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Chief Executive’s Report 4-1

MEMO

To: Board Members

From: Peter Bramley, Chief Executive

Date: 23 April 2019

Subject: Chief Executive’s Report

1. INTRODUCTORY COMMENTS

Recently we had our 3 yearly visit by the independent Audit Agency to assess the quality and risk management systems for our DHB. I want to acknowledge the huge effort by many teams in preparing for the audit, especially the Clinical Governance support team. The nine auditors, as well as a number of trainees, spent a week in our organisation travelling across the district visiting wards, inpatient units, disability services and community teams. They visited at a time when our hospital world was incredibly busy, with occupancy every day in Nelson at 100% or more. The Auditors at the end of the week provided some overall comments on their visit. The most important message they gave was that “patients were getting good care and are safe”. They identified a number of areas where we can improve – like improving our documentation, handovers, and discharge processes, and making sure we meet the appropriate privacy requirements. Perhaps one of the most pleasing messages they gave was the “staff at all times were seen to act in a friendly, respectful and professional manner – firstly towards patients, and also to fellow staff”. We should be extremely proud of our care teams in the way they deliver care from day to day, often in the midst of significant demand and busyness.

2. PRIMARY & COMMUNITY

Patient Story: Complex medical patient requiring hospital level care in the community; a great success story:

Mr F had already spent 17 days in hospital with a diagnosis of prosthetic valve infective endocarditis. This diagnosis meant he was going to require 6 weeks of intensive double IV antibiotics. The type of antibiotics and the treatment regime required has not previously been managed in the Nelson community. Previously, a patient with this treatment plan would have been managed in the hospital. Gentamycin needs to be very closely monitored with regular blood tests to ensure renal function is not deteriorating. The following is an excerpt from the infectious diseases specialist’s first email to the District Nursing Service:

“He is a pretty robust 78yr old with prosthetic valve infective endocarditis – the most difficult to cure. This will be a tough man to look after due to the complexity of treatment – but will be worth the effort.”

A lot of time was spent planning how the District Nursing Service could manage this man’s care in the community as he is based rurally. He required daily visits for:

IV infusion of Gentamycin over 30mins via a PICC line.

Connection of an IV infuser of Penicillin which runs for 24hrs.

Status This report contains: For decision Update Regular report

For information


Blood tests 3 times weekly via PICC line, taken by District Nurse.

Further bloods tests for Gentamycin peak and trough levels twice in a day on Fridays.

Daily assessment of his condition, monitoring symptoms and risk level. Daily visits took between 1-1.5 hours. Plans were put in place for shared care with the Wakefield District Nurses and Richmond Clinic nurses. He would come into clinic for the days he required his blood tests and have his antibiotics administered at the same time. It has taken a lot of co-ordination and planning of care.

Mr F’s treatment is now complete and it has been extremely successful. For Mr F it has made a huge difference to his quality of life and health outcomes by being able to have his treatment at home. It has saved a bed in the hospital for 6 weeks. The interdisciplinary care and communication between the infectious diseases specialists, district nurses and pharmacy has been seamless.

This is a great example of how complex hospital level care can be delivered in the community by expert district nurses. The skills, knowledge and ability to practice autonomously has had a huge impact on this patient’s journey.

The inter-agency liaison and collaboration between NMH, NBPH and MPHO has been very successful in assisting the distribution of adequate numbers of MMR vaccines around all primary care practices, and ensuring adequate stock. This has been essential to keep to our target of achieving all scheduled MMR vaccinations at 15 months and at 4 years of age. Liaison has occurred with the NMH Communications Team around poster advertising messages for ED and practices. All primary schools, early childhood education centres and Kohanga Reo have received a Measles Advisory from the Medical Officer of Health.

The official opening of the Seddon water treatment plant was attended by invited guests including Mayor, Member of Parliament, Council engineering staff, Seddon Water User Group, consultants and drinking water staff from NMH.

Nelson Marlborough Health had the best adolescent oral health enrolment and utilisation results in New Zealand in 2018 with the latest interim results at 80% compared to 67.5% nationally.

In March we received a total of 64 referrals to the Stop Smoking Service (24 from Marlborough and 40 from Nelson). Of the 64 referrals two were Pēpi First. New clinics have started in Victory Community Centre and the Motueka Community House. Visibility at the community centres has led to new referrals.

