CANTERBURY DHB BOARD. Thursday 13 March am. Board Room, 3 rd Floor, The Princess Margaret Hospital, Christchurch

Transcription

1 CANTERBURY DHB BOARD Thursday 13 March am Board Room, 3 rd Floor, The Princess Margaret Hospital, Christchurch

2 ATTENDANCE CANTERBURY DISTRICT HEALTH BOARD MEMBERS Murray Cleverley (Chair) Steve Wakefield (Deputy Chair) Sally Buck Anna Crighton Andrew Dickerson Jo Kane Aaron Keown Chris Mene Edie Moke David Morrell Susan Wallace Executive Support David Meates (Chief Executive) Mary Gordon (Executive Director of Nursing) Carolyn Gullery (General Manager Planning and Funding) Hector Matthews (Executive Director -Maori and Pacific Health) Nigel Millar (Chief Medical Officer) Justine White (General Manager - Finance) Kay Jenkins (Executive Assistant - Governance Support) Stella Ward (Executive Director Allied Health Scientific & Technical) AGA-Board March Attendance List.docx Page 1 of 1 13/09/2012

3 AGENDA PUBLIC CANTERBURY DISTRICT HEALTH BOARD MEETING To be held in Board Room, 3 rd Floor, the Princess Margaret Hospital, Christchurch Thursday 13 March 2014 commencing at 9.00am ADMINISTRATION Apologies 1. Interest Register Update Board Interest Register and Declaration of Interest on items to be covered during the meeting. 2. Confirmation of the Minutes of Previous Meeting Meeting of 13 February Carried Forward/Action List Items REPORTS 4. Chair s Update (Oral) Murray Cleverley Chairman 5. Chief Executive s Update David Meates Chief Executive 6. Finance Report Justine White General Manager, Finance 9.00am 9.10am 9.10am 9.25am 9.25am 9.50am 9.50am 10.05am MORNING TEA 7. CDHB Submission Process Evon Currie General Manager, Population Health 8. Health Target Report Quarter 2 Carolyn Gullery General Manger, Planning & Funding am 10.20am 10.30am 10.30am 10.45am 9. Review QFARC Committee Terms of Reference Justine White 10.45am 11.00am 10. Advice to Board CPHAC Meeting 25 February Advice to Board DSAC Meeting 25 February 2014 Anna Crighton Chairperson CPHAC Committee Chris Mene Chairperson DSAC Committee 11.00am 11.10am 11.10am 11.20am 12. Resolution to Exclude The Public Justine White 11.20am 11.25am Information Items - ESTIMATED FINISH TIME PUBLIC OPEN MEETING 11.25am NEXT MEETING Thursday 17 April am AGA - Board Public - Agenda -13 March 2014.doc 07/03/14

4 CANTERBURY DISTRICT HEALTH BOARD MEMBERS INTERESTS REGISTER CANTERBURY DISTRICT HEALTH BOARD REGISTER OF MEMBERS CONFLICTS OF INTERESTS (As disclosed on appointment to the Board and updated from time-to-time, as necessary) MURRAY CLEVERLEY (CHAIR) Trust AORAKI Director Business Class Ltd Managing Director Opihi Vineyard Ltd - Chairman Canterbury Economic Development Co Ltd - Director Shoe Shield Ltd - Director Animal Care Solutions - Director Sky Holdings Ltd Director District Health Boards NZ - Director South Island Neurosurgical Services Board - Director KCL Properties - Director Warbirds Over Wanaka - Director CERA Employee South Canterbury DHB Board Chairman STEVE WAKEFIELD (DEPUTY CHAIR) Deloitte Partner Partner of professional services including accounting, tax, auditing and consulting services. Trustee Anglican Church Property Trustees Holds all property on behalf of the Anglican Church in the Diocese of Christchurch Trustee the Court Theatre Trust Professional Theatre Company National Board Member YHA New Zealand Ltd Operates around 50 youth hostels throughout New Zealand Board member Canterbury Cricket Association Operates all professional and amateur cricket in Canterbury. Developing Hagley Oval as an international cricket ground. Director CropLogic Ltd Start up company in the provision of systems to enhance food production efficiency. Vestry Member (Board of Trustees) St Barnabas Church Local Anglican Parish Church Board of Trustees. Trustee Greater Christchurch Schools Network Trust Objectives are to facilitate improved digital teaching and learning in Christchurch. Item 1- Board-March Members Interest Register.doc Page 1 of 5 07/03/14

5 I am a trustee and a beneficiary of a family trust that holds various investments, one of which is a shareholding in listed company Fletcher Building Limited, which may supply building materials or construction services, or tender to provide such to CDHB. SALLY BUCK Christchurch City Council Community Board Member I am a member of the Fendalton/Waimairi Community Board which has delegated responsibilities from the Christchurch City Council. Independence House Board Member Independence House is funded through the Ministry of Health to provide SIL and residential care for intellectually disabled youth and adults. Wainoni Avonside Community Support Trust - Board Member Is a community organisation affiliated to the Methodist Church in Wainoni runs programmes for older people. Just Dirt Trust Board Member ANNA CRIGHTON New Zealand Historic Places Trust Board Member Governance of New Zealand Heritage. Canterbury DHB owns buildings that may be considered by the Trust to have historical significance. Christchurch Heritage Trust Chair - Governance of Christchurch Heritage. Historic Places Aotearoa Inc - President ANDREW DICKERSON Health Care of the Elderly Education Trust - Chair Promotes and supports teaching and research in the area of care of older people. Recipients of financial assistance for research, education or training could include employees of the Canterbury DHB. Canterbury Medical Research Foundation - Member Provides financial assistance for medical research and research facilities in Christchurch. Recipients of financial assistance for research, education or training could include employees of the Canterbury DHB. NZ Historic Places Trust - Member The Trust promotes the identification, preservation and conservation of the historical & cultural heritage of New Zealand. Canterbury District Health Board owns buildings that may be considered by the Trust to have historical significance. No Conflicts of Interest are envisaged for the following interests, but should a conflict arise this will be discussed at the time. Item 1- Board-March Members Interest Register.doc Page 2 of 5 07/03/14

6 NZ Gerontology Association - Member Professional association that promotes the interests of older people and an understanding of ageing. Hope Foundation for Research on Ageing - Member Promotes research on New Zealand s ageing population and its implications for the future. Osteoporosis (Canterbury) Inc. - Member Provides support, information and advice to people with osteoporosis. Neurological Foundation of New Zealand Inc. - Member Provides support and information to people with diseases and disorders of the brain and nervous system. Abbeyfield New Zealand Inc. - Member Promotes and establishes community housing for lonely and socially isolated older people using the Abbeyfield model. Consultant I have a private consultancy specialising in management consultancy services (including communication management, communication strategy and marketing) to the not for profit sector, professional associations, social service and public sector agencies.. JO KANE Latimer Community Housing Trust Project Manager Delivers social housing in Christchurch for the vulnerable and elderly in the community. Registered Resource Management Act Commissioner From time to time I sit on RMA panels throughout Canterbury. If any conflicts of interest arise from this they will be advised. NZ Royal Humane Society Director Provides an awards system for acts of bravery in New Zealand. It is not anticipated any conflicts of interest will arise. HurriKane Consulting Project Management Partner/Consultant Is a private consultancy in management, communication and project management. Any conflicts of interest that arise will be disclosed/advised. AARON KEOWN Christchurch City Council - Shirley Papanui Community Board Member I am an elected member of the Shirley Papanui Community Board. Grouse Entertainment Ltd Director and Shareholder Grouse Films Ltd Director CHRIS MENE Christchurch Polytechnic Institute of Technology (CPIT) - Advisory Board Member to Bachelor of Applied Science CPIT is a tertiary institution and I contribute as an industry advisor into the Bachelor of Applied Science (with Speciality) degree course. This course includes two specialities which are (1) Physical Activity Health and Wellness and (2) Sports Science. This is a voluntary position. Item 1- Board-March Members Interest Register.doc Page 3 of 5 07/03/14

7 Canterbury Clinical Network Project Manager, Child & Youth Workstream Contracted to Pegasus Health Wayne Francis Charitable Trust - Board Member The Wayne Francis Charitable Trust is a philanthropic family organisation committed to making a positive and lasting contribution to the community. The Youth focussed Trust funds cancer research which embodies some of the Trust s fundamental objectives prevention, long-term change, and actions that strive to benefit the lives of many. Sport Canterbury Board Member Core Education Director Has an interest in the interface between education and health EDIE MOKE Director -Health Benefits Ltd (HBL) I am also Chair of the Finance Audit and Risk Committee of HBL. The role of HBL is to work in partnership with DHBs to reduce their administrative, support and procurement costs. The CDHB holds shares in HBL and HBL is also a shareholder in Health Alliance NZ Ltd, which provides shared services to Northern Region DHBs. Board Member South Canterbury DHB Appointed member DAVID MORRELL British Honorary Consul Interest relates to my supporting British nationals and relatives who may be hospitalised arising from injury related accidents, or use other services of the Canterbury DHB, including Mental Health Services. In addition a conflict of interest may arise from time to time in respect to Coroners Inquest hearings involving British nationals. Nurses Memorial Chapel Trust Chair (Canterbury DHB Appointee) - Trust responsible for Memorial on the Christchurch Hospital site. Historic Places Trust Subscribing Member The Trust s mission is to promote the identification, protection, preservation and conservation of the historical and cultural heritage of New Zealand. The Trust identifies records and acts in respect of significant ancestral sites and buildings. The Trust has already been involved with Canterbury DHB buildings. My wife is a member of the Hospital Ladies Visitors Association no potential conflict of interest is expected and should this arise it will be declared at that time. Honorary Canon- Christchurch Cathedral The Cathedral congregation runs a food programme in association with Canterbury DHB staff. Great Christchurch Buildings Trust Trustee The Trust seeks the restoration of key Christchurch heritage buildings, particularly Christchurch Cathedral, and is also involved in facilitating the building of social housing. Item 1- Board-March Members Interest Register.doc Page 4 of 5 07/03/14

8 SUSAN WALLACE Member West Coast DHB Appointed board member West Coast DHB Te Rūnanga o Ngāi Tahu - Affiliated Member of TRONT. Māori Women s Welfare League (MWWL) Member of Maori Women s Welfare League, is a recipient of Ministry of Health funding for HEHA programmes. Chair Poutini Waiora Trust Is a West Coast Maori provider affiliated with He Oranga Pounamu and recipient of Ministry of Health funding. Te Waipounamu MWWL -Area Representative to National Executive of MWWL. Item 1- Board-March Members Interest Register.doc Page 5 of 5 07/03/14

