Ora Regional M ori Health Plan May 2011

Transcription

1 Tū Ora Māori Health Plan May 2011

2 Māori Health Plan May 2011 Central Region District Health Boards Prepared by: Jim Wiki (Capital & Coast District Health Board) on behalf of Central Region s Technical Advisory Services Limited Acknowledgements: The development of this plan could not have been possible without the input of those who participated in the initial consultation, general discussion and initial thinking. In particular, an acknowledgement to Paora Trim for his assistance with the development of the mihi. Nō reira e mihi ana ki a koutou. Central Region s Technical Advisory Services Limited PO Box Wellington 6140 Phone Fax info@centraltas.co.nz Central Region s Technical Advisory Services Limited

3 CONTENTS Mihi... 2 Executive Summary... 3 Introduction... 4 Direction... 5 Services Plan... 5 Central Region DHBs Māori Health Plans... 6 Framework... 7 Vision... 8 Aims... 8 Key Drivers... 9 Focus Areas... 9 Priority Indicators Key Indicators Tū Ora Action Plan Māori Workforce Development Quality Service Provision Collaborative Action Measuring and Sharing Information Appendices National Direction Whānau Ora He Korowai Oranga Māori Health Planning Central Cancer Network Plan Central Region Strategic Plan for the Development of Mental Health and Addiction Services Central Region DHBs Māori Forum Central Region Ethnicity Distribution Central Region Deprivation Distribution Central Region Whānau Ora Providers Acronyms Glossary References

4 Mihi E ngā Iwi, e ngā reo, e te huihuinga Tēnā koutou, Tēnā Koutou, Tēnā Koutou katoa Ko te mihi tuatahi ki te Atua i runga rawa nāna i homai, nāna i tango atu. Tuarua, he mihi aroha ki ngā tini aituā kua whetūrangitia, haere koutou, haere koutou, haere koutou, e moe. Otirā, rātou ki a rātou, tātou ki a tātou, ā tēnā tātou katoa. Tū Ora mai! Tū Ora mai! kia tū mai tātou hei whai ake i te hauora mō tātou te iwi Māori i roto i tēnei rohe whānui. Ka whakatakoto tēnei mahere rautaki i tēnei kaupapa tino taumaha mō tātou. Otirā, mā mātou, mā tātou te mahi e mahi, kia ora ai te iwi Māori. Ko te whakatauakī kua whiriwhiria hei tautoko i tēnei kaupapa ko He waka eke noa Nō reira Tēnā koutou, Tēnā koutou, ā, kia tau te rangimārie ki runga i a tātou katoa To the people, to the many languages and to those who have gathered. Greetings to you all. Firstly a special greeting to the Lord, He who giveth, He who taketh away. A loving greeting to those who have passed before us, them unto themselves, the living unto ourselves Stand tall, Stand tall. Let us all stand tall in the pursuit of health for all Maori in the Central Region. This plan lays down a weighty challenge for us all; however, by working together, the wellbeing of Maori will be achieved. This is underpinned by the proverb which supports this plan He waka eke noa literally meaning A canoe which we are all in with no exception otherwise translated as we are all in this together. This plan has been named Tū Ora and undertakes a number of connotations. Primarily it's a challenge to taking a strong stance towards improving the health and wellbeing of Māori. It is also a reference to Tū Kaha which is now ensconced as a brand of strengths based Māori health activity within the Central Region. Finally, it is a play on language phonics - To Life / Health / Wellbeing: To Ora: Tū Ora. The cover of this plan is inextricably linked to Tū Kaha through the use of it s brand logo. The design is a representation of lower part of the North Island from Whanganui, through Mid Central, across to the Hawkes Bay, down through the Wairarapa to Hutt Valley and Wellington. The background of woven flax depicts the knitting together of the six DHBs within the Central Region to provide a regional response to improved Māori Health outcome. 2

5 Executive Summary This Central Region Māori Health plan - Tū Ora aspires to guide an ongoing improvement in Māori health and Māori health outcome. It sets a five year action plan that advocates and encourages collective thinking and action from all levels of the health sector within the Central Region with the aim of reducing the disparities experienced by Māori and improved Māori health outcome. Tū Ora provides the platform to embrace the current context and direction of Whānau Ora and calls for leadership to drive sustainable change in a challenging political and fiscal environment. To achieve the vision and aims of Tū Ora, four key focus areas have been identified as enablers of change: 1. Māori Workforce Development; 2. Quality Service Provision; 3. Collaborative Action; and, 4. Sharing and Measuring Information. Tū Ora endorses the use of key priority indicators to measure and report the progress of the region s Māori health status, the impact on Māori and the reduction in disparity. It is acknowledged that implementing this plan provides the Central Region DHBs with an immense challenge and will require a collective response from within the region s health sector and across other sectors. 3

