midcentral district health board a g e n d a · beagley, vicki 5.10.15 massey university employee,...

Distribution

Committee Members Brendan Duffy (Chair) Adrian Broad (Deputy Chair) Barbara Cameron Ann Chapman Nadarajah Manoharan Dot McKinnon (ex officio) Vicky Beagley Donald Campbell Tawhiti Kunaiti

Board Members Diane Anderson Michael Feyen Karen Naylor Oriana Paewai Barbara Robson

Management Team Kathryn Cook, CEO Craig Johnston, General Manager, Strategy,

Planning & Performance General Manager, Quality & Innovation Neil Wanden, General Manager, Finance &

Corporate Support Keyur Anjaria, General Manager, People & Culture Stephanie Turner, General Manager, Maori & Pacific Scott Ambridge, General Manager, Enable New

Zealand Ken Clark, Chief Medical Officer Celina Eves, Executive Director, Nursing &

Midwifery Steve Miller, Chief Information Officer Gabrielle Scott, Executive Director, Allied Health Chiquita Hansen, CEO, Central PHO Cushla Lucas, Acting Service Director, Regional

Cancer Treatment Service Debbie Davies, Acting Service Director, Community Lyn Horgan, Operations Director, Hospital Services Muriel Hancock, Director, Patient Safety & Clinical

Effectiveness Chris Nolan, Service Director, Mental Health &

Addictions Services Jill Matthews, PAO Megan Doran, Committee Secretary Communications Dept, MDHB External Auditor Board Records

National Health Board Peter Jane, Account Manager

Public Copies (9) www.midcentraldhb.govt.nz/orderpaper

MidCentral District Health Board

A g e n d a

Healthy Communities Advisory Committee

Part 1

Date: 13 February 2018

Time: 1.30pm

Place: Board Room Board Office Heretaunga Street Palmerston North

Contact Details Committee Secretary Telephone 06-3508928 Facsimile 06-3508926

Next Meeting Date 20 March 2018 Deadline for Agenda Items 2 March 2018

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MidCentral District Health Board

Healthy Communities Advisory Committee Meeting

Tuesday, 13 February 2018

Part 1O r d e r 1. ADMINISTRATIVE MATTERS 1.30pm

1.1 Apologies

1.2 Late Items

1.3 Conflict and/or Register of Interests Update

Pages 5-7

1.4 Minutes of the Previous Meeting

Pages: 8-21Documentation: minutes of 17 October 2017 & 28 November

2017 Recommendation: that the minutes of the previous meetings

held on 17 October 2017 & 28 November 2017 be confirmed as a true and correct record.

1.5 Recommendations to the Board

To note that all recommendations contained in the minutes were approved by the Board.

1.6 Matters Arising from the Minutes

To consider any matters arising from the minutes of the meeting held on17 October 2017 & 28 November 2018 for which specific items do not appear on the agenda or in management reports.

2. OPPERATIONAL PLANNING 1.35pm

2.1 Health Promotion Agency and Presentation

Pages: 22-25Documentation: report from Project Manager dated 19

January 2017 Recommendation: that the committee note this update and

presentation A presentation will be provided

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2.2 Child Development Service Update Pages: 26-30 Documentation: report from Executive Director, Allied

Health, Clinical Director, Child Health & Senior Portfolio Manager dated 5 February 2018

Recommendation: that the committee endorse this update for the Child Development Service and; that the committee note the decision not to proceed with the additional Psycho-diagnostic Service FTE for the 2017/18 year and; that the committee support collaboration with the Ministries of Education and Health and Enable NZ to redesign the intersectoral approach to children with learning, behaviour and developmental problems.

3. PARTNERSHIPS & CONSUMER 2.30pm 3.1 Ora Konnect – Development of an IFHC model for the

South Western Suburbs of Palmerston North

Pages: 31-37 Documentation: report from Operations Director Maori

Strategy & Support/Project Lead Ora Konnect dated 16 January 2018

Recommendation: that the update on the advancement of Ora Konnect be noted

3.2 Disability Support System Transformation Update Pages: 38-41 Documentation: report from General Manager, Enable New

Zealand dated 1 February 2018

Recommendation: that the Committee notes the update and progress of the transformation of the Disability Support System.

4. PERFORMANCE REPORTING 2.40pm 4.1 Ohakea PFAS Contamination Response Pages: 42-46 Documentation: report from Medical Officer of Health,

Manager Public Health & Technical Manager Operations dated 5 February 2018

Recommendation: that the ongoing role of MDHB’s Public Health Service in the investigation and response to the Ohakea PFAS contamination be noted.

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4.2 Strategy, Planning & Performance Operating Report

Pages: 47-58Documentation: report from Strategy, Planning &

Performance dated 13 February 2018Recommendation: that this report be noted

5. COMMITTEE’S WORK PROGRAMME 2.45pm

Pages: 59-62Documentation: report from General Manager, Strategy,

Planning & Performance dated 7 February 2018

Recommendation: that progress against the 2017/18 work programme be noted

6. LATE ITEMS

To discuss any such items as identified under item 2.

7. DATE OF NEXT MEETING

20 March 2018

8. EXCLUSION OF PUBLIC

Recommendation: that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference Termination Service Change of Provider Update

Subject of negotiation 9(2)(j)

“In Committee” minutes of the meetings held on 17 October 2017 & 28 November 2017

For reasons stated in the previous agendas

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Please advise all changes to Jill Matthews, Manager, Administration & Communication Page 1 of 3

REGISTER OF INTERESTS: SUMMARY, FEBRUARY 2018 Name Date Company/Organisation Nature of Interest Anderson, Diane 1.7.16 Nil Broad, Adrian 24.6.14 Manawatu Horowhenua Tararua Diabetes

Trust Trust Manager.

9.12.13 Palmerston North City Council Councillor. 3.5.16 ACROSS – Te Kotahitanga oTe Wairua Board Member.

Cameron, Barbara 25.4.13 Manawatu District Council Councillor. Member & Deputy Chair, Manawatu District Licensing Committee

1.11.16 Ministry of Social Development Member, MSD’s Community Response Forum. Chapman, Ann 17.12.13 Otaki Mail Part Owner.

18.5.12 Otaki Community Health Trust Member.

21.12.07 Gen-i Son is employee. 29.4.16 Central Region’s Technical Advisory Service Grandson is an employee.

Duffy, Brendan 3.8.17 MITO Board Member. 3.8.17 Local Government Commission Commissioner. 3.8.17 Electra Trust Trustee. 3.8.17 Environmental Legal Assistance Fund,

Ministry for the Environment Deputy Chair.

3.8.17 Business Kapiti Horowhenua Inc (BKH) Board Member. 3.8.17 Life to the Max, Horowhenua Chair.

Feyen, Michael 5.12.16 Horowhenua District Council Mayor.

Manoharan, Nadarajah

9.12.13 Surgical Educators of the Royal Australasian College of Surgeons

Educator.

9.12.13 Private Otorhinogology Practice, Palmerston North

Owner.

9.7.17 Aroha Ultimate Care Wife is an employee (facility manager) McKinnon, Dot 5.12.16 Whanganui DHB Chairperson.

Cousin of Whanganui DHB General Manager 9.2.17 NZ DHB Chairs’ National Executive Member. 9.2.17 Health Practitioners Disciplinary Tribunal Member.

9.2.17 Health Sector Relationship Agreement Committee

Member

9.2.17 Four Regions Trust (formerly known as Powerco Trust)

Chair.

9.2.17 Whanganui Eyecare and Medical Trust Husband is chair. 21.3.17 Moore Law & Associates Legal Executive, Director and Shareholder. 4.7.17 20 DHBs (Central Region’s Technical

Advisory Service) Member, National Health Workforce Strategy

21.3.17 Chardonnay Properties Limited Part owner. 19.12.17 ERSG Board Member 19.2.17 Regional Governance Group Chair

Naylor, Karen 6.12.10 MidCentral DHB Employee. 22.9.15 New Zealand Nurses Organisation Member & Workplace Delegate

Board Member 9.10.16 Palmerston North City Council Councillor.

Paewai, Oriana 1.5.10 Rangitane o Tamaki nui a Rua CEO. 1.5.10 Te Runanga o Raukawa Governance Group Member. 1.5.10 Manawhenua Hauora Chair.

Member, Child Health Tamariki Ora District Group.

13.6.17 Te Whiti ki te Uru Co-ordinating Chair. 13.6.17 Tararua Hauora Services Charitable Trust Trustee. 13.6.17 Central Primary Health Organisation Member, Alliance Leadership Team (Central

PHO Board). 13.6.17 Feilding Health Care Member, Clinical Governance Group. 13.6.17 Manawatu District Council Member, Nga Manu Taiko, a standing

committee of the Council. 13.6.17 Te Ohu Auahi Mutunga (TOAM) Member, Governance Board. 13.6.17 Before School Checks (B4SC) Collective Member. 13.6.17 Nga Kaitiaki o Ngati Kauwhata Inc Committee member. 13.6.17 Te Tihi o Ruahine Whanau Ora Alliance Member.

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Robson, Barbara 19.7.16 Kind Hearts Trust Board Member. 1.11.16 Royal NZ College of GPs

Member (consumer representative), Health Care Home Standard Working Group.

10.12.01

Federation of Women’s Health Councils Aotearoa NZ (Inc)

Co-convenor.

31.5.10 Medicines Review Committee Consumer Representative. Feb 13 Ministry of Health Member, Electronic Oral Health Record Design

Group. Member, Consumer Reference Group – National Workforce Strategy Project (MoH & HWNZ)

11.10.16 Ernst & Young Daughter is an employee – Business Advisor. COMMITTEE MEMBERS Beagley, Vicki 5.10.15 Massey University Employee, research office. 5.10.15 Arohanui Hospice Husband, John Freebairn, is the current chair. 5.10.15 Supportlinks/Enable New Zealand Son receives respite care. 11.10.16 Palmerston North City Council Member, District Licensing Committee. Campbell, Donald 2.7.14 Nil Emery, Dennis 1.9.15 Arohanui Hospice Employee. 1.9.15 Manawhenua Hauora Member. 1.9.15 Ngati Maniapoto me Ngati Kauwhata Iwi Iwi descendent of both tribes. 1.9.15 Nga Kaitiaki O Ngati Kauwhata Inc, Feilding

- NKOK Chairman

1.9.15 Feilding Integrated Family Health Centre Through the Iwi of NKONK 1.9.15 Te Tihi O Ruahine Whanau Ora Trust 1.9.15 Whanau Ora Strategic Innovation &

Development Group (WOSIDG), Palmerston North

Chairperson / Member.

1.9.15 Whaioro Mental Health Trust – P. North Board Member & Iwi Trustee. Hartevelt, Tony 14.8.16 Otaki Family Medicine Ltd Independent Director designate. 14.8.16 Merck Sharpe & Dohme (Merck)

(NZ operations for Global Pharmaceutical Company)

Elder son is NZ market access manager.

14.8.16 Fairfax Media Younger son is news director for Stuff.co.nz Kirkcaldie, Ewen 1.8.08 PKF Rutherfords Ltd Director. Kolbe, Anne 22.7.16 Kolbe Medical Services Ltd Director and joint owner. 22.7.16 Communio, NZ Senior Consultant and Contractor. 22.7.16 Whanganui DHB Member, Risk & Audit Committee. 22.7.16 Health Research Council of NZ Husband chairs the clinical trials advisory

committee. 22.7.16 Auckland University Holds an adjunct appointment (Associate

Professor level). Husband is also an employee of Auckland University (Professor of Medicine, FMHS).

22.7.16 Australian Medical Council Husband is a member of the Medical School Advisory Committee, and leads the Medical Specialties Advisory Committee Accreditation Team.

22.7.16 Royal Australasian College of Physicians Husband is a member of the College’s governance working party, and chairs the revalidation working party.

22.7.16 EXCITE International Board Member, and Chair of Advisory Council. 22.7.16 Medicare Benefits Schedule Review

Taskforce (Australia) Senior Advisor/ Government taskforce to review the Medicare Benefits Schedule.

22.7.16 Institute of Environmental Science & Research (ESR)

Daughter employed as forensic scientist.

13.3.17 Siggins Miller, Australia Senior Advisor & Associate. Kunaiti, Tawhiti 20.7.10 Central Primary Health Organisation Employee. Wife is an employee – Contracts

Administrator. (28.10.16) 28.10.16 Manawhenua Hauora Manawhenua representative on HCAC 28.10.16 Te Tihi O Ruahine Whanau Ora Alliance

Trust Employee – Pou Whakarae, Principal Cultural Leader.

28.10.16 Whanau Ora Strategic Innovation Development Group (WOSIDG)

Member.

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28.10.16 New Zealand College of Clinical Psychologists

Council Member for NZCCP as Pou Whakarae, Principal Cultural Leader.