The Individualised Placement Support pilot in Blenheim is progressing well. This pilot sees two employment specialists employed by Te Ara Mahi co-located and integrated with the Witherlea Mental Health teams.

NMH, Nelson Bays Primary Health two general practices in Motueka are exploring a 6 month pilot for mental health and addiction treatment in general practice, similar to the Procare pilot currently underway.


Progress – Targets & Volumes

Target Name Target Actual

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

B4 School Checks

Total 1440 High Deprivation 176 90% (1440) of all 4 year olds in the Nelson Marlborough population are required to have a B4 School Check completed.

1206 84% 106 67% (13 more needed) (need to be at 75% by 7 April 2019)

8 Month Immunisations

Total 95% Maori 95% Pacific 95% Asian 95% 95% of all children at 8 months of age are required to be fully immunised

Monthly results ending March 2019

Total 92% Maori 74% Pacific 100% Asian 100% Total declines/opt offs 5.2% (accurate data will not be available until 11 April 2019)

Quarterly results ending March 2019

Total 88% Maori 86% Pacific 100% Asian 96%

Total declines/opt offs 8.1% (accurate data will not be available until 11 April 2019)

2 Year 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


Total 88% Maori 92% Pacific 50% (1 out of 2 vaccinated) Asian 100% Total declines/opt offs 11.1% (accurate data will not be available until 11 April 2019)

Quarterly results ending March 2019 Total 89% Maori 88% Pacific 90% (9 out of 10 vaccinated) Asian 100%



Target Name Target Actual

5 Year Immunisations

No Target


Total 88% Maori 86% Pacific 80% (4 out of 5 vaccinated) Asian 100% Total declines/opt offs 8.9% (accurate data will not be available until 11 April 2019)

Quarterly results ending March 2019

Total 88% Maori 85% Pacific 69% (9 out of 13 vaccinated) Asian 100%


HPV 75% of year 8 girls in Nelson Marlborough are immunised against HPV

Adolescent Oral Health

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

Cervical 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 81.1% Maori 73.9% Pacific 75.9% Asian 66.3% Other 82.9% (latest figures available as at January 2019)

3. MENTAL HEALTH & ADDICTIONS AND DSS 3.1 Audit Teams

Two audit teams visited several DSS homes, Wahi Oranga and Alexander Hospital. Another separate audit team visited the Addictions Service. The Auditors found DSS very welcoming and helpful. They noted that we demonstrated our commitment to, and knowledge of, the needs of the people we support very well. In Mental Health services they commented that we demonstrated a very collaborative model, had good MDT processes and have a person centred, recovery journey focus. OST (Opioid Substitution Treatment) services also received positive feedback. The Auditors made the observation that we have a good team who are supportive of each other, and are recovery oriented. It was great to have the audit teams recognise the compassion and great work our staff do every day to support people.


3.2 Emergency Response

Ongoing support via Nelson Bays Primary Health is being provided to people affected by the fires. The navigators continue to accept a small stream of referrals for support.

3.3 Top of the South Impact Forum

The workstreams are progressing well:

Family Safety – FVIARS meeting, attended by community MH Social Worker, is working well. Whangaia Nga Pa Harakeke model discussed at management support group meeting.

Youth – Hui were held this month and feedback will be prepared at the next Impact Forum.

Reducing Harm Caused by Methamphetamine – o Contract drafted to bring in an expert to adapt the MATRIX meth treatment

programme for NZ and to begin a programme in Nelson. Our focus needs to be to develop a programme which also services people living in remote areas.

o Police and Health are developing a joint education programme to upskill our wider workforce on meth, how to respond when use is disclosed, and where people can go to for help.

Housing – o The complex case model still appears to be working as intended with agencies

contacting each other about specific individuals to determine best solutions. o The group has agreed on a new stream of work which will look at addressing

‘affordability’. This stream addresses those households that have low income. 3.4 Older Persons (Alexandra Hospital)

Bed utilisation at 90% leading to increased opportunities to restore a therapeutic environment. Acuity manageable, however several patients requiring high input due to risk of falls and aggression.

January February March

Bed Occupancy 91% 105% 90%

Admissions 8 5 4

Discharges 8 4 8

# Waiting for D6 Beds (dementia)

2 0 1

3.5 Community Teams – Nelson and Wairau Older Persons Mental Health

January

Nelson January Wairau

February Nelson

February Wairau

March Nelson

March Wairau

Referrals Received

11 7 6 6 7 5

Referrals Accepted

10 4 6 5 6 5

# clients with CM

59 26 60 26 59 26


3.6 Addictions Service

The Addiction Service continues to receive a high volume of referrals. Self-referrals are the majority of referral sources, with alcohol being the most concerning substance due to increases in drinking patterns and associated issues from the increases.

Adult

Nelson/Tasman

Adult

Wairau

Youth

Nelson/Tasman

Youth

Wairau

Feb Mar Feb Mar Feb Mar Feb Mar

Referrals 101 112 27 34 13 18 3 10

3.7 Nelson and Tasman Adult Mental Health

February March

Referrals accepted 53 40

3.8 Marlborough Adult Mental Health


Referrals accepted 8 12 10

Advice only or redirected to other services e.g. ACC, AOD, primary care

10 20 22

3.9 Child and Adolescent Mental Health Service (CAMHS)

The reduction in our waitlist is our biggest highlight this month. The Nelson team have reduced the waitlist for case management by 62%, leaving 26 currently waiting to be seen.

Nelson/Tasman Wairau

February March February March

Referrals 86 75 42 42

Waitlist 55 26 29 24

Discharges 54 71 18 18

Redirected to Other Agencies 16 18 10 16

3.10 Mental Health Admissions Unit (Wahi Oranga)


Admissions 30 32 21

Discharges 32 25 27

Seclusion: Episodes Number of Patients

32

6

23

8

26

6

Seclusion work is slow, but ongoing. We have established the ‘Zero Seclusion’ Quality Board.

A meeting was held with Restorative Justice staff to further enhance inter-agency relations.


3.11 Disability Support Services

4. INFORMATION TECHNOLOGY

The Patientrack rollout to all adult acute areas in Wairau has been successfully completed, with planning underway for Nelson Hospital. There is steady progress with other PaperLite projects of eTriage, and eRadiology ordering and sign-off.

Regionally adopted Acute and Advanced Care Plans are now available in HCS, with work underway to integrate the Acute plan with EDaaG.

Disability Support Services (DSS)

ID PD LTCH Total YTD Total ID PD LTCH Total YTD Total

Current Moh

Contract

As per Contracts at month

end 163.5 17 180.5 165.5 16 181.5

Beds – Moh

Individual contracts


end 8 1 9 7 0 7

Beds – S&P-

Chronic Health

Conditions


end 1 9 10 1 8 9

Beds – Individual

contracts with ACC


end 1 1 2 1 2 3

Beds – Others -

CY&F & Mental

Health 1.5 2 3.5 1.5 2 3.5

Residential contracts -

Actual at month end 175 21 9 205 176 20 8 204

Total number of

people supported

Residential service users -

Actual at month end 175 21 9 205 decrease 1 176 20 8 204 decrease 1

Respite service users -

Actual at month end 3 3 6 increase 1 3 4 7 increase 1

Child Respite service users -

Actual at month end 31 31 decrease 1 32 32 increase 1

Personal cares/SIL service

users - Actual at month end 0 0 0 decrease 1 0 0 0

Private Support in own

home 1 1 increase 1

Total number of people

supported 209 24 9 242 212 24 8 244

Total Available Beds -

Service wide Count of ALL bedrooms 230 230

Total available bed days 6,440 55,890 7,130 63,020

Total Occupied Bed

days

Actual for full month -

includes respite 5,889 51,167 6,545 57,712

Note: **7 PDSS service users occupy

ID beds & 3 ID SU in PD beds - -

Total Occupied Beds

Based on actual bed days

for full month (includes

respite volumes) 91.4% 91.5% 91.8% 91.6%

Last

month

Current

month Variance

Last

month

Current

month Variance

244 242 2- 242 244 2

Referrals

Total long term residential

referrals 12 13 13 13

Referrals - Child

Respite Child Respite referrrals 13 11 11 11

New Referrals in the month 11 5 5 2

Of above total

referrals Transitioning to service - - - -

On Waiting List 13 13 13 13

Vacant Beds at End

of month 13 13 13 13

Less people transitioning to

service - - - -

Vacant Beds 13 13 13 13

Current March 2019 YTD March 2019Current February 2019

YTD February

2019

Service provided

Total number of people supported

Contracted Services

Number of people supported


Project Status

Name Description Status Original Due date

Revised due date

PaperLite and New

eTriage Electronic triage of referrals delivered via ERMS

ENT pilot successfully gone live. Next tranche of services being prepared for a May go-live includes General Surgery, Orthopaedics, Physiotherapy, Endoscopy, Gastroenterology and vascular. Code sets sent to the region to configure the software ahead of May.

various May 18

eRadiology Regional project for online ordering and sign-off for Radiology tests and results.