6 Introduction There is general recognition in New Zealand that Māori do not, on average, enjoy the same levels of health and independence as the general population. The reasons for this are complex and have been the subject of much debate and discussion. However, two factors which are often cited are: - the relatively poor socio-economic status of some Māori which leads to increased prevalence of disease and greater susceptibility to disability; and - the failure of many publicly-funded health and disability support services to meet the needs of Māori via services which are appropriate and accessible. (Ministry of Health, 1998) Twelve years on and this statement is still relevant within the context of the current health environment. The development of a Māori Health plan acknowledges the unique relationship between the Crown and Māori. It is also important that there is recognition that Māori health is the responsibility of the entire health sector and it will take a collective response to aspire an improvement of Māori health outcome. The implementation of this plan will require a collaborative effort over the next five years and provides a challenge for our Central Region District Health Board executives and leaders, health providers and services, the health workforce and the communities as the journey requires sustained commitment, collective energy and the resources to make a difference. Given the direction of the health sector in a move towards Better, Sooner, More Convenient and Whānau Ora in terms of service provision, it is essential that rather than doing more, we need to do things better within our current fiscal constraints. As such, it is important to acknowledge that this plan is merely one piece of the Central Region health jigsaw puzzle which aligns directly with current regional planning so as not to duplicate those plans but provide an emphasis on those areas which have a either a particular focus on Māori, an area for improvement in Māori health or Health Inequalities. Tū Ora aims to guide us all in maintaining Māori Health as a priority by ensuring that the planned actions impact positively on improving the health status of Māori within the Central Region. 4

7 Direction Services Plan (Central Region's Technical Advisory Services Limited, 2010) In September 2010 the final draft of the Services plan was completed for National Health Board submission. This plan describes the current services in place across the Central Region, including those that already represent steps towards a regional configuration. Clinical networks, sub-regional initiatives, and work towards effective integration of primary and secondary services including the Better, Sooner, More Convenient programme are outlined. The governance mechanisms being put in place for regional planning, funding, and service delivery are described. Projects and planning in respect to services identified as vulnerable are also delineated. The plan highlighted that inequalities in health persist, with Māori and Pacific Peoples more likely to die prematurely from an avoidable condition than other ethnic groups. The way health is provided in the future will need to change to meet the needs of an ageing population, with longer term health care needs and delivered in a way that reduces rather than exacerbates health inequalities. Māori, Pacific Peoples, those on low incomes, and the people of some of the region s rural communities are disadvantaged as a result of the way health services are currently provided. Another key highlight was the importance of the inter-relationship between recruitment and retention of appropriately skilled staff, and the ability to continue to deliver high quality health care safely to consumers in a culturally appropriate manner are key issues to be resolved for the future sustainability of services across the region. This will require a more diverse, dispersed workforce, including a greater proportion of Māori health clinicians. In signing up to [the] RSP 1 the six DHB Chairs and Boards have committed to the recognition of the Treaty of Waitangi, the RSP will be developed in partnership with Māori in areas of service and policy development, and implementation to ensure equal standards of healthcare, equality of access to healthcare and equity of health outcomes for Māori. 1 Central Region's Technical Advisory Services Limited,

8 Central Region DHBs Māori Health Plans Each DHB is required to produce and implement a Māori Health plan with the aim of improving the health of Māori and to reduce inequalities in their district. These are informed by the DHBs Māori population, their health needs and the DHBs strategic objectives. A review was undertaken of the six Central Region DHBs Māori Health Plans. Of the six plans; two were still current with the remaining four either under review or being updated. The review highlighted a number of commonalities in particular, Whānau Ora, as an overall aim, was the most common factor. Underpinning the aim of Whānau Ora was: - Reducing Inequalities; - Reducing the impact of long term conditions; and/or, - Improvement in Māori Health outcome Other common factors in key heading areas included: - Workforce Development; - Quality Service Provision; - Collaboration; and, - Measuring Information These findings provide the basis of a framework, derived from common thinking for Māori Health across the Central Region. 6

9 Framework This framework builds on the national Māori Health Strategy, He Korowai Oranga and provides a quick view of the aims, the priorities and the focus areas that will guide the Central Region s actions over the next five years. Central to this framework is the concept of whānau as the principal focus in the planning; funding; and, decision making processes in the pathway to making positive changes to Māori health outcome. The framework takes into consideration national and regional direction; and the commonalities of the six Central Region DHBs Māori Health plans in order to address the comprehensive and complex issues surrounding Māori health. However, the model does not assert to capture all Māori health issues in its entirety, rather it provides a basis to engender change and encourages a commitment to improved Māori health outcome within the Central Region. 7

10 Vision Whānau Ora: healthy families supported to achieve optimum health and wellbeing, as espoused in He Korowai Oranga and consistent amongst much of the literature in terms of Māori Health, is the optimal vision for which to aspire. Whānau Ora is a common thread which is woven into national, regional and local direction, one that is intrinsically Māori yet can be encompassed by all and therefore challenges the one size fits all mentality. As a concept, strategic aim, or model for implementation, Whānau Ora challenges the way we work, think, and, make decisions. It provides the impetus to change what is not working; improve what is working and to strive for better health outcomes for Māori. Given the current direction, impetus and roll out of the Whānau Ora policy, it is imperative that the Central Region DHBs define and determine what Whānau Ora is, by Central Region for Central Region, in order to understand the implications of implementing this policy. Aims It is well documented that the greatest disparities, in terms of life expectancy, are between ethnic groups and between populations with different socio-economic status, as measured by deprivation index. Given the inequitable rates of morbidity and mortality between the health of Māori and non-māori, reducing disparities continues to be a key aim across the health sector with the intention of improving health outcomes for Māori and other population groups. As such reducing the disparities that exist for Māori in the Central Region through the achievement of better Māori health outcomes needs to be the highest priority in order to achieve Whānau Ora. It is imperative that this plan advocates for a coordinated approach and collective response to work together in areas aimed at reducing disparity and therefore, improve Māori health outcome given the vastness of the Central Region s geographical area and population composition. 8