9 MINUTES DRAFT MINUTES OF THE CANTERBURY DISTRICT HEALTH BOARD MEETING held in the Board Room, 3 rd Floor, H Block, The Princess Margaret Hospital on Thursday 13 February 2014 commencing at 9.00am BOARD MEMBERS Murray Cleverley (Chair); Steve Wakefield (Deputy Chair); Sally Buck; Anna Crighton; Andrew Dickerson; Jo Kane; Aaron Keown; Chris Mene; Edie Moke; David Morrell; and Susan Wallace (via video conference). APOLOGIES An apology for lateness was received from Chris Mene (11.10am). EXECUTIVE SUPPORT David Meates (Chief Executive); Mary Gordon (Executive Director of Nursing); Greg Hamilton (Team Leader, Planning & Funding); Stella Ward (Executive Director, Allied Health); Justine White, (General Manager, Finance); Kevin Roche (Assistant Board Secretary) and Kay Jenkins (Executive Assistant, Governance Support). 1. INTEREST REGISTER Additions/Alterations to the Interest Register Murray Cleverley advised that NZ Pet Foods should be deleted and his position at Trust Aoraki should be amended to read Director. Sally Buck advised that Wainoni Trust should be changed to WACST and Just Dirt Trust Board Member should be added. Anna Crighton advised that her position on Christchurch Heritage Trust should be changed from Trustee to Chair. Declarations of Interest for Items on Today s Agenda There were no declarations of interest for items on today s agenda. Perceived Conflicts of Interest There were no perceived conflicts of interest. 2. CONFIRMATION OF MINUTES OF THE PREVIOUS MEETINGS Resolution (1/14) (Moved; David Morrell /seconded; Steve Wakefield - carried): That the minutes of the Meeting of the Canterbury District Health Board held at The Princess Margaret Hospital on 19 December 2013 be confirmed as a true and correct record. 3. CARRIED FORWARD/ACTION LIST ITEMS In relation to the CCC Local Alcohol Policy, the Chief Executive advised that the Healthy Christchurch Champions had met earlier in the week and further feedback will be provided to the Board Public/2014/13February/Minutes Page 1 of 6 13 March 2014

10 Council from this group. Regular updates will be provided to the CPHAC Meetings. The carried forward items were noted. Clarification was sought regarding the resolution at the December 2013 Board meeting regarding meeting dates. It was agreed that the meeting dates for 2015 be reviewed in September 2014 with the dates for 2014 remaining unchanged.. 4. CHAIR S UPDATE The Chair commented on: Partnership Group Meeting - he is in discussions with the Chair of the Partnership Group regarding the sharing of more information to this Board. The Chairs Update was noted. South Island Alliance Meeting Main focus was on the South Island Patient Information Care System (SIPICS). He commented that the South Island Alliance is in good heart with all DHBS working well together. The Chair s update was noted. 5. CHIEF EXECUTIVE S UPDATE David Meates, Chief Executive spoke to this report which was taken as read. In addition he commented on: Older Person s Health and the Supporting Carers Project Mental Health Accommodation this is continuing to be a major issue which housing of vulnerable people across the community and remains a priority for the CDHB. Discussion took place around the responsibilities of the CDHB in this to provide solutions and influence other organisations. The Board noted that this was costly for the DHB in respect to the discharge of mental health patients into the community. Performance Management Frameworks 3,500 staff are now covered by a new performance management process. With Microsoft s announcement that Windows XP is becoming end of life in April the CDHB was in the process of a Windows 7 Upgrade Project. A new software platform has been developed and the upgrade of all PCs is timed to be completed by the end of April A lot of focus is currently on the frail elderly which is one of the biggest indicators of a health system working well. The Chief Nurse from the National Health Service UK has been visiting Canterbury this week to understand what we do here. The following week there would be a contingent from Singapore visiting. This week there was a graduation for Nursing Graduates. It should be noted that we are one of only two DHBs recruiting new Mental Health Nursing Graduates. Forth year medical students commenced in Canterbury this week. With the ongoing repairs due to the earthquakes one cardiac operating theatre has been out of action over the last few weeks and the team have worked to ensure that this has not affected services. Discussion took place regarding the immunisation health target. The Board noted that there is a sub group of the Alliance working on this. A report will be provided to the CPHAC Committee later in the year. Board Public/2014/13February/Minutes Page 2 of 6 13 March 2014

11 A point was raised in regard to whether there has been an increase in oral health problems since fluoride was removed from the water supply. Information on this will also be provided to the CPHAC Committee. A point was also raised regarding boil water notices in the Selwyn DC area and whether the CDHB should be doing something about this. A summary of a working engagement that is taking place will be sent to the CPHAC Committee. A request was made for the Board to see what our whole of system communication plan looks like. A query was made in regard to Brackenridge Estate Ltd and it was agreed that an update would come to the April meeting of the Board Resolution (2/14) (Moved Edie Moke /seconded David Morrell carried) That the Board: i. Notes the Chief Executive s Update 6. FINANCE REPORT Justine White, General Manager, Finance, presented this report which was taken as read. She advised that the consolidated Canterbury DHB financial result for the month of December 2013 was a deficit of $1.511m, which was $0.028m unfavourable against the budgeted deficit of $1.483m. The year to date position was $0.390m favourable. A query was made as to whether the $52M owed to us by the Ministry of Health at year end was going to be pursued. The Board noted that it has been agreed to offset this against money we now owe them for the Facilities Development Project.. A point was raised in regard to the MP for Waimakariri reporting to the media that the government had provided $7M over and above our normal funding for the Rangiora project and whether there is a time frame for us to receive this funding. Concern was also raised regarding the perception held in the Community. The Chief Executive advised that the $7M to underpin the development at Rangiora has already been approved by this Board and it should also be noted that the project is being undertaken in two stages. The Board noted that there have already been public meetings held and a further public meeting is scheduled for 5 March. The Chair of QFARC asked for the Board to be able to see the cash flow projections for the next 2 3 years in graph form with actuals tracked against this. Resolution (3/14) (Moved Steve Wakefield/seconded Aaron Keown carried) That the Board: i. Notes the financial result for the period ended 31 December COMMITTEE ARRANGEMENTS/MEMBERSHIP 2014 The Chair spoke to this report. He commented that he has looked at our governance structure and believed that that this did not allow for specialisation. He added that all Board members would still receive all papers and have the ability to attend all meetings if they wished. Board Public/2014/13February/Minutes Page 3 of 6 13 March 2014

12 In regard to the DSAC Committee he commented that it is his view that by having this joint with CPHAC there was no specialised focus. He added that he would also like to see the health of vulnerable people covered by this committee. He advised that he will also be having discussions with Manawhenua with a view to having some Board representation on their committee. The Chair asked each Board member to provide their comments to the meeting. Resolution (4/14) (Moved Anna Crighton/seconded Chris Mene carried) That the Board i. Confirms the re-establishment of a separate Disability Support Advisory Committee; and ii. Confirms that the make-up of four of the Board Committees (Quality, Finance Audit and Risk Committee, Hospital Advisory Committee, Community and Public Health Advisory Committee and Disability Support Advisory Committee) comprise five Board members and three non-board members; and iii. Confirms the appointment of Board members to the Quality, Finance Audit and Risk Committee, Hospital Advisory Committee, Community and Public Health Advisory Committee and Disability Support Advisory Committee as per the schedule attached as Appendix 1; and iv. Confirms the appointment of Chair s and Deputy Chair s to the Committees as shown in Appendix 1; and v. Confirms that the term of Committee appointments for Board members is for a three year term until the end of February 2016 (while they remain members of the Board); and vi. Confirms the continuation of the Appointments and Remuneration Committee and the appointment of the members of this Committee as per the schedule attached as Appendix 1 vii. Notes that a further report will come to the Board s March meeting regarding the external/community membership of the Quality, Finance Audit and Risk Committee, Hospital Advisory Committee, Community and Public Heath and Disability Advisory Committee and Disability Support Advisory Committee; and viii. Approves the extension of membership for a further month (if required), until 30 April 2014, for the current external members of the Board s Committees should external appointments not be finalised at the March 2014 Board meeting; and ix. Notes that the Terms of Reference (TOR) for all Committees (which are due to be reviewed in February 2014 as per their current TOR) will be amended/developed accordingly and submitted to Committees at their next meetings and then to the Board for approval. x. Agrees that a review of the Committee structure being undertaken in 18 months time xi. Agrees that Sally Buck be appointed as Deputy Chair of the DSAC Committee in place of Jo Kane 8. REPORT OF THE CDHB ELECTORAL OFFICER Justine White, General Manager, Finance, presented this report. A query was made regarding at what point the CDHB had input into the voting system used i.e. STV or FFP. The Chief Executive advised that this was a broader government issue which should be discussed nationally. Board Public/2014/13February/Minutes Page 4 of 6 13 March 2014

13 Resolution (5/14) (Moved Jo Kane/seconded Susan Wallace carried) That the Board: i. Notes the content of the report, providing an updated summary of the 2013 Canterbury DHB elections. 9. ADVICE TO BOARD HOSPITAL ADVISORY COMMITTEE MEETING David Morrell, Chair, Hospital Advisory Committee spoke to the report from the Committee meeting held on 28 January The Board noted the following key points from the meeting: The meeting held between ACC staff and staff of the Older Persons Health & Rehabilitation Service following on from the unsuccessful tender to provide Brain Injury Rehabilitation services for the ACC, and the improved relationship and understanding resulting from this which is seen as benefiting the Canterbury DHB. The issue of financial reporting, monitoring, and budget setting within the Canterbury DHB and the complexities of changing from transactional to value accounting. The advances in business analysis in respect to the Emergency Department (ED) and the ability to now monitor the impacts of other programmes on ED attendances. The advances in electronic medicine and the move towards a paperless environment, and also the specific benefits accruing to the West Coast from electronic medicine, working in collaboration with the Canterbury DHB. The current high level of surgery outsourced to the private sector, and the safety limit boundaries for case complexity in this process. Resolution (6/14) (Moved; David Morrell /seconded; Aaron Keown carried) That the Board: i. Notes the HAC Update 28 January RESOLUTION TO EXCLUDE THE PUBLIC Resolution (7/14) (Moved; Anna Crighton /seconded; Sally Buck carried) That the Board: i resolve that the public be excluded from the following part of the proceedings of this meeting, namely items 1,2,3,4,5,6,7,8,9 and the information items contained in the report. ii. notes that the general subject of each matter to be considered while the public is excluded and the reason for passing this resolution in relation to each matter and the specific grounds under Schedule 3, Clause 32 of the New Zealand Public Health and Disability Act 2000 (the Act) in respect to these items are as follows: GENERAL SUBJECT OF EACH MATTER TO BE CONSIDERED GROUND(S) FOR THE PASSING OF THIS RESOLUTION REFERENCE OFFICIAL INFORMATION ACT 1982 (Section 9) Board Public/2014/13February/Minutes Page 5 of 6 13 March 2014

14 1. Confirmation of minutes of the public excluded meeting of 19 December Chair and Chief Executive -Update on Emerging Issues 3. CDHB Submission Land Transport Act Amendment Bill 4. Demolition 45 St Asaph Additional Budget 5. CDHB Contribution Facilities Development Project For the reasons set out in the previous Board agenda. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). s9(2)(j) S9(2)(a) s9(2)(j) s9(2)(j) 6. Earthquake Repairs Programme of Work Insurance Decision Making Framework To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 7. Legal Risk Report Protect the privacy of natural persons To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). Maintain legal professional privilege s9(2)(j) S9(2)(a) s9(2)(j) s9(2)(h) 8. Facilities Project Update Presentation To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). s9(2)(j) 9. QFARC Meeting Update - 28 January 2014 To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). s9(2)(j) iii notes that this resolution is made in reliance on the New Zealand Public Health and Disability Act 2000 (the Act ), Schedule 3, Clause 32 and that the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 ; There being no further business the public open section of the meeting closed at 12.30pm. Murray Cleverley, Chairman Date Board Public/2014/13February/Minutes Page 6 of 6 13 March 2014