Temple-Camp, Cynric

3.2.15 Breastscreen Coast to Coast Lead Pathologist. 23.7.13 International Academy of Pathology Board Member.

1.7.08 Medlab Central Ltd. Business Unit of Sonic Health Care Ltd

CEO.

1.7.08 MidCentral Health (MCH) Wife is employed as a Medical Consultant by MCH.

1.7.08 National Coronial Pathology Services Advisory Group to Ministry of Justice

Member

1.7.08 T-Lab Director. 7.4.09 Ministerial Advisory Group Member. MANAGEMENT Cook, Kathryn 4.5.15 Aspen Pharma Sister is an employee. 1.7.16 Central Region’s Technical Advisory Service Director. Ambridge, Scott 20.8.10 Nil Anjaria, Keyur 17.7.17 MidCentral DHB Wife is a user of the Needs Assessment &

Service Co-ordination Service. Clark, Kenneth 3.8.10 Dr Kenneth Clark Ltd Private gynaecology practice, Palmerston

North. Coglan, Michele 3.2.16 Nil Hansen, Chiquita 9.2.16 MidCentral DHB Employed by MDHB and seconded to Central

PHO 8/10ths. 9.2.16 Central PHO Central PHO’s CEO. Johnston, Craig 19.2.16 Central PHO Member, Alliance Leadership Team. 19.4.16 MidCentral DHB Son is an employee of MidCentral DHB and

works within hospital services. Miller, Steve 18.4.17 Puriri Trust & Puriri Farm Partnerships Director. Farming business. Scott, Gabrielle 19.8.16 MidCentral DHB Son is a casual employee of MidCentral DHB

and works within various hospital services. Turner, Stephanie 17.2.16 Waingawa Ltd Director. Farming business. Wanden, Neil 16.2.16 Opus International Wife is a major shareholder. Matthews, Jill 1.3.16 Nil Amoore, Anne 23.8.04 Nil Small, Jeff 2002 Allied Laundry Services Limited (ALSL) Director (appointed by MDHB’s Board)

Horgan, Lyn 1.5.17 Coronial Services Sister is Coroner based in Wellington.

Hancock, Muriel 1.2.18 MidCentral DHB Sister an employee (registered nurse in ICU) Nolan, Chris Russell, Greig 3.10.16 City Doctors Minority shareholder. 3.10.16 NZ Medical Council Member, Education Committee. Downing, Eileen 2.9.10 Nil Andrews, David Smith, Jo 27.8.10 Nil Nepia-Tule, Claudine

1.9.10 Nil

Bradnock, Barb 26.8.10 Nil Jermey, David 31.8.17 Central Primary Health Organisation Member, Alliance Leadership Team Ayres, Vivienne 26.8.10 Nil Channing, Chris 27.8.10 Nil Els, Johan 28.10.16 Nil Tanner, Steve 16.2.16 Nil Brogden, Greg 16.2.16 Nil Purdy, Darry 13.10.17 Ross Intermediate Trustee 13.10.17 Graham Wastney Family Trust Trustee 13.10.17 Spotless Facility Services Limited Brother-in-law an employee (not at MDHB

site) 13.10.17 Setpoint Solutions Limited Brother-in-law an employee (but not for

MDHB) 13.10.17 Crossroads Church Attendee Manderson, John 16.2.16 Nil

7777777

MidCentral District Health Board Minutes of the Healthy Communities Advisory Committee meeting held on Tuesday, 17 October 2017 at 1pm at MidCentral District Health Board Offices, Board Room, Gate 2, Heretaunga Street, Palmerston North

PRESENT

HCAC Members Brendan Duffy (Chair) Adrian Broad (Deputy Chair) Barbara Cameron Nadarajah Manoharan Dot McKinnon (ex Officio) Vicki Beagley Donald Campbell Tawhiti Kunaiti

IN ATTENDANCE

Diane Anderson, Chair, Quality & Excellence Advisory Committee Barbara Robson, Committee Member, Quality & Excellence Advisory Committee Craig Johnston, General Manager, Strategy, Planning & Performance Neil Wanden, General Manager, Finance & Corporate Services Stephanie Turner, General Manager, Maori & Pacific Gabrielle Scott, Executive Director, Allied Health Debbie Davies, Acting Service Director, Community Megan Doran, Committee Secretary Vivienne Ayres, Manager, DHB Planning and Accountability Claudine Nepia-Tule, Portfolio Manager, Mental Health & Addictions Jo Smith, Senior Portfolio Manager, Health of Older People and Palliative Care David Jermey, Portfolio Manager, Primary Health Care David Jack, Emergency Planner, Primary Health Care Steve Tanner, Finance Manager John Manderson, Programme Manager Paula McCool, Communications

OTHER

Public: (0) Media: (0)

1. APOLOGIES

There were apologies from Board Member Ann Chapman and Kathryn Cook, CEO.

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2. NOTIFICATION OF LATE ITEMS

There were no late items

3. CONFLICT AND/OR REGISTER OF INTERESTS UPDATE

3.1 Amendment to the Register of Interests

There were no amendments to the Register of Interests.

3.2 Declaration of Conflicts in Relation to Today’s Business

No declarations were advised in relation to the meeting.

4. PARTNERSHIPS & CONSUMER

4.1 Presentation by Maryanne Thomson, Home Care Medical

Maryanne Thomson from Home Care Medical presented to the Committee.

4.2 Health Charter

The General Manager, Strategy, Planning & Performance introduced this paper noting that it had been on the work programme for quite some time. The draft charter document required a major rework but its purpose was still relevant to the DHB. This was well demonstrated by the Health Needs Assessment, also on the Committee’s agenda, which highlighted the impact of broader health and social factors on people’s lives.

The other potential role for the Charter is to provide an overarching framework for the locality plans. This would be particularly relevant for agencies like the DHB that cover a broad area, for example Police, and the Ministry of Social Development. The locality plans would be the local plan of what would actually happen in that specific community.

The Committee agreed that draft charter document needs a major rework, if it is to continue. It was suggested that now the DHB has very well established relationships with its intersectoral partners at many levels, with a huge amount work already being done in the intersectoral space, redeveloping the Charter might not be the best use of resources. The General Manager, Strategy, Planning & Performance advised that the DHB would need to talk to other Agencies with whom we interact first before a decision could be made.

It was recommended:

that this report be noted

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5. STRATEGIC & ANNUAL PLANNING

5.1 Health Needs Assessment

The General Manager, Strategy, Planning & Performance introduced Dr Richard Fong to the committee and commented that assessing the health needs of the community is the starting point for everything the DHB does. Dr Fong outlined two key messages from the Health Needs Assessment. The first is inequality and the importance of focusing on the people, not on the specific diseases. Basically, the same groups of people have poorer health across all the major disease. To improve their health status, it is important to address the factors and circumstances affecting these people, not the diseases.

The second message is that demand for our health services is increasing over time. Although there can be debate about the cause of this, the DHB needs to plan for the increase in health services.

The Committee congratulated and thanked Dr Fong for his report.

It was recommended:

the Executive Summary extracted from the final draft 2017 Health Heeds Assessment for MidCentral and Whanganui DHBs (attached) be noted.

5.2 Equity Snapshot and Impact for Planning

The General Manager, Maori & Pacific advised the Committee that this report was an update on progress. The Equity Snapshot was scheduled to go to the Executive Leadership Team and a draft would be available in the operational planning process and finally to the Board and Manawhenua.

The Snapshot also includes an equity tool kit which identifies the actions necessary to address inequality and how the DHB can implement them. The tool kit will be a resource for every cluster to use to help develop a set of actions with an equity focus. It had taken longer than expected to complete this work because of its complexity.

The General Manager, Maori & Pacific confirmed there would be an opportunity for the Committee to provide feedback. This would be used for 2018/19.

It was recommended:

that the progress on the Equity Snapshot and Impact for Planning is noted.

6. PERFORMANCE REPORTING

6.1 MidCentral Health Horowhenua STAR 4 Project Report

The General Manager, Strategy, Planning & Performance advised that this report had been tabled and discussed at the Quality & Excellence Advisory Committee.

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This piece of work arose out of rostering difficulties with medical staffing at the Horowhenua Health Centre inpatient unit. It concerned itself with staffing options, rosters etc. During the course of this review, which was completed by an independent contractor, it was identified that the most attractive options were consider how the medical staffing could work both across inpatient unit and primary and community services.

Secondly, it highlighted the need to reconsider the overall Horowhenua Integrated Family Health Centre plan because it contains a lot of good material which has not been implemented.

A member advised that there had been some research data produced national regarding GPs to the ratio of patient numbers and that MidCentral had been in the media recently and had the worst rates of ratio between GP’s to patients. Would the impact of Horowhenua be negative towards our total district data on this issue? Would MidCentral be better or worse? The General Manager, Strategy, Planning & Performance advised that across the MidCentral District the ratio of patients to GPs is very high. The district has a very small GP roster and furthermore local GPs are comparatively old. This is not new; this had been on the DHB’s horizon for more than 10-15 years and was across the district as a whole.

There was discussion about the concept of Horowhenua Hospital moving towards a ‘Rural Hospital’. The Committee was concerned that the community could read this the wrong way. Horowhenua is a growing community in an urban environment and now it looked as though the DHB would be providing a Rural Service. The General Manager, Strategy, Planning & Performance clarified that ‘Rural Hospital’ refers to an inpatient unit that provides general medical care to a community, whereas Horowhenua Health Centre currently provides mainly specialist Assessment, Treatment and Rehab services. The ‘Rural Hospital’ concept would work very well for the Horowhenua community and was part of the original concept of the Health Centre.

It was recommended:

the Horowhenua START 4 project report be noted

6.2 Re-commissioning of Home & Community Support Services

The Senior Portfolio Manager, Health of Older People and Palliative Care introduced this report. It was to provide forward discussion to the retender of some services across the DHB in the space of Home and Community Support. It was explained that this was not about saving money or reducing services. In fact, it’s about enhancing them. The Committee was concerned about the need to actively manage communications around this process.

It was recommended:

that the DHB’s intention to re-commission Home & Community Support Services is noted

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6.3 Strategy, Planning & Performance Operating Report

4.1 Locality Planning The first views of what the locality plans are going to look like in the different plans had started to form. There would be an infographic visual look which would be the bases of the plan and there would also be various supporting documentation. The Locality Planning had collected a lot of information from the community. This would come together and provide others with information that they could use for their own activities.

4.2 2018/19 Annual Planning The 2017/18 planning was very difficult from a process point of view due to factors external to the DHB’s control. The DHB is in a better position now, with our locality plans and our strategy, we are looking towards getting on top of the plan. There is work underway to get the budgeting and planning processes all integrated. The Ministry timelines would probably stay the same as with previous years but there is likely to be considerable change in priorities and direction as a result of the change of government. It is expected that the indication of Funding will be provided before Christmas but that the detailed Funding Envelope will not come until after the Budget in May. This Annual Plan is being constructed as if the clusters are in place.

5.3.2 UCOL U-Kinetics Cessation It was noted that the U-Kinetics programme will continue to run until the end of December 2017. Arrangements are in place to manage people currently in the service. Discussions have been occurring with clinical leads about service requirements and there has been a lot of interest from potential service providers.

It was recommended:


7. MINUTES OF THE PREVIOUS MEETINGS

It was recommended:

that the minutes of the previous meetings held on 25 July 2017 and 5 September 2017 be confirmed as a true and correct record.

7.1 Recommendations to Board

It was noted that the Board approved all recommendations contained in the minutes.


A member advised that there was a typo item 7 – Committee’s work Programme and it should be Kainga Whanau Ora.

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8. COMMITTEES’ WORK PROGRAMME

It was recommended:

that progress against the 2017/18 work programme be noted

9. LATE ITEMS

There were no late items.

10. DATE OF NEXT MEETING

28 November 2017 (Shared matters of interest) 13 February 2018

11. EXCLUSION OF THE PUBLIC

It was recommended:

that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference “In Committee” minutes of the meetings held on 25 July 2017 and 5 September 2017

For reasons stated in the previous agenda

Confirmed this 28th day of November 2017

………………………………………… Chairperson

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MidCentral District Health Board Minutes of the joint Healthy Communities Advisory Committee and Quality & Excellence Advisory Committee Minutes of meeting held on Tuesday 28 November 2017 at 9am at MidCentral District Health Board Offices, Board Room, Gate 2, Heretaunga Street, Palmerston North

The shared matters of interest section of the meeting commenced at 9.00am.

This section of the meeting was chaired by Brendan Duffy, Chair, Healthy Communities Advisory Committee.