11 Key Drivers To facilitate the achievement of Tū Ora s vision and aims, the collaborative response to reducing the impact of long term conditions provides us with the challenge to do things differently both from a operational aspect and a leadership aspect. This will require Central Region leadership to take a proactive stance on supporting improved access to services and interventions in the critical areas where Māori have high morbidity and mortality. It will also require Māori to take ownership of the direction of Māori health so as to support the self determination of their own health status in order to gain positive change. Presenting on Māori leadership and providing a strengths based view, Durie (2010) succinctly identifies that gains in Māori health will be accelerated by quality leadership that can respond positively to a rapidly changing environment [however this will require transformation and an attitudinal shift from]: how bad it is to how good it can be ; Māori needs to Māori aspirations ; what will the Government do to what will we do, now and in the future ; putting out fires to building platforms for tomorrow ; and, being led to taking the lead. Focus Areas As enablers of change, four focus areas have been identified as key areas of action: 1. Māori Workforce Development 2. Quality Service Provision 3. Collaborative Action 4. Sharing and Measuring Information It is envisaged that the targeted actions underlying these focus areas will support improvement and sustainability over time by optimising the planning, funding and delivery of health provision for Māori within the Central Region. These focus areas are further described within the action plan. Cognisant of the current political and fiscal environment, the actions within this plan will be either cost-neutral or cost-effective. Where actions are cost-neutral it is expected that Central Region DHBs will provide collective in-kind support with human capital and / or 9

12 material resource. Should the action require financial resource it is considered more effective for individual DHBs to contribute funds to enable a collective financial pool to reduce financial burden on any one DHB. At all times these actions will be subject to the principles of value for money and include identifiable short, medium and long term outcomes. The inputs to the key actions have been assigned either or Contributory. means that the action is part of a regional response. Contributory indicates that this work is being undertaken at a local level, however collectively it contributes to a positive change in the key focus area. Priority Indicators It is important to have priority indicators to, over time, measure, monitor and report the progress and impact of regional Māori health status. With the acceleration of Whānau Ora, a Ministry of Health Review Group has identified a set of national level indicators that have either Māori measures or are of significance to Māori health. At this point national priorities are Health Targets and Indicators of DHB Performance shown in DHB Annual Plans. (Ministry of Health, 2010c). In order to avoid duplication and an increased analytical workload, it is prudent that the Health Targets and National Level Indicators are also used to as Tu Ora s priority indicators to monitor the progress of Māori health and levels of disparity in the Central Region. These indicators are described as below. Key Indicators Health Targets - Shorter stays in Emergency Departments - Improved access to elective surgery - Shorter waits for cancer treatment - Increased immunisation - Better help for smokers to quit - Better diabetes and cardiovascular services 10

13 National Level Indicators Health Issue Indicator(s)Target Reporting Health Target Data Quality Accuracy of ethnicity reporting in PHO registers Annually No Access to care Percentage of Māori enrolled in PHOs Annually No Ambulatory Sensitive Hospitalisations rates per 100,000 for the 0-4, 45-64, and 0-74 age groups Annually No Maternal health Exclusive breastfeeding at 6 months Annually No Cardiovascular disease Percentage of the eligible population who have had their CVD risk assessed within the past three years Quarterly Yes Number of tertiary cardiac interventions (no target, information only) Annually No Diabetes Percentage of people who attend their diabetes annual review (DAR) Quarterly Yes Percentage of people with diabetes who complete a DAR and have a HbA1c level less than 8% Quarterly Yes Cancer Breast Screening 6 Monthly No Cervical Screening 6 Monthly No Smoking Hospitalised smokers provided with advice and help to quit Quarterly Yes Current smokers enrolled in a PHO and provided with advice and help to quit Annually Yes Immunisation Percentage of two year olds fully immunised Quarterly Yes Seasonal influenza immunisation rates in the eligible population (65 years and over) 6 Monthly No Workforce Percentage of Māori staff in DHBs by occupation class. (no target, information only) Management Clinical Administrative Annually Source: Indicators for Measuring Progress towards Whānau Ora, a Ministry of Health Review Group. Notes: All measures will be reported by: Māori, non-māori, Total Population, DHB and Nationally. Where possible, the data for the headline indicator set will be sourced by the Ministry and provided to the DHB and therefore will not add any further reporting requirements for the DHB. No 11