Comrad referral eTriage added to scope. Earliest go live 20th May 19. Tactical ACC flag to be added to eOrder form, ACC automation to be scoped by SIAPO as a separate add on project. Investigating future ED/EDaaG/Radiology system & process improvements.

Mar 18 May 19

eObservations (Patientrack)

Mobile Nursing tool to record EWS, assessments, & provide active alerts.

Wairau now using Patientrack in all adult acute areas. Nelson planned for May 2019, with good clinical engagement. Regional instance meetings held and awaiting plan from CDHB on integration. Regional Governance group set up with Kirsty Martin the CIO representative.

July 18 Oct 18 for pilot.

5. CLINICAL SERVICES

The high demand for acute care to our NMH community is having an impact on our ability to deliver elective care. On top, elective delivery has been further disrupted by the number of industrial action events that have occurred this year. The time taken to plan and then safely deliver care through each industrial action period has had a significant impact on the workload of the operational and service management teams. Our hospital team remains responsive to the acute patient demands and for 16 days during March we opened our Day Surgery Unit overnight to ensure we had enough beds to accommodate our acute patients.

Our ability to ensure timely care for our patients requiring admission from ED remains a challenge, however all patients discharged directly from ED met the 95% target. The minutes our ‘to be admitted’ patients are spending within the ED environment is increasing. A number of hospital flow projects are being considered across the district to enable a pull from ED as although the MAPU unit is welcomed, it will not alleviate all of the issues all of the time.

Nelson occupancy was 93% adult inpatient for March, and Wairau occupancy 76% adult inpatient.


An ESPI recovery plan for all services not meeting the timeliness of care to patients target has been developed and signed off with Service Managers and HODs. This is causing a significant amount of discussion internally as staff grapple with the challenge of delivering services within the capacity available. NMH has received a letter from the Ministry of Health giving us dispensation regarding ESPI performance until the end October 2019.

5.1 Health Targets

Year to date, as at the end of March 2019, 4,528 discharges were completed against a plan of 4,973 (91%). This is under plan by 445 discharges. Acute case weighted discharges (CWD) for March were 1,409 against a plan of 1,183 (119%):

ENT 120% YTD end March

General Surgery 107% YTD end March

Orthopaedics 134% YTD end March

Urology 118% YTD end March

Vascular 296% YTD end March. The higher levels of acutes year to date as at March in these specialities is having an impact on being able to meet the expected elective and health target discharges, particularly in orthopaedics where we are delivering 90% YTD March. Year to date delivery for orthopaedic interventions is 366 joints against a total year plan of 394. This is under plan by 28.

5.2 Shorter Stays in Emergency Department

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

-

20

40

60

80

100

120

140

160

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

Dec

-18

Jan

-19

Feb

-19

Mar

-19

NMDHB ED Performance

Presentations Per Day NMDHB 6 Hr Target Results ED 6 Hour Target

85.0%

87.0%

89.0%

91.0%

93.0%

95.0%

97.0%

99.0%

64

69

74

79

84

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

Dec

-18

Jan

-19

Feb

-19

Mar

-19

Nelson ED Performance



Length of stay target for past 3 months

January 2019 February 2019 March 2019

Total <6hrs Total <6hrs Total <6hrs

Nelson 2,556 2,354

92.1% 2,174 1,967

91.5% 2,496 2,207

88%

Wairau 1,735 1,645

94.8% 1,453 1,393

95.9% 1,538 1,460

95%

Number of Presentations in Nelson ED

Shorter Stays in ED (% admitted patients <6 hour LOS (by month))

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

40 42 44 46 48 50 52 54 56 58

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

Dec

-18

Jan

-19

Feb

-19

Mar

-19

Wairau ED Performance



Shorter Stays in ED (% non-admitted patients <6 hour LOS (by month))

Breach Analysis

Red: Hospital delays (ward/bed, Radiology, blood result, MCT) Blue: Other (prolonged observation, delayed decision making, other) Green: High ED activity Orange: External delays (transfer to other hospital, waiting on transport)

Breach Analysis Nelson

Delay reason Mar 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19

Waiting for Ward Team 49 (44.1%) 58 (30.2%) 49 (21.5%) 74 (27.8%) 73 (36.3%) 90 (44.3%) 100 (34.8%)

Prolonged Observation 23 (20.7%) 53 (27.6%) 54 (23.7%) 64 (24.1%) 54 (26.9%) 31 (15.3%) 53 (18.5%)

Waiting for Ward Bed 19 (17.1%) 34 (17.7%) 66 (28.9%) 55 (20.7%) 19 (9.5%) 48 (23.6%) 75 (26.1%)

Other 9 (8.1%) 12 (6.2%) 13 (5.7%) 19 (7.1%) 11 (5.5%) 11 (5.4%) 11 (3.8%)

Waiting for MCT 4 (3.6%) 6 (3.1%) 6 (2.6%) 6 (2.3%) 7 (3.5%) 3 (1.5%) 14 (4.9%)

High ED Activity 4 (3.6%) 11 (5.7%) 24 (10.5%) 30 (11.3%) 25 (12.4%) 5 (2.5%) 21 (7.3%)

Waiting for Radiology 3 (2.7%) 8 (4.2%) 6 (2.6%) 8 (3%) 5 (2.5%) 8 (3.9%) 5 (1.7%)

Transfer to Other Hospital 0 (0%) 0 (0%) 3 (1.3%) 1 (0.4%) 0 (0%) 0 (0%) 1 (0.3%)

Waiting for Transport 0 (0%) 10 (5.2%) 7 (3.1%) 9 (3.4%) 7 (3.5%) 7 (3.4%) 7 (2.4%)

Total 111 192 228 266 201 203 287


Number of Presentations in Wairau ED

Breach Analysis Wairau

Delay reason Mar 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19

Prolonged Observation 19 (37.3%) 30 (39.5%) 23 (32.9%) 33 (40.2%) 30 (34.1%) 24 (40%) 34 (43%) Waiting for Ward Team 11 (21.6%) 9 (11.8%) 14 (20%) 9 (11%) 12 (13.6%) 14 (23.3%) 9 (11.4%)

Other 6 (11.8%) 9 (11.8%) 6 (8.6%) 6 (7.3%) 4 (4.5%) 6 (10%) 3 (3.8%)

Waiting for Radiology 5 (9.8%) 5 (6.6%) 7 (10%) 6 (7.3%) 6 (6.8%) 2 (3.3%) 6 (7.6%)

High ED Activity 5 (9.8%) 11 (14.5%) 9 (12.9%) 11 (13.4%) 18 (20.5%) 9 (15%) 12 (15.2%) Waiting for Ward Bed 4 (7.8%) 5 (6.6%) 5 (7.1%) 11 (13.4%) 10 (11.4%) 3 (5%) 9 (11.4%) Transfer to Other Hospital 1 (2%) 3 (3.9%) 3 (4.3%) 1 (1.2%) 1 (1.1%) 1 (1.7%) 1 (1.3%)

Waiting for MCT 0 (0%) 0 (0%) 0 (0%) 3 (3.7%) 3 (3.4%) 0 (0%) 1 (1.3%) Waiting for Transport 0 (0%) 4 (5.3%) 3 (4.3%) 2 (2.4%) 4 (4.5%) 1 (1.7%) 4 (5.1%)

Total 51 76 70 82 88 60 79

5.3 Elective / Acute Arranged Services

ESPI 2 was Red for the month of March, with 188 patients not been seen within 120 days of referral acceptance. This was a decrease from 320 patients in February. ESPI 5 was Red for the month of March with 109 patients not being treated within120 days of being given certainty.

5.4 Enhanced Access to Diagnostics

0

20

40

60

80

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-1

8

Jan

-19

Feb

-19

Mar

-19

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

waiting outside 6 weeks (excluding referrals for scans that are planned patient

events)

Diagnostic ReportingTemplate - CT (DHB wide)Total Number acceptedreferrals waiting outside 6weeks (excluding referrals forscans that are planned patientevents)


5.5 Improving Diagnostic Waiting Times – Colonoscopy

At the end of March, there were 335 overdue colonoscopies, down from 348 at the end of February. The rate of referrals is increasing and our ability to staff additional sessions to keep up with demand is limited.

5.6 Faster Cancer Treatment – Oncology

0

100

200

300

400

500

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-1

8

Jan

-19

Feb

-19

Mar

-19

Diagnostic Reporting Template - MRI Total Number accepted referrals

waiting outside 6 weeks (excluding referrals for scans that are planned

patient events)

Diagnostic ReportingTemplate - MRI TotalNumber accepted referralswaiting outside 6 weeks(excluding referrals forscans that are plannedpatient events)

0123456789

10

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-1

8

Jan

-19

Feb

-19

Mar

-19

Diagnostic Reporting Template - CTCTotal number accepted referrals waiting outside 6 weeks (excluding referrals for scans that are planned patient events

Series2

FCT Monthly Report - Mar 2019 Reporting Month: Feb 2018 - Quarter 3 - 2018-2019

As at 28/03/2019

62 Day Indicator Records

TARGET SUMMARY (90%)

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

Within 62

Days

Exceeded

62 Days

Within 62

Days

Exceeded

62 Days

85% 15% 90% 10% 90% 10% 88% 12% 89% 11% 84% 16% 90% 10%

Number of Records 22 4 19 2 26 3 67 9 63 8 73 14 276 32

Total Number of Records

Numbers Including all Delay Codes 81% 19% 86% 14% 76% 24% 81% 19% 70% 30% 78% 22% 78% 22%

Number of Records 22 5 19 3 26 8 67 16 63 27 73 20 276 77

Total Number of Records

90% of patients had their 1st

treatment

within: # days

62 Day Delay Code Break Down

01 - Patient Reason (chosen to delay)

02 - Clinical Cons. (co-morbidities)

03 - Capacity Constraints

TUMOUR STREAM ETHNICITY

Rolling 12 Months (Mar 18-Feb 19) Column1

Brain/CNS 100% 3 0% 3 Chinese 0% 0 100% 1 1

Breast 97% 60 3% 2 62 European not further defined 100% 12 0% 0 12

Gynaecological 75% 12 25% 4 16 Maori 68% 13 32% 6 19

Haematological 86% 18 14% 3 21 New Zealand European 77% 216 23% 66 282

Head & Neck 35% 6 65% 11 17 Not Stated 100% 5 0% 0 5

Lower Gastrointestinal 64% 30 36% 17 47 Other Asian 100% 1 0% 0 1

Lung 71% 36 29% 15 51 Other Ethnicity 100% 6 0% 0 6

Other 29% 2 71% 5 7 Other European 78% 14 22% 4 18

Sarcoma 67% 2 33% 1 3 Other Pacific Peoples 100% 1 0% 0 1

Skin 94% 66 6% 4 70 Response Unidentifiable 100% 2 0% 0 2

Upper Gastrointestinal 68% 13 32% 6 19 Samoan 100% 2 0% 0 2

Urological 76% 28 24% 9 37 Southeast Asian 100% 3 0% 0 3

Grand Total 78% 276 22% 77 353 Tongan 100% 1 0% 0 1

Grand Total 78% 276 22% 77 353

Total

Records

Within

62 Days

Within 62

DaysRolling 12 Months (Mar 18-Feb 19)

Completed Records

Exceeded

62 Days

Total

Records

Mar -19

(in progress)

0 1 1

Quarter 3

(2017-2018)

1

Quarter 2

3

109

Feb-19

0

1

2

65

Exceeded

62 Days

Exceeded

62 Days

35

32

16

8

5

14

6

353

Rolling 12 Months

Mar 18-Feb 19

10

84

9

Rolling 12 Months

Mar 18-Feb 19

308

90 93

83

27 22 34

Feb-19 Jan-19Quarter 3

(in progress)Quarter 2

29 76 71

Numbers as Reported by MOH

(Capacity Constraint delay only)

26 21

Quarter 3

(2017-2018)

87

Quarter 3Jan-19

75

83

64 87

Mar -19

(in progress)

3

Within 62

Days

Within

62 Days

1

4

Exceeded

62 Days

4


6. NURSING

The certification process was completed early April and we await the final report. The feedback for staff was excellent with an acknowledgement of the significant pressure they work under on what seems like a daily basis. Despite the challenges this presents, our staff continue to deliver excellent care, they are engaged with their patients, they are welcoming and interested, and wanting to be involved in change. The culture was also commented on as having changed dramatically from the previous visit with the hospital having a good vibe. The auditing group thanked the teams for the great experience they had while being here.

CCDM work is continuing at a rapid speed with all workstreams now underway. The governance site visit is scheduled for 24 May, and planning is underway for the programme for the day.

Professor Brian Dolan OBE, Director of Service Improvement from Canterbury DHB presented at workshops held on 13 and 14 March. The topics of discussion included Leadership for Change, Building Resilience, CNM/CMM – Your Role as a Nursing/Midwifery Leader, Patient Flow, Capacity and Demand, Different Ways of Working. The event was very successful and showed the benefit of interdisciplinary workshops for sharing work experience and learnings. A further two day workshop is planned for August.

Development of a Mental Health Assessment ED pathway and guideline has been completed and is awaiting final review.

7. ALLIED HEALTH

The district wide Pastoral Care Team / Chaplaincy team have continued to support patients and whānau across the hospital and community services. They also have a key role supporting staff after the tragic events in Christchurch, and specific local events have seen pastoral care being increasingly visible. Of note, in March a total of 1,205 contacts occurred, and of these 193 were with staff.

At the request of Canterbury DHB, NMH Social Workers have been supporting our Christchurch colleagues. A number of social workers from both physical and mental health have been working at Christchurch Hospital. This has been a significant team effort and a regional response.

The Executive Leadership Team has supported the three areas of focus that the Staff Engagement: Working Together group recommended (Healthy Teams, Workforce Aggression and Musculoskeletal Injuries).

The NMH Falls Alliance continues to be a system approach to falls prevention in the older population. A recent participant in the in-home programme commented as follows:

“Before the programme I stopped driving as I wasn’t confident I could get in and

out of my car and that I could walk any distance. Now after completing the

programme I feel more confident, and confident that I can get in and out if my car,

so I’m back driving!”

A visually impaired participant has also improved in her confidence and is now not reliant on her daughter taking her places as she can go in a taxi and is less socially isolated and is back playing bowls.


8. MĀORI HEALTH 8.1 Advance Care Directives Project (Nga Whakaaro Pono)

The Advance Care Directives is one of the latest Te Waka Hauora projects and seeks to integrate, in the first instance, the option of Advance Care Directives which are in video form for tangatawhaiora/clients in the area of Mental Health & Addictions.

8.2 Hauora Direct Integration

Wairau Community Clinic and Omaka Medical are both currently piloting the Hauora Direct assessment tool with whānau within their practices.

8.3 Hapū Wānanga

The Hapū Wānanga programme covers all of the key health priority areas that you would expect to see in a mainstream programme, but does it in a kaupapa Maori way. Points of interest the five Hapū Wānanga Te Waka Hauora have facilitated to date include:

High rate of NZ Māori attendance

Lower number of first-time mothers (primips) attending

100% completion rate. The 2-day format may support completion compared to other PPE (Pregnancy & Parenting Education) that are often held over successive weeks.

8.4 Bowel Screening Programme

The Bowel Screening Roadshow activities continue to target our priority populations across Te Tau Ihu. The Bowel Screening Team is visiting with organisations and communities to promote the programme, provide information and answer questions from whānau. In the last month, Te Piki Oranga Motueka have received training regarding the programme and delivery of the outreach service. In addition to this we have delivered a session in the Wairau community to a Pacific men’s fono and to the Sit and Be Fit Class run by TPO in Wairau and Waikawa.

9. CLINICAL GOVERNANCE 9.1 Service User Complaints

We received 40 new complaints in March compared to 52 the previous month. Thirty-one complaints were closed, and 74 complaints remain open and active.

10. PERFORMANCE APPRAISALS

To date we are at 54.7% of staff with a current appraisal.


Peter Bramley CHIEF EXECUTIVE

RECOMMENDATION: THAT THE CHIEF EXECUTIVE’S REPORT BE RECEIVED

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