15 CARRIED FORWARD/ACTION ITEMS PUBLIC CANTERBURY DISTRICT HEALTH BOARD CARRIED FORWARD ITEMS AS AT 13 MARCH 2014 DATE ACTION COMMENTARY REFERRED TO STATUS QFARC 1 October 2013 CCC Local Alcohol Policy (LAP) Issue of support from the CDHB if appeals to the final policy are lodged General Manager Population Health To be kept under review- LAP not yet publically notified by CCC. Will then become subject to appeal. 2. Board 13 February 2014 Immunisation National Health Targets Report back on Immunisation rates especially in relation to Maori children General Manager P & F To be covered by regular reports to the Board and CPHAC (see today s agenda) Item 3 -Board 13 march 14 -Carried Forward-Action List.doc Page 1 of 1 07/03/14

16 CHIEF EXECUTIVE S UPDATE TO: SOURCE: Chair and Members Canterbury District Health Board Chief Executive DATE: 13 March 2014 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT This report is a regular report and standing agenda item, providing the latest update and overview of key organisational activities and progress from the Chief Executive to the Board of the Canterbury DHB. Its format has been reorganised around the key organisational priorities that drive the Board and Executive Management Team s work programmes. Its content has been refocused on reporting recent performance, together with current and upcoming activity. 2. RECOMMENDATION That the Board: i. notes the Chief Executive s update. 3. DISCUSSION PUTTING THE PATIENT FIRST Patient Safety Open for Better Care Patient Safety Campaign The current focus area of the campaign is about to move to reducing perioperative harm. This incorporates surgical safety checklist, venous thromboembolism prevention and perioperative mortality, with a national workshop to be hosted by the Health Quality and Safety Commission in April. Preparation is also underway for an April Falls awareness promotion and will include a workshop by Francis Healey, a UK expert in patient falls prevention. Incident Management Chief Executives have agreed for the South Island business case to go to Board Chairs. In anticipation of approval, work is continuing on a standardised taxonomy for all South Island DHB s. The Canterbury DHB business case is being refined and an initial project plan is under development. In conjunction with the rollout of the electronic reporting system it is anticipated there will be training of staff in Just culture and the consideration of human factors in the incident investigation. This work is being supported by investigation training workshop held for key Quality staff in February. Quality Improvement Process As part of the take up of use of the software data system Signals for Noise the quality improvement method has been standardised for use across the organisation to support learning from quality improvement activities. The improvement activity (Plan, Do, Study, Act) will be able to be viewed in real time alongside the measures that are being used to target improvements. Board March 2014 CEO Report Page 1 of 15 07/03/14

17 Performance Excellence It has been agreed the chosen quality improvement framework Performance Excellence Criteria for Healthcare (New Zealand Business Excellence Foundation Baldridge criteria) will be known as Health Excellence at CDHB. This is in line with Counties Manukau and Bay of Plenty District Health Boards (Bronze Medal winners). REDUCING THE TIME PEOPLE SPEND WAITING Frail Older Persons Pathway To improve the flow of frail older persons in the assessment, treatment, and rehabilitation (ATR) inpatient setting a number of activities are being undertaken. Assertive Board Rounds have been undertaken on the Health of Older Persons (HOP) exemplar wards, Ward 1A and 2B. This is being supported by project resource and the use of peer reviews amongst both doctors and charge nurses. Due to the success, they will roll out to all wards in the inpatient setting at TPMH in April to coincide with Registrar/SMO changeover and provide time to embed across the ATR wards. Goal sheets now exist at the beds. These are an important part of both staff being able to focus on and take responsibility for the expected date of discharge, but also for the patient to have a role in setting their goals, and ultimately supporting the conversation and visibility of the individual s goals. One of the key performance measures we have set for the health system, is to reduce the number of beds occupied by people over the age of 75 for more than 14 days. We have seen a change in the number and initial reduction which then started to trend back. This recent increase has been a result of accepting direct referrals from the community, due to the created increased availability of beds. Observation of this has resulted in the need to investigate whether this is the best approach for community referred patients and whether a more tailored response involving assessment and CREST would be more appropriate. It is being explored whether undertaking a single point of entry through Christchurch Hospital with an intervention of a rapid response community based assessment can achieve a greater outcome. More focus on this area is to start. Two other key steps are to re-organise the way in which Rehab services undertake its in-reach process at Christchurch Hospital. Working alongside each other Christchurch Hospital and HOP are looking to having an Health of Older Person s (HOP) physician for the day available to support Christchurch Hospital. This will enable early decision making with the older person. The second key step is to bring to life data and understanding why there are some long stay patients. Undertaking case study of some patients to better understand where and what we do across the patient journey and how we can make improvements is important. Enhanced Recovery After Surgery (ERAS) The overall aim of the Quality Improvement Collaborative (QIC) is to enhance the surgical outcomes and patient experience for patients receiving Total Hip Replacement, Total Knee Replacement and Fracture Neck of Femur surgery. Some of the local identified improvement opportunities aim to: - Improve access and timeliness to surgery and faster discharge home - Minimise the negative impacts of surgery - Enable a faster and enhanced recovery - Reduce costs of care - Reduce variations in care The objective is that we manage patients according to ERAS principles by December This is a whole of system process that impacts across the hospital and community settings. Community support and services will be provided with more education and support. Other parts of the person s pathway development will cover pre-operative physiotherapy, occupational therapy assessments, and education. This extends to pre-operative anaesthetic and surgical assessments, including those techniques that facilitate early mobility. Our post-operative approach includes early patient mobilisation, physiotherapy and early discharge with the right support in the right place. Finally ensuring that this is achieving what is important is understanding how our patients are experiencing their surgery. A greater focus on interacting, Board March 2014 CEO Report Page 2 of 15

18 asking the question of a patient and their satisfaction is an important component of this change. This is a collective approach across Older Persons Health & Rehabilitation and Christchurch Hospital and has a joint focus group of clinical staff supported by management at both sites. Ashburton Hospital Work continues on projects from the review of Triage 4 & 5 presentations at Ashburton Hospital. St John have now introduced the triage service for the Ashburton district whereby 111 callers are triaged to appropriate services and the call may not necessarily result in an ambulance callout and subsequent transport to hospital. Work is underway to introduce the Global Trigger Tools programme to Ashburton Hospital. This is an international initiative to reduce patient harm caused by errors in hospitals. Overseas research has found that only 10 to 20 per cent of errors are reported voluntarily. The Global Trigger tools programme takes a different approach to our reporting rather than relying on people to do so. An interdisciplinary team reviews patient records looking for triggers which indicate an error has or could have been made. The information gained can then be used to improve the quality and safety of services provided. There is extremely good clinical engagement by staff at Ashburton Hospital in the Ashburton Hospital redevelopment programme for wards and Acute Admissions Unit/Theatre. Good progress is being made on the initial concept designs for all facilities. Mental Health are continuing to closely monitor activity in the Adult and Child and Youth services to understand demand and community need. This information is being shared with relevant government agencies including CERA and Ministry of Health. Demand for child and youth services has increased 40% in the previous two years. Demand for adult services has increased 20% in the previous two years. Demand for psychiatric emergency services have increased 35%. - While aspects of these reports are concerning, in that they reflect a level of distress in our community, they also highlight how responsive our staff and services have been to the changing needs of our community. We are absorbing significant and unprecedented increases in community demand, occupancy of inpatient acute services is relatively stable (but creeping) in adult services. Although the number of new people coming into community services is increasing, the numbers of new people coming into acute inpatient services are dropping, as is length of stay, and with huge reductions in use of seclusion and restraint. Wait times for adult community services are less than 10 days which is less than pre quake. - The results of the mental health system are impressive and are a testament to our workforce, their engagement with change, and commitment to quality mental health care. Cataract Pathway Improvements The cataract pathway has reached completion and a team of staff has been assembled to look at how to remove waste from this in order to reduce waiting times. Cancer Care Co-Ordination On Electronic Request Management System (ERMS) The service is working with Canterbury Initiative to open a pathway for electronic GP referral to cancer care co-ordination on suspicion of cancer. This will augment the current processes that flag potential cancer testing to the team from within the hospital system and will support seamless transfer of care for the patient journey. Senior nurses from the primary sector and oncology service have also met to discuss strategic alignment of cancer service co-ordinator models of care with the primary health care co-ordinators. Gynaecology Oncology Enhanced Recovery After Surgery The principles of Enhanced Recovery after Surgery (Fast-Track or ERAS) were adopted by the gynaecology oncology service in The aims were to improve the perioperative care of women undergoing surgery for Gynaecological Cancer ensuring that women undergoing major abdominal surgery had the right care delivered to the right patient at the right time by the right person in the right Item 5 - Board March CEO Board report.docx Page 3 of 14 07/03/14

19 way. Patients are provided with clear education prior to their admission about their expected date of discharge, expectations of early mobilisation. The changes have included: - Education of nurses to change practice - Avoiding preoperative dehydration and starvation - Careful perioperative fluid management- avoiding fluid overload - Early oral feeding - Early mobilisation including expectations, from day one, that patients will take four walks a day and eat their meals while sitting up - Analgesia- intrathecal morphine, wound catheters and PCA- with a change to regular oral analgesia generally on day one - Laxatives from day zero - Early discharge with the introduction of post discharge follow up phone calls to support patients and check progress To achieve this we have increased use of laparoscopic surgery by the Gynaecological Oncology team. We have introduced venous thromboembolism guidelines and extended anticoagulant prophylaxis on discharge (28 days) patients/family are educated to administer rather than make a District Nurse referral. A recent audit on the ERAS process has resulted in a significant reduction of at least two days in average length of stay, higher levels of satisfaction with the service provided and significantly less post operative complications. Food Delivery System Changes at TPMH With the relocation of wards from TPMH to Christchurch Hospital, the food delivery system has seen the removal of Steamplicity back to the conventional food delivery system to better meet patient needs and reduce waste. This has seen a 50% reduction of food waste. Upgrade to Delphic AP Laboratory Information System The Anatomical Pathology (AP) Department has completed the first stage of a major upgrade to the Laboratory Information System and changes to the histology laboratory workflow. In 2012, following several high profile errors throughout New Zealand histology laboratories, the Ministry of Health produced the Report of the National Panel to review Breast Biopsy Errors This report emphasised the need to develop targeted criteria for greater levels of specimen tracking and security. CHL will be audited against these new criteria in August Many of the new criteria are addressed with the technology solution provided in the upgraded LIS software and associated hardware, (2D barcodes and On-demand printing). The upgraded LIS software with additional hardware and infrastructure, when finally commissioned in June 2014 will significantly reduce the risks of CHL mishandling biopsies and patient receiving incorrect pathology results as identified in the above MOH report. ICNet This infection prevention and control management tool was introduced in Canterbury 12 months ago and is currently the first and only installation in NZ currently. The project is linked to, and supports, the National Surgical Site Infection Improvement (SSII) programme with Canterbury being the national host of the application. Two milestones will be reached during March 2014: - Leveraging off the current ICNet installation, the regional clinical systems work and the integration of the WCDHB laboratory with CHL, the ICNet system will be rolled out to the WCDHB. This will also be a world first as the system will capture both community and secondary care information and integrate the Infection Prevention and Control picture across the system. - ICNet integration with the Scope Theatre system will be operational which will allow the automatic collection of SSII data (replacing the current manual collection) and the automated feed of reporting data into the national monitor. This is a pilot that will be replicated around NZ as both products roll out. Haematology Antibody Therapy Clinical benefits from antibody therapy in Haematology, Rheumatology, Neurology and Gastroenterology have been dramatic. Occasionally these therapies fail to be effective because, some patients develop antibodies Board March 2014 CEO Report Page 4 of 15