14 Tū Ora Action Plan Māori Workforce Development The development of a sustainable workforce is critical to the provision of quality health services in the future. More so, Māori are disproportionately represented within the clinical professions therefore, the development of a clinical workforce with a focus on specialising in key health areas. To drive improved Māori Health outcome will also require development and increases in Māori leadership and management capability. This action area aims to increase the capacity and capability of the Māori health workforce. Increased Māori Capacity Lead: CRMM 1. Implement Central Region activity for the Kia Ora Hauora Māori (KOH) health as a career programme 2. Support current scholarship initiatives targeting Māori uptake of Health related study pathways. Support at least two regional KOH Career Educator Engagement events. Promote and facilitate a regional KOH intervention focused on encouraging school students to take up the sciences. Promote enrolment on the KOH website and follow-up user contact details Maintain and update the Central Region s KOH webpage. Participate in at least four career events and /or expos Coordinate regional KOH Project Reference Group meetings and participate in the National Coordination Centre operational meetings Increased enrolment of Māori in Health related study pathways Recruit a minimum of 250 new Māori onto a health-related study pathway in secondary or tertiary study. A minimum of 20 scholarships per annum Increased enrolment of Māori in Health related study pathways Contributory 3. Provide a regionally collated report Quarterly report Ongoing Māori scholarship initiatives Contributory 12

15 Increased Māori Capacity Lead: CRMM which includes a narrative of local DHB Māori scholarships. collected and analysed. 4. Implement a regional stock take on current Māori health workforce development initiatives in the Central DHB region. Stocktake undertaken, assessed and reported workforce initiatives collected and analysed. 5. Investigate the development of, and implement a regional scholarship fund. A minimum of two regional scholarships scholarship programme implemented. 6. Optimise HWNZ Hauora Māori funding to progress a regional support programme. Year 1: 80% completion rate Year 2: 85% completion rate Year 3: 90% completion rate 2013 programme implemented. Improved Māori Capability Lead: CRMM 1. Provide regional support of the implementation of Ngā Manukura ō Āpōpō Emerging and Advanced Leaders in Māori nursing and midwifery Clinical Leadership Training. 2. Support leadership development component that aims to develop the current Māori leadership capability in the central region network. A minimum of six places filled by Central Region Māori nurses annually A minimum of two leadership development placements undertaken annually Ongoing Increased Māori clinical leadership. Contributory Ongoing Increased Māori leadership Contributory 13

16 Quality Service Provision Improving the quality and service effectiveness of Māori and mainstream services is a key driver of change for improved Māori health outcome. This action area aims to focus on improved access to services and interventions and engender mainstream responsiveness to the health of Māori. Shorter waiting times for Oncology Lead: Services Plan 1. Continued improvement in access times to radiation to ensure timely treatment. 2. plan developed and implemented to deliver the national medical oncology models of care, including national Medical Oncology Prioritisation Criteria Health target that 100% of people needing radiation treatment will have this within 4 weeks is met. 100% of people needing Medical Oncology will have this within four weeks. Prioritisation criteria introduced and utilised in clinical treatment. models of care plan developed Quarterly reporting Quarterly reporting December 2011 Population health indicators Intervention rates are monitored for equity of access to screening, diagnosis, treatment and outcomes for cancer supported by culturally relevant services and Whānau Ora approaches Reduce premature death from Cancer among Māori by 2015 Incorporation of Whānau Ora approaches where appropriate. Access to Treatment for Target / Priority Cancers Lead: Services Plan 1. To improve diagnosis and treatment of target/ priority cancers through: Implement new monitoring system for access to priority cancers. June 2012 lung and bowel tumour stream Implement national standards including: June 2012 Primary Care Indicators: Improved coordination of patient journeys support 14

17 Access to Treatment for Target / Priority Cancers Lead: Services Plan activities Breast and prostate (2012/13 ) Upper GI, head and neck, gynaecology (2013/14) Access to an MDM opinion Monitor timely access to specialist services the following objectives: Reduction in avoidable acute demand on publiclyfunded hospital services Better management of patients with chronic conditions to support those people living in the community to live well and have their social and healthcare needs supported Incorporation of Whānau Ora approaches where appropriate. Reducing Health Inequalities Lead: Services Plan 1. CNN supports service providers to identify and address inequalities relating to cancer control including: Providing pilot funding to local cancer networks to implement activities they identify to address an area of inequality Monitoring the impact of initiatives aimed at addressing inequalities and promoting good practice Inequalities influenced by ethnicity, geography and socio-economic status are reduced Quarterly reporting Primary Care Indicators: Improved coordination of patient journeys support the following objectives: Reduction in avoidable acute demand on publiclyfunded hospital services Better management of patients with chronic conditions to support those people living in the community to live well and 15

18 Reducing Health Inequalities Lead: Services Plan 2. Continuing to engage with Māori and Pacific communities and service providers to identify and progress specific activities to address inequalities. Focus areas to include: Māori leadership / participation Pacific participation Demystifying Cancer Workshops Monitoring progress with respect to addressing inequalities for Māori and Pacific have their social and healthcare needs supported Incorporation of Whānau Ora approaches where appropriate. Results monitored and reported annually. Annually Address inequalities experienced by Māori and Pacific Activities 1. Scope the development of single integrated specialist cancer treatment services across: Radiation Oncology Medical Oncology Clinical Haematology Surgical Oncology. Feasibility study of a regional cancer service July 2013 Primary Care Indicators: Improved coordination of patient journeys support the following objectives: Reduction in avoidable acute demand on publiclyfunded hospital services Better management of patients with chronic 16

19 Reducing Health Inequalities Lead: Services Plan conditions to support those people living in the community to live well and have their social and healthcare needs supported Incorporation of Whānau Ora approaches where appropriate. Elective Services Lead: Services Plan 1. To deliver the health Target of 29,366 elective surgery discharges by: Production of a regional surgical production plan for the elective patient pathway. consistency of referral guidelines, and access criteria Develop elective system to maximise total regional elective capacity and reduce waiting times Exceed the Health Target of 29,366 discharges Increased understanding of regional capacity including the impact of acute surgery, to inform the regions understanding for 2011/12 and 2012/13 year production planning. Identify barriers to access (e.g. SIRs analysis) 30 June July 2011, and March June 2012 booking system in place Inequalities Improved equity of access, and reduced variations in SIRs between DHBs. Monitor and report on reduced disparities for Māori and Pacific People Reduce disparities for Māori and Pacific People from current baseline 17

20 Cardiac Surgery Lead: Services Plan 1. Ensure cardiac surgery waiting list is maintained at levels agreed with NHB. Develop workout plans if performance requires it. 2. Deliver the agreed number of cardiac surgery discharges by: Improve current reporting of waiting times and interventions for the region within electives reporting. 3. Cardiac network will investigate varying SIR for different cardiac procedures for disparities driven by: Ethnicity Geography Socio economic status No one waiting more than 6 months for non urgent treatment. Cardio-thoracic surgical volumes as per DHB DAPS will be achieved and monitored for equity of access Quarterly Quarterly Quarter 2 for use in planning for the 2012/13 year. Inequalities Improved equity of access, and reduced variations in SIRs between DHBs. Monitor and report on reduced disparities for Māori and Pacific People Reduce disparities for Māori and Pacific People from current baseline and where appropriate recommend required changes to services. Rationale: Ischaemic heart disease is the main cause of avoidable death in the under 75 s in the region. Māori have higher rates of IHD avoidable death than other ethnic groups. research indicates that Māori are less likely to receive angiogram or PCI following first 18

21 Cardiac Surgery Lead: Services Plan acute admission with Acute Coronary Syndrome 2 4. Work towards providing equity of access to cardiac procedures. Review and monitor waiting times for cardiac procedures and implement corrective action plans as required. As required Improved access to care. 5. To undertake analysis of ethnic disparities in accessing cardiac revascularisation within the Central Region and compare nationally. Complete research and produce report on findings with Te Röpü Rangahau Hauora a Eru Pömare (Wellington School of Medicine and Health Sciences). April 2011 Ethnic Disparities in Cardiac Revascularisation 6. Develop and implement self management programmes. 7. Develop and implement a cardiac rehabilitation at home model. Ensure over time 95% of eligible patients access to [cardiac rehabilitation] services. August 2010 June 2011 Cardiac Rehabilitation to reduce the inequalities and disparities of access to cardiac rehabilitation within the Central Region. 8. Develop and implement a heart manual that is culturally appropriate and acceptable to Māori and Pacific peoples. June Complete regional audit of people who have suffered acute coronary syndrome and number who have attended some form of cardiac rehabilitation. December Summary of Central Data for Acute Cardiac Events (2010) Te Ropu Rangahau Hauora a Eru Pomare (Eru Pomare Maori Health Research Centre), University of Otago 19

22 Bariatric Surgery Lead: Services Plan 1. Develop regional plan to meet target. 31 procedures completed. July 2012 Model of Care Lead: Services Plan 1. Develop and implement a model of integrated health care for an ageing population which is planned regionally and implemented locally and improves on the current approach Model developed and piloted Reduction in frequent readmissions in to older adult services June 2012 Inequalities Effective ethnic monitoring tool into the programmes of work will address barriers to service access. 2. Review medication prescribing patterns for older adults within the Central Region and benchmark nationally if possible Report outlining current medication prescribing patterns. June 2012 Number of Māori accessing older adults services Dementia Services Lead: Services Plan 1. To implement the Dementia Behavioural Support Advisory Service ( DBSA) specifications. 2. Develop, implement and evaluate initiatives to increase the use of technology, ongoing training and support for the Central Region work Six monthly progress reports on the implementation of new national guidelines for dementia care. Supports workforce development and training aligned to the national training process with Let s Get Real June 2012 June 2012 Inequalities Effective ethnic monitoring tool into the programmes of work will address barriers to service access. Number of Māori accessing older adults services 20

23 Dementia Services Lead: Services Plan force, including e learning and web based tools. 3. Investigate why Maori and Pacific Islander are not using aged residential care Radiology Services Lead: Services Plan 1. Improve regional IT infrastructure by procuring and deploying a regional Picture Archiving and Communications System (PACS) and disaster recovery programme 2. Complete a review of the current radiology service with a view to the following: Developing a regional radiology after-hours service including application of regional standardised RIS codes and regional RIS system Developing a regional radiology service Suitable regional PACS solution installed and migrated. Common RIS codes used in preparation for implementation of a common RIS system. June-October 2011 December 2012 Inequalities health inequalities will be addressed by improving infrastructure support and Report completed with recommendations June 2012 reducing wait list times to appropriate imaging. 21

24 Strengthening Clinical Leadership and Clinical Governance Lead: Services Plan 1. leadership supporting regional service development, especially to increase Māori and Pacific leadership capacity and capability Establishment of a Clinical Board, with Terms of Reference and participation from all DHBs. September 2011 Workforce indicators: Increased Māori and Pacific People workforce development and leadership Population Health and Inequalities Reduced geographical variations in service quality and safety due to greater standardisation of clinical practice across the Region Capital Asset Management Lead: Services Plan 1. Establish the terms of reference of the regional capital committee to oversee capital investment proposals across the region (replacement and new proposals) above a specific threshold or where the commonality of equipment is a likely outcome. Criteria for decision-making to be developed and applied eg consideration of population health need, cost/benefit. The regional capital planning and asset management committee established by 1 July 2011 All CRDHBs represented Review of 2011/12 capital plans to identify opportunities Improvements in financial performance 2011/12 through collaborative planning will set the baseline for year on year financial recovery. Quarterly reporting of the regional capital capital Committee functioning effectively by 1 Jan 2012 Primary Care Increased regional focus on systems integration, and improved patient flows across the system, with more care delivered in or closer to home or in primary care, and reduced waiting times. Alignment to the principles underpinning Whānau Ora 22

25 Capital Asset Management Lead: Services Plan committee through regional governance structures. and Better Sooner More Convenient Care. Health inequalities Improved linkages between population health and the reduction of health inequalities particularly for Māori are targeted through business case templates Transport and Accommodation Lead: Services Plan 1. Actively participate in any national work on Transport and Accommodation Participation in review As required Inequalities Patients and their whānau or family in remote communities do not experience disadvantage in accessing services due to transport or accommodation needs. Responsiveness Lead: CRMM 1. Development and implementation of a Māori provider sustainability framework. framework developed and embedded Increased provider capacity and capability. 23

26 Responsiveness Lead: CRMM 2. Influence the setting of targets aimed at improving service access and clinical interventions for Māori to regional services in the areas of: Cardiac Renal Cancer 3. Engage with the Central Region Mental Health forum to scope improvements in Māori mental health issues including, yet not limited to: Youth Alcohol & Drug Suicide Develop and implement a Central regional bi-cultural training outcomes framework. Targets developed, agreed and reported annually. Any age related criteria reconsidered to address the earlier onset of chronic health conditions experienced by Māori. Central Region Mental Health forum engaged. Māori mental health priorities agreed. Increased cultural competency. Increased patient satisfaction. A regionally agreed sustainability pathway implemented 2012 Reduce disparities Reduce disparities 2012 Improved mainstream responsiveness. 24

27 Collaborative Action Collaboration, not only within the Central Region health sector but also across sectors, is critical to meeting the broad health and social needs of populations as defined by the aim of Whānau Ora. Agreeing priorities, targeting and pooling funds provide agencies and organisations the opportunity to use resources in a better way. This action area supports activities to strengthen; the regional Māori health network, collaborative regional leadership, and across-sector development. Collaborative Action Lead: CRMM 1. Participate and contribute to CRTAS work projects to identify opportunities which advances regional advance regional Māori Health / Inequalities work. 2. Convene a regional hui to define and determine a health perspective on Whānau Ora by Central Region for Central Region. 3. Develop and promote a Whānau Ora framework for the Central Region. 4. Implement a bi-annual Central Region DHB Maori health development conference: Tu Kaha. 5. Investigate the development of an across-sector regional Māori plan. 6. Support and facilitate an across-sector collaboration to support the direction of the Whānau. Quarterly meetings Ongoing Proactive engagement on CRTAS led work to drive a greater impetus on addressing Maori inequities in the Central Region. hui held. Whānau Ora defined for Central Region. Whānau Ora framework developed, implemented and monitored. June 2011 Improved across sector collaboration and relationships Two conferences implemented & 2014 Plan scoped. Agencies engaged Improved regional relationships. Six monthly meetings. Ongoing 25

28 Measuring and Sharing Information The monitoring and reporting of progress of Māori Health will provide accountability to the key stakeholders within the health sector, across sector, and, for our communities. It is an effective way to identify any gaps, issues and risks which may need to be addressed both at regional and local level. Just as important, it is a tool to evidence impact and outcome. Measuring and Sharing Information Lead: CRMM 1. Develop a regional reporting framework to monitor progress in the regions Māori health status. Reporting framework developed and includes Health Targets and national indicators of Whānau Ora. June 2012 Improved reporting and monitoring of Māori Health. 2. Input to and utilise the Māori health regional communication framework. CRMM informs and provides input to TAS communications. Ongoing Report progress of Māori health. Contributory CRMM quarterly reports to Central Region CEO forum. 3. Implement a regional research project aligned to improving Māori ASH rates. Research project agreed and undertaken 2013 Research report completed and disseminated. Measuring and Sharing Information Lead: Services Plan 4. Improving the overall health of the population of the Central Region is the main focus for regional working for the 6 DHBs. Health Targets are met as an indicator of health system success Inequalities measured for Māori, Pacific Peoples, high needs, and other for: 2011/ /12 Increased population health and improved consumer involvement and experience. 5. Putting patients and family/ whānau first. - Service access - Morbidity and - Mortality 26

29 Measuring and Sharing Information Lead: Services Plan 6. Continue to see downward trend in avoidable hospitalisations and premature death from preventable conditions. 7. DHBs ensure that the vision of a Tobacco-free Aotearoa by 2020 is achieved ahead of time. Māori health programme agreed and established. Consumer voice is strengthened in regional planning. 2011/ /12 8. Facilitate and monitor the delivery of community based services to people with heart failure throughout urban and rural areas. Indicators identified, agreed and reported. June 2011 Improving equity of access to heart failure services and moving the focus to primary care. 9. Gain regional agreement and report quarterly on standardised key performance indicators for heart failure such as: 100% of DHB areas have Heart Failure pathways in place. 10. Standardise information, education and resource materials for people with heart failure. Standardised resources developed. July CCN contracts CRTAS to provide analytical support for the network. Production of six-monthly regional cancer control indicator reports Development of systems to report on tumour stream indicators. Ongoing Ongoing Timely, accurate data supports the planning and performance monitoring of cancer services across the region. 27

30 Appendices National Direction Whānau Ora Whānau Ora has always been the concept at the forefront of Māori Health and was further emphasised in a strategic context with the development of He Korowai Oranga in In 2009, the idealism of Whānau Ora was driven to move from concept to implementation in line with, and complimentary to, the direction of Better, Sooner, More Convenient, by developing comprehensively coherent models of service delivery, by whānau for whānau, in order to reduce service duplication. Whānau Ora has been well publicised in that it is an inclusive approach to providing services and opportunities to whānau across New Zealand. It empowers whānau as a whole, rather than focusing separately on individual whānau members and their problems (Te Puni Kokiri, 2010). Whānau Ora is about being self-sustaining; it is about restoring that sense of collective responsibility to care for our own; ultimately it is about ensuring the generations to follow inherit the world that we create for them (Turia, 2010). To do this, providers will need to work collaboratively with each other, government agencies and with families and whānau (Collins, 2010). In 2009, a taskforce was put in place to investigate and make recommendations of how Whānau Ora could be realised. The Whānau Ora: Report of the Taskforce on Whānau - Centred Initiatives (Durie, Cooper, Grennell, Snively, & Tuaine, 2010) was completed in April This report made six key recommendations to the Minister Responsible for Whānau Ora which included: 1. that an independent Trust be constituted to govern, coordinate and implement Whānau Ora, and report to a dedicated Minister of Whānau Ora. 2. the establishment of a specific Whānau Ora appropriation(s) to be managed by the Trust. 3. that Whānau Ora services are integrated and comprehensive, and focused on measurable outcomes that will contribute to whānau empowerment. 4. that Whānau Ora services are shaped by te ao Māori. 5. that all government agencies with responsibilities for any aspect of whānau wellbeing commit to the Whānau Ora principles and support the Whānau Ora approach. 6. that the Trust establish regional panels to ensure Whānau Ora contributes in positive and realistic ways in local communities. 28

31 As a result, 25 providers were announced in the initial selection of Whānau Ora providers of which 7 providers, encompassing 17 services, are from within the Central Region DHB area. He Korowai Oranga (Ministry of Health, 2002) He Korowai Oranga, the Māori Health Strategy, sets the direction for the health and disability sector in relation to Maori. The overall aim of He Korowai Oranga is Whānau Ora: Māori families supported to achieve their maximum health and wellbeing. It fulfils the special relationship between the Crown and Māori by encapsulating the principles of: Partnership Working together with iwi, hāpu, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services. Participation Involving Māori at all levels of the sector, in decision making, planning, development and delivery of health and disability services. Protection Working to ensure Māori have at least the same level of health as non-māori and safeguarding Māori cultural concepts, values and practices. He Korowai Oranga is accompanied by a separate action plan, Whakataataka, which outlines the implementation and specifies the roles, responsibilities, performance expectations, measures and initiatives for achieving the strategy. Māori Health Planning The draft Operational Policy Framework for 2011/12 will require DHBs to develop a stand alone Māori Health plan that will ensure that strategic objectives become activities. The Māori Health Plan [will record] the Māori health issues within their district that the DHB plans to focus on, what they are doing about those issues, and how they will measure progress. The Māori Health Plan will include a description of the health status of the Māori population in the district; national priorities; regional priorities and local priorities (Ministry of Health, 2010a). Additionally, Māori Health plans, including a set of 10 key health issue indicators, will follow a template which is to be piloted by Lakes and Bay of Plenty DHBs. Where possible, it is proposed that the data for the headline indicator set will be sourced by the Ministry and provided to the DHB and therefore will not add any further reporting requirements for the DHB. 29

32 To compliment this, the draft 2011/12 Service Coverage Schedule indicates that Crown objectives for Māori health will be met by working to ensure that all health and disability services are provided in a timely manner, are of high quality, and are effective in order to improve the health of Māori and their whānau, and reduce health inequalities for Māori (Ministry of Health, 2010b) It also provides direction to ensure that mainstream services are effective for Māori and work to improve access for Māori, particularly for primary care services; building Māori health providers capacity and capability are also important strategies in improving Māori health status; [and, continued] support [for] accelerated development of the Māori health workforce at all levels of the health sector. (Ministry of Health, 2010b). Central Cancer Network Plan (Central Cancer Network, 2009) This plan seeks to support DHBs and local cancer network stakeholders to deliver on their cancer control and palliative care plans by focusing on those objectives common to these plans. The plan affirms that reducing inequalities is a critical component of the framework. Ethnic, intra-regional and inter-regional inequalities exist in the CCN region for cancer screening, cancer incidence, cancer treatment and cancer outcomes. Identifying and addressing inequalities is a key focus across all strategic priorities. As such, a key focus point within this plan is to address inequalities with particular focus on those experienced by Māori and Pacific peoples. Central Region Strategic Plan for the Development of Mental Health and Addiction Services (Central Region's Technical Advisory Services Limited, 2007) In March 2007, the Strategic Plan for the Development of Mental Health and Addiction Services was completed. This document articulates the vision for how mental health services could look in 2016, and was developed after considerable sector feedback. The plan included specific commentary on Māori mental health stating In 2016, mental health and addiction services will be specifically configured to provide accessible, responsive, high quality, safe and appropriate health services and supports to meet the needs of Māori. When Māori do chose to use [mainstream] services, these will be provided in a culturally appropriate and competent manner. Māori concepts of health will be the basis of kaupapa Māori mental health and addiction services practice. Alongside this will be the incorporation of whānau ora and Māori concepts of health into [mainstream] services. This 30

33 approach will support positive outcomes for Māori whānau, hapū, and iwi in all mental health and addiction services. Central Region DHBs Māori Forum Currently there are two regional Māori forums; the Central Region Māori Managers forum and the Central Region Māori Relationship Board forum. The Central Region Māori Managers forum is a cohesive group of Māori managers who actively meet, discuss, act and advocate for improvement in Māori Health within the region. They have implemented a number of regional initiatives resulting from national direction and are aligned with the national Māori manager s forum, Tumu Whakarae. The Central Region Māori Relationship Board forum has recently been established. The purpose of this forum is to advance a collective Māori governance and iwi relationship view to the decision-making table. Although in it s infancy, this forum is beginning to make headway at a regional governance level. Central Region Ethnicity Distribution Central Region ethnicity make-up is similar on a national level however, marked differences exist between Central Region DHB populations, as illustrated in Table 1. In Whanganui and Hawke s Bay almost one in four of the population are Māori. Capital & Coast and Hutt Valley have the largest proportion of Pacific Peoples. Table 1: Ethnicity distribution by DHB in 2006 Māori Other Pacific Peoples Whanganui 24% 74% 2% Hawke s Bay 24% 73% 3% MidCentral 18% 80% 2% Hutt Valley 16% 76% 8% Wairarapa 15% 83% 2% Capital & Coast 11% 82% 8% Central Region 17% 78% 5% New Zealand 15% 79% 6% Central Region Deprivation Distribution Socio-economic deprivation can be measured via the NZDep index (derived from variables contained in the Census about factors such as income and employment). There is great contrast between the proportions of people in each DHB living in the least deprived quintile (1) and the most deprived quintile (5). As illustrated in Figure 1, Capital & Coast has a more affluent population. Whanganui has a particularly poor population with 35% of people living in the most deprived quintile (5) and Māori being particularly over represented with 53% of all Māori in Whanganui residing in quintile 5. Capital & Coast and Wairarapa have the lowest proportion in the most deprived quintile (15% and 16% respectively). 31

34 Across all DHBs there are higher proportions of Māori and Pacific Peoples in the two most deprived quintiles. Figure 1: Population distribution by DHB, deprivation quintile and ethnicity (2006) (Central Region's Technical Advisory Services Limited, 2010) Central Region Whānau Ora Providers Takitimu (Hawke s Bay) Te Taiwhenua o Heretaunga Hawke s Bay Hauora Collective Te Kupenga Hauora Ahuriri; Te Roopū Huihuinga Hauora; Central Health Ltd Te Tai Hauāuru (Whanganui/Taranaki) Te Oranganui Iwi Health Authority Primary Health Organisation Te Whanganui ā Tara (Wellington) Te Rūnanga o Toa Rangatira Inc Oratoa PHO; Oratoa Medical Centres; Oratoa Health Unit; Oratoa Dental Service; Rangataua Mauriora; Oratoa Residential Disability Service Hā O Te Ora O Wharekauri Trust Pacific Health Service Wellington & Teaomanino Trust Tākiri Mai Te Ata & Te Rūnanganui o Taranaki Whānui ki te Upoko o te Ika a Maui Inc. Kōkiri Marae Health & Social Services; Mana Wahine; Nāku Ēnei Tamariki Inc (Māori Section); Tū Kotahi Māori Asthma Trust; Wainuiomata Marae; Whai Oranga o te Iwi Health Centre; Te Awakairangi (Hutt Valley) Provider Collective; Te Rūnanganui o Taranaki Whānui ki te Upoko o te Ika a Maui Inc. 32