PRESENT

HCAC Members Brendan Duffy (Chair) Adrian Broad (Deputy Chair) Ann Chapman Barbara Cameron Dot McKinnon (ex officio) Nadarajah Manoharan Vicki Beagley Donald Campbell

QEAC Members Diane Anderson (Chair) Karen Naylor (Deputy Chair) Oriana Paewai Barbara Robson Dennis Emery

IN ATTENDANCE

Kathryn Cook, Chief Executive Amanda Driffill, Service Manager, Medical Services & Ambulatory Care Barb Bradnock, Senior Portfolio Manager, Children, Youth & Intersectoral Partnerships Carolyn Donaldson, Committee Secretary Chris Nolan, Service Director, Mental Health Services Claudine Nepia-Tule, Portfolio Manager, Mental Health & Addictions Craig Johnston, General Manager, Strategy, Planning & Performance Cushla Lucas, Service Manager, Regional Cancer Treatment Service David Jermey, Portfolio Manager, Primary Healthcare Deborah Davies, Acting Service Manager, Community Services Gabrielle Scott, Executive Director, Allied Health (part meeting) Jan Dewar, Nurse Director, Medicine, Surgery & Emergency Jess Long, Project Director Jo Smith, Senior Portfolio Manager John Manderson, Programme Manager, Business Improvement Kerry Juan, Business Advisor (part meeting)

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Keyur Anjaria, General Manager, People & Culture Lyn Horgan, Operations Director, Hospital Services Marcel Westerlund, Clinical Director, Mental Health Muriel Hancock, Director, Patient Safety & Clinical Effectiveness Neil Wanden, General Manager, Finance & Corporate Services Stephanie Turner, General Manager, Maori & Pacific Vivienne Ayres, Manager, DHB Planning and Accountability Dennis Geddis, Communications Team Leader

OTHER

Public: (2) Media: (1)

1 APOLOGIES

Apologies were received from Michael Feyen and Cynric Temple-Camp. Apologies for lateness were received from Barbara Cameron and Dot McKinnon.

2 LATE ITEMS

There were no late items.

3 CONFLICT AND/OR REGISTER OF INTERESTS UPDATE

3.1 Amendment to the Register of Interests

There were no amendments to the register of interests.

3.2 Declaration of Conflicts in Relation to Today’s Business

There were no declarations of conflicts of interest.

4 STRATEGIC & ANNUAL PLANNING

4.1 Delivering on Government Priorities: 2017/18 Quarter 1

The Manager DHB Planning and Accountability spoke to the report.

It was noted the Annual Plan for 2017/18 had not yet received formal Ministerial approval. The Ministry has advised that all sections except the financials have been approved.

Barbara Cameron joined the meeting.

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The three health targets that are presenting a persistent challenge to the organisation were discussed. These are Shorter Stays in ED, Immunisation and Better Help for Smokers to Quit, Hospital.

Dot McKinnon joined the meeting.

It was noted that there are no financial penalties against any of the Health Targets. The area where there are potential financial penalties for non-performance is in elective services. Specifically, the DHB loses income if the Elective Initiatives Programme is not fully delivered and there are financial penalties if Elective Services Patient Flow Indicators 2 and 5 are in red for greater than 4 months.

It was recommended:

That the Committees note this report.

5 PARTNERHIPS & CONSUMER

5.1 U-Kinetics Replacement Service Update

It was recommended:

that this report be noted.

5.2 Update on Outcomes of Tararua forum re Manawatu gorge Closure

The update on activities taken to lessen the impact of the gorge closure on health services was appreciated by the committee. A member asked that funding was put aside for technology, as the Ministry did not cover it.

Committee members stressed the importance of continuing to support key activities such as the health shuttle given the lengthy period it will take before the Gorge issue is resolved. The health and safety of the volunteers was raised. Management gave an assurance that they would continue to be in contact with the shuttle service and that the DHB will provide support where ever it can.

It was recommended:


6 COMMITTEES’ WORK PROGRAMME

It was agreed a query about the QEAC’s work programme and reducing the reporting frequency of professional practice development professional standards from nine months to six monthly would be discussed when approving the QEAC minutes.

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The Committee acknowledged the challenge Management faced trying to find a long term solution to physical space requirements within the restraints of the current site configuration.

It was recommended:

that progress against the 2017/18 work programmes be noted.

7 DATE OF NEXT MEETING

13 February 2018 20 March 2018 (Shared matters of interest)

QUALITY & EXCELLENCE MATTERS (Information only for Healthy Communities Advisory Committee)

This section of the meeting was chaired by Diane Anderson, Chair, Quality & Excellence Advisory Committee.

8 STRATEGIC & ANNUAL PLANNING

8.1 Mental Health and Addiction Service – Model of Care

The Service Director, Mental Health & Addiction Services introduced Dr Marcel Westerlund, Clinical Director, Mental Health & Addiction Services to members. The meeting was advised that the Mental Health and Addictions Model of Care was an important underpinning document, which is particularly relevant to the redevelopment programme for Ward 21.

A member noted that the new Government had stated there would be some new funding for mental health, and the member asked what plans had been made for that funding. Management advised no information had been received regarding this matter yet but it was being looked forward to with great anticipation.

The CEO reminded members that the Board had signed off on the Long Term Investment Plan which included a range of capital projects including Ward 21. At this stage, no significant changes to components of the long-term plan had been identified. Two options for Ward 21 were under consideration.

Management advised the report included several work-streams which were about building up referrals and pathways from educational institutions. These work-steams would include the relationship with tertiary education health service providers.

17

Management noted reporting on access to maternal mental health services was done separately to the regional services provided by Capital and Coast DHB in the acute care continuum.

It was also noted that the model of care developed would build on cultural and historic models of care already in place.

It was recommended:


8.2 A Development Plan for Improving Specialist Cardiovascular Management

The Development Plan was presented to the Joint Committee by Amanda Driffel. Staffing considerations for the new service were discussed, particularly the need to recruit Cardiologists with interventional skill sets and then provide them with enough work to maintain their competency. Management advised that it was intended to recruit two interventional cardiologists. Currently one cardiologist was on 12 months leave and a replacement had been successfully recruited. It was noted that the cardiology workforce has been reasonably consistent over the last few years.

It was recommended that the Committee:

Note that the proposal improves access to care and outcomes for cardiac patients.

Note that the proposal meets the DHBs priorities to: • Achieve equity of outcomes across communities• Achieve quality and excellence by design• Partner with people and whānau to support health and wellbeing• Connect and transform primary, community and specialist care

Note that the proposal is consistent with the Central Region Cardiac System of Care Strategic Plan 2016-2021 and the Board’s own Long Term Investment Plan 2016-2026.

Note that the draft business case is NPV positive over a range of scenarios and is expected to have a payback position of 4-8 years.

Endorse the proposal for Board consideration to proceed to detailed design of a Cardiac Catheterisation Laboratory prior to a final business case.

9 PERFORMANCE REPORTING

9.1 Care Capacity Demand Management Programme

A member inquired as to how long it would be before the CCDM programme would help to actively resolve situations where areas were understaffed. Management

18

indicated that the recent appointment of a TrendCare Coordinator was an important step in this process. Eight areas had collected sufficiently robust TrendCare data, and five of those areas were moving quite quickly towards being able to provide draft recommendations early in the New Year. The expectation was that other areas would be completed over the next 12 months with a focus needed to ensure TrendCare data was robust in those areas. The Variance Response Management programme was in place and work would be undertaken to make it more robust when responding. Management noted a query regarding reporting on the programme, and suggested a plan would be provided for the next QEAC meeting on reporting arrangements. That would provide an opportunity for the new Executive Director, Nursing & Midwifery who commences on 8 January 2018, to comment. A list of where TrendCare was used and the amount of financial resources to enable it to be implemented was also requested.

It was recommended:

that the Care Capacity Demand Management programme be noted.

9.2 Operational Report

In speaking to this report, the CEO noted it was a transitional report as the organisation moved to cluster reporting arrangements.

The report was then considered section by section. The main issues covered in discussion on this item were as follows.

In Acute and Elective Services, the key pieces of work were “Medimorph”, consisting of four key focus areas, and the perioperative improvement programme “Optimise”. The postponement of Dr Peter Jones’ visit at the end of October was noted. Management advised he was rescheduled for early 2018. He would talk to ED staff, discuss the Medimorph programme. As an outcome he would no doubt have some helpful suggestions about how MidCentral can further improve against the ED target. Previous visits from the Target Champion had been very helpful to the DHB.

In relation to mitigating some of the challenges facing the continence service, Management explained that a large number of people come each year to secondary care for assessments and prescriptions for consumables. The potential for this work to be undertaken in community settings, possibly in primary care, is being investigated.

The plan to lease some theatre sessions from Crest Hospital for day case work was noted. Other medium term options relating to surgery capacity were also being explored eg weekend lists.

The various work being done to address the financial position was also covered, eg the key projects “Medimorph” and “Optimise”, reducing the average length of stay. It was noted that costs were impacted by increased volumes and problems like large equipment breakdowns such as the linear accelerator.

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Of note in the cancer service update was the outage of the linear accelerator for three weeks. Services were managed internally with no outsourcing required. A member commented that with the new government in place, there was talk about increasing the age of eligible women for breast screening. Management were asked if this was put in place, could it be achieved. The Acting Service Manager, RCTS thought some investment would be required to do that, but detailed planning cannot be undertaken until firm advice is received from the Ministry of Health.

The Service Director, Mental Health & Addiction Services, went over the key successes in developing services and matching resources to demand. There was pressure on the Child, Adolescent and Family Service and also the Alcohol and Other Drugs Service.

Management were asked to consider reporting on the maternal mental health service activity in the monthly mental health dashboard update, so that there was more visibility of the service. Management agreed it could be done. Some concern was expressed at the results for KPIs 18 and 19 – Community Interface and Post-Discharge Community Care. The Service Director said it was hoped to have a league table for the national KPIs included with this report, and also advised that everyone in this report was followed up.

A member noted good work was now coming from the Unison forums. Management agreed saying there was great support from the Ministry of Social Development for this network.

The endorsement of the PHC nursing integration project, which initially focussed on the alignment of District Nursing Services with GPTeams, was highlighted. It is planned to scale this to cover more GPTeams with a focus on equity, and also to incorporate the advanced nursing workforce of the DHB.

Dental Services were continuing to make inroads into the dental arrears.

In relation to immunisation against mumps, Management advised that immunity declines with age. Booster vaccinations are available. To date there had not been enough mumps cases in the district to need a large scale programme.

The Director, Patient Safety & Clinical Effectiveness, commented on the huge amount of work being done around medication safety, noting in particular the opioid collaborative. The deteriorating patient programme which is a national programme, has just implemented a new early warning score system. A video conferencing facility for interpreter services for use by deaf patients and their families has been implemented via Skype.

Management confirmed they were aware of the national antimicrobial response plan which had just been released. An update would be provided to members when there was any development on it.

Management explained the DHB was not an outlier in respect to the number of falls and that the results reflected the definition of a fall.

The relationship with the new birthing centre was explained.

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Management agreed to include the table on patient transfers again in future reporting.

Management confirmed it was intended that an HR section would be added to each cluster’s reporting, moving forward.

It was recommended:

that the Operations Report for September and October 2017 be noted.

Dennis Emery left the meeting.

10 MEETINGS

10.1 Minutes

It was recommended:

that the minutes of the previous meeting held on 17 October 2017 be confirmed as a true and correct record.

10.2 Recommendations to Board

It was noted that the Board approved all recommendations contained in the minutes.


A request was made that the reporting frequency of the professional practice development professional standards be six monthly rather than nine monthly.

11 LATE ITEMS

12 EXCLUSION OF THE PUBLIC

It was recommended:

that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference “In Committee” minutes of previous meeting

For reasons stated in the previous agenda

2018/19 Annual Planning – Strategic Priorities

Subject of negotiation 9(2)(j)

Contracting Arrangements with Birthing Centres Ltd

Under negotiation 9(2)(j)

Operations Report: Potential Serious Adverse Events and Complaints To protect personal privacy 9(2)(a)

2121212121

COPY TO: Strategy, Planning & Performance

MidCentral DHB Heretaunga Street

PO Box 2056 Palmerston North 4440

Phone Fax

+64 (6) 350 8928 +64 (6) 355 8926

For:

Decision

Endorsement Noting

To Healthy Communities Advisory Committee

Author Maha Patel

Project Manager

Strategy, Planning and Performance

Endorsed by Chief Executive

Date 19 January 2018

Subject Health Promotion Agency Report and Presentation Overview

RECOMMENDATION

It is recommended that the Committee:

• note this update and presentation

Strategic Alignment

The Health Promotion Agency’s mission is to inspire all New Zealanders to lead healthier lives. This is directly aligned to our local MidCentral DHB vision of Quality Living, Healthy lives, Well Communities. Health Promotion can be achieved through information and working with our partners, which are also essential enablers to achieve better health outcomes and better health care for all.

Glossary

MidCentral DHB – MidCentral District Health Board

HCAC – Health Communities Advisory Committee

HPA- Health Promotion Agency

RM- Regional Managers

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1. PURPOSE

This report provides background information to the Healthy Communities Advisory Committee regarding the Health Promotion Agency. The report is in preparation for the presentation by Giselle Bareta, the Central Region Manager, Alcohol and Community from the Health Promotion Agency.

2. BACKGROUND

The Health Promotion Agency (HPA) is a Crown entity under the Crown Entities Act 2004. It was established on 1 July 2012 by the New Zealand Public Health and Disability Act 2000 with an overall function to lead and support activities for:

• Promoting health and wellbeing and encouraging healthy lifestyles• Preventing disease, illness and injury• Enabling environments that support health and wellbeing and healthy

lifestyles• Reducing personal, social and economic harm.

It also has the following alcohol-specific functions: • Giving advice and making recommendations to government, government

agencies, industry, non-government bodies, communities, healthprofessionals and others on the sale, supply, consumption, misuse and harmof alcohol so far as those matters relate to HPA’s general functions

• Undertaking or working with others to research the use of alcohol in NewZealand, public attitudes towards alcohol, and problems associated with, orconsequent on, the misuse of alcohol.

As a Crown Agent under the Crown Entities Act 2004, the HPA is required to give effect to government policy when directed by the responsible Minister. However, in delivering its alcohol-specific functions, HPA must only have regard to government policy if directed to do so by the Minister.

The HPA has a mandate to lead and support national health promotion activities and initiatives. HPA has managed a number of high-profile campaigns and built strong relationships with many other organisations, providing leadership, acting as a catalyst for change, and encouraging collaboration.

The Agency is funded from Vote Health and the levy on alcohol produced or imported for sale in New Zealand.

The HPA has three offices, a head office in Wellington and regional offices in Christchurch and Auckland. The majority of HPA staff are located in Wellington. The alcohol work programme is the only work programme at HPA that has Regional Managers (Southern RM - Christchurch, Central RM – Wellington and Northern RM – Auckland).

2.1 Health Promotion Agency Strategic Framework The vision for the HPA is for all New Zealanders to realise their potential for good health and improved quality of life and New Zealand’s economic and social development is enhanced by people leading healthier lives.

The figure below outlines the HPA’s Strategic Framework. It outlines the strategic intentions that HPA contributes to and the HPA’s output classes.

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2.2 Health Promotion Agency Work Plan The HPA’s work spans a range of major issues, the major health priorities include:

• Alcohol• Mental health• Tobacco control• Minimising gambling harm• Immunisation• Skin cancer prevention• Nutrition and physical activity• Health education resources.

The HPA also undertakes work in other areas when requested to do so by its Ministers or the Ministry of Health. Other programme areas of work have included stroke, rheumatic fever and oral health.

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The Agency leads and supports national health promotion initiatives through: • Marketing and communications• Health education• Policy and advice• Resources, events and online tools• Research and evaluation• Strategic relationships.

Much of HPA’s work uses marketing approaches aimed at achieving behaviour change. Promoting health and wellbeing, working with communities and communicating health messages to priority audiences are major parts of the public face of HPA.

3. PRESENTATION TO THE HEALTHY COMMUNITIES ADVISORYCOMMITTEE

The presentation to HCAC will provide an overview of HPA, the work that they do, and how the Regional Manager role connects what they see, hear and feel on the ground to HPAs strategic priorities.

The presentation will also provide an opportunity to discuss the priority areas for MidCentral DHB and from a governance perspective, the opportunities to support the HPA and influence the HPA future work programme to align with our strategic priorities.

3.1 Guest Speaker - Giselle Bareta Giselle Bareta is a Regional Manager for the Alcohol and Community Team at the Health Promotion Agency where she works across the central region to support locally led alcohol-harm reduction initiatives.

In 1997, Giselle completed a BA Education and Criminology and in 2014 she achieved MPP Master of Public Policy. Giselle’s professional background has involved interpretation and application of legislation in particular the Local Government Act 2002 and Sale and Supply of Alcohol Act 2012; policy development and advice to local government; design and implementation of community safety initiatives; organisational process improvement/service delivery initiatives; research and evaluation.

Giselle has a passion for alcohol-harm reduction, thinking strategically about what works in particular settings and how she can assist others in the delivery of effective health promotion activity. She works alongside key stakeholders in a range of settings offering expertise and support for community-led action on alcohol-harm reduction.

4. RECOMMENDATION

It is recommended:

that the Committee note this update and presentation.

Maha Patel Project Manager, Strategy, Planning & Performance

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Phone Fax

+64 (6) 350 8928 +64 (6) 355 8926

For:

√ Decision

√ Endorsement

Noting


Author Gabrielle Scott, Executive Director Allied Health

Dr Jeff Brown, Clinical Director Child Health

Barb Bradnock, Senior Portfolio Manager

Endorsed by Kathryn Cook

Chief Executive MidCentral DHB

Craig Johnston

General Manager Strategy, Planning and Performance

Date 5 February 2018

Subject Child Development Service Update

RECOMMENDATION

It is recommended:

• that the committee endorse this update for the Child Development Serviceand;

• that the committee note the decision not to proceed with the additionalPsycho-diagnostic Service FTE for the 2017/18 year and;

• that the committee support collaboration with the Ministries of Education andHealth and Enable NZ to redesign the intersectoral approach to children withlearning, behaviour and developmental problems.

STRATEGIC ALIGNMENT

This report is aligned to the New Zealand Disability Strategy, the associated Convention on the Rights of Persons with Disabilities, the New Zealand Health Strategy’s goal of services Closer to Home and MCH Strategic Imperative of Partnering with People and Whanau to support wellbeing.

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Glossary

ASD – Autism Spectrum Disorder

CAFS – Children Adolescent and Family Mental Health Services

CE – Chief Executive

CDC – Centres for Disease Control and Prevention USA

CDS – Child Development Services

CYFS – Child Youth & Family Services

DHB – District Health Board

DSS – Disability Support Services

FTE – Full time equivalent

Gateway – General health assessment service for children taken into Oranga Tamariki care

MCH – MidCentral Health

MDHB – MidCentral District Health Board

MDHB’s - MidCentral District Health Boards

MDT – Multidisciplinary Team

MoH – Ministry of Health

MCOT – Ministry for Children Oranga Tamariki (formally CYFS)

NGO – Non Governmental Organisations

Paruru Mowai – Service for mothers with vulnerable pregnancies where midwives can refer for MDT care and monitoring by a intersectorial group

PHO – Primary Health Organisation

RTLB – Resource Teachers of Learning and Behaviour

VNT – Visiting Neurodevelopmental Therapy either a physiotherapist or occupational therapist working in a transdisciplinary way.

WDHB – Whanganui District Health Board

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1. PURPOSE

To provide the committee an update on the MDHB’s Child Development Service (CDS) as requested by the Committee at the last meeting.

2. BACKGROUND

The CDS is a community based non-medical, multidisciplinary allied health service with staff situated in Palmerston North, Horowhenua and Dannevirke. Staff undertake assessment and intervention services for babies and children aged 0-16 years that have been identified as having a long-term disability or are at risk of developing one.

The service is funded by the Ministry of Health (MoH) through the Disability Support Services (DSS) Under 65 years portfolio with additional supplementary funding provided by the MidCentral DHB.

In July 2017, a presentation was provided to the committee by Dr Jeff Brown, Clinical Director Child Health and Gabrielle Scott, Executive Director, Allied Health.

Following the presentation the committee requested ongoing updates in relation to the physical environment of the service and how the organisation is planning to better meet the needs of children with disabilities within a changing system.

3. UPDATE

3.1 Facility issues The July presentation flagged accommodation issues for the CDS. At the end of November 2017, Committee members visited the service to get a better understanding of the constraints under which the service is operating. It is expected that these issues will be dealt with in the medium to long term. Firstly, it is anticipated that the integrated service model will provide opportunities for different models of service built on intersectoral alignment. The timeframe for cluster development is the 2018 calendar year. Secondly, the Strategic Property Plan development may provide solutions to the accommodation issues in the future for the CDS.

3.2 Additional learning/behaviour assessment service As previously advised to the Committee, it was intended to expand the CDS’s service capacity through the addition of clinical psychologist and occupational therapy resources. This was to address the ongoing lack of access for a multi-disciplinary approach to psycho diagnostic assessments and the ongoing difficulty trying to manage the ever increasing waiting list for children with learning and behaviour issues.

This initiative was included in the 2017/18 Annual Plan and was provided for in the funder’s budget. It was phased to occur in quarter three – ie, from January 2018.

It is now intended that the DHB not proceed with this initiative. There are three reasons for this:

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• The proposal that MidCentral DHB fund additional capacity out of itsPopulation Based Funding Formula was based on a desire to address theimmediate and pressing needs of children in our district. However, fundingchild disability services is actually the responsibility of the Ministry of Health.

• The Ministry is undertaking a review of this service area. MidCentral DHB isparticipating in this review and has offered to be part of a pilot.

• MidCentral DHB’s financial position is such that the DHB is no longer in aposition to absorb the cost of service expansions.

The funding saved through not proceeding with this initiative is $110,000 in 2017/18 and $220,000 per annum thereafter. This funding will help reduce the DHB’s deficit.

This service expansion was expected to have a direct impact on children and their families/whanau. It would help deal with the increasing numbers of children who wait for assessments which determine their access to Ministry of Education and health supports, which are key to the child’s progress. Focusing and speeding up the assessment process was expected to have potential lifetime benefits for the individual families concerned.

The service expansion was also expected to benefit a range of service agencies, including our own Child Health service. For example, at present learning and behaviour issues comprise a significant proportion of all the children referred to Child Health. Other agencies are similarly affected. Having a single, focused service and a clear service map (which has already been developed) was expected to have benefits across the system.

Notwithstanding the benefits that would result from the proposed service expansion, the Ministry of Health is responsible for planning and funding of disability services for children. The Ministry has recently initiated a piece of work with the Ministry of Education to co-design child early intervention services. This piece of work is in parallel with the Enabling Good Lives disability redevelopment project. The Ministry of Health will support the Good Start to Life project and will include a review of the national CDS and Autism Spectrum Disorder (ASD) contracts.

Recent discussions with the Ministry have raised the possibility of piloting the redesign of the national paediatric disability service at MidCentral DHB. This will be a great opportunity for MidCentral DHB to support and lead the redesign of the child development services. Discussions will continue in February 2018 with the Ministries of Health and Education and MidCentral DHB to progress a whole of system redesign of assessment, therapy and ongoing support.

In the meantime, while waiting for the Ministry review process to work through, the issue of children waiting for psychological and non-urgent assessments can be addressed by contracting additional assessments from Massey University. Massey’s capacity is limited to about 30 assessments a year, which will need to be targeted to the highest priority cases. The prioritisation will be undertaken by the newly developed cross service Multidisciplinary Team (MDT). The role of this MDT is to reduce the unnecessary bouncing of referrals between services ensuring families a

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more seamless referral process. The team involves paediatrics, mental health and CDS.

3.3 Waiting times With the exception of children requiring psychologist and/or non-urgent assessment, the CDS is managing to see all referrals within six weeks.

3.4 Staffing The CDS team is an experienced and relatively stable allied health team made up of physiotherapy, occupational therapy, social work, speech and language therapy, clinical psychology and visiting neurodevelopmental therapy. Recent vacancies in speech language therapy have been recruited.

Responsibility for the employment of the allied health staff is an issue for Ministries and DHB to address noting the potential projects mentioned in this report.

4. SUMMARY

Despite the physical constraints the CDS continues to deliver high quality services to our community. The innovative approach to work intersectorally has already improved access for some more complex families. Within the proposed MoH redesign work opportunities may be further realised for families and staff in terms of new models of care and improved working facilities.

5. RECOMMENDATION

It is recommended:

that the committee endorse this update for the Child Development Service and;

that the committee note the decision not to proceed with the additional Psycho-diagnostic Service FTE for the 2017/18 year and;

that the committee support collaboration with the Ministries of Education and Health and Enable NZ to redesign the intersectoral approach to children with learning, behaviour and developmental problems.

Gabrielle Scott Dr Jeff Brown Barb Bradnock Executive Director Allied Health

Clinical Director Child Health

Senior Portfolio Manager

30




For:

Decision

Endorsement

X Noting


Author Wayne Blissett, Operations Director Maori Strategy and Support | Programme Lead Ora Konnect

Endorsed by Craig Johnston, GM Strategy, Planning & Performance

Date 16 January 2018

Subject Ora Konnect – Development of an IFHC model for the South Western Suburbs of Palmerston North

RECOMMENDATION

It is recommended that the Committee:

• that the update on the advancement of Ora Konnect be noted.

Strategic Alignment

This report is aligned to MidCentral DHB’s strategy and strategic imperatives, particularly, Achieving Equity of Outcomes Across Communities

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Glossary

CIO – Chief Information Officer

CPHO – Central Primary Health Organisation

ELT – Executive Leadership Team

IFHC – Integrated Family Health Centre

IT – Information Technology


PMS – Practice Management Software

SW – South Western

Whanau Tahi – An integrated technology platform used by Te Pou Matakana the North Island Whanau Ora Commissioning Agency

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1. PURPOSE

The purpose of this paper is to provide an introduction and overview of Ora Konnect - the development of an Integrated Family Health Centre model for the South Western suburbs (Awapuni, Highbury & Cloverlea) of Palmerston North.

2. SUMMARY

Ora Konnect takes a fresh approach to improving health and wellbeing by focusing on the strengths and opportunities that exist in the defined community that is the SW suburbs of Palmerston North.

The SW suburbs are an important part of the MidCentral DHB and for other key health and social service agencies that service the area. Health, social service providers, Whānau Ora and community feedback strongly expressed that delivery of these services around a physical building allowing co-location of services i.e. an Integrated Family Health Centre (IFHC), would not add any value in this community. The foundation of Ora Konnect is based on the understanding that these agencies are committed to transformational change so that services are adaptive and resilient, given the current and future challenges faced by the community.

In light of this, Ora Konnect aims to be a health and social service delivery model that is grounded in Alliancing, which has proven to be successful across a number of different contexts and environments. It will be a virtually joined model of service delivery that utilises technology as a platform for integration across people, services and sectors. The intended model will be based on linking smaller specific service providers to a larger network of resources. Together this will enable a clients to access a wider range of services and sectors in a more connected, efficient and sustainable way.

Ora Konnect represents a purposeful departure from the status quo of a ‘bricks and mortar approach’ and will require some experimentation, risk and commitment.

Since approval of the Case to Change the focus has been translating the concept into a practical reality through the adoption of a project management approach. The next steps are focused on practical implementation such as the formalisation of the Ora Konnect Alliance with Dr Iain McCormick and engagement with Pharmacy and General Practice Teams across Palmerston North.

3. BACKGROUND

In 2014 the Karanga te rā Karanga te ao community profile was commissioned for the purpose of informing future strategies to enhance health and social service provision in the SW suburbs of Palmerston North City. The aim was improving the

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health and wellbeing of the SW communities. The name Karanga te rā Karanga to ao, a call that “summons and welcomes in a new day and a new dawn”, exemplifies the innovative approach required to advance current capabilities and address a highly complex system.

The profile provided an understanding of the issues these communities face and identified the challenges and the areas that require attention. It also acknowledged existing strengths and the invaluable potential that resides within the SW suburbs. The interview feedback and shared ideas highlight the need for change, and joined up care and support. On the basis of the findings presented in the report the following recommendations were made:

• Develop a model of service delivery that improves integration and coordinationof health and social services

• Continue to build relationships within the SW suburbs• Expand and refine the service mapping exercise• Maintain a clear focus on the Population being served

The purpose of Ora Konnect is to build on these findings and provide a model of how to address the health and social needs of the community by using an evidence based approach drawing on the current data profile, exploring current models and approaches locally, nationally and internationally.

MidCentral DHB in partnering with Central PHO and Te Tihi have drawn on the community voice and intelligence of the Karanga te rā, Karanga te ao community profile. This partnership approach demonstrates the desire to work innovatively to develop a dynamic and agile Case for Change.

MidCentral DHB’s strategic imperatives actively challenge the health disparities across the District. Ora Konnect’s alignment is essential to creating a ‘joined up system’ that can actively enhance the health journey of whānau and address key health issues across the continuum of care.

Ora Konnect will provide the opportunity to transform health and social service delivery, into an approach that will meet the needs of Whānau now and in the future. The SW suburbs “community voice” has clearly stated that Whānau need greater flexibility around how and when services are delivered, what these services are, and the importance of connecting up providers so that the services are focused around client need rather than agency/service provider constraints.

3.1 Phase 1 MidCentral DHB began exploring the options for a SW suburbs IFHC in July 2016. Phase one resulted in the development of a Case for Change. This case describes the informal network of allied agencies that work together at a local level and who have a high level of collective local knowledge. Ora Konnect provides an opportunity to transform what has started, into an approach that will meet the needs of Whānau now and in the future.

The Case for Change establishes that Ora Konnect is an evidence based model that supports the ambition for the delivery of integrated Whānau Ora health and social services in the SW suburbs. Data indicates that the age demographic and associated complexities of this populations’ health need, combined with increasing compliance requirements, and financial austerity, all signal the need to arrange services in new and different ways. Ora Konnect presents an opportunity to design

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a community based delivery system in the interests of the SW suburbs community and the wider Palmerston North region.

Ora Konnect has been shaped for the community, by the community and will continue to ensure that the community voice is embedded as work progresses. The proposed Alliance structure will be underpinned by a collective impact framework and the philosophy of Whānau Ora using evidence and system analysis to support understanding of community need and the available skills and resources. Ora Konnect will actively support the reshaping of attitudes, beliefs and practices to improve the delivery of services to meet the social and cultural needs of all whānau and families across the community to provide an innovative model that eliminates barriers for whānau and families.

It is important to note that the existing IFHC’s in the district have resulted over time – some came into existence within 3 years, others after 10 years of concerted effort. Over that time those involved learned that well-formed relationships and co-design are central to the success of IFHCs. In the same way, establishing strong relationships in anticipation of the work ahead has been central to phase one of Ora Konnect. We also know that Alliancing across differing sectors requires time to ensure all parties have a common language and are striving for the same outcomes.

The Ora Konnect Case for Change was endorsed by the CPHO Board and MidCentral ELT in August 2017

3.2 Phase 2 Following endorsement from the CPHO Board and MDHB ELT Wayne Blissett was seconded from Pae Ora Maori Health Directorate two days a week as Programme Lead. Debbie Te Puni was contracted as the Ora Konnect Programme Co-ordinator to support implementation in October 2017.

Progress has continued to be made, building on the Case for Change to a project implementation approach. The Ora Konnect Working Group has been reconstituted with an updated Terms of Reference and composition, the Steering Group has also been reconstituted and Terms of Reference reviewed. The revision of the Working Group has created the opportunity to invite more diversity and representation across sectors as we move to implementation.

A project plan has been drafted and been through the Working Group and Steering Group for refinement and confirmation. The project plan draws on the Collective Impact methodology to support discrete components of the overall change for the South Western Suburbs. The Ora Konnect Case for Change explored these opportunities with the Alliancing Approach put forward as the key recommendation with Whanau Ora providing the base methodology for advancing the Alliancing approach. Contact has been made with Dr Iain McCormick to plan dates in February to commence the formal development of the Alliancing approach.

The work with Whakapai Hauora – Best Care around the Health Care Home process has been integrated into the Ora Konnect Project Plan as a discrete component.

Ora Links is a professional forum that commenced in April 2017. The first forum was hosted by the Palmerston North City Council, followed by Best Care Whakapai Hauora in May 2017. The aim of this forum is to provide a platform to establish relationships, build on experiences and create an environment that influences

35

collective innovation. It has been a means of instigating conversations between professionals who would otherwise not engage. The opportunity to engage with local initiatives is especially important and strengthens working relationships that support better outcomes for the community.

Ora Konnect Links recognises the need for a changed approach to the delivery of care and support. It is another tool that reinforces the need for change and enables relevant people across all sectors to discuss how they may effectively plan for change. These initial conversations are fundamental to the design and delivery of integrated practice and provide a platform for positive disruption across the various sectors. The Ora Links continues as a professional network of interested parties to the development of Ora Konnect. The next forum is to be hosted by Te Waka Huia in February 2018.

A critical component of the Ora Konnect development is the adoption of an integrated technology platform that will assist to integrate and align services, processes and communication as part of the virtual connection. Accordingly the MidCentral DHB CIO has been invited onto the Steering Group alongside the IT Manager of CPHO to sit on the Steering Group to ensure a cohesive approach to IT developments and data sharing. The movement by CPHO to a new PMS platform creates new opportunities for IT system integration and development. During the Case for Change work, Whanau Tahi was assessed as having the core components required for Ora Konnect. Whanau Tahi continues to remain a focus of investigation in regards to data sharing, import and case management. A full due diligence process will have to be undertaken to understand the full potential and challenges of any system that is adopted as part of the Ora Konnect process.

From a locality planning perspective the Locality Planning team is about to commence the locality planning process for Palmerston North. Over March the team will plan and develop a model for how locality planning will occur for Palmerston North. It will be based on learnings from the current locality planning taking place across the district and the uniqueness of Palmerston North. The existing work from the Karanga te rā Karanga te ao community profile and Ora Konnect will be utilised as part of the process.

3.3 Next Steps During the next quarter the focus is on;

• Finalisation of the Project Implementation Plan and Work BreakdownSchedule at the Steering Group meeting 15th February 2018

• Commence the formalisation of the Ora Konnect Alliance with Dr IainMcCormick and the interested partners with the completion of an Allianceagreement 27th and 28th February 2018

• Engagement with Pharmacy and General Practice Teams across PalmerstonNorth as part of a professional network to support Ora Konnect 15th February2018

• Due Diligence programme to identify the best integrated technology platformto invest in to support the vision of Ora Konnect – Meeting with Steven Miller15th February.

36

• Sustain Ora Konnect Links as a community network and resource link for OraKonnect – Next Forum 22nd February 2018

• Continue to build the conversation with the Community and ensure ongoingcommunity engagement and support.

• A further update will be provided to the Committee in May.

4. RECOMMENDATION

It is recommended:

that the update on the advancement of Ora Konnect be noted.

Wayne Blissett Operations Director Maori Strategy and Support | Programme Lead Ora Konnect

37

For:

Decision

Endorsement

√ Noting


Author Scott Ambridge, General Manager Enable New Zealand

Endorsed by Kathryn Cook, CEO MDHB


Subject Disability Support System Transformation Update

RECOMMENDATION

It is recommended that:

• The Committee notes the update and progress of the transformation of theDisability Support System.

Strategic Alignment

This report is aligned with MDHB’s strategy, specifically achieving equity of outcomes across communities. This is relevant for disabled people and their whanau who face significant barriers to participation and citizenship. It is also aligned to the goal to connect and transform primary, community and specialist care as the work in this area will change the way in which current DHB services interface with the new system and in the longer term may also drive service change.

Glossary

DHB – District Health Board DIAS – Disability Information Advisory Service DSS – Disability Support System EGL – Enabling Good Lives ENZ – Enable New Zealand MDHB – MidCentral District Health Board NASC – Needs Assessment and Service Co-ordination WEKA – What Everyone Keeps Asking

38

1. PURPOSE

The purpose of this memo is to update HCAC on the DSS Transformation for MDHB.

2. BACKGROUND

The new (detailed) design for the DSS is in the final stages of development after the high level design was presented and approved by Cabinet early in 2017.

The high level plan was developed by a co-design group comprising people with disabilities and family representatives, and supported by a number of officials including the General Manager, Enable New Zealand.

Subsequently, more than twenty working groups were set up across a number of work streams that included:

• Funding mechanism for building capability of disabled people and families• Disability information – front end of the new system• Funding• EGL roles• System responsiveness – creating a learning system• Safeguarding

A number of DHB staff were involved in workshops relating to the detailed design of the proposed new transformed DSS. The activity has been very intense over the last few months; the General Manager ENZ in particular, spent around three days per week in workshops.

3. UPDATE

An update on activities relating to the DSS transformation is summarised below:

• The two most challenging work streams have been around funding andresources.

• The final Cabinet paper will be presented to the new Government in February, alittle later than first anticipated, which signals that the MidCentral regionprototype will be launched in October 2018 (initial date was July 2018).

• Contentious areas with the current system such as the DSS eligibility criteriaand needs assessment processes have yet to be fully worked through, this islikely to occur during the implementation phase (Mar – Sept 2018)

• The General Manager ENZ remains focused on ensuring that the new design isintentional about targeting pockets of our population that are completelyisolated and currently not engaging with the current system (such as ruralMāori, migrant and Pacifica communities).

• It is anticipated the language around “social investment” will change. However,the approach of investing early is still a strong feature of the new system.

• The DHB working group (co led by the General Manager, Enable New Zealandand the Executive Director Allied Health) has been progressing well, criticalareas of focus are the interface with mental health and children’s team. Workincludes identifying service gaps, mapping current interfaces and describingpossible future scenarios. See further update below.

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3.1 Critical shifts/changes:

An overall picture of what the detailed design will look like is now emerging, and listed below are some of the changes that are likely to be incorporated into the new design:

• Putting decision making in the hands of the disabled person - a move toindividual budgets and support, greater choice and flexibility around how themoney is spent with less barriers and impediments.

• A connector who walks beside the disabled person and their family to help planand envision their “good life”.

• A greater role for disabled people and families/whanau is governance andleadership.

• Specific funding to build resilience and capability in disabled people and tosupport individuals who are in crisis.

• Investing early to achieve better outcomes.• Strong technology focus.

3.2 DHB Working Group – DSS Transformation

The health interfaces are very complex and in order to better understand and support how the disabled person and their whanau will interface with “health systems”, a DHB working group was established. The group comprises a broad range of participants from across the health continuum – primary health, mental health, social workers, NASC (to name a few). Its role is to act as a subject matter expert providing insights into the current system (barriers, service gaps, challenges, what is working well that could be further built on) and feeding these into the detailed design work.

Key trends emerging from the group are summarised below:

• Recognition that much of the information gathered in the stages of diagnosisand ongoing medical oversight is important to be aware of and take account ofin service planning and design approaches.

• The need for the early and full identification of all relevant health issues – bothat the time of initial diagnosis and through life, as people’s health status isincreasingly vulnerable due to compromised physical function and inadequateholistic oversight.

• The need for full and regular health monitoring to ensure potential healthvulnerability and co-morbidities are identified and dealt with accordingly, tomaximise each person’s wellbeing and ensure that reversible situations can bemanaged, and appropriate treatments are delivered in a timely and accessiblemanner. (This includes everything from dental care through to diabetes andobesity identification and management, cardio-respiratory health, kidneyhealth, cancer diagnosis and management, musculoskeletal compromise,psychological and mental health supports, etc).

• Strong advocacy is required, from appropriately skilled support people, toensure that disabled people are heard, their concerns respected and theirhealth needs are recognised, prioritised and administered in an equitablemanner to that offered to other health service users (it was noted that disabledpeople’s health concerns are very often dismissed, overlooked or considered tobe an ‘unfortunate’ aspect of their impairment and they are often not heardand/or their concerns not adequately / appropriately addressed).

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3.3 Implications for MDHB

The new system will provide MidCentral DHB with an opportunity to review the way in which disabled people are supported in our community.

The system transformation opens the way for the disabled people to engage with a range of providers and services. As a major provider of disability services, Enable New Zealand has a strong interest in ensuring it has an ongoing relationship with the Ministry of Health and will report progress on contractual matters through the Enable New Zealand Governance Group.

4. RECOMMENDATION

It is recommended:

That the Committee notes the update and progress of the transformation of the Disability Support System.

Scott Ambridge General Manager Enable New Zealand

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COPY TO: Specialist Community & Regional Services



For:

Decision

Endorsement

x Noting


Authors Dr Robert Weir, Medical Officer of Health

Dr Robert Holdaway, Manager Public Health

Peter Wood, Technical Manager Operations, Central North Island Drinking Water Assessment Unit

Endorsed by Kathryn Cook, Chief Executive

Date 5th February 2018

Subject Ohakea PFAS Contamination Response

RECOMMENDATION

It is recommended:

• that the ongoing role of MDHB’s Public Health Service in the investigationand response to the Ohakea PFAS contamination be noted.

Strategic Alignment

This update relates to MDHB’s statutory & contractual responsibilities regarding drinking water safety and is aligned to the MDHB Strategy.

Glossary PHS – MidCentral Health’s Public Health Service DWAs – Drinking Water Assessors (employed by PHS) MOoH – Medical Officer of Health MfE – Ministry for the Environment NZDF – New Zealand Defence Force MoH – Ministry of Health HRC – Horizons Regional Council (Manawatu-Whanganui Regional Council) MDC – Manawatu District Council PFAS – Perfluoroalkyl Substances PDP - Pattle, Delamore Partners Ltd

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1. PURPOSEMidCentral Health’s Public Health Service has reported previously to the Board inrelation to drinking water quality, risks for which were clearly outlined in the reportfrom the Havelock North Drinking Water Inquiry. Since the Inquiry reported back, PHShas been working closely with other key stakeholders, particularly Horizons RegionalCouncil and the seven Territorial Authorities within this region to ensure a joined upapproach to drinking water quality.

The purpose of this paper is to update the committee around the ongoing investigation and response to the contamination of land surrounding the Ohakea Air Force Base by perfluoroalkyl substances (PFAS).

While the contamination does not appear to have reached any community water supplies, it has contaminated surface and groundwater on properties close to the Ohakea Base. In some cases, the property owners have been drinking this water.

An “All of Government” response to this is being led by the Ministry for the Environment (MfE), and there are a number of organisations involved at both a local and a national level.

2. POTENTIAL ENVIRONMENTAL CONTAMINATION WITH PFAS

On Monday 27th November 2017 MDHB’s Public Health Service was advised by the Ministry of Health (MoH) that the New Zealand Defence Force (NZDF) and Ministry for the Environment (MfE) were investigating the possible contamination of surface and groundwater surrounding two RNZAF Bases (Ohakea and Woodbourne), by PFAS.

PFAS are a class of man-made chemicals that have been used since the 1950s in the production of a wide range of products that resist heat, stains, grease and water, including furniture protectants, floor wax and specialised firefighting foam. They are persistent in the environment and in the human body, and are resistant to environmental degradation. The Ministry of Health (MoH) has confirmed that exposure to PFOS and/or PFOA will not pose any significant health effects today. It is also recognized that these compounds accumulate in the body but we don’t fully understand the effects this could have on human health in the long-term. Therefore, a precautionary approach is being taken to the situation surrounding Base Ohakea.

Testing of surface water and groundwater sources: Initial testing on the base confirmed that PFAS were present in surface and groundwater samples. Computer modelling suggested that a number of properties to the south-west of the base might have been contaminated.

MfE and NZDF developed a testing programme in an effort to establish the extent to which PFAS had spread to properties close to the base. MDHB’s Public Health Service (PHS) supported NZDF with their stakeholder visits to answer any health-related questions that might arise.

The sampling programme took place between 7th and 20th December. The initial investigation was contracted to Pattle Delamore Partners Limited (PDP) by NZDF. Samples have now been analysed, the results received and collated, and individual landowners provided with reports.

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Water testing results: Of 26 groundwater samples collected from properties around Base Ohakea, PFAS were detected in 19 samples (73%). Thirteen samples exceeded the interim drinking water guideline levels, and five of these were recorded as being from bores currently used for drinking water. PFAS were also detected in all of the eight surface water samples, with levels exceeding the interim drinking water guidelines in five of the samples.

3. THE RESPONSE - CURRENT ROLES AND RESPONSIBILITIES

Ministry for the Environment MfE is taking the overall lead/coordination role in the investigation and response to the contamination. They are chairing the All of Government Committee.

It is understood that MfE are working with other stakeholders to develop a communications plan to ensure that information is provided in a timely manner, to the public and to the media.

New Zealand Defense Force NZDF operates Base Ohakea. They have led the liaison meetings with affected landowners/tenants and have undertaken the preliminary testing (see above) and are about to embark on the second round (utilising external contractors). They are seeking to gain a better understanding of the current extent of contamination, where it has spread to, and where it is likely to spread in future.

In the meantime they continue to supply the affected landowners with bottled water, and we understand that they have offered those whose water exceeds the interim guidelines with rainwater tanks. It isn’t clear whether this offer has been taken up at this point.

Horizons Regional Council Regional Councils are responsible under the Resource Management Act (RMA) and National Environmental Standards (NES) Regulations for maintaining and monitoring the quality of the groundwater to achieve the RMA’s sustainable management purpose. This includes preventing contamination of groundwater. They may permit some activities and require consents for others such as taking water and the discharge of contaminants. HRC have announced that they will be undertaking an investigation into the contamination, under the RMA provisions. HRC will be involved in any resource consent applications in respect of longer term solutions to the provision of drinking water to those affected.

Manawatu District Council Territorial authorities are responsible for managing land uses and generally provide community drinking water, stormwater and sewage services. However, the properties affected by the PFAS contamination are not currently connected to a community drinking water supply, relying instead on self-supply from a mix of shallow bores and/or rainwater. MDC have undertaken to develop a paper outlining possible options for medium/long term water supplies. This paper is expected to be completed shortly, and should serve as a starting point for discussion.

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Ministry of Health The Ministry of Health as lead for the health response administers the legislation for drinking water, including the Health (Drinking Water Amendment) Act 2007. MoH is representing health at the AoG level.

Key activities to date have included: • development of the initial advice around the health effects of PFAS;• tasked Healthline to provide advice to those affected;• development of a health Q&A sheet;• establishment of the process for affected property owners/tenants to meet with

the Medical Officer of Health;• development of the process for those affected who have ongoing health

concerns to have a free wellness check with their GP;• provision of background educational material for GPs.

MDHB MDHB employs a number of designated staff including two Medical Officers of Health (MOsH); three Drinking Water Assessors (DWAs) and several Health Protection Officers, who administer the Health (Drinking Water Amendment) Act 2007 at the local level. MDHB is also responsible for coordinating the local health response.

Key activities to date have included: • Health Protection staff involvement in the liaison visits, answering health-

related questions.• The Medical Officer of Health meeting with two families who are affected by the

contamination.

Once the options paper is released by MDC mid-February this will be provided to AoG for their consideration. Depending on decisions made at AoG level, DWA staff will work with the other stakeholders to ensure that property owners have sustainable access to drinking water that meets requisite standards and the interim guideline levels for PFAS.

Ministry for Primary Industries MPI has a responsibility for food safety. Their role in the response has been to assess the risks associated with consumption of the water by stock on the affected land, and the subsequent risks to human health resulting from consumption of food, such as home grown vegetables, home-kill meat and eggs.

Further Information on PFAS: Further information on PFAS may be found on the MfE website:

http://www.mfe.govt.nz/more/hazards/hazardous-substances/pfas/about-pfas

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4. RECOMMENDATION

It is recommended:

that the update around the Ohakea PFAS contamination situation be noted.

46




Phone Fax

+64 (6) 350 8928 +64 (6) 355 8926

For:

Decision

Endorsement

X Noting


Author Strategy, Planning & Performance

Endorsed by Craig Johnston, General Manager, Strategy, Planning & Performance


Subject Strategy, Planning & Performance Operating Report

RECOMMENDATION

It is recommended:

• That this report be noted

Strategic Alignment

This report aligns to the MidCentral Strategy and to the Annual Plan.

Glossary

Central PHO – Central Primary Health Organisation


GP – General Practitioner



NP – Nurse Practitioner

OEP – Otago Exercise Programme

Stats NZ – Statistics New Zealand

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1. PURPOSE

This report provides the Committee with an update on the activities of Strategy, Planning and Performance. It is for the Healthy Communities Advisory Committee’s information and discussion – no decision is required.

2. SUMMARY

The Mental Health and Addictions portfolio has been working towards the reconfiguration of primary mental health and addictions services. Key milestones have been identified and project management is in place. The aim of the project is to integrate the primary and specialist mental health and addictions across IFHC sites across the district.

The Maternal Child and Youth portfolio is undertaking a project to develop robust systems and processes for all adolescents transitioning to adult services. The project will take a staged approach Initial steps include:

• Scoping the various patient groupings and identifying best options tolikely ensure a win.

• Researching tools and systems already established• Identifying key people.• Commencing the patient package.

2018 is also Census year and the DHB will be working to ensure that inpatient responses are appropriately captured on Census day.

3. RECOMMENDATION

It is recommended:


Craig Johnston General Manager Strategy, Planning & Performance

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4. STRATEGIC AND ANNUAL PLANNING

4.1 Locality Planning

Work continues on the final stages of Locality Planning. This includes:

- Presenting the proposed tangible actions under the four priority headings foreach locality to the local Advisory Groups, the Consumer and Clinical Councilfor their feedback

- Developing an implementation plan to ensure all tangible actions withinplans are mapped to appropriate Portfolios / Leads / Clusters forimplementation

- Working with Graphics on the stylized package for the community facingHealth and Wellbeing Plans for each locality, this will include incorporating TeReo into the final document once the contents have been approved

- Developing a communications plan to socialise the Health and WellbeingPlans, as well as mechanisms to keep the community informed and updatedon a regular basis

- Final plans are due to be presented to the Board in April

Palmerston North Locality Planning will commence in March 2018. Over March the team will plan and develop a model for how locality planning will occur for Palmerston North. It will be based on learnings from the current locality planning taking place across the district and the uniqueness of Palmerton North. The existing work from the Karanga te rā Karanga te ao community profile and Ora Konnect will be utilised as part of the process.

Jane Presto the newly appointed Locality Manager for Capital and Coast District Health Board spent a day with the team looking at our approach to Locality Planning. She is looking to adopt a similar approach for her region.

5. CLUSTER MATTERS

5.1 Health of Older People

5.1.1 Update on Pay Equity Settlement Key work in the Older People’s portfolio preceding the Christmas break was focused on the ‘Care and Support Workers Pay Equity Settlement. This dominated activity in 2017. Aged Care Providers were given the opportunity to meet with their DHB prior to December to ascertain concerns around sustainability. Two Providers approached the DHB for additional assistance and in December these Providers received one-off payments as a result of being negatively impacted by the settlement. The settlement looked at industry averages for the current workforce. In some instances providers have exceeded the industry average and are being given time to readjust in order to be more sustainable.

5.1.2 Aged Residential Care Complaints and Audits Analysed for 2017 Aged Residential Care Provider complaints within this portfolio are analysed around this time of year with a view to identify key learning’s that the sector can harness and apply to their own services. There has been a pleasing reduction in 2017; a five year low, not only in the number of complaints but those substantiated. Poor communication is usually at the heart of most complaints.

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Table 1. Aged Residential Care Complaints to Strategy, Planning & Performance

The indicative results have been analysed for 2017 Aged Residential Care audits by type across the district. Certification is the regular cycled audit usually on a 3-4 year rotation; surveillance audits are mid-way in the certification audit and are unannounced, partial provisional audits occur when facilities reconfigure, build new premises or purchase a new facility. We are waiting the final result for one facility, though it is not expected this will skew the results significantly.

The average corrective action results are extremely pleasing against previous years. Two facilities have received large numbers of corrective actions, one a new build and the partial provisional corrective actions reflect the audit being completed too advanced of occupation date (floorings and suchlike not completed); the other facility received 12 corrective actions and is known to the DHB. This type of result is an outlier and is currently being supported and monitored.

Table 2. Audits by Type

5.1.3 Falls & Fracture Programme for the District A key project underway across the district is the falls and fracture programme for the in-home OEP and community exercise programmes. Dialogue is occurring with the Central PHO to deliver on the in-home aspect while Sport Manawatu is developing the community group exercise component.

The initial timeline will see front line services for frail older people commence around April, with a full contingent of services being provided over the following months.

0

10

20

30

40

2013 2014 2015 2016 2017

ARC complaints districtwide over 5 year periodComplaints

Substantiated

NotsubstantiatedFU HDC

0

2

4

6

8

10

12

14

2011 2012 2013 2014 2015 2016 2017Num

ber o

f cor

rect

ive

Actio

ns

Year

Average # Corrective Actions Across 37 Facilities by Type

TotalCert AuditSurv AuditPartial Prov

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The broader work-plan for improving the lives of older people falls out of the 2016 National Healthy Aging Strategy; there is much to be done across the sector, MidCentral is well down the track on a number of initiatives either already available or in train.

5.2 Mental Health and Addictions

5.2.1 Te Ara Rau- Primary Mental Health & Addictions Work has been underway for the last 3 months towards the reconfiguration of primary mental health and addictions services, in which a Mobilisation project group has been established with primary and specialist service key leads.

Key milestones have been identified and a project manager has been recruited. The aim of the project is to integrate the primary mental health and addictions clinicians and specialist clinicians across IFHCs sites across the district.

Mental health teams will be based on site with primary care clinicians, such as GPs and NPs to offer free accessible help for people with mental health issues. Early intervention and continuing care will help people avoid significant mental health distress and assist them to live lives fully.

The project team will also be undertaking a review of the Shared Care program in primary care. Reportedly there are 925 clients enrolled, however, there are several issues which the DHB have raised, such as understanding what the program provides and whether clients have transition plans in place. This particular project will require working alongside GP’s and further update will be made. The project team will be further exploring the Shared Care Program, which is part of this year’s Annual Plan initiatives.

5.2.2 Inquiry into Mental Health and Addiction The Government has recently announced details of a ministerial inquiry into Mental Health and Addiction. In announcing the inquiry, the Prime Minister Jacinda Ardern identified the following key drivers for the Inquiry:

• addressing inequalities in mental health and addiction outcomes;• underfunding of mental health and addiction services; and• stubbornly high suicide rates.

In this context, the Inquiry will help to produce an accurate picture of how well New Zealand’s current mental health and addiction services are working, and to create a baseline from which a proposed pathway for improvements can be outlined. The Inquiry will inform the Government’s decisions on future arrangements for mental health and addiction and future investment priorities.

The announcement referenced strong support from consumers, providers, experts and the wider public for changing New Zealand’s approach to mental health and addiction. This Inquiry is an opportunity to build consensus on the specific changes needed to enable improved and equitable outcomes for those with mental health and addiction needs. We know that there are particular inequalities for Māori, Pacific peoples, people with disabilities, refugees and youth.

The Inquiry will acknowledge and take into account the good work and efforts that have already been made and will consider previous reviews, reports and recent consultation relating to mental health, addiction and suicide prevention.

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The terms of reference for the Inquiry are broad. Its purpose and objectives, are to:

• hear the voices of the community, people with lived experience of mentalhealth and addiction problems, people affected by suicide, and peopleinvolved in preventing and responding to mental health and addictionproblems, on New Zealand’s current approach to mental health andaddiction, and what needs to change;

• report on how New Zealand is preventing mental health and addictionproblems and responding to the needs of people with those problems; and

• recommend specific changes to improve New Zealand’s approach to mentalhealth, with a particular focus on equity of access, community confidence inthe mental health system and better outcomes, particularly for Māori andother groups with disproportionally poorer outcomes;

Its scope is to consider:

• mental health problems across the full spectrum from mental distress toenduring psychiatric illness;

• mental health and addiction needs from the perspective of both:

a. identifying and responding to people with mental health and addictionproblems; and

b. preventing mental health problems and promoting mental well-being;

• prevention of suicide;

• activities directly related to mental health and addiction undertaken withinthe broader health and disability sector (in community, primary andsecondary care), as well as the education, justice and social sectors andthrough the accident compensation and wider workplace relations and safetysystems; and

• opportunities to build on the efforts of whānau, communities, employers,people working in mental health and others to promote mental health.

The Inquiry will be chaired by former Health and Disability Commissioner, Professor Ron Paterson. Full membership is as follows:

Professor Ron Paterson (Chair) Dr Barbara Disley Sir Mason Durie Mr Dean Rangihuna Dr Jemaima Tiatia-Seath Mr Josiah Tualamali’i

The Inquiry will report back to the Government by the end of October.

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5.3 Maternal & Child Health

Transition Project: The 2016/17 Annual Plan included a project to improve the transition of (young people with a health condition from child health to adult health services) to progress a transition planning project. This work is being under taken by a highly experienced Clinical Nurse Specialist, Child Health to complete the programme of work.

This move is important, because it reflects the developmental changes young people go through as they become more independent and start to manage their own health care. The goal in moving to an adult service is that young people receive developmentally appropriate healthcare.

MidCentral Health currently has no formal and very few informal processes in place for transitioning adolescents from Child health services to adult services or Primary Care.

The aim of the transition project is to develop robust systems and processes for all adolescents transitioning to adult services. This will include the following:

• Provide high quality, co-ordinated, uninterrupted health care that is patient-centred, age and developmentally appropriate, culturally competent, flexible,responsive and comprehensive with respect to all persons involved.

• Promote skills in communication, decision-making, assertiveness and self-care, self-determination and self-advocacy.

• Enhance the young person's sense of control and independence.• Provide support and guidance for the parent/carer of the young person.• Maximise lifelong functioning and potential.

Key components to ensure an effective system is in place will include:

• Presence of a written policy.• Patient information package with associated tools for both the health

professional and the adolescent.• Individualised preparation that addresses psychosocial and

educational/vocational needs provides opportunities for adolescents toexpress opinions and make informed decisions and gives them the option ofbeing seen by professionals without their parents.

• The needs of parents/carers acknowledged and addressed.• A coordinated transfer process with a named coordinator/case manager, and

continuity in health personnel until the time of transfer where possible.• An interested and capable adult service.• Administrative support.• Primary health care involvement• Staff education

The project will take a staged approach as it is likely not everything is possible in the first instance.

Initial steps include:

• Scoping the various patient groupings and identifying best options to likelyensure a win.

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• Researching tools and systems already established• Identifying key people.• Commencing the patient package.

The project has got off to a great start with acceptance and willingness from all Paediatricians and Child Health staff. It is noted there are already pockets of informal transition already occurring in a timely manner as and when needed but there is significant appetite for an agreed standard of practice/guideline that can be used across the sector. Already of concern is the capacity of Adult services to engage in the pathway development. The project manager is looking to work alongside Primary Care to develop some appropriate road maps to guide clinical practice and improve transition and they appear very receptive to this.

5.4 Primary & Population Health

5.4.1 Ora Kinectics – Interim Service Replacing U-Kinetics The Ora Kinetics service launched on January 8 2018 in the Gravitate 24 gym located on Tremaine Avenue. The service has been contracted until the end of June 2018 whilst MidCentral DHB completes a tender process.

Ora Kinetics is providing a twelve week supervised exercise programme based on the previous U-Kinetics model to those who are currently on the waitlist and who still clinically require a supervised exercise programme. Depending on capacity, the service may also be able to take some new referrals.

In terms of the procurement of a new service we released our tender documents on the GETS website (www.gets.govt.nz) at the end of January. An evaluation panel has been formed whose role will be to evaluate the responses received against a list of weighted criteria with the intention to shortlist potential respondents. Once the shortlisted respondents have been identified they will be invited to present their Service proposal to the evaluation panel and answer any questions that may have risen. Subsequently the evaluation panel will meet to discuss and determine a successful respondent. Our intention is to have a new service contracted by the beginning of June 2018, to start seeing clients from the beginning of July 2018.

5.4.2 Primary Care Emergency Preparedness The regional Primary Care Emergency Planner has recently carried out an inventory of the eight Mass Casualty Supply kits across the MidCentral district. The kits which are located in GP practices / IFHCs are designed to be used in Mass Causality Incidents where a local General Practice is involved in emergencies such as earthquakes or large scale road accidents. The kits contain advanced first aid materials such as bandages, wound closures, airways, sutures and other sterile equipment. The kits are also available for ambulance requirements should the need arise. MidCentral DHB is accountable for the kits and a maintenance program has been put in place in conjunction with the hospital pharmacy and Materials Management to ensure that the kits contents remain up to date.

5.4.3 Water Quality MidCentral Health’s Public Health Service has reported previously to the Board in relation to drinking water quality, risks for which were clearly outlined in the Stage 1 report from the Havelock North Drinking Water Inquiry. (Note: a report on the water contamination at Ohakea is included under separate cover).

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The Stage 2 report, which was received in December 2017, introduced six principles that the Inquiry believe should underpin every aspect of the New Zealand approach to drinking water.

The report makes 51 recommendations, a number of which are framed as “early and urgent”. These include:

• Promulgating the principles of drinking water safety;• Abolishing the secure classification system;• Encouraging universal treatment;• Establishing a Drinking Water Regulator;• Implementing interim improvements at and by the Ministry of Health;• Amending the Resource Management Act to expressly recognise Drinking

Water Source Protection;• Encourage Joint Working Groups• Urgently amend the Health Act.

The report is currently being considered by the government, with an announcement expected at the end of February 2018.

In the meantime, work is underway to implement those aspects if the findings that are not reliant on decisions by the government.

A letter has been drafted on behalf of the DHB Chief Executive encouraging all community drinking water suppliers to continue treating their water supplies (noting that all public supplies in this region are currently chlorinated). This letter is expected to be sent out shortly.

The Joint Working Group (comprising Horizons Regional Council; the seven Territorial Authorities in the region and MDHB’s Public Health Service) has been functioning for some time. Work is underway to formalise the group and to adopt the draft workplan, which includes:

• Looking at land use around the drinking water catchments;• A review of borehead security;• Workshopping responsibilities of drinking water suppliers around monitoring

and reporting.

The Inquiry was clear in it’s view that the “softly softly” approach to enforcement needs to be replaced by a more robust response. To this end, The Central North Island Drinking Water Assessment Unit Technical Manager (Peter Wood) has been working on a revised Escalation Procedure – this will be informed by the recently amended Environmental Health Manual produced by the Ministry of Health. The procedure will be used to evaluate and follow up on instances of non-compliance with the Drinking Water Standards and the Health (Drinking Water Amendment) Act.

6. NATIONAL AND REGIONAL MATTERS

6.1 New Legislation for Health Practitioners

On 31 January 2018, the Health Minister, Dr David Clark advised that new legislation will be in place to improve people’s access to some health services across New Zealand.

55

The changes will allow other suitably qualified health professionals, such as nurse practitioners, to issue sick leave certificates, certify death in some circumstances and prescribe more medications.

Previously, before the changes were in place, certain functions could only be carried out by doctors. By changing the words “medical practitioner” to “health practitioner” in some Acts, people will have improved access to various health services, which is particularly significant for those in smaller, rural communities.

The Health Practitioners (Replacement of Statutory References to Medical Practitioners) Act affects the following seven amendment Acts as of 31 January 2018: • Accident Compensation Amendment Act 2016• Burial and Cremation Amendment Act 2016• Children, Young Persons, and Their Families Amendment Act (No 2) 2016• Holidays Amendment Act 2016• Medicines Amendment Act 2016• Mental Health (Compulsory Assessment and Treatment) Amendment Act 2016• Misuse of Drugs Amendment Act 2016

The original intent of the law was to protect public safety by ensuring only doctors with the required knowledge and skills could carry out these tasks. The new legislation offers the opportunity to better use our highly-qualified health workforce, which means health professionals are able to work smarter and use all their training and expertise to improve people’s health.

This direction of travel is entirely consistent with MidCentral’s long-standing strategy of supporting the development of capacity and capability, particularly in the primary and community sector. This includes supporting expanding scopes for our nursing and allied workforce. The new legislation will open up more possibilities for our clinical teams, particular our Integrated Family Health Centres, which are presently using work arounds to enable clinicians to operation at their full potential.

6.2 MDHB & MSD Data Sharing Project

In mid-2017 MDHB and the Ministry of Social Development (MSD) initiated a partnership research project with Orion Health to describe common factors or patterns of interaction for patients/clients who end up on a long-term health related benefit when compared to those who successfully return to work and self-sufficiency.

The hope is that by gaining better insight into any patterns of interactions, we can design new (or redesign existing) services for either health or MSD that enable earlier or more effective intervention that might help those clients/patients achieve better health and employment outcomes. Any proposed changes will form the basis of a subsequent business case for change. This would include further consideration of privacy, human rights and ethics implications.

This health and social data sharing project leads the way in New Zealand (and to some extent internationally) and therefore the project has taken extreme care to seek wide input as to how patient interests and information are protected. At the outset the decision was taken to use de-identified patient information and to utilise

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http://www.legislation.govt.nz/act/public/2016/0073/latest/DLM6514118.html?search=ts_act%40bill%40regulation%40deemedreg_amendment+act+_resel_25_a&p=1

http://www.legislation.govt.nz/act/public/2016/0074/latest/DLM6983801.html?search=ad_act___2016___25_ac%40bn%40rn%40dn%40apub%40aloc%40apri%40apro%40aimp%40bgov%40bloc%40bpri%40bmem%40rpub%40rimp_ac%40ainf%40anif%40bcur%40rinf%40rnif_a_aw_se&p=1

http://www.legislation.govt.nz/act/public/2016/0075/latest/DLM6983901.html?search=ad_act___2016___25_ac%40bn%40rn%40dn%40apub%40aloc%40apri%40apro%40aimp%40bgov%40bloc%40bpri%40bmem%40rpub%40rimp_ac%40ainf%40anif%40bcur%40rinf%40rnif_a_aw_se&p=1

http://www.legislation.govt.nz/act/public/2016/0076/latest/DLM6984001.html?search=y_act_2016__ac%40ainf%40anif%40aaif_ac%40bn%40rn_25_a&p=2

http://www.legislation.govt.nz/act/public/2016/0078/latest/DLM6984201.html



the national and MidCentral DHB/Central PHO ethics approval processes to underpin privacy protection.

A full ethics application was submitted to the Health and Disability Ethics Committee (HDEC) and was considered by the Southern HDEC on 14 November. HDEC provisional approval was received on 28 November with a small number of conditions.

HDEC requirements included a full Privacy Impact Assessment. This has now been completed by way of a full Privacy, Human Rights and Ethics (PHRaE) assessment. This has in turn been reviewed by Buddle Findlay on behalf of MidCentral DHB. It is supportive of the project and feedback provided is currently being considered by MDHB.

A Cloud Risk Assessment has been completed. An MSD Security Risk Assessment and Certification and Accreditation is in progress and a Data Sharing Agreement has been prepared. Application was also made to the MidCentral Māori Research Review Group and formal endorsement received.

Once MDHB approves the Buddle Findlay legal review of the Privacy Impact Assessment, the additional information requested by HDEC will be submitted. This is expected to occur in the next few weeks.

HDEC approval also requires a Locality Authorisation. This will take the form of a research application to the MDHB Clinical Board for approval. This application has been prepared and Dr Ken Clark (Chair) has been advising and assisting with readying this for submission to the Clinical Board for approval once HDEC approval is received.

It should be noted that each of the above approval documents is highly inter-related and have needed to be progressed in parallel to ensure they are consistent. However, as already mentioned, given the significance of the project, a deliberate and careful approach has been taken. The project continues to be driven by the Advisory Group and overseen by the Governance Group, both of which meet on a regular basis.

6.3 New Zealand Census 2018

Every five years Stats NZ runs the census – the official count of how many people and dwellings there are in New Zealand. The next census day is Tuesday 6 March 2018. Statistics New Zealand has sought assistance from DHBs (and other organisations) to support our communities complete their census questions, either on-line or in paper based form.

The Operations team from Stats NZ will be working with us to help with the count of everyone staying in our facilities on census night. It is our responsibility to make every effort to ensure that all people staying at Palmerston North Hospital and Horowhenua Health Centre complete their census form (either on-line or on paper). A Census pack is to be provided to every person staying overnight on March 6th, which will then be collected on March 7th. Relatives or hospital staff will need to fill in individual forms on behalf of those patients unable to complete them, and Census field officers will be made available to assist wherever necessary.

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MidCentral has a nominated key contact person who will oversee this process for the hospital facilities. A project plan, including communication strategy, is currently being developed. This will be supplemented with material to be provided by Stats NZ for this purpose.

From the DHB’s viewpoint, it is in our interests to promote and support everyone to participate in the Census. The aggregate, de-identified information is used as a key input for policy, planning, funding and delivery of health and disability services in our district.

7. FINANCE REPORT

7.1 Summary Income and Expenditure for the period ended 31 December 2017 was as follows:

The Funding result for the month of December 2017 was a $1,416k deficit, which was a favourable variance against budget of $329k.

The provision held back from Revenue for non-achievement of the Elective budget in the financial result was increased by $188k in the month. This YTD provision as at 31 December is $729k. This represents net delivery shortfalls in overall elective initiative inpatient services, with a range of overs and unders, but the majority of the shortfall continues to be in orthopaedic services.

This provision is deferred revenue pending output delivery and, if we can achieve target volumes, the deferred revenue is potentially available by year-end. This remains one of the critical factors in managing our overall financial performance for the year.

All other Funding costs are tracking near or under the budget.

$000 Dec-16 Dec-16 Actual Actual Budget Variance Actual Actual Budget Variance

Revenue 47,216 47,165 47,811 (646) 276,021 286,290 286,961 (671)

Expenditure

Other Outsourced Services 484 556 556 0 2,901 3,583 3,583 0Provider Payments 46,044 48,025 49,000 975 273,990 282,775 284,625 1,850

Total Expenditure 46,527 48,581 49,556 975 276,892 286,357 288,208 1,850

Surplus/(Deficit) 689 (1,416) (1,745) 329 (871) (67) (1,247) 1,180

Favourable to Budget Unfavourable to Budget but within 5 Unfavourable to Budget outside 5%

Funding December 2017 Result

Dec-17 Year to date

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COPY TO: CEO’s Office MidCentral DHB

Heretaunga Street, PO Box 2056 Palmerston North 4440

Phone Fax

+64 (6) 350 8910 +64 (6) 355 0616

For:

Decision

Endorsement

X Noting


Author General Manager, Strategy, Planning & Performance

Endorsed by CEO


Subject Committee’s Work Programme

RECOMMENDATION

It is recommended:

• that progress against the 2017/18 work programme be noted.

Strategic Alignment

This report is aligned to the DHB’s Strategy and key enabler, “Stewardship”. It discusses an aspect of effective governance.

Glossary

CCDM – Care Capacity Demand Manager


HCAC – Healthy Communities Advisory Committee


MDHB – MidCentral District Health Board

MoH – Ministry of Health

PHO – Primary Health Organisation

QEAC – Quality & Excellence Advisory Committee

TBA – To be advised

VRM – Variance Response Management

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1. PURPOSE

This report updates members on the 2017/18 work programme and subsequently scheduled reports.

The report is for the Committee’s consideration and no decision is required.

2. BACKGROUND

Each year the Board establishes a reporting framework for the DHB’s governance function. This purpose of the framework is to ensure the Board and its Committees receive the reports they require to enable them to carry out their function effectively. From the framework, work programmes for the Board and each committee are developed.

The work programme sets out planned reporting points for routine reports and project updates. When events indicate a significant increase in risk within a project, that risk will be reported in an interim update.

Brief updates are noted in Section 3 for a number of initiatives and, where relevant, an update on reporting dates.

3. 2017/18 WORK PROGRAMME - BRIEF UPDATES

Reporting is occurring in line with the work programme.

A report is provided this month on the Ohakea water contamination issue, and we have scheduled an update for next month on what we are doing with Housing New Zealand to support them in their work with families from a health perspective.

A representative of the Health Promotion Agency will present to the Committee on the 13th February regarding the work they are doing. A brief background paper is provided for members’ information regarding the role of this Agency.

A copy of the Committee’s work programme is attached – refer Appendix A.

4. RECOMMENDATION

It is recommended:

• that progress against the 2017/18 work programmes be noted.

Craig Johnston General Manager Strategy, Planning & Performance

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APPENDIX A – HCAC’s 2017/18 WORK PROGRAMME

Healthy Communities Advisory Committee: Standing Items Frqncy Jul Sep*

Oct Nov*

Feb Mar*

May Jun*

Jul Resp

Strategic & Annual Planning

• C/f 2016/17: Update against 2016/17 Maori Health Plan Indicators Annual X S Turner • 2018/19 Annual Plan – approach, priorities and financial assumptions Annual X C Johnston • Health needs assessment –update and impact for planning Annual X R Fong • Equity snapshot – update and impact for planning Annual X S Turner • 2018/19 Annual Plan – draft and workshop Annual X* C Johnston • Locality Planning (via Ops report with separate reports if decision required) 12-weekly X X X X X K Isles • 2018-19 Regional Service Plan – priorities and approach X* V Ayres • 2017/18 Funding Arrangements Document Annual X V Ayres • 2018/19 Funding Arrangements Document Annual X V Ayres • Mental Health Programme 12-weekly X* X* X* X* C Nolan/C Nepia-

Tule • Business Caseso Strategic Business Case – Ward 21 One-off X C Nolan

Partnerships & Consumer

• Disability update Annual X J Smith • NZ Disability Support Service Transformation 12-weekly X X X X X S Ambridge • Health Charter update (with key stakeholders in attendance, eg Police) Annual X C Hansen

Performance Reporting

• Operational Report 12-weekly X X X X X X X C Johnston • 2017/18 Annual Plan – implementation progress – MoH priorities Quarterly X* X* X* X* V Ayres • 2017/18 Annual Plan - implementation programme – MDHB initiatives 6-monthly X X V Ayres • Non-financial reporting, including health targets and system level measures Quarterly X* X* X* X* V Ayres

Integration

• Central PHO report and presentation Annual X* D Jeremy • PHARMAC report and presentation Annual X* G Sundararajah • Health Promotions Agency report and presentation Annual X C Johnston Standing Items due in Out Years: Strategic Plan review 2019/20

*=joint meeting or report

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Healthy Communities Advisory Committee: Other Matters Raised by Committee and/or ELT

Item Raised Scheduled Resp Status • VRM & Hospital Operations Centre June 17 TBA L Horgan & N Wanden • Presentations from:o Ministry of Health & Ministry of Education re disability programmeso Enable Good Lives Teamo Levin Children’s Teamo Kaianga Whanau Ora

July 17 TBA C Johnston

• Update of MDHB/Horizons hosted forum re water quality within district,including matter of trace elements in Horowhenua water and whether thiswas impacting the health (including mental health) of residents

Bd Sep 17 May 18 D Davies

• Update on discussions with Housing NZ re supporting their clients Weekly Update 1.12.17

March 18 B Bradnock

• Drinking Water Quality: MDHB work programme following Stage 2 Inquiry Rpt 2 Board Dec 17 April 18 R Weir & D Davies Completed Items • Outcome of MDHB/Horizons hosted forum re water quality within district* May 17 July N Glubb Completed • Presentation re child area – areas of intersection, eg disability, mental

health and paediatricsMay 17 July 17 B Bradnock & G Scott Completed

• Details of Tu Kaha Conference June 17 TBA S Turner Completed • Horowhenua Report Bd, June 17 October C Johnston & L Horgan Completed • Proposed approach to communicating St John’s 111 Clinical Hub July 17 Sep 17 D Jermey Completed • Mental Health: regional residential review project Sep 17 rpt 28 Nov C Nepia-Tule & C Nolan Completed • Manawatu Gorge: update re MDHB’s involvement Board, Nov 17 Nov 17 C Johnston Completed • Commissioning framework –more information Board, Nov 17 Nov 17 C Johnston Completed • Child health team update 2 July 17 Feb 18 B Bradnock & G Scott Completed • IFHC for Awapuni, Highbury and Cloverlea area of town (Ora Connect) Board, Nov 17 Feb 18 W Blissett Completed • Update re accessing $1m for primary mental health services Bd Aug 17 Aug 17 C Johnston Completed

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