20 to them. The Immunology laboratory has developed assays to detect these anti-drug antibodies and has worked closely with the Haematology research unit, Rheumatologists and Gastroenterologists to transfer these assays from a research environment into a diagnostic service to clinicians. Identifying patients with anti-drug antibodies early will eliminate wasting money on treatments which are no longer effective and indicate which patients should transfer to a different antibody therapy for a better clinical outcome. INTEGRATING THE CANTERBURY HEALTH SYSTEM Community Pharmacy The Lean Based business and process review project for community pharmacies has now completed 13 pharmacies. This project aims to enable Community Pharmacists to work at the top of their scope by freeing up more of their time to spend with patients on medications management, and to work with their primary care colleagues on integrated services. The results to date have enabled community pharmacists to invest an additional five hours per week in direct-to-patient care. The pharmacies involved have been extremely positive about the process and it has complemented the implementation of the new community pharmacy agreement in a way that enhances patient care. Acute Demand Management In Quarter 2 Canterbury met the ED Health Target after falling one percent short in Quarter 1. The October to December quarter performance was 95.5% of attendees admitted or discharged within 6 hours. Work is progressing on improving the outcomes of patients with heart failure through an integrated, sector-wide approach. The focus is on implementing a best practice model of care across ambulance, primary care and the hospital sector (including emergency, general medicine and older persons health). Following the example of the Chronic Obstructive Pulmonary Disease (COPD) initiative, a red card is being developed to guide patients self management, and advise when to access additional medical support. A new Ambulance pathway will support St John staff to identify people that can be safely managed in primary care and help them access a clinically appropriate level of care. HealthPathways information is being updated to reflect the changes to the models of care and guide general practice referral criteria to specialist services. Long-Term Conditions The Integrated Diabetes Services Development Group (IDSDG) and Primary Health Organisations (PHOs) have implemented a Diabetes High-Risk Podiatry service that applies a best practice model of care across Canterbury. Auditing and reporting processes are being progressed with the podiatrists and PHOs to enable monitoring of this service. The community delivery of diabetes retinal screening, implemented in February 2013, has resulted in at least 6770 people screened in Canterbury to date, of which 15% were screened in the community at one of the six contracted optometrists, or a mobile clinic. Options for increasing the volume of screens provided in the community are being explored alongside work to streamline the transfer of data between the optometrists and the retinal screening Hub which sits in specialist services. For information on CVD risk assessment and smoking cessation, refer to the section on the national health targets below. Item 5 - Board March CEO Board report.docx Page 5 of 14 07/03/14

21 SUPPORTING OUR VULNERABLE POPULATIONS Child & Youth Health B4 School Checks We have made up some ground following the seasonal drop off in January; however we will need to keep a steady focus over the next few months to ensure we achieve the target. Our clinical coordinator has been working with providers to ensure they understand the oral health component of the Check as this is an area where concerns have been identified with referral volumes showing that not all children requiring a referral have had one. Some improvements to the national database will support improved reporting for this. Delivering Gateway Assessments continues to be a challenge due to a lack of doctors to deliver these complex assessments. However, we have made progress with this and are providing some additional sessions to reduce the backlog by the end of February. We have been working with the Ministry of Education to improve the flow of education profiles to enable us to proceed to delivery of the health assessment component of the Gateway Assessment. Older People s Health The Supporting Carers Project has high level support regarding the direction for a new service model that is clinically led, volunteer-run and uses sites in the local community for normalised activities for people with dementia and their carers and for a quality improvement process for existing day care service providers. Ongoing project definition will continue as approaches to implementing this work are considered. All Falls Prevention service providers have completed Enable s service accreditation, and are now prescribing low-risk, high volume Occupational Therapy equipment thereby addressing a former bottleneck in equipment provision. The current Falls Prevention Service is under review, with a reconfiguration likely of the existing service delivery. This will enable a more responsive falls prevention service at all levels of frailty, and better ensure that Falls prevention is more integrated within the wrap-around support service approach. The review is being undertaken in collaboration with the current service providers. Mental Health Demand across the system continues to trend upwards in line with predictions of post disaster impact. Even with the additional capacity created since 2011, services are fully utilised and increasing responsiveness through better collaboration within health and with other sectors. Child Adolescent and Family Services (CAF) are working with Education to support school communities (children, families, teachers, and staff). Primary mental health services are reviewing their service delivery model to identify any opportunities for improvement, including better integration with NGO community services. Supporting people to access suitable housing is challenging and there is close monitoring of need. Leaders across the system are working with other sectors to find sustainable solutions and mental health housing providers are doing all they can to achieve positive outcomes for people in the current environment. Accommodation In mid February there were 23 people in inpatient or residential services waiting on accommodation in order to be discharged, and 84 people across the mental health system in either unsuitable, unsafe, or homeless situations. We continue to work closely with Comcare Trust on the provision of social housing and are also in regular discussions with CERA. Delays with discharge have a significant flow-on effect across the system. Planning and Funding have increased investment in housing options including the provision of respite beds in order to assist flow through services, in particular inpatient and residential services. Increasing the number of mental health residential services is not consistent with our preferred approach of supporting people in their own housing. However, this has been required due to lack of affordable housing options in Christchurch. Board March 2014 CEO Report Page 6 of 15

22 Māori & Pacific Health Canterbury DHB is the lead DHB in the Te Waipounamu (South Island) Region for the Kia Ora Hauora programme. Kia Ora Hauora, the Māori Health as a Career Programme, aims to recruit new Māori onto a health study pathway over the next three years. The programme aims to achieve this through: - increasing access to Māori health career information - increasing uptake and achievement by Māori students in Secondary School science - increasing recruitment of Māori tertiary students studying a health or health related qualification - increasing retention rates for Māori tertiary students studying a health or health related qualification As at December 2013 highlights for Kia Ora Hauora were as follows: people registered of these are Māori of these in Canterbury - 82% are under 25 years of age with 58% in secondary school and 19% in tertiary study - 44% are enrolled in a health study pathway and 45% are potentially in a health study pathway A dashboard for Kia Ora Hauora in Te Waipounamu as at December 2013 is attached as Appendix 1. The third edition of Canterbury s Pacific Primary Health Care Report, for the three Canterbury Primary Health Organisations (Christchurch PHO, Rural Canterbury PHO and Pegasus Health) has recently been published. The broad question being asked in this report is how well primary health care services are addressing and improving health outcomes for Pacific peoples. The audiences for the report are the Pacific Reference Group and the Canterbury health sector through the Canterbury Clinical Network (CCN). There have been many successes over the past year. By working collectively to improve health outcomes the PHOs have developed shared priorities and started working towards greater consistency across the health sector. There have been encouraging improvements in coverage and rates of utilisation of some programmes and services in 2012/13: - B4 School Checks coverage for Pacific children has shown improvement over the past three years. Pacific coverage is now at 71% up from 64% in 2011/12 and 57% in 2010/11. - Childhood immunisation coverage at 24 months for Pacific children is high at 94.1%, with only an estimated 17 children not fully immunised. Coverage at 8 months is also high at 90.1% with an estimated 28 Pacific children not fully immunised. - Cervical screening 3-year coverage is still below the target of 80% although Pacific coverage rates have been steadily increasing over the past 3 years and now sit at 66.4%. - The quality and consistency of ethnicity data collection is being addressed through training in general practices across the three PHOs. Some programmes and services have maintained coverage/rates of utilisation for Pacific peoples such as GP delivered smoking cessation programmes, although the rate may be lower than expected given the relatively high rates of smoking in the Pacific population. Some programmes and services still have lower coverage/rate utilisation than would be considered desirable. These include the lactation consultancy service whereby Pacific mothers only represented 0.8% of clients utilising this service. Given that Pacific females represent 2.9% of enrolled females aged and the reports of low rates of breastfeeding in Pacific mothers this reflects a lower than desirable referral rate. Item 5 - Board March CEO Board report.docx Page 7 of 14 07/03/14

23 A new cultural competency education programme for primary health care has recently begun in Canterbury. The Treaty and its application to health care is the first new module being offered. Following on the development of a shared Canterbury Māori Health Framework in 2013, development of an Overarching Pacific Health Framework is underway which will provide shared outcomes and activities that contribute to improving the health and wellbeing of Pacific populations in Canterbury. Te Tairanga Kaumātua is a recently formed collective of services looking to improve delivery and outcomes for kaumātua Māori. Led by our recently appointed Kaumātua Clinical Assessor, the collective held its first hui this month to start the process of better collaboration between services. Rehua Marae Day Programme for Kaumātua has re-opened for The programme was in some doubt because of low post-earthquake numbers, but has stabilised and is continuing in The Christchurch PHO mobile nurse has built up relationships with the Māori development team at the University of Canterbury. Her role is to support Māori/Pacific and high needs enrolled people. She is a Practice Nurse at the University and is contracted by the PHO for 4 hours a week to provide the extra mobile service in and around the campus. Regular health promotion messages are put on the Māori website. A powhiri was held as part of Orientation week for Māori students along with an introduction to the health Centre. There will also be free BSL testing and a stand on knowing your standard drinks as part of Lunch on the Lawn available for all students. The mobile nurse is planning on providing healthy cooking demonstrations in the near future and we are discussing the possibility of holding some of these at the Māori Studies Department at the University. Extra cervical screening clinics are planned for the remainder of During these clinics the nurse will also check mammography status and smoking status. If time permits opportunistic CVDRA will also be offered/ completed. All Canterbury PHOs have been working collaboratively to deliver the Cultural Competency programme and are preparing for the planned roll out of ethnicity data collection audit tool. Promoting Healthy Environments & Lifestyles All Right? social marketing campaign update - The All Right? team has created a number of tools, including Facebook covers and advertisements to help people mark the third anniversary of the 22 February earthquake. The focus has been on acknowledging the broad range of emotions Cantabrians (and others) may be feeling at this time. It is hoped that by seeing and sharing these emotions Cantabrians will see that others are feeling the same way they are and take some comfort from that. One of the newest All Right? resources has been created in partnership with SKIP (Strategies with Kids, Information for Parents). It has been developed after feedback from a wide range parents showing they felt time poor and were worried that in the rush to get everything done, it was their kids who were missing out. The Pack of Tiny Adventures offers parents suggestions for activities they can do with their preschool children with some only taking a minute. The All Right? campaign was featured recently in the Huffington Post and a number of enquiries have been fielded from international organisations interested in the campaign. The campaign appears to have struck a chord with other areas where there have been disasters and it seems it may be the only campaign of its type internationally. The campaign continues to receive a large amount of unsolicited positive feedback and is currently replicating the research it undertook last year to inform the future direction of the campaign. Recreational water Several media releases warning the general public of toxic cyanobacteria algae blooms have been issued this season. These have included: Lake Forsyth (Te Wairewa), Lake Ellesmere (Te Waihora), the Whitecliffs Domain and Glentunnel on the Selwyn River, St Anne s Lagoon (Mata Kopae), two sites on the Ashley River and a recreational pond in Board March 2014 CEO Report Page 8 of 15

24 Hanmer. An alert mode has just been placed on the Hurunui River. It is possible this may be raised to a warning in the near future. An extreme toxic contamination health warning has been placed on Walnut Creek, Akaroa. Environment Canterbury was alerted to the contamination after dead eels were discovered in the creek. Due to the popularity of the creek for gathering watercress a media release has advised people not to eat or drink anything form the creek until the health warning has been lifted. The nature of the toxin is unknown at this stage but an investigation is ongoing to determine the source of the contamination. Children s face paint found to contain unacceptable levels of lead The Ministry of Health commissions Consumer NZ to undertake surveys of a number of potentially hazardous substances and products that are available to the public. One product (Carnival Colors face paint) has been identified as containing extremely high levels of lead (15,200mg/kg). Given the levels, Consumer NZ have released a media statement alerting people about the product. Although the company are undertaking a voluntary recall of the product, Community and Public Health have compiled a list of stores who are likely to stock this item and Public Health staff will visit these stores to ensure compliance. The Good One campaign The Party Register (The Good One campaign is a joint project between Community and Public Health, the NZ Police, ACC, The Health Promotion Agency and the Universities of Canterbury and Lincoln. The Good One campaign encourages students to register their party in advance, gain advice and recruit police support. The project is an alcohol harm reduction strategy that aims to enable students to plan for a safe and successful party before, during, and after the event. Information and advice is available online and includes guidance about how to reduce noise, keep numbers manageable, ensure a plentiful supply of food and water for guests, cope with intoxicated people, and also what help is available if required. In addition there are reminders about the laws relating to the supply of alcohol and local liquor bans. This project aims to encourage students to take responsibility for their party plans and seek responsible behaviour from their guests, whilst also increasing their awareness of the support agencies can provide. The collaborative approach of the agencies involved allows a consistent messaging regarding alcohol harm reduction to be presented to students and fosters improved relationships between police and party organisers. Healthy Christchurch Healthy Christchurch has continued its support for the Winter Make it Right campaign which has evolved this year into Find the 900. Led by CanCERN (Canterbury Community Earthquake Recovery Network) the Find the 900 campaign is informed by CanCERN and CERA surveys which have estimated that it is likely that there are some 900 households across 15 suburbs still living with significant earthquake damage. Healthy Christchurch staff, based at Community and Public Health, are linking with services across the wider DHB in order to help support patient referrals to the CanCERN campaign. The campaign will ensure that temporary household repairs are undertaken, prior to winter, with a focus on carrying out sewer repairs, and achieving weather tightness of the home together with warmer living temperatures. The Healthy Christchurch initiatives Warmer Canterbury and the All Right? campaign are also linked with the CanCERN Find the 900 campaign. Item 5 - Board March CEO Board report.docx Page 9 of 14 07/03/14

25 SUPPORTING OUR TRANSFORMATION Living within our Financial Means The consolidated Canterbury DHB financial result for the month of January 2014 was a deficit of $0.404m, which was $0.406m unfavourable against the budgeted surplus of $0.002m. The year to date position is $0.011m unfavourable. The breakdown of the result for the month is as follows: Staffing, Training, Employee Engagement and Performance Management Health and Wellness - The safe manual handling programme has been approved for implementation. This programme will target the prevention injuries from lifting. The influenza vaccination programme for staff will commence on 6th March. HSNO audits have almost been completed across the organisation and training for Duty Managers and other key staff is in place. Learning and Development - Numbers of enrolments for the Leadership and Management development calendar continue to grow, with 327 enrolments so far for the calendar year compared to 651 enrolments for the whole of The new health system Staff Orientation programme is due to launch on the 10th March. Engagement A summary report highlighting our successes, progress and learning has been prepared for general release. We have completed support for Nurse Maude to run an engagement survey and feedback results. Employment Relations - support for HBL programs is in place. We are continuing to see increased stress levels in the FPSC areas as a result of this process. Processes are in place to support and involve staff throughout the organisation in working through the various changes taking place. Negotiations continue for PSA South Island Clerical Workers and a bargaining strategy is being developed for Home Based Support Workers Effective Information Systems February has been a busy month with major projects underway. The Medications Management project is in full flight with the first rollout of the product, to the Inpatient Mental Health unit at Hillmorton due to go live early May This has been a very large project and achievement of the go-live will be a major milestone. Once this is completed, we will be rapidly rolling out the product across the organisation for the rest of this calendar year. The Patient Administration Systems replacement project (PICS) is also gathering steam. This will be the largest computer systems implementation project that the CDHB has ever attempted. Planning is well underway with the regional program business case approved by the NHITB and the CDHB business case, which supports the regional program, also being developed with haste. HBL is preparing the business case for the IT initiative. Called the National Infrastructure Program (NIP) the plan is to reduce the number of datacentres maintained by DHBs and to move most computing facilities into commercial datacentres. This will in effect, lead to a time Board March 2014 CEO Report Page 10 of 15

26 when we no longer need to procure computer hardware (servers & storage) and will instead, buy compute power as a service from datacentres. The Canterbury DHB is involved in advisory groups associated with the project. The report should be published in July Establishing Integrated Family Health Centres (IFHCs) and Community Health Hubs Akaroa Ashburton Burwood Kaikoura Rangiora An update on the Akaroa IFHC will be presented to the Board in the March meeting; This development will come under the governance of the CCN IFHS governance group along with the 15 or so other private IFHC developments in Canterbury. Following an EOI, a preferred group has been identified for the development of a privately funded IFHC on Ashburton Hospital grounds. We are soon to meet with this group to work out their requirements of the DHB, prior to them completing a business case. The IFHS governance group will determine the timing of a similar EOI to identify potential providers at the Burwood Hospital site. A Memorandum of Understanding has been completed and is under final review prior to sign off by Kaikoura District Council (KDC) and the Canterbury DHB relating to the financial contribution from each party towards the new health facility and ongoing governance. The Kaikoura Trust is actively raising funds for the project. Tenders for construction are being sought. Project Manager and Architect appointed. Design concept commenced, two phase approach to construction with first phase of maternity and flexi beds. Communications plan for Waimakariri community in regards to the Rangiora Hub development completed and was presented to the Board in February. Public update meeting on March 5th. Fit-for-Purpose Hospital Facilities Ashburton Hospital (Wards & Theatres Project) Demolition work: A methodology has now been agreed for the removal of asbestos contamination below the floors of the old Outpatients and Therapy Services. Work should restart on 03/03/2014. The methodology for dealing with asbestos contamination in the Old Theatre block has not yet been agreed. The asbestos problems have added significant costs to this portion of the work. Design Consultants appointment: All consultants now appointed. Concept design: Still finalising the design with the clinical staff, for the new Theatre / AAU area, but close to sign-off. Once that has been agreed, the project cost can be re-evaluated. Burwood Hospital Burwood Chapel remedial works and structural upgrade: Building consent received and planning underway to commence work very soon. Christchurch Hospital Children s Haematology Oncology Centre (CHOC): Contractor appointed and work has commenced. Item 5 - Board March CEO Board report.docx Page 11 of 14 07/03/14

27 Design work underway for staircase works on the Laboratory building. Building consent application lodged for 1 st staircase. Contractors appointed. Decanting of staff being organized at present, prior to the works commencing. Other earthquake repairs continue at Christchurch Hospital, including: - Ongoing levelling of walkways and entrances to reduce trip hazards. - Stairwell repairs, with disruption for at least another 12 months in these areas. (Parkside, stair 5, expected to be completed by the end of March. Two further stairs yet to be started. - Ongoing repairs of seismic joints throughout the Christchurch site. - Ongoing cosmetic repairs throughout the hospital. These continue to be restricted due to access and / or availability of suitable decanting spaces for clinical areas. - Replacement of heavy ceiling tiles as areas are made available. Note that this involves the need to add in new fire barriers above the ceiling. Our ability to compete such work is constrained by the access permitted in to clinical spaces. Christchurch Women s Hospital Cosmetic repairs continue, on the floors, in various parts of the building. The Princess Margaret Hospital (TPMH) Servery repairs. Demolition of the old servery roof is progressing well. About 2 weeks more demolition is planned. After that the contractors will progress to the weatherproofing of the areas now exposed. Partition wall risk mitigation is continuing on all levels across the whole TPMH site. Kaikoura Hospital Out to tender at present. Hillmorton Hospital Adult Inpatient Unit: all areas now operational. Minor extra works being progressed. Fergusson building refurbishment: Progressing well. First portion of the refurbished building now occupied by staff. Refurbishment of sections of the ground floor has now commenced. Due completion in May Other Sites Demolition of 45 St Asaph Street: Completed. 235 Antigua and Boiler house: Updated engineers report received that identifies the capacity of the boiler house as 30-40% NBS (IL4). Costs to seismically upgrade the existing, or build a new, boiler house have been prepared. 41 St Asaph Street: Demolition of this building (to make way for the proposed new public car park) requires the existing Social Work, Child Protection and CSSD teams to move out. The Portacoms for the Social Workers have been ordered, and a temporary extension to the PM Car Park has been completed. Design for the work required to move CSSD to TSU and CLS is progressing well. Maintenance and Engineering, Site Redevelopment, Security and Emergency Planning continues to be housed temporarily in the former stores warehouse in St Asaph Street. The future of this building is, as yet, undecided. It will either be demolished or require substantive repairs (likely to be uneconomic due to the level of earthquake damage). 7 Durham Street: Fit- out the extra space in this building, for use by I.S. and the Orion teams; has commenced Hillmorton Food Services building: Structural Engineer is progressing the design to seismically upgrade this building. Board March 2014 CEO Report Page 12 of 15

28 Old Lyndhurst Clinic: Design being progressed ready for the building consent submissions. 230B Antigua Street fit out: Design being progressed. Temporary Public Car Park on Brewery Site: Now open. Relocation of Hospital Dental Service: Design and costs being progressed, ready for Capex approval. Hillmorton Master Plan: Progressing well. ICU expansion: User group meeting started. EQ repair work commenced in the old CTW area. Linwood Avenue: This is a project to relocatee a service from Burwood. Negotiating with council in an endeavour to obtain an exemption for building consent. DELIVERING THE NATIONAL HEALTH TARGETS Following a difficult Quarter 1 in which performance fell just short of target (94% achieved), Canterbury has lifted performance against the ED health target, with 95. 5% of attendees admitted or discharged within 6 hours during Quarter 2. Canterbury is ahead of target at the end of quarter 2 delivering 8665 elective surgeries in the six months year to date, representing 101.7% of the YTD target. In addition CDHB met ESPI targets for five months for ESPI 2 and 5 at the end of December. ESPI 2 was green meaning no one waited more than five months. ESPI 5 was yellow meaning we did not achieve zero patients waiting more than five months but we were within the buffer with no financial penalty. 100% of people ready for chemotherapy or radiotherapy received treatment within four weeks in January. The eight-month-old immunisation health target has increased to 90% for the 2013/14 year. In Quarterr 2, 93% of eligible children were fully immunised by age eight months. Canterbury had strong results for Pacific (97%), Asian (96%) and NZ European (96%) children. Māori coverage was weaker at 86%; however, the Canterbury Immunisation Service Level Alliance is forming a sub-group to focus on why Māori whānau are declining immunisation and why Māori children are overdue at milestone age, and to develop an action plan. Canterbury achieved the hospital smoking cessation health target to quit in January, with 95% of hospitalised smokers offered advice and support to quit. A variety of initiatives are in place to ensure we maintain our performance. 49% of smokers expected to attend primary care received help and advice to quit in Quarter 2. This represents a substantial increase of 11% on the Quarter 1 result of 37%. Activities to improve performance against both primary care health targets are outlined below. Item 5 - Board March CEO Board report.docx Page 13 of 14 07/03/14

29 45% of the eligible population had a cardiovascular disease risk assessment (CVDRA) in the last five years for Quarter 2. This represents a 9% increase on the Quarter 1 result of 36%. Use of our local solution clinical conversation risk assessments is growing, with 2,150 recorded in Quarter 2 compared with 904 in the previous three quarters combined. Activities to improve the delivery and recording of both primary care health targets include: IT tools that prompt delivery and streamlines data capture: Pegasus completed the roll out of the Dashboard in October All PHOs continue to assist practices optimise the use of the IT tools that support the delivery and recording of health target activity. Cross-system info sharing: We are providing PHOs with lists of their enrolled patients discharged from hospital who received ABC and/or have a CVD risk of >20%. General practice can then code and follow up with these patients as clinically indicated. A similar approach has been implemented with the Pharmacy Quit Card Initiative and patients provided with ABC through the Medication Management programme. Increased resource where needed: more admin (for data capture/recall), more consultations, extended hours, low cost/free access, and mobile nurse/outreach services. Incentive programmes are in place in RCPHO and CPHO. Pegasus has progressed the rollout of their incentive frame work; due for completion at the end of February. Increased visibility: Monthly monitoring (fortnightly for Pegasus) and reporting to the Ministry commenced November Education for practice staff: One-on-one and group sessions, including Practice Liaison support. Clinical engagement: The health targets are a regular item in all PHO clinical governance group meetings. Information has been sent to all practices on the importance of delivering and recording the targets. 4. APPENDICES Appendix 1: Dashboard for Kia Ora Hauora in Te Waipounamu (Dec 2013) Report prepared by: David Meates, Chief Executive Board March 2014 CEO Report Page 14 of 15

30 Appendix 1 Item 5 - Board March CEO Board report.docx Page 15 of 1 07/03/14

31 FINANCE REPORT AS AT 31 JANUARY 2014 TO: SOURCE: Chair and Members Canterbury District Health Board Finance DATE: 13 March 2014 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT This is a regular report and standing agenda item providing an update on the latest financial results and other relevant financial matters to the Board of the Canterbury DHB. A more detailed report is presented to and reviewed by the Quality, Finance, Audit and Risk Committee (QFARC) monthly, prior to this report being prepared. 2. RECOMMENDATION That the Board: i. notes the financial result for the period ended 31 January DISCUSSION Overview of January 2014 Financial Result The financial information in this report represents a summary and update of the financial statements forwarded to the Ministry of Health and presented to and reviewed by QFARC. The consolidated Canterbury DHB financial result for the month of January 2014 was a deficit of $0.404m, which was $0.406m unfavourable against the budgeted surplus of $0.002m. The year to date position is $0.011m unfavourable. The breakdown of January s result is as follows: Board-March 2014-Finance Report Page 1 of 13 07/03/2014

32 4. APPENDICES Appendix 1: Financial Result - January 2014 Appendix 2: Statement of Financial Performance January 2014 Appendix 3: Statement of Financial Position January 2014 Appendix 4: Cashflow and Bank January 2014 Appendix 5: Cashflow Forecast to 30 June 2024 Report prepared by: Justine White, General Manager Finance Board-March 2014 FinanceReport Page 2 of 13 07/03/2014

33 APPENDIX 1: FINANCIAL RESULT FINANCIAL PERFORMANCE OVERVIEW YTD JANUARY 2014 We have submitted an Annual Plan with a net deficit of $25m, which is entirely consistent with the Detailed Business Case as compiled for the Facilities Development Plan. It is important to note that, as consistent with prior years, The Annual Plan excludes earthquake related expenses and revenues, due to the highly volatile nature of these items, and that the YTD earthquake costs included in the results above are $3.390m. On a quaked adjusted comparable basis there is a favourable variance to plan of $0.333m (year to date $3.3m). KEY RISKS AND ISSUES We are continuing to actively monitor earthquake related cost trends, especially given that insurance revenue was recognised in the 2012/13 financial year, yet we expect to continue to incur earthquake related repair and maintenance expenditure, and the depreciation impacts of quake related capital spend for a significant number of years. Board-March FinanceReport Page 3 of 13 07/03/2014

34 PERSONNEL COSTS/PERSONNEL ACCRUED FTE KEY RISKS AND ISSUES Stringent controls and reporting of personnel costs are being used to manage further deterioration against budget. Note that the FTE trend, although higher than budget, fits within our management and administration cap. Board-March FinanceReport Page 4 of 13 07/03/2014

35 TREATMENT & NON TREATMENT RELATED COSTS KEY RISKS AND ISSUES Treatment Related: Albeit with cyclical patterns these costs tend to be managed to predictions, a continuation of key oversight should enable us to meet budget throughout the year. Non Treatment Related: Repairs and maintenance and consultancy costs linked to earthquake repairs will continue to be volatile during the financial year. Board-March FinanceReport Page 5 of 13 07/03/2014

36 EXTERNAL PROVIDER COSTS External provider costs for the month are favourable to budget. Refer to the Planning and Funding section of the report for further information KEY RISKS AND ISSUES Capacity constraints within the system require continued monitoring of trends and demand for services. Board-March FinanceReport Page 6 of 13 07/03/2014

37 EARTHQUAKE Earthquake costs for both consultants and repair work continue to be expensed as we review work in progress and allocate these between opex and capex. This process does result in a short delay between the costs being incurred, and allocated. Of our January expenditure, we have attributed $0.737m as being direct earthquake costs, with a YTD variance of $3.390m. This includes repair costs expensed, as well as security, building lease costs, and other earthquake related costs. A significant amount of indirect costs are also being incurred, however these are often difficult to isolate specifically. It should be noted that the current quake coded costs exclude additional funder activity related to the earthquakes such as increased outsourced surgery, these are captured under external provider costs. KEY RISKS AND ISSUES The variability and uncertainty of these costs will put pressure on meeting our monthly budgets in future periods. Board-March FinanceReport Page 7 of 13 07/03/2014

38 FINANCIAL POSITION The DHB s cash on hand position continues to be strong and includes $ m held with Westpac, but through Health Benefits Ltd. We anticipate costs of earthquake repairs and related expenses to continue to impact our cash balances that were otherwise being accumulated for our facilities redevelopment. Our insurance settlement has now been received and is reflected in our cash position. The $35m earthquake related deficit support indicated by the Ministry of Health is yet to be received and is therefore still showing as a receivable. As previously noted, a significant portion of the repairs and maintenance that we are undertaking (and will continue to undertake in the future) to place our buildings and infrastructure back to pre earthquake condition is being capitalised and depreciated, resulting in the amortisation of costs over a number of years. We continue to review and close off earthquake related projects, accounting for the increase in building asset cost, and, as noted above, facilities costs. Appendix 4 shows the breakdown in deposits. KEY RISKS AND ISSUES Earthquake costs continue to be difficult to predict with certainty, including the impact on the valuation of our facilities. Board-March FinanceReport Page 8 of 13 07/03/2014

39 APPENDIX 2: STATEMENT OF FINANCIAL PERFORMANCE The Group financial results cover Canterbury District Health Board as well as its subsidiaries - Canterbury Linen Service Limited and Brackenridge Estate Limited Board-March FinanceReport Page 9 of 13 07/03/2014

40 The Group financial results cover Canterbury District Health Board as well as its subsidiaries - Canterbury Linen Service Limited and Brackenridge Estate Limited Board-March FinanceReport Page 10 of 13 07/03/2014

41 APPENDIX 3: STATEMENT OF FINANCIAL POSITION Board-March FinanceReport Page 11 of 13 07/03/2014

42 APPENDIX 4: CASHFLOW & BANK At the end of January, the total exposure to our banking partners (including Brackenridge and our trust funds) for on call, term deposits, and bonds, was: HBL shared treasury function Westpac BNZ ASB ANZ/National Other Current Month $M Previous Month $M Board-March FinanceReport Page 12 of 13 07/03/2014

43 APPENDIX 5: CASHFLOW FORECAST TO 30 JUNE 2024 Board-March FinanceReport Page 13 of 13 07/03/2014

44 CDHB SUBMISSION PROCESS TO: SOURCE: Chair and Members Canterbury District Health Board Executive Team DATE: 13 March 2014 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The purpose of this report is to inform the Board on the development of a coordinated internal process related to the preparation and lodgement of submissions by the Canterbury DHB to public consultation documents related to health by; Parliament, Central and Local Government organisations and other institutions. Endorsement from the Board is sought to the proposed process in view of the criteria as to when formal approval to a submission would be sought from the Community & Public Health Advisory Committee and/or Board. This report has been submitted to and approved by the Executive Management Team (EMT). It should be noted that the current terms of reference (TOR) for the Community & Public Health Advisory Committee (currently under revision) contain a reference to the submission process. If the recommendation as below is endorsed by the Board some modification to that Committee s TOR will therefore be required. This report was considered by the Community & Public Health Advisory Committee at its meeting on 25 March 2014 and the recommendation of that Committee is detailed below. 2. RECOMMENDATION That the Board, as recommended by the Community & Public Health Advisory Committee: i. Notes and endorses the proposed Submission Procedure (Appendix One); ii. Notes the next steps highlighted below to implement the proposed submission process. iii. Notes that some amendment to the terms of reference for the Community & Public Health Advisory Committee will be required if the proposed process is endorsed by the Board. 3. SUMMARY Recent joint submissions have involved greater collaboration across the Canterbury DHB (CDHB) and with external organisations. This work has improved the coordination of content and alignment with the CDHB s strategic direction, reduced duplication, enhanced input and generally improved the quality of submissions. However, this work has also highlighted the lack of a clear process for responding to submissions. Multiple submissions are sometimes being made on behalf of the CDHB, some submission opportunities are being missed, and there is no central record of the submissions made in the CDHB s name. Board March 2014 CDHB Submission Process Page 1 of 4

45 The introduction of a clear process will better ensure interested parties have an opportunity to input into CDHB submissions, reduce duplication and ensure appropriate approval and timely completion of submissions. There will also be a transparent process and associated record when the CDHB decides not to make a submission. Until recently, submissions from the Canterbury DHB have been completed primarily within divisions with Board/Committee approval sought for some key submissions. This approach has meant it has been possible on occasion for multiple submissions to be made on behalf of the CDHB. The approval process for submissions is not always clear and there is no central record of the submissions made in the CDHB s name. Initially prompted by the increased submissions regarding earthquake recovery; a joint Community & Public Health (C&PH) and Planning & Funding (P&F) working group came together last year to develop a process to improve the coordination of submissions being made on behalf of the CDHB. The proposed Submissions Procedure aligns with the C&PH and P&F submission procedure currently in place but confirms that process at an organisational level. It is also informed by the submission procedures in place in other DHBs including (most specifically) the Nelson Marlborough DHB. The proposed process is supported by four documents: A Submission Decision Tool, Submission Planning Tool, Generic Submission Preamble An online Submission Intranet Page with a Submissions Tracking List. Identification of a CDHB Submission Coordinator (from within C&PH) is also proposed to monitor, coordinate and support the formal organisational-wide submissions made on behalf of the CDHB. The aim of this process is not to interfere with internal processes that are logically part of an individual s employee or division s role but to put some simple clear procedures in place that eliminate duplication, ensure records of submissions are accessible and provide opportunity for input from across, and in some cases beyond, the Canterbury DHB. 4. DISCUSSION When submissions are completed by individual staff or divisions without General Manager, EMT or Board sign-off, it is possible for more than one submission to be made on behalf of the Canterbury DHB and for submissions to contradict one another. It is possible that some individuals or departments may wish to provide input into a submission but are unaware that a submission is being prepared. Thus an opportunity may be missed to make a submission if no-one is aware of them happening. It is also possible that a submission from an individual working for the Canterbury DHB made on Canterbury DHB letterhead or referencing their Canterbury DHB role may be taken as the Canterbury DHB viewpoint when it is not. While individual staff in their private capacity may wish to make submissions, where the submission is made in the Canterbury DHB s name, or could be taken as the Canterbury DHB s viewpoint, then is it reasonable that a process of approval is followed before those submissions are made. The proposed process aims to reduce duplication, provide transparency around the submissions being made, and ensure that submissions made on behalf of the Canterbury DHB are consistent with our vision and goals. Page 2 of 4

46 Individual Divisional Submissions Where there are regular submissions made from one individual or division as an accepted part of their role or responsibility there is no intention to interfere with the approved, established processes. These are generally a stated part of the person s or division s role or are approved by the General Manager of the division or their delegate on behalf of the CEO. There are occasions where feedback is sought through national networks and forums from individuals in their professional roles or from specific divisions throughout the Canterbury DHB. This process is not intended to interfere with the way in which this kind of feedback is currently provided. The proposed process is only intended to cover formal organisational-wide submissions made on behalf of the CDHB. Sometimes technical or clinical submissions may come from several departments from within one division, but if they are all required to be approved by the divisional General Manager there is a means of eliminating duplication and ensuring alignment with the Canterbury DHB s direction at this point. These submissions could possibly be logged on the online submissions tracking list, but this will depend on the volume of submissions which is not clearly understood as there is currently no central record. While there is no suggestion to alter these accepted processes at this point in time we propose that the need for General Manager approved for divisional submissions is reiterated across the organisation. Formal (Multiple Division and Organisational-wide) Submissions These are the submissions where there is the greatest opportunity for improved coordination and where it is proposed the Canterbury DHB adopt a new process. The proposed process is based on the informal process that currently happens between the C&PH and P&F divisions, which was introduced in response to a series of submissions on recovery-related documents in These submissions were coordinated and collated by staff from C&PH and included: The draft Central City Plan (Christchurch City Council); The draft CERA Recovery Strategy (CERA); The draft Canterbury Land Transport Strategy (Environment Canterbury); The draft Education Renewal Recovery Plan (Ministry of Education); and The Green Paper for Vulnerable Children (Ministry of Social Development). The coordination of input from across the Canterbury DHB and the wider health system, allowed for wider discussion and recognition of the perspectives of others in the system and meant a better submission was made. This kind of coordinated approach is proposed as the way forward for formal submissions in the future. While it is difficult to pre-define which category each and every submission would fall into; it is envisaged that formal submissions would be those which would require input from multiple divisions across the Canterbury DHB (or from external organisations) and would require EMT, CEO or Board sign-off. These would include those submissions made to Select Committees, which also require Ministerial sign-off before they can be submitted. It is envisaged these would also include submissions made by the Clinical Board. If a formal submission is identified, the topic, submission details and lead contact would be loaded onto an online tracking list and all staff advised through the CEO update so anyone with an interest can come forward and contribute. A Submission Lead would be identified and would coordinate and collate the response and ensure that that the process is stepped through with appropriate sign-off before submission. Completed formal submissions would be loaded online for future reference. Page 3 of 4

47 While part of the role of the Submissions Coordinator would be to scan for submission opportunities, the process allows for individuals/divisions to identify and advise of submission opportunities. Even if these are not all picked-up at an organisation-wide level there would be a coordinated sense of what submissions were being completed and by whom. Submission Tools It is recommended that in order to support a more coordinated approach the following tools are needed: A Submission Decision Tool to systematically consider submission opportunities and determine whether the CDHB should complete a submission, whether that submission should be specific to one division or should be a formal organisation-wide submission and to determine who should take a lead in preparing the submission on behalf of the CDHB; A Submission Planning Tool to support the relevant Submission Lead to plan timeframes, ensure appropriate consultation and ensure appropriate sign-off for a given submission; A Generic Submission Preamble to ensure alignment with CDHB direction; and A Submission Intranet Page with a Submissions Tracking List to list all current and upcoming submissions, provide opportunity for people to input into submissions and hold history both of the submissions made by the CDHB and of submissions that have been considered but are not being pursued. 5. NEXT STEPS Should the Board endorse the proposed Submission Procedure the next steps would be: C&PH to identify a Submissions Coordinator to support formal submissions; Communication of the new process via the CEO Update; Submission Tracking List established (history list uploaded); Generic Submission Preamble uploaded; and Submission Process launched on the Intranet. It is suggested that this process would take two months to put in place once approval has been provided. It is also suggested that a review be undertaken in six months to determine how well the process is working and whether changes need to be made. 6. APPENDICES Appendix 1: Appendix 2: Appendix 3: Appendix 4: Canterbury DHB Submission Procedure (and flowchart). Submission Decision Tool. Submission Planning Tool. Generic Submission Preamble Report prepared by: Evon Currie, General Manager Poulation Health Carolyn Gullery, General Manager, Population Health Report approved for release by: Executive Management Team Page 4 of 4

48 CDHB SUBMISSIONS PROCEDURE Appendix 1 Overview Submissions are an important means for the Canterbury District Health Board (DHB) to influence the decision making processes of other organisations. Engaging in consultation processes contributes to the DHB s mission To promote, enhance and facilitate the health and wellbeing of the people of Canterbury by influencing decisions that impact on the health and wellbeing of our population. Objective To systematically identify and consider submission opportunities with relevance to the DHB. To provide a clear understanding of who should complete and sign off submissions on behalf of the DHB. To make transparent when the DHB decides not to make a submission. To improve the quality, consistency and coordination of submissions. To ensure submissions represent the DHB s viewpoint and are aligned to the strategic direction, vision and goals of the DHB. To enhance consultation across the DHB/or the wider Canterbury health system. To maintain a record of the submissions made on behalf of the DHB. Associated Documents [to hyperlink all] Scope CDHB Submissions: Online Tracking List. CDHB Submissions: Decision Tool. CDHB Submissions: Planning Tool. CDHB Submissions: Generic Preamble. This procedure applies to all Canterbury DHB staff, and non DHB individuals contracted to the Canterbury DHB, and covers all written and oral submissions to external agencies. Principles Consideration of submissions will follow a transparent, consistent and documented process. Any staff member can identify submission opportunities. Input into organisational submissions will be widely available across the organisation. Submissions will be consistent with any existing Canterbury DHB position statements, and will reflect the strategic direction, vision and goals of the DHB. Only one submission will represent the DHB on any one topic. Information presented will be factually correct, based on published evidence, and will support agencies in amending or developing public policy or direction. Appropriate approvals will be obtained before submissions made on behalf of the DHB are submitted. All formal submissions made on behalf of the DHB will be accessible and stored centrally. Representing the Canterbury DHB All submissions to external agencies will be done within an employee s scope of practice and delegated authority and will represent the Canterbury DHB s perspective and not personal views. DHB staff are not precluded from making personal submissions relevant to their professional expertise and experience, but when doing so must explicitly state that they are doing this as member of the public or of another organisation and not as a DHB employee. If, as part of their DHB role, a staff member is part of an external group or network which is developing a submission, approval of the staff member s manager should be sought before either the staff member s name or signature, or reference to Canterbury DHB is included in the submission. The manager will consider any potential risk to the organisation and discuss with the Divisional GM if necessary. Draft CDHB Submission Procedure 1 07/03/14

49 Definitions Submission A document containing professional opinions, observations, evidence and recommendations provided to a requesting agency for consideration in terms of influencing or informing a published discussion document or draft policy. Submissions Coordinator The individual identified from within C&PH to support the DHB submissions process and take on the role of Submissions Lead for organisational level submissions where appropriate. Submission Lead The individual identified to take responsibility for completing a particular submission. This may or may not on occasion also be the Submissions Coordinator. Decision Tool A form designed to help systematically consider submission opportunities and determine whether the DHB would complete a submission and who should complete the submission depending on the level of input and consultation required. Planning Tool A checklist designed to support a Submission Lead to plan timeframes for completion of a given submission and help ensure appropriate consultation and approval(s) for the submission. Generic Preamble A statement written as an introduction for formal submissions, summarising the key direction and goals of the DHB and referencing any existing DHB position statements. This can be adapted as necessary by a Submission Lead when completing a formal submission on behalf of the DHB. Online Submissions Tracking List An intranet submission page containing all current and upcoming formal submissions, provides details on how interested parties can provide input into submissions and holds history both of the submissions made by the DHB and of submissions that have been considered but were not pursued. DHB SUBMISSIONS PROCEDURE Identifying Submissions 1. The Submissions Coordinator will regularly scan key websites for submission opportunities and upload all formal submissions being undertaken by the DHB to the online Submissions Tracking List [insert hyperlink]. 2. DHB Board members who identify submission opportunities will ask the GM C&PH to consider these. 3. Individual staff or leadership groups who identify submission topics of interest (that are not already on the online Submissions Tracking List) will inform the Submissions Coordinator [insert hyperlink] The Submission Coordinator will complete the Decision Tool which will determine: a. Whether a submission from the DHB is appropriate or not; b. Whether the submission is more relevant for a specific individual/division to complete (such as a technical submission on an application under the Resource Management Act) and therefore does not need to go through the formal submissions process; or c. Whether the submission does need to go through the formal submissions process If (a) applies and a DHB submission is not to be made, the decision will be recorded by the Submissions Coordinator for future reference, including noting on the Submissions Tracking List. 6. If (b) applies and the submission is relevant to one individual or division, a Submission Lead will be identified within that division, will prepare the submission for approval by their Divisional GM or their delegate and take responsibility for ensuring the submission is forwarded to the consulting agency prior to the closing date. Formal Submission Process If (c) applies this is the procedure for formal (organisational or Canterbury wide) submissions: 1. A Submission Lead will be identified and that person will be responsible for coordinating and collating input, preparing the submission, gaining appropriate approval, and forwarding the submission to the consulting agency prior to the closing date. 1 In this instance the reference to Leadership Groups would include Service Level Alliances, Alliance Workstreams and the Clinical Board. 2 If after completing the Decision Tool there is still a question as to whether a submission should go through the formal process or not (or a debate as to whether the DHB should or shouldn t make a submission) this will be referred to the joint C&PH/P&F leadership team or to EMT for a final decision.

50 2. Details of the formal submission will uploaded onto the online Submissions Tracking List (including relevant links, dates and contacts) and will be publicised to staff via the daily internal update and/or the CDHB CEO Update. 3. Staff or divisions who have relevant expertise and are interested in providing input into the submission should make contact with the Submission Lead via the information provided online on the Submission Tacking List. 4. Due to the time bound nature of submissions, timeliness is critical and all staff and management providing input into submissions and those responsible for approvals must carry out their roles within pre agreed timeframes and ensure all unnecessary delays are avoided. 5. If timeframes for completion of the submission are too short for the full formal process to be followed (particularly in terms of approval or consultation processes) prior approval will be sought for an abbreviated process by the Submission Lead. 6. For submissions with significant implications for Māori and Pacific Health, the Executive Director for Māori and Pacific Health should be consulted for guidance, including any additional consultation requirements. 7. If an oral submission is desired, approval must be obtained as part of the approval process. 8. If conflicting views arise this will be referred to the joint C&PH/P&F Leadership Team to make a decision as to which view is most representative of the DHB and will be put forward as the submission A final copy of the submission will be uploaded to the online Submissions Tracking List so that it is accessible to staff and available for future reference. 10. An update on current submissions will be presented to EMT on a fortnightly basis by the GM C&PH. Submission Coordinator Actions: 1. Regularly scan key websites for submission opportunities. 2. Support completion of the Decision Tool for any opportunities to determine whether to submit, the level of consultation, and the sign off required. 3. Regularly update the online Submissions Tracking List to ensure people are informed of how to provide input into any formal DHB submissions underway. 4. Provide advice and support to people wishing to provide input into submissions or Submission Leads coordinating submissions to ensure that opportunities are realised, the relevant people have input into submissions, appropriate approvals are sought and submissions are completed in a timely manner. 5. Where timeframes for the submission are too short for the full process to be followed, support approval of an abbreviated process via the C&PH and P&F Joint Leadership Team. 6. Ensure all completed formal submissions are uploaded to the online Submissions Tracking List. Identified Submission Lead Actions: 1. Use the Planning Tool to develop a timeline for completion of the submission taking essential steps into account, such as consultation with the CEO s Office and DHB Board secretary to arrange appropriate approvals (including where notification to the Minister s Office is required for Select Committee submissions). 2. Where timeframes for the submission are too short for the full process to be followed seek approval for an abbreviated process and ensure submitters and approvers are aware of the shorter timeframes. 3. Determine the most appropriate mechanisms for coordinating input into the submission from individuals and departments within the DHB (and where appropriate across the wider Canterbury health system) either in person, via , or through an arranged submission meeting. For formal submissions, use tools such as the daily updates and weekly CEO Update to advise people of how to provide input. 4. Collate the input received and prepare the final submission draft ensuring it is aligned to the DHB direction, reflective of the input provided and the language used is readily understandable and appropriate. 5. Ensure that the appropriate sign off has been completed, and forward the final approved submission to the consulting agency before the closing date. 6. Document the development, approval and despatch of the submission and provide this information and a final copy of the submission to the Submission Coordinator for uploading to the Submissions Tracking List. 3 If there is further debate EMT will make the final decision in this regard.

51 C&PH and P&F Leadership Team Actions: 1. Screen and prioritise submission opportunities with relevance to health and the Canterbury DHB particularly when completion of the Decision Tool is not able to clearly determine the level of consultation and sign off required for a submission or where there is a dispute in this regard. 2. Provide approval for an abbreviated process should timeframes not allow for the full formal submission process to be followed (particularly in terms of approvals and consultation). Designated Approver Divisional GM (or delegate), EMT, CEO or DHB Board: 1. Review the final submission draft, including a summary of any significant feedback received during the consultation process which has not been included in the submission. Provide approval and/or feedback as appropriate. Sign off Points: 1. A submission being completed outside of the formal submission process by an individual or division should be approved by the relevant Divisional GM or their appointed delegate. 2. The Decision Tool should be used to initially determine the level of sign off required for a submission being completed under the formal submission process, whether that is the relevant Divisional GM, EMT, CEO or the DHB Board or (in the case of a submission to any Select Committee) by both the DHB Board and the Ministry of Health. The relevant Submission Lead is responsible for finally determining the level of sign off required, guided by the Submission Planning Tool and Submission Coordinator. 3. Appropriate notice and time for review should be allowed in planning completion of the submission. 4. If EMT or Board approval is required, wherever possible the submission will be provided to a scheduled EMT or Board meeting. If not, circulation via will be negotiated with the CEO s office or the Board Secretary at least one week before the submission is due to be sent. 5. If the submission timeframe does not allow for all the above steps to occur, then an abbreviated process may be approved by the joint C&PH/P&F Joint Leadership Team or EMT. Approval for an abbreviated process should be sought at the beginning of the submission process and the process will be supported by the Submissions Coordinator. Procedure Owner Date of Authorisation Insert Insert

52 I want to make a submission DRAFT Submission Process Is the submission listed on the DHB tracking list [insert link] No Submission Coordinator Yes Identify lead from within Department Lead completes submission None Division only submission Ends Not DHB appropriate Submission Coordinator completes Decision Tool Formal submission Lead identified Not sure CPH / P&F Leadership Team decide Approval sought Timeframes established Insufficient time CPH / P&F Leadership agree shorter process Submitted Sufficient time Load all submission details on line Contact identified Lead and provide input Lead completes submission Approval sought Submitted Submission Coordinator final version of submission Load to online history file

53 CDHB Submissions: Decision Tool for Submission Coordinator Appendix 2 Title of Consultation: Click here to enter text. Consulting Organisation: Click here to enter text. Summary of Submission Content & Purpose: Click here to enter text. Deadline Date: Click here to select a date. Strategic Considerations Should the DHB Complete a Submission? Will the Submission have an Impact on the CDHB mission? To promote, enhance and facilitate the health and wellbeing of the people of Canterbury YES/NO Click here to enter any notes. Will the Submission have an Impact on the CDHB Strategic Goals? Support people to take increased responsibility for their health and wellbeing Support people in a community based setting and provide a point of ongoing continuity Free up hospital based specialist resources to respond to episodic events and more complex cases and support primary care YES/NO YES/NO YES/NO Click here to enter any notes. Will the Submission provide an Opportunity to Influence Determinants of Health? Lifestyle, Community Local Economy, Activities Built Environment Natural Environment YES/NO YES/NO YES/NO YES/NO YES/NO Click here to enter any notes. Global Ecosystem Will the Submission provide an Opportunity to Influence Health Inequalities? Reduce health inequalities YES/NO Click here to enter any notes. Improve Māori Health YES/NO Click here to enter any notes. Will the Submission have an Impact on Health Service Delivery? Change in Access Change in Service Model Change in Provider Change in Practice YES/NO YES/NO YES/NO YES/NO Click here to enter any notes. Strategic Considerations At What Level Should the Submission Be Completed? What is the Scale of the Consultation? National submission / National policy Regional impact / or Effect on Other DHBs Local impact (Canterbury Only) Effect on other health providers (external to DHB) Effect on more than one DHB Division Technical submission on specialist topic YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO Click here to enter any notes. Other considerations Likely impact of the submission Risk of not submitting Annual/Repeated Submission HIGH/MED/LOW HIGH/MED/LOW YES/NO YES/NO Click here to enter any notes. Upstream involvement in the policy/plan Engagement (e.g. in order to have right of reply or future input) Strategic Considerations Who will Complete the Submission? Consider engagement (e.g. anticipated interest and specific knowledge / expertise needed) Advisory requirements Community & Public Health Planning & Funding Quality Information Services Human Resources Finance Communications Legal Facilities/Business Development Older Persons Health Women s & Children s Mental Health Laboratory Services Rural Health Medical/Surgical Services Maori Health Primary Care Community Services (NGOs) Clinical Advisor Māori /Pacific Advisor Other Advisor YES/NO YES/NO YES/NO Click here to enter any notes. Divisional GM EMT Clinical Board CCN District Alliance DHB Board Ministry of Health CDHB Submissions Decision Tool Version 1 (draft) 23/10/13

54 Identify Leads Submission proposed to be lead by which Division Submission Lead Other Divisions to be consulted Click here to enter text. Click here to enter text. Click here to enter text. Approval Level (Tick all that apply. Multiple approvals may be required) Divisional GM EMT CEO Board Ministry of Health Sign off NAME SIGNED DATE Form completed by Form discussed by Recommendation (Tick one) Referred To DHB Should Not Submit Organisation Level Submission Divisional Submission CDHB Submissions Decision Tool Version 1 (draft) 23/10/13

55 CDHB Submissions: Planning Tool for Submission Lead Appendix 3 The Planning Tool is to be completed by the submission lead with support from the Submission Coordinator as necessary. Title of Consultation: Click here to enter text. Consulting Organisation: Click here to enter text. Submission Lead: Click here to enter text. Deadline Date: Click here to select a date. Suggested Approach 1. Use the information provided in the Decision Tool and to develop a timeline for completion of the submission taking essential steps into account, such as consultation with the CEO s Office and DHB Board secretary to arrange appropriate approvals (including where notification to the Minister s Office is required for Select Committee submissions). Document the timeline in the Approval Process and Timeframes section below. 2. Where timeframes for the submission are too short for the full process to be followed seek approval for an abbreviated process and ensure submitters and approvers are aware of the shorter timeframes. 3. Determine the most appropriate mechanisms for coordinating input into the submission from individuals and departments within the DHB (and where appropriate across the wider Canterbury health system) either in person, via , or through an arranged submission meeting. For formal submissions, use tools such as the daily updates and weekly CEO Update to advise people of how to provide input. 4. Collate the input received and prepare the final submission draft using the Submission Template ensuring it is aligned to the DHB direction, reflective of the input provided and the language used is readily understandable and appropriate. 5. Ensure that the appropriate sign off has been completed, and forward the final approved submission to the consulting agency before the closing date. 6. Document the development, approval and despatch of the submission in the Sign off and Submission section below and provide this information and a final copy of the submission to the Submission Coordinator for uploading to the Submissions Tracking List. Approval Process and Timeframes Approval Level (Approval levels decided during decision process delete as appropriate) Date Approval Required Divisