeted position of $28.592m giving a negative variance $2.465m.

2. MATTERS ARISING

Discharge Planning. An update on discharge planning will be provided as part of the General Manager’s presentation at the meeting. Referral Letters. It is confirmed that patients receipt a copy of the letter acknowledging acceptance or decline of their referral. Staff Acknowledgement. An acknowledgement to staff around electives will be provided in the Connections magazine once the financial year has been completed. Workforce. Noted the average age of retirement in 2013/14 was 64, and in 2014/15 it was 65 years of age. Staff leaving for other reasons in 2013/14 the average age was 44, and in 2014/15 was 43. Shisha Hookah Bar. The Health Protection Officer has contacted the person seeking to open a Shisha Hookah bar in Nelson and reminded them of their obligations under the Smoke Free Act. No further information is available to date. RMOs Leave. The issue of RMOs being employed with high leave balances was raised at the CFO forum. The issue is in relation to the national MECA and at this stage there is no agreement to resolve.



3. FINANCIAL UPDATE

The financial results of May shows a deficit for the month of $721k, and combined with April’s deficit of $688k, raises the significant concern of an ongoing financial challenge going into the new financial year. The key drivers of this variance in Clinical Services are the costs of: (a) Medical locums to cover vacancies and support safe clinical services (b) Nursing personnel especially in our inpatient areas (c) Outsourced services which includes additional clinics, colonoscopies and

radiology procedures (d) Clinical supplies which includes pharmaceuticals, implants, blood and patient

consumables (e) Patient Transport, both moving patients across the district, but also supporting

travel to other DHBs for care.

Immediate actions have been put in place to ensure the pattern does not continue, and in particular, to ensure Clinical Services goes into the new financial year confident that it can live within its means. The actions underway include:

(a) Review of all locum and outsourced spending with sign off of future locums by

General Manager (b) Review of 2015/16 budgets at cost centre level to ensure any risks are

identified and mitigated (c) All nursing overtime, time in lieu, use of casuals, and assignment of watches

and specials to be approved by our Associate Directors of Nursing (d) All nursing rosters to be reviewed to ensure they match budget available, and

review of any nursing staff working over and above their budgeted hours (e) A review and discussion with medical leadership around the demand and

capacity of our orthopaedic and general surgical services (f) A focus on patient flow and ensuring patients are receiving their care in the

most appropriate setting. There are opportunities for better discharge planning, and better use of our Intensive Care and High Dependency Units

(g) A review of hospital pharmaceutical spend by clinical leadership to see if we can slow the increase in costs in this area

(h) Maximising the new daily ambulance service across the district between Wairau and Nelson hospitals, to appropriately reduce the number of patient flights

(i) Planned new investment for the 2015/2016 is being held until there is confidence Clinical Services can deliver services within their proposed budget.

Our clinical teams are providing great care for our community every day. Our current challenge is to do that within our financial means. Actions are underway to provide confidence that we will do this as we move into the 2015/16 financial year.



4. SERVICE REPORTS

4.1 Elective Services

General The Clinical Service delivered 1,837 caseweights (101.5%) of plan for May. Acute caseweight activity was 99.5% of plan for the month with 1,200 actual caseweights being delivered against a plan of 1,205. Elective caseweight activity was 105.61% of plan for the month with 637 actual caseweights being delivered against a plan of 603. Discharges YTD health target to end of April 2015 indicates we have delivered 5,149 discharges against a plan of 4,988, 161 discharges above plan.



NMDHB Summary - Activity YTD

Caseweights

NMDHBMay 2015

Service

Unit Code Description TypeAnnual

Plan

Budget

YTD

Actual

YTD

Vol

Variance

Actual %

Complete

vs YTD

Plan

Medical M00001 General Medicine DRG's Acute 4600 4232 3997 -235 94%

Elective 150 136 166 30 122%

M00001 Total 4750 4368 4163 -205 95%

M05001 Emergency Medicine DRG's Acute 1200 1113 1315 202 118%

M05001 Total 1200 1113 1315 202 118%

M10001 Cardiology DRG's Acute 1143 1052 898 -153 85%

Elective 307 279 332 53 119%

M10001 Total 1450 1331 1230 -101 92%

Medical Total 7400 6812 6708 -104 98%

SubSpec D01001 Inpatient Dental DRG's Acute 20 18 19 1 106%

Elective 160 145 185 39 127%

D01001 Total 180 163 203 41 125%

S25001 Ear, Nose and Throat DRG's Acute 90 83 91 9 110%

Elective 446 405 464 58 114%

S25001 Total 536 488 555 67 114%

S40001 Ophthalmology DRG's Acute 23 22 29 7 134%

Elective 396 360 298 -62 83%

S40001 Total 419 382 327 -55 86%

S70001 Urology DRG's Acute 230 214 198 -16 92%

Elective 450 409 503 94 123%

S70001 Total 680 623 701 78 113%

SubSpec Total 1815 1656 1787 131 108%

Surgical S00001 General Surgery DRG's Acute 2650 2478 2027 -451 82%

Elective 1807 1662 1464 -199 88%

S00001 Total 4457 4140 3491 -650 84%

S05001 Anaesthesia Services DRG's Acute 4 4 5 1 126%

S05001 Total 4 4 5 1 126%

S45001 Orthopaedics DRG's Acute 2150 1991 1945 -46 98%

Elective 2382 2199 2081 -117 95%

S45001 Total 4532 4189 4026 -164 96%

S75001 Vascular DRG's Acute 35 32 98 66 308%

Elective 275 250 271 21 109%

S75001 Total 310 282 369 88 131%

Surgical Total 9303 8615 7890 -725 92%

W C & Y M55001 Paediatric Medicine DRG's Acute 630 542 473 -69 87%

Elective 70 64 74 10 116%

M55001 Total 700 606 547 -59 90%

S30001 Gynaecology DRG's Acute 214 201 219 18 109%

Elective 756 687 762 75 111%

S30001 Total 970 889 981 93 110%

W06003 Neonatal Inpatient DRG's Acute 416 384 374 -10 97%

W06003 Total 416 384 374 -10 97%

W10001 Maternity DRG's Acute 1430 1320 1322 2 100%

W10001 Total 1430 1320 1322 2 100%

W C & Y Total 3516 3198 3224 26 101%

Grand Total 22034 20282 19609 -672 97%

MoH Elective Discharges NB. Note that these are Elective Discharges as per the MoH Elective Discharges definitions that have been performed at NMDHB

These are NMDHB-domiciled cases within the specified Purchase Unit Codes and exclude inflows from other DHBs

Service

Unit Code Description Annual PlanBudget

YTD

Actual

YTD

Vol

Variance

Actual %

Complete

vs YTD

Plan

SubSpec S25001 Ear, Nose and Throat - Elective Discharges 676 615 643 28 105%

S40001 Ophthalmology - Elective Discharges 776 706 540 -166 76%

S70001 Urology - Elective Discharges 413 375 408 33 109%

SubSpec Total 1865 1697 1591 -106 94%

Surgical MS02016 Skin Lesions - Elective Discharges 427 391 648 257 166%

S00001 General Surgery - Elective Discharges 1268 1163 1097 -66 94%

S45001 Orthopaedics - Elective Discharges 1036 952 928 -24 98%

S75001 Vascular - Elective Discharges 100 91 93 2 102%

Surgical Total 2831 2596 2766 170 107%

W C & Y S30001 Gynaecology - Elective Discharges 764 695 786 91 113%

W C & Y Total 764 695 786 91 113%

Grand Total 5460 4988 5143 155 103%



Production Plan Elective DischargesNote that these are elective discharges that align with the caseweights above - ie publically-funded cases where NMDHB is DHB of service

These overlap the dataset shown above in the MoH Elective Discharges but are not an exact fit

May 2015

Service

Unit Code Description Annual PlanBudget

YTD

Actual

YTD

Vol

Variance

Actual %

Complete

vs YTD

Plan

Medical M10001 Cardiology - Discharges 323 294 365 71 124%

Medical Total 323 294 365 71 124%

SubSpec D01001 Inpatient Dental - Discharges 327 297 356 59 120%

S25001 Ear, Nose and Throat - Discharges 676 614 648 34 105%

S40001 Ophthalmology Discharges 776 706 555 -151 79%

S70001 Urology - Discharges 413 375 410 35 109%

SubSpec Total 2192 1993 1969 -24 99%

Surgical MS02016 Skin lesion excisions (discharges) 427 391 666 275 170%

S00001 General Surgery - Discharges 1268 1163 1106 -57 95%

S45001 Orthopaedics - Discharges 1036 952 939 -13 99%

S75001 Vascular - Discharges 100 91 93 2 102%

Surgical Total 2831 2596 2804 208 108%

W C & Y M55001 Paediatric Medical - Discharges 0 0 151 151 0%

S30001 Gynaecology - Discharges 764 709 796 87 112%

W C & Y Total 764 709 947 238 134%

Grand Total 6110 5592 6085 493 109%

Outpatient Attendances

First Specialist Assessments

NMDHBMay 2015

Service Unit Code Description Annual PlanBudget

YTD

Actual

YTD

Vol

Variance

Act %

Complete

vs YTD

Plan

Medical M00002 General Medicine - 1st attendance 1700 1546 1519 -27 98%

M10002 Cardiology - 1st attendance 2100 1909 2340 431 123%

M15002 Dermatology - 1st attendance 400 364 294 -70 81%

M20004 Diabetes - 1st attendance 120 109 120 11 110%

M25002 Gastroenterology - 1st attendance 1500 1364 941 -423 69%

M30002 Haematology - 1st attendance 130 118 95 -23 80%

M40002 Infectious Diseases - 1st Attendance 40 36 27 -9 74%

M45002 Neurology - 1st attendance 500 455 252 -203 55%

M50020 Oncology - 1st attendance 360 327 372 45 114%

M50022 Radiation Oncology - 1st Attendance 170 155 180 25 116%

M60002 Renal Medicine - 1st attendance 51 46 54 8 116%

M65002 Respiratory - 1st attendance 150 136 231 95 169%

M70002 Rheumatology (incl immunology) - 1st att 200 182 314 132 173%

Medical Total 7421 6747 6739 -8 100%

SubSpec S25002 Ear Nose and Throat - 1st attendance 1300 1182 1455 273 123%

S40002 Ophthalmology - 1st attendance 1802 1640 1547 -93 94%

S70002 Urology - 1st attendance 1200 1091 1312 221 120%

SubSpec Total 4302 3912 4314 402 110%

Surgical S00002 General Surgery - 1st attendance 3300 3062 2596 -466 85%

S45002 Orthopaedics - 1st attendance 4000 3692 3520 -172 95%

S75002 Vascular Surgery 1st Attendance 280 255 223 -32 88%

Surgical Total 7580 7009 6339 -670 90%

W C & Y M55002 Paediatric Medical Outpatient - 1st attendance 975 886 817 -69 92%

S30002 Gynaecology - 1st attendance 1450 1318 1192 -126 90%

W03002 1st obstetric consults 720 665 780 115 117%

W C & Y Total 3145 2870 2789 -81 97%

Grand Total 22448 20537 20181 -356 98%



Subsequent Attendances

NMDHBMay 2015


YTD

Actual

YTD

Vol

Variance

Act %

Complete

vs YTD

Plan

Medical M00003 General Medicine - Subsequent attendance 2320 2109 2122 13 101%

M10003 Cardiology - Subsequent attendance 2450 2227 2078 -149 93%

M15003 Dermatology - Subsequent attendance 486 442 319 -123 72%

M20005 Diabetes - Subsequent attendance 330 300 424 124 141%

M25003 Gastroenterology - Subsequent attendance 906 824 1136 312 138%

M30003 Haematology - Subsequent attendance 400 364 440 76 121%

M40003 Infectious Diseases - Subsequent attendance 100 91 39 -52 43%

M45003 Neurology - Subsequent attendance 600 545 765 220 140%

M50021 Oncology - Subsequent attendance 3240 2946 2888 -58 98%

M50023 Radiation Oncology - Subsequent attendance 268 244 389 145 160%

M60003 Renal Medicine - Subsequent attendance 356 324 374 50 116%

M65003 Respiratory - Subsequent attendance 240 218 255 37 117%

M70003 Rheumatology (incl immunology) - Subsequ 500 455 745 290 164%

Medical Total 12196 11088 11974 886 108%

SubSpec S25003 Ear Nose and Throat - Subsequent attenda 2000 1818 2001 183 110%

S40003 Opthalmology - Subsequent attendance 6400 5824 6037 213 104%

S70003 Urology - Subsequent attendance 2052 1865 1995 130 107%

SubSpec Total 10452 9507 10033 526 106%

Surgical S00003 General Surgery - Subsequent attendance 3650 3387 3438 51 101%

S45003 Orthopaedics - Subsequent attendance 6300 5815 5652 -163 97%

S75003 Vascular Surgery Subsequent Attendance 500 455 560 106 123%

Surgical Total 10450 9657 9650 -7 100%

W C & Y M55003 Paediatric Medical Outpatient - Subsequent attendance 2800 2546 2390 -156 94%

S30003 Gynaecology - Subsequent attendance 1245 1132 1340 208 118%

W03003 Subsequent obstetric consults 700 646 787 141 122%

W C & Y Total 4745 4324 4517 193 104%

Grand Total 37843 34576 36174 1598 105%

Medical & Surgical Procedures

NMDHBMay 2015


YTD

Actual

YTD

Vol

Variance

Actual %

Complete

vs YTD Plan

Medical M00006 General Medicine - Blood Transfusions 650 591 734 143 124%

M15004 Dermatology - UV Treatment 480 436 536 100 123%

M20007 Diabetes - Fundus Screening 1800 1638 1760 122 107%

M45004 Neurology - Botulinum toxin therapy 90 82 96 14 117%

M60008 Renal Medicine - Incentre dialysis 1600 1455 1667 212 115%

M65005 Respiratory - Bronchoscopy 70 64 32 -32 50%

M65006 Sleep apnoea - assessment 180 164 136 -28 83%

M65007 Sleep apnoea - long term treatment 300 273 326 53 120%

MS02005 Gastroscopy - Any Health Speciality 950 882 862 -20 98%

MS02009 IV Chemotherapy - cancer - Any health sp 2450 2227 2183 -44 98%

Medical Total 8570 7811 8332 521 107%

SubSpec S25006 ENT Minor procedure 1000 909 1069 160 118%

S40004 Minor Eye Procedures 20 18 3 -15 16%

S40004A Avastin (Intraocular injections) 1600 1456 1761 305 121%

S40005 Eye - Argon Laser 200 182 102 -80 56%

S70005 Urology - Cystoscopy 400 364 465 101 128%

S70006 Urology - Lithotripsy 24 22 27 5 124%

S70007 Urology - Urodynamics 60 55 76 21 139%

SubSpec Total 3304 3005 3503 498 117%

Surgical M25008 Capsule Endoscopy 10 9 18 9 198%

MS02007 Colonoscopy - Any Health Speciality 1700 1578 1686 108 107%

MS02014 Colonoscopy and Gastroscopy (Performed together, ie top & tail)170 158 132 -26 84%

MS02016 Skin lesion excisions 427 391 666 275 170%

S00008 Minor operations (Gen Surgery) 450 418 170 -248 41%

Surgical Total 2757 2553 2672 119 105%

W C & Y S30006 Termination of Pregnancy 430 391 345 -46 88%

S30008 Gynaecology - High cost Minor Procedures 75 68 100 32 147%

W03005 Amniocentesis 20 18 4 -14 22%

W C & Y Total 525 478 449 -29 94%

Grand Total 15156 13847 14956 1109 108%



Improving Diagnostic Waiting Times – Colonoscopy May diagnostic reporting is due at Ministry on 20 June 2015. NMDHB Colonoscopy information is as follows:



Improving Diagnostic Waiting Times:

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

Total Number accepted referrals waiting outside 6 weeks (excluding

referrals for scans that are planned patient events) 95 100 168 180 161 217 299 297 297 346 262



referrals for scans that are planned patient events) 213 163 255 281 286 310 329 344 362 413 402



referrals for scans that are planned patient events) 0 0 0 52 68 80 101 99 100 113 71 0

Diagnostic Reporting Template - MRI

Diagnostic Reporting Template - CT (DHB wide)

Diagnostic Reporting Template - CTC (DHB wide)

050

100150200250300350400

Diagnostic Reporting Template - CT (DHB wide) Total Number accepted referrals waiting outside

6 weeks (excluding referrals for scans that are planned patient events)

Diagnostic Reporting Template -CT (DHB wide) Total Number accepted referrals waiting outside

6 weeks (excluding referrals for scans that are planned patient events)

0

100

200

300

400

500

Diagnostic Reporting Template - MRI Total Number accepted referrals waiting outside 6 weeks (excluding referrals for scans that are

planned patient events)

Diagnostic Reporting Template -MRI Total Number accepted referrals waiting outside 6 weeks

(excluding referrals for scans that are planned patient events)

0

20

40

60

80

100

120

Jul-

14

Au

g-1

4

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

Diagnostic Reporting Template - CTCTotal number accepted referrals waiting outside

6 weeks (excluding referrals for scans that are

planned patient events

Diagnostic Reporting Template -CTC. Total number accepted referrals waiting outside 6 weeks

(excluding referrals for planned patient events)



Intervention Rates/Health Targets Cataracts Cataract intervention rates required for 2014/15 for NMDHB are 520 discharges. May 2015 saw us undertake 40 cataracts against a plan of 48. YTD delivery is 443 cataracts against a plan of 474. Joints Joint intervention rates required for 2014/15 for NMDHB is 440 discharges. May 2015 saw us undertake 36 joints against a plan of 38. YTD is 455 joints against a plan of 402. Cardiac Surgery Cardiac Surgery intervention rates required for 2014/15 for NMDHB is 103 discharges. YTD to end April 2015 is 86 discharges – 38 Acute and 48 Elective. Bariatric Surgery Bariatric Surgery intervention rates required for 2014/15 is four discharges. YTD delivery to end April 2015 is four discharges. Shorter Stays in Emergency Department In May 96.1% of patients were admitted and discharged within the six hour guideline.

ESPI Results Electives Initiative NMDHB is required to deliver 6,029 discharges in 2014/15. The April 2015 Ministry Reports indicate we have delivered 5,149 surgical discharges against a plan of 4,988 (103.2%). ESPI 1 Update ESPI 1 compliance (acknowledgement and acceptance of referrals) is now able to be reported electronically.



Trend for the previous 3 months



ESPI’s – 4 months



Final April (4 month) ESPI results



Theatre Cancellations



4.2 Specialist Services RADIOLOGY Highlights

MRI Wairau opening 29 May 2015

IANZ Accreditation visit (Nelson and Wairau) – no corrective actions although a number of recommendations expected, especially around resourcing – reports due early June.

Quality Initiatives

Progressing new call structure for Radiologists

Nuclear Medicine review continues

Weekly Operations Meetings (district wide) to review waitlist, delivery, resources and any other operations issues

Wairau working with Wairau Inpatients Unit to arrange “staff swaps” for four hour periods where staff can understand and view issues in radiology/inpatients. Aim is to increase understanding, discussion and realise more effective and considered patient flow

Preparing a communication around referrals to go out to hospital and community regarding the completeness of referrals.

Targets

Challenge to meet targets in Nelson due to shortage of Radiologist resource

CT daily throughput increased by outsourcing some reporting

Plain film reporting is being outsourced in part to maintain a reasonable clinical reporting timeframe

MOH CT targets, improved across MRI and CT – expect this to progressively continue.

Personnel

Interviewing for 2.0FTE Radiologist roles

Marlborough Breast Screening remains an issue. Diagnostic Breast Imaging being undertaken as is delivered in Nelson, ie at Nelson Radiology Limited. Having to re-advertise this position as no successful applicants. Second staff member has returned to work in a limited capacity. Locums being used as available.

COMMUNITY ORAL HEALTH SERVICE Highlights

Caries free rates at five years of age and again at year eight across the district show overall improvement between 2013 and 2014 – significant result

Pilot tooth brushing programme across Marlborough kindergartens being led by our oral health educator



DA application of Fluoride varnish programme remains work in development – being led by Community Dental Therapist (WR) – once in place expected to reduce the number of visits required at hubs and free Dental Therapist time allowing more focus on new enrolments and arrears

COHS have joined project from Maori Health Directorate around reduction of Maori DNAs.

Targets

Arrears remain at 18%, with DNA rate down to 9%

Number of children <5 yrs enrolled is 6,631; target for this year 7,242

Arrears plan formulated which re-focuses resources to hubs with highest arrears Mobiles reduced from two chairs (as arrears good on mobile units) to single chair with the additional resource being refocused into hubs.

Red = Arrears Target, Blue = Arrears, Green = DNA



2015 TCR Arrears % PSR

May Nelson 3969 1140 29 % 1372

Stoke 2925 692 24 % 959

Richmond 3585 609 17 % 915

Motueka 1770 67 4 % 601

Tasman Mobile 2217 123 6 % 641

Blenheim 4662 1057 23 % 1573

Mobile 1807 130 7 % 570

Totals 20935 3818 18 % 6631

OPHTHALMOLOGY Quality Initiatives

Working with CMO and ACMO regarding the implementation of district wide triage process as first step to equity of access and standardisation across both sites

Working with HOD towards introduction of performance appraisals/work plan for SMO team.

Targets

Pressure from overdue follow-ups still biggest issue

Ever increasing Avastins results in an increase in three follow-up SMO appointments plus nine other Avastin appointments per patient per year.

PROJECTS Picture Archiving and Communication Service (PACS) / Radiology Information System (RIS)

PACS/RIS upgrade complete and final check complete. Notice of discontinuing and turn off AGFA PACS units given. Servers were turned off on 31 May 2015.

National Radiology Service Improvement Project (NRSII)

Project dashboard

Project progresses well with service improvements identified

Value stream mapping now complete.



4.3 Women Child and Youth Service and Associate Director of Midwifery MATERNAL CHILD HEALTH INTEGRATION PROJECT Highlights

The contract was finalised between a contracting company and the NMDHB for the development of a Smartphone APP to support families so they know when their key scheduled appointments are next due.

Core Health Team

Some early pregnancy information packs have been developed to be distributed across our networks to encourage families to enrol with an LMC early in their pregnancy.

Tools for Co-ordinated Care

A trial will take place in June with one GP, two LMCs and a patient to utilise Manage My Health, which is a programme developed by MedTech, to assist with coordinating care.

Child Health Calendar

We have drafted two wallet cards for families to have to assist them to know when their appointments are due with different providers, one for the antenatal period and the other for 0-6 years.

Resources Centres

There has been en expression of interest document drafted to give to both PHOs requesting them to submit a proposal on how they can support each community Hub to become a resource service for families and how they can both support outreach hubs to become established across their regions.

CHILDREN’S TEAMS General

Service Manager met with the Local Operations management meeting. The main issue being raised at this point is the availability of Lead Professionals.

Targets

Marlborough Children’s Team is expected to have 130 children being referred to the services in the first two years. Currently there have been approximately 20 referred in six months.

PAEDIATRICS Highlights

The SCBU Department held a meeting with paediatrics and ADON to plan the delivery for a set of triplets. The outcome was that the triplets were birthed in Nelson and had a good outcome for all three babies.



OBSTETRICS AND GYNAECOLOGY SERVICE Quality Initiatives PACU

A good meeting was held this month and attended by anaesthetics, maternity staff, ADON, O&G and theatre nursing to discuss the model of care for delivery of elective caesareans. All agreed that the model of care is progressing well.

4.4 Medical Services CARDIOLOGY Personnel

Offers have been made for both the cardiology vacancies. One has an electrophysiology subspecialty and a case is being made for the placement of ICD (implantable cardiac devices) in Nelson

The second post has been offered to a UK candidate with long experience in Interventional Cardiology.

RMOS General

Recruiting is underway for ED registrars but proving difficult, this is aggravated by the ability of the Department to only offer six month appointments.

PHYSICIANS NELSON Financial/General

We continue to rely on locum support for gastroenterology and respiratory medicine as well as acute general cover with this significantly impacting the financials.

Highlights

Very positive feedback from the After Hours Duty Managers for the medical registrars is pleasing.

NEUROLOGY

The job description for the nursing role has been finalised ready for advertising by the ADON.



DERMATOLOGY

An external Doctor has agreed to conduct a review of dermatology at the end of June. He will help advise the model of care going forward.

EMERGENCY NELSON

Triage Categories

There appears to be a significant increase in triage 2 & 3 categories

Only 55% of triage 2 patients were seen inside triage time (ATS benchmark 80%).

PROJECT UPDATES FCT Oncology NMDHB featured in proposals covering:

Maori experience of cancer, collaboration with SCN, TPO and regional approach in out years

Head and Neck pathway, collaboration with CDHB and WCDHB

Colorectal pathway, collaboration with CDHB and WCDHB

Routes to diagnosis, comparison of ED, referral by GP and other, collaboration with SDHB.

80

82

84

86

88

90

92

94

96

98

100

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

% Patients <6hrs in ED

% < 6 hours

Target



FCT Monthly Report Reporting Month: Quarter 4 2014/15

As at 02/06/2015

62 Day Indicator Records

Target Summary

Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days

73% 27% 73% 27% 78% 22% 73% 27% 70% 30%

Number of Records 8 3 8 3 7 2 16 6 125 54

Total Number of Records 11 11 9 22 179

78 101 112 101 102

Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days

68% 13% 56% 44%

27 13 136 108

40 244

110 116

YEAR TO DATE

Tumour Stream % Within 62 Days Within 62 Days

% Exceeded

62 Days Exceeded 62 Days

Total

Records Column1 Ethnicity Column2 % Ethnicity Numbers

Brain/CNS 100% 1 0% 0 1 European not further defined 1% 2

Breast 95% 41 5% 2 43 Not stated 2% 4

Gynaecological 71% 10 29% 4 14 NZ European 85% 153

Haematological 33% 1 67% 2 3 NZ Maori 6% 10

Head & Neck 41% 7 59% 10 17 Other Asian 1% 1

Lower Gastrointestinal 70% 19 30% 8 27 Other European 4% 8

Lung 54% 15 46% 13 28 Response unidentifiable 1% 1

Other 0% 0 0% 0 0 Total 1 179

Sarcoma 100% 2 0% 0 2

Skin 100% 3 0% 0 3

Upper Gastrointestinal 75% 9 25% 3 12

Urological 57% 16 43% 12 28

Blank 100% 1 0% 0 1

All Streams 70% 125 30% 54 179

85% of patients had their 1st

treatment within: # days

Quarter 3 Previous Year

Completed Records


May-2015

(in progress)Apr-15 Mar-15

Quarter 4

(in progress) Year to Date




Target Summary

Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days

71% 29% 71% 29% 90% 10% 71% 29% 81% 19%

Number of Records 12 5 27 11 44 5 39 16 326 77

Total Number of Records 17 38 49 55 403

32 36 26 43 35

Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days

87% 13% 80% 20%

103 15 280 68

118 348

28 34

YEAR TO DATE

Tumour Stream % Within 31 Days Within 31 Days

% Exceeded

31 Days Exceeded 31 Days

Total

Records Column4 Ethnicity Co

lum

n2

% Ethnicity Numbers

Brain/CNS 92% 11 8% 1 12 African 0% 2

Breast 98% 62 6% 4 63 Don't know 0% 1

Gynaecological 80% 16 25% 5 20 European not further defined 2% 7

Haematological 92% 23 12% 3 25 Not stated 1% 5

Head & Neck 67% 8 33% 4 12 NZ European 85% 341

Lower Gastrointestinal 102% 48 13% 6 47 NZ Maori 3% 11

Lung 96% 22 9% 2 23 Other Asian 0% 1

Other 100% 4 0% 0 4 Other Ethnicity 0% 1

Sarcoma 133% 4 0% 0 3 Other European 8% 32

Skin 85% 39 24% 11 46 Response unidentifiable 0% 1

Upper Gastrointestinal 108% 26 0% 0 24 Tongan 0% 1

Urological 62% 54 40% 35 87 Total 100% 403

Blank 100% 9 0% 0 9

All Streams 81% 326 19% 77 403

Completed Records


May-2015

(in progress)Apr-15 Mar-15 Quarter 4

(in progress) Year to Date

85% of patients had their 1st

treatment within: # days

Quarter 3 Previous Year



0 50 100 150 200 250 300

Audiology Nelson

Dietary Nelson

Occupational Therapy Nelson

Orthotics Nelson

Physiotherapy Nelson

Social Work Nelson

Speech Language Therapy Nelson

<5 Months

5-6 Months

6 Months

4.5 Allied Health Services Facility

The DHBs requirement to find alternative premises for the Chemotherapy/Oncology Service, has resulted in a decision to relocate the Nelson/Tasman community allied health services to the Richmond Hub.

ERMS Referrals

All GP’s now have access to refer electronically via ERMS or via the advanced form.

Waiting List (Excludes CDS) Graph 1 indicates total number of patients waiting a first specialist allied health assessment for all departments’ ie audiology, orthotics, physiotherapy, occupational therapy, speech therapy, dietetics and social work. Each department has various strategies in place to address their own department waiting list. Graph 1a – YTD Total Allied Health Waiting List and by Department

Graph 1b – Waiting List by Department

0

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6 Months

5-6 Months



PHYSIOTHERAPY

The Nelson and Wairau Team Leaders continue to work closely, aiming to have a district wide approach. Demand for the service continues to be high.

Graph 4 a – Physiotherapy Waiting List Nelson

Project Updates Allied Health Assistant National Qualification

Following the graduation of the first group of four assistants it is anticipated that newly appointed assistants will commence in the next cohort.

Calderdale Framework

The next phase in implementing the Calderdale framework is underway and training has been arranged, the DAH/SM will become an accredited CF trainer to ensure success of the pilot.

Enhanced Recovery after Surgery – Orthopaedic Hip and Knee

Project is moving into business as usual and continual quality improvement. The new MOH focus and additional funding for primary care musculoskeletal prevention will be another phase of the pathway in early preventative management.

4.6 Surgical Services ELECTIVE SERVICES

Production Plan 2015/16 presented to the ELT

National Patient Flow phase 2 data requirements: Provisional plan sent to Ministry NPF team

NPF exception Letter written for CEO to MOH re our need for an exemption of those data fields we have no capacity to collect (5 compulsory and 11 pending compulsory) – until PICS is implemented.

0 50

100 150 200 250 300 350 400 450 500

Nelson Physiotherapy

6 Months

5-6 Months

<5 Months



THEATRES

A total of 194 theatre sessions were resourced and utilised in Nelson theatres

This is 94% session utilisation rate of our Nelson capacity in OT 1-5. If we include OT6 in these calculations, then our utilisation rate drops to 78%. Of the 194 resourced sessions in May, seven of these were completed in OT6.

GENERAL SURGERY

Continued use of locums in Wairau for coverage of surgical call every fourth weekend

General Surgeon John Emanuel retired 29 May 2015

Resignation of Vascular Surgeon. ENDOSCOPY

Investigating with SIAPO team a capacity planning tool

Endoscopy User Group meeting with good engagement. 4.7 Nursing - Wairau GENERAL Highlights

Recruited staff for Road Transfer Ambulance Service commenced 1 May.

Quality boards have been re-established in IPU with KPIs being displayed. Quality Initiatives

Telemetry contingency plan in draft

St Johns Daily Road transfer project. Commenced 1 May with 11 patients transferred via road during the first month

HQSC – Safer Opioid project underway. 4.8 Nursing - Nelson ADON HIGHLIGHTS

During the month of May there was an Ebola Alert which highlighted improvements needed to our system. Additional to this there was an Earthquake which necessitated an Emergency Response Team activation. No major events were recorded

Telemetry Failure highlighted a need for contingency plans for Duty Nurse Managers to activate to mobilise patients

Quality Boards currently being reviewed and re-established in wards.

Discussion is underway with Occupational Health around Principles of a Lifting Team to avoid back and strain injuries among nursing staff

Special Care Baby Unit (SCBU) has been successful in caring for Twins and Triplets born at Nelson and cared for by Nelson SCBU team, this has contributed to more effective utilisation of SCBU and reduced IDF as well as kept newborns closer to home cared by skilled nursing and medical staff



Regional Discharge Committee has identified champion wards to conduct a project to improve discharge planning processes.

4.9 Public Health, Rural and District Nursing Services GENERAL

A workshop held in Motueka on Rural Palliative Care was a useful step in cementing the relationship between rural health providers, the Nelson Tasman Regional Hospice Trust and the District Nursing in particular. This was organised by NTRHT after discussions with NMDHB

The NMDHB is now the leading DHB in New Zealand on the smoking target. ONCOLOGY

The decision has been made to shift all of Oncology Services, including chemotherapy, to the fifth floor of the Percy Brunette building.

PUBLIC HEALTH EVD (Ebola Virus Disease) response

The NMDHB Emergency Response Team and Public Health Service has requested a debrief meeting with the Ministry of Health relating to the transfer of the symptomatic healthcare worker who was transferred to Wellington hospital last month.

Tarakohe Breakwater-Shellfish Warning Signage

Following diarrhoea and vomiting in two people after the consumption of mussels and oysters off the outer side of the breakwater at Tarakohe the PHS recommended that the Tasman District Council (TDC) erect a warning sign at the port Tarakohe breakwater.

Taylor River – Marlborough District Council (MDC)

At the conclusion of this year’s recreational water sampling programme in Marlborough, the PHS recommended to the MDC that they review the Taylor River water quality.

Smoke free Environment Act

A complaint was received from a tobacco retailer about another retailer selling electronic cigarettes they considered illegal due to the e-cigarette looking like a tobacco product. E-cigarettes that look like tobacco cigarettes can be sold only to over 18 year old people however they cannot be sold by retail if they contain nicotine or make a therapeutic claim under the Medicines Act 1981. The complainant has been advised and the e-cigarette retailer will be investigated to ensure they are aware and comply.



Vision Hearing Screening

The vision and hearing re-screening in Marlborough has now been completed. The catch-up of Nelson/Tasman is now underway and progressing well.

Highlights Council Long Term Plan Submissions

The PHS has prepared submissions on behalf of the DHB for all three council Long Term Plans. These have included a strong emphasis on the value of water fluoridation.

Targets

Target Name Target Actual – At November 2013

Smokefree DHBs

95% of patients admitted to hospital who are smokers, are given advice and support to quit.

97.92% for April of completed coded discharges at 24/5/15 97.87% at report date for May- coding incomplete

B4 School Checks

1432 Total 139 High Deprivation 80% (1432) of all 4 year olds in the Nelson Marlborough population are required to have a B4 School Check completed.

1412 92% 132 84% (need to be at 100% by 7 July 2015)

8mths Immunisations

Total 85% Maori 85% Pacific 85% Asian 85% 85% of all children at 8 months of age are required to be fully immunised

Monthly results ending May 2015 Total 89% Maori 82% Pacific 100% Asian 100% (accurate data will not be available until 11 June 2015)

2yrs Immunisations

Total 95% Maori 95% Pacific 95% Asian 95% 95% of all children at the age of 2 years are required to be fully immunised)

Monthly results ending May 2015 Total 94% Maori 94% Pacific 0% Asian 100% (accurate data will not be available until 11 May 2015)

HPV 70% (approx) of year HPV dose 1: 443 (51.4%)



8 girls in Nelson Marlborough are immunised against HPV

HPV dose 2: 1 Data entry is incomplete at this time

Adolescent Oral Health

78% of eligible adolescents will utilise/attend the adolescent dental service annually (January – December)

Interim data around the enrolment and utilisation targets for 2014/ 2015 from the Ministry of Health and NMDHB Adolescent Oral Health Service was received Feb 2015. Percentage rates not available as yet. Complete data available June 2015. http://oralhealthdata.hiirc.org.nz/

Cx Screening

80% of women aged between 20 and 69 in the Nelson Marlborough population are required to have been screened in the past 3 years

Total 80.2% Maori 67.7% Asian 61.6% Pacific 67.2% Other 82.5% (latest figures available as at March 2015) These figures are now based on the 2013 Census, which has shown a significant decrease for both Asian & Pacific.

DISTRICT NURSING General

District Nursing has now moved to a common database across Nelson and Wairau

The Nelson DN team is eagerly anticipating the move to the Richmond hub. This is anticipated to be mid July

District Nursing is now regularly attending meetings of the Motueka Health Alliance

After discussion with Kimi Hauora Wairau a project to create an alliance with general practice has been initiated. This will aim to facilitate GPs and DNs working more closely together. It will also work on getting DN access to writing into Concerto and in turn, Health Connect South.

Highlights

Some 350 delegates attended the NZ Conference on Wound Care, at the Conference Centre in Blenheim in late May. This attracted international speakers. Two DNs from the Wairau team were leaders in organising this event.

http://oralhealthdata.hiirc.org.nz/



DIABETES NURSING General

Planning is well under way to implement the trial of Specialist Diabetes Nursing working with General Practice. The project is to be discussed with the Clinical Governance Group of NBPH in June.

4.10 Clinical Support Services GENERAL – SERVICE ISSUES

The DHB Coding Team is significantly challenged with current staff vacancies, with four staff missing from the complement of five

We currently have two vacancies for Team Leaders with the wider service, with the recent resignation of the Team Leader ED, Ortho and Allied Health.

Highlights

We have appointed a new trainer at Nelson

The uptake of the new Winscribe app by SMO’s and HOD’s has been very high. This means the associated problems with Dictaphones and loss of dictation has all but disappeared

Medical Records have started a trial with the Oncology Department at Nelson by not delivering the patient file to their clinics. The SMO’s will instead use the clinical intranet. It is hoped to expand this trial to other departments in due course

Medical Records are moving to a combined patient record from 1 July. Where there may currently exist a file at both Nelson and Wairau for the same patient, from 1 July that file will be merged and held at the hospital nearest to the patient’s home location. The process for merging files was initially tested with Cardiology.

PROJECT/INVESTIGATION UPDATES South Island Patient Administration System (SI PICS) Training Plan

Work in progress continues with process mapping and identification of service improvement initiatives. The confirmed appointment of two dedicated trainers to Clinical Support will significantly address the risks around training beyond go-live of PICS sometime in late 2016.

QUALITY INITIATIVES

Working with GM Clinical Governance Support, and Maori Health and Whanau Ora team to identify Maori health pathways and the incidence of DNA’s at outpatients and theatre cancellations involving Maori.



4.11 ERMS

3032 requests to all providers were generated using ERMS in May 2015. This figure includes requests for outpatient assessment, referrals to private providers, requests for specialist advice, and radiology services

The chart below shows ERMS requests as a percentage of all outpatient medical and surgical assessment referrals received by the DHB Year to Date for 2014/15 and recorded in the Oracare patient administration system. Nearly three quarters of all outpatient requests in May were sent via ERMS.

Primary and secondary mental health services have been working to pilot using ERMS to deliver Mental Health referrals in Marlborough in development

Installation to final two Nelson practices to be completed in June 2015, making the completion of Stage 1 of ERMS project

Planning to begin for Stage 2 of ERMS when Health Connect South becomes available in September 2015.



5. CLINICAL SERVICES FINANCIALS

Executive: GMCS Month: May 2015

May May May YTD YTD YTD Full Year

Actual Budget Var Actual Budget Var Budget

Revenue

12 - Ministry of Health 348,696 334,348 14,348 5,376,822 4,975,351 401,472 5,309,699

14 - Other Government - Other DHBs 39,199 24,523 14,676 316,748 269,488 47,260 294,011

15 - Other Government - ACC 383,183 356,069 27,113 3,998,224 3,905,506 92,718 4,216,305

16 - Other Government - Other 89,350 57,933 31,417 784,297 637,267 147,030 695,200

17 - Patient and Consumer Sourced 237,353 355,738 (118,385) 3,852,836 3,939,865 (87,029) 4,296,994

18 - Other Income 165,245 145,791 19,454 1,653,673 1,599,887 53,786 1,745,678

19 - Internal Income 17,853,135 17,823,747 29,388 195,808,858 195,631,136 177,723 213,399,954

Total Revenue 19,116,160 19,098,150 18,011 211,791,459 210,958,500 832,959 229,957,840

Workforce

21 - Medical Personnel 3,208,783 3,199,778 (9,005) 35,364,482 35,932,121 567,639 39,282,051

31 - Outsourced - Medical Personnel 297,420 116,047 (181,373) 2,939,739 1,246,064 (1,693,675) 1,338,442

Total Medical 3,506,203 3,315,825 (190,378) 38,304,221 37,178,185 (1,126,036) 40,620,493

22 - Nursing Personnel 3,335,805 3,176,521 (159,284) 36,251,772 35,548,464 (703,308) 38,961,016

32 - Outsourced - Nursing Personnel 6,836 43 (6,793) 140,012 475 (139,537) 518

Total Nursing 3,342,641 3,176,564 (166,077) 36,391,784 35,548,938 (842,845) 38,961,534

23 - Allied Health Personnel 1,238,391 1,310,453 72,062 13,524,330 14,567,668 1,043,338 15,935,554

33 - Outsourced - Allied Health (9,478) 4,753 14,230 21,446 52,278 30,831 57,030

Total Allied Health 1,228,913 1,315,205 86,292 13,545,776 14,619,945 1,074,169 15,992,584

24 - Support Personnel 65,229 67,289 2,060 751,160 751,420 260 822,208

Total Hotel Services 65,229 67,289 2,060 751,160 751,420 260 822,208

25 - Management/Administration Personnel 749,433 725,689 (23,745) 7,984,128 8,223,356 239,228 8,983,416

35 - Outsourced - Management/Admin 11,258 0 (11,258) 179,937 0 (179,937) 0

Total Management/Admin 760,691 725,689 (35,003) 8,164,065 8,223,356 59,291 8,983,416

Total Workforce Costs 8,903,678 8,600,572 (303,106) 97,157,006 96,321,845 (835,161) 105,380,235

36 - Outsourced - Clinical Services 814,868 674,273 (140,595) 8,053,437 7,195,313 (858,124) 7,873,694

37 - Outsourced - Corporate/Governance 0 0 0 7,634 0 (7,634) 0

38 - Outsourced Funder Services 0 0 0 3,200 0 (3,200) 0

Outsourced Services 814,868 674,273 (140,595) 8,064,271 7,195,313 (868,958) 7,873,694

41 - Treatment Disposables 1,009,049 938,681 (70,368) 10,744,965 9,917,577 (827,389) 10,825,692

42 - Diagnostic Supplies & Other Clinical Supplies 74,991 63,930 (11,060) 752,912 732,599 (20,313) 796,767

43 - Instruments & Equipment 201,143 175,402 (25,741) 1,824,952 1,946,322 121,369 2,115,298

44 - Patient Appliances 126,975 126,769 (206) 1,442,142 1,380,073 (62,069) 1,505,082

45 - Implants and Prostheses 505,509 507,923 2,414 5,527,826 5,199,727 (328,099) 5,692,509

46 - Pharmaceuticals 571,770 576,794 5,024 6,306,518 5,964,656 (341,862) 6,502,687

47 - Other Clinical & Client Costs 275,818 214,581 (61,237) 2,659,433 2,360,391 (299,042) 2,574,972

Clinical Supplies 2,765,256 2,604,081 (161,175) 29,258,749 27,501,345 (1,757,404) 30,013,008

51 - Hotel Services, Laundry & Cleaning 445,903 422,713 (23,190) 4,644,051 4,600,559 (43,492) 5,011,928

52 - Facilities 40,769 33,580 (7,188) 420,947 357,809 (63,138) 391,856

53 - Transport 38,373 28,924 (9,450) 388,012 319,943 (68,069) 348,780

54 - IT Systems & Telecommunications 105,911 48,655 (57,256) 862,621 534,264 (328,358) 582,750

55 - Interest & Financing Charges 95 71 (24) 1,020 779 (241) 850

148 - Depreciation 337,749 329,586 (8,163) 3,379,026 3,625,446 246,420 3,955,028

56 - Professional Fees & Expenses 5,776 11,234 5,457 80,589 132,979 52,390 144,213

57 - Other Operating Expenses 94,464 76,601 (17,863) 828,183 840,362 12,179 916,404

Infrastructure 1,069,041 951,364 (117,677) 10,604,450 10,412,141 (192,309) 11,351,808

6136 - Laboratory 491,990 482,042 (9,948) 5,261,973 5,173,342 (88,630) 5,619,155

6235 - Primary Health Care Strategy - Other 16,667 16,720 54 183,333 183,922 589 200,643

6289 - Travel & Accommodation 283,616 280,948 (2,669) 2,972,132 2,789,463 (182,670) 3,051,712

6290 - Inter District Flows Personal Health - Own

DHB Population 2,914,091 2,912,748 (1,343) 31,382,326 32,040,233 657,907 34,952,981

6692 - Inter District Flows Disability Support -

Own DHB Population 16,268 16,268 0 178,384 178,949 564 195,216

Provider Payments 3,722,632 3,708,727 (13,905) 39,978,148 40,365,909 387,760 44,019,707

81 - Internal Transfers 54,947 51,933 (3,014) 601,751 569,480 (32,271) 621,413

Internal Allocations 54,947 51,933 (3,014) 601,751 569,480 (32,271) 621,413

Total Costs 17,330,422 16,590,949 (739,473) 185,664,376 182,366,033 (3,298,342) 199,259,865

Net Result 1,785,738 2,507,200 (721,462) 26,127,083 28,592,466 (2,465,383) 30,697,975

FTEs

May May May YTD YTD YTD Full Year

Actual Budget Var Actual Budget Var Budget

20 - Medical Personnel 177.31 172.91 (4.40) 168.31 173.31 5.00 173.30

22 - Nursing Personnel 528.10 500.27 (27.83) 501.15 498.38 (2.77) 498.54

2402 - Allied Health Personnel 211.82 218.61 6.78 203.39 218.58 15.19 218.61

26 - Hotel Services 19.12 18.24 (0.88) 19.15 18.23 (0.92) 18.23

28 - Management/Administration 188.06 174.68 (13.39) 173.15 174.78 1.62 174.78

1,124.41 1,084.70 (39.71) 1,065.15 1,083.28 18.13 1,083.46



Peter Bramley General Manager Clinical Services

RECOMMENDATION:

THAT THE CLINICAL SERVICES REPORT BE RECEIVED.

Nelson Marlborough District Health Board Open Meeting

Glossary 5-1

GLOSSARY OF COMMONLY USED ACRONYMS, ABBREVIATIONS AND MAORI TRANSLATION

ABC Ask about their smoking status; brief advice to quit; cessation A4HC Action for Healthy Children A&D / AOD Alcohol and Drug / Alcohol and Other Drugs A&R Audit & Risk Committee ACC Accident Compensation Corporation ACMO Associate Chief Medical Officer ACNM - Associate Charge Nurse Manager ACU Ambulatory Care Unit ACP Advanced Care Plan ADM Acute Demand Management ADON Associate Director of Nursing AE Alternative Education AEP Accredited Employer Programme AIR Agreed Information Repository ALOS Average Length of Stay ALT Alliance Leadership Team (short version of (TOSHALT) AOD Alcohol and Drug AOHS Adolescent Oral Health Services AP Annual Plan with Statement of Intent ARC Aged Residential Care ARF Audit Risk and Finance ARCC Aged Residential Care Contract ARRC Aged Related Residential Care ASD Autism Spectrum Disorder ASMS Association of Salaried Medical Specialists AT&R Assessment, Treatment & Rehabilitation BSCQ Balanced Score Card Quadrant BA Business Analyst BCTI Buyer Created Tax Invoice BFCI Breast Feeding Community Initiative BFCI Baby Friendly Community Initiative BOT Board of Trustees BS Business Support BSI Blood Stream Infection BSMC Better, Sooner, More Convenient CaaG Capacity at a Glance CAMHS Child and Adolescent Mental Health Services CARES Coordinated Access Response Electronic Service CBAC Community Based Assessment Centres CBF Capitation Based Funding CBSD Community Based Service Directorate CE (CEO) Chief Executive (Chief Executive Officer) CEA Collective Employee Agreement CDHB Canterbury District Health Board CCDHB Capital & Coast District Health Board (also called C & C) CCDM Care Capacity Demand Management CCDP Care Capacity Demand Planning CCF Chronic Conditions Framework CCT Continuing Care Team CCU Coronary Care Unit CDEM Civil Defence Emergency Management CDHB Canterbury District Health Board CDM Chronic Disease Management CEG Coordinating Executive Group (for emergency management)


Glossary 5-2

CeTas Central Technical Advisory Support CFA Crown Funding Agreement or Crown Funding Agency CFO Chief Financial Officer CGC Clinical Governance Committee CHFA Crown Health Financing Agency CHS Community Health Services CIMS Coordinated Incident Management System CIO Chief Information Officer CLAB Central Line Associated Bacteraemia CME Continuing Medical Education CMI Chronic Medical Illness CMO Chief Medical Officer CMS Contract Management System CNM Charge Nurse Manager Concerto IT system which provides clinician’s interface to systems COHS Community Oral Health Service COO Chief Operating Officer COPD Chronic Obstructive Pulmonary Disease COPMI Children of Parents with Mental Illness CPHAC Community and Public Health Advisory Committee CPIP Community Pharmacy Intervention Project CPNE Continuing Practice Nurse Education CPO Controlled Purchase Operations

CPSOG Community Pharmacy Services Operational Group

CPU Critical Purchase Units CRG Christchurch Radiology Group CRISP Central Region Information Systems Plan CSR Contract Status Report CSSD Central Sterile Supply Department CSSD Clinical Services Support Directorate CTA Clinical Training Agency CTC Contributions to Cost CTANAG Clinical Training Agency Nursing Advisory Group CTU Combined Trade Unions CVD Cardiovascular Disease CVDRA Cardiovascular/Diabetes Risk Assessment CWD Case Weighted Discharge CYF Child, Youth and Family CYFS Child, Youth and Family Service DAH Director of Allied Health DAP District Annual Plan DAR Diabetes Annual Review DBT Dialectical Behaviour Training DHB District Health Board DHBNZ District Health Boards New Zealand DHBRF District Health Boards Research Fund DIFS District Immunisation Facilitation Services DiSAC Disability Support Advisory Committee DGH Director General of Health DMH Director of Maori Health DNA Did Not Attend DONM Director of Nursing and Midwifery DR Disaster Recovery DRG Diagnostic Related Group DSP District Strategic Plan DSS Disability Support Services DWCSP District Wide Clinical Services Plan EAP Employee Assistance Programme


Glossary 5-3

EBID Earnings Before Interest & Depreciation ECWD Equivalent Case Weighted Discharge ED Emergency Department EDA Economic Development Agency EDaaG ED at a Glance EFI Energy For Industry ELT Executive Leadership Team EMPG Emergency Management Planning Group ENT Ears, Nose and Throat EOI Expression of Interest EPA Enduring Power of Attorney EQP Earthquake Prone Building Policy ERMS ereferral Management System ESA Electronic Special Authority ESOL English Speakers of Other Languages ESPI Elective Services Patient Flow Indicators ESR Environmental Science & Research ESU Enrolled Service Unit EVIDEM Evidence and Value: Impact on Decision Making FCT Faster Cancer Treatment FF&E Furniture, Fixtures and Equipment FFT Future Funding Track FMIS Financial Management Information System FOMHT Friends of Motueka Hospital Trust FOUND Found Directory is an up-to-date listing of community groups and

organisations in Nelson/Tasman FPSC Finance Procurement and Supply Chain FRC Fee Review Committee FSA First Specialist Assessment FST Financially Sustainable Threshold FTE Full Time Equivalent FVIP Family Violence Intervention Programme GM General Manager GMS General Medical Subsidy GP General Practitioner GRx Green Prescription hA healthAlliance HAC Hospital Advisory Committee HBI Hospital Benchmarking Information HBSS Home Based Support Services HBT Home Based Treatment H&DC / HDC Health and Disability Commissioner HDSP Health & Disability Services Plan Programme HDU High Dependency Unit HEA Health Education Assessments He Kawenata Covenant, agreement, treaty, testament (PM Ryan Maori Dictionary pg 104) HEeADSSS Psychosocial tool – Home, Education, eating, Activities, Drugs and Alcohol,

Sexuality, Suicidality (mood), Safety HEHA Healthy Eating Healthy Action HEP Hospital Emergency Plan HESDJ Ministries of Health, Education, Social Development, Justice HFA Health Funding Authority HHS Hospital and Health Services HIA Health Impact Assessment HM Household Management HMS Health Management System HODs Heads of Department HOP Health of Older People


Glossary 5-4

HP Health Promotion HPI Health Practitioner Index HPV Human Papilloma Virus HR Human Resources HR & OD Human Resources and Organisational Development HQSC Health Quality & Safety Commission IANZ International Accreditation New Zealand IBA Information Builders of Australia IDF Inter District Flow IDSS Intellectual Disability Support Services IFRS International Financial Reporting Standards IHB Iwi Health Board

ILM Investment Logic Mapping

IM Information Management InterRAI Inter Residential Assessment Instrument IoD Institute of Directors New Zealand IPAC Independent Practitioner Association Council IPC Intensive Patient Care IPC Units Intensive Psychiatric Care Units IPG Immunisation Partnership Group IPSAS International Public Sector Accounting Standards IPU In-Patient Unit IS Information Systems ISSP Information Services Strategic Plan IT Information Technology JAMHWSAP Joint Action Maori Health & Wellness Strategic Action Plan JOG Joint Oversight Group KIM Knowledge and Information Management Kotahitanga Unity, accord, coalition, solidarity (PM Ryan Maori Dictionary pg 127) KPI Key Performance Indicator KHW Kimi Hauora Wairau (Marlborough PHO) LA Local Authority LCN Local Cancer Network LIS Laboratory Information Systems LOS Length of Stay LSCS Lower Segment Caesarean Section LTC Long Term Care LTCCP Long Term Council Community Plan LTO Licence to Occupy LTS-CHC Long Term Supports – Chronic Health Condition LTSFSG Long Term Service Framework Steering Group Manaakitanga Goodwill, show respect, or kindness to ((PM Ryan Maori Dictionary pg 172) Manawhenua Power, prestige, authority over land (HW Williams Maori Dictionary pg 172) Manawhenua O Te Tau Ihu O Te Waka A Maui – Referring to the eight iwi who hold tribal

authority over the top of the South Island (no reference) MA Medical Advisor MCT Mobile Community Team MDC Marlborough District Council

MDM Multidisciplinary Meetings

MDO Maori Development Organisation MDS Maori Development Service MDT Multi Disciplinary Team MECA Multi Employer Collective Agreement MHAU Mental Health Admission Unit MHC Mental Health Commissioner MHD Maori Health Directorate MHDSF Maori Health and Disability Strategy Framework MHFS Maori Health Foundation Strategy


Glossary 5-5

MHINC Mental Health Information Network Collection MHSD Mental Health Service Directorate MHWSF Maori Health and Wellness Strategic Framework MMG Medicines Management Group MOH Ministry of Health MOH Medical Officer of Health MOA Memorandum of Agreement MOSS Medical Officer Special Scale MOU Memorandum of Understanding MOW Meals on Wheels MPDS Maori Provider Development Scheme MQ&S Maternity Quality & Safety Programme MRI Magnetic Resonance Imaging MRT Medical Radiation Technologist (or Technician) MSD Ministry of Social Development MSD Marlborough Services Directorate MSSD Medical Surgical Services Directorate NPA Nutrition and Physical Activity NRAHDD Nelson Region After Hours & Duty Doctor Limited NRL Nelson Radiology Ltd NRT Nicotine Replacement Therapy MRSA Methicillin Resistant Staphylococcus Aureus NHBIT National Health Board IT NASC Needs Assessment Service Coordination NBPH Nelson Bays Primary Health NCC National Capital Committee NCC Nelson City Council NCSP National Cervical Screening Programme NETP Nursing Entry to Practice NGO Non Government Organisation NHCC National Health Coordination Centre NHI National Health Index NIR National Immunisation Register NMDHB Nelson Marlborough District Health Board NMDS National Minimum Dataset NMIT Nelson Marlborough Institute of Technology NN Nelson NPA Nutrition and Physical Activity (Programme) NPV Net Present Value NRAHDD Nelson Regional After Hours and Duty Doctor Ltd NSU National Screening Unit NTOS National Terms of Settlement NZHIS NZ Health Information Services NZMA New Zealand Medical Association NZNO NZ Nurses Organisation NZPH&D Act NZ Public Health and Disability Act 2000 OAG Office of the Auditor General OECD Organisation for Economic Co-operation and Development OIA Official Information Act OIS Outreach Immunisation Services OPD Outpatient Department OPF Operational Policy Framework OPJ Optimising the Patient Journey OSH Occupational Health and Safety OT Occupational Therapy PACS Picture Archiving Computer System PAS Patient Administration System P&F Planning and Funding


Glossary 5-6

PANT Physical Activity and Nutrition Team PBF(F) Population Based Funding (Formula) PC Personal Cares P&C Primary & Community PCBU Person Conducting Business Unit PCI Percutaneous Coronary Intervention PCO Primary Care Organisation PCT Pharmaceutical Cancer Treatments PDR Performance Development Review PDRP Professional Development and Recognition Programme PDSA Plan, Do, Study, Act PFG Performance Framework Group (formerly known as Services Framework

Group) PHS Public Health Service PHCS Primary Health Care Strategy PHI Public Health Intelligence PHO Primary Health Organisation PHOA PHO Alliance PHONZ PHO New Zealand PHS Public Health Service PHU Public Health Unit PIA Performance Improvement Actions PICS Patient Information Care System PN Practice Nurse PPE Property, Plant & Equipment assets PPP PHO Performance Programme PSAAP PHO Service Agreement Amendment Protocol PT Patient PTAC Pharmacology and Therapeutics Committee PRIMHD Project for the Integration of Mental Health Data PVS Price Volume Schedule Q&SGC Quality & Safety Governance Committee QA Quality Assurance QHNZ Quality Health NZ QIC Quality Improvement Council QIPPS Quality Improvement Programme Planning System Rangatiratanga Autonomy, evidence of greatness (HW Williams Maori Dictionary pg 323) RDA Resident Doctors Association RDA Riding for Disabled RIF Rural Innovation Fund RFI Request for Information RFP Request for Proposal RICF Reducing Inequalities Contingency Funding RIS Radiology Information System RM Registered Midwife RMO Resident Medical Officer RN Registered Nurse ROI Registration of Interest RSE Recognised Seasonal Employer RSL Research and Sabbatical Leave SAC1 Severity Assessment Code SAC2 Severity Assessment Code SAN Storage Area Network SCBU Special Care Baby Unit SCN Southern Cancer Network SDB Special Dental Benefit Services SHSOP Specialist Health Services for Older People SIA Services to Improve Access


Glossary 5-7

SIAPO South Island Alliance Programme Office SICF South Island Chairs Forum SICSP South Island Clinical Services Plan SI HSP South Island Health Services Plan SIRCC South Island Regional Capital Committee SISSAL South Island Shared Service Agency SLA Service Level Agreement SLATs Service Level Alliance Teams SLH SouthLink Health SMO Senior Medical Officer SNA Special Needs Assessment SOI Statement of Intent SOPD Surgical Outpatients Department SOPH School of Population Health

SPaIT Strategy Planning and Integration Team SPAS Strategy Planning & Alliance Support SSBs Sugar Sweetened Beverages SSE Sentinel and Serious Events

TDC Tasman District Council TLA Territorial Local Authority TOW Treaty of Waitangi TOR Terms of Reference ToSHA Top of the South Health Alliance

TPOT The Productive Operating Theatre

TRTT Te Roopu Tupu Tahi UG User Group VLCA Very Low Cost Access VRA Vascular Risk Assessment WAM Wairau Accident & Medical Trust WAVE (Project) Working to Add Value through E-Information WEll Whanau Engagement, Innovation and Integration WIP Work in Progress WR Wairau YOTS Youth Offending Teams YTD Year to Date YTS Youth Transition Service As at 17 June 2015

hospital advisory committee respect nelson …section 6: presentation the gm maori health &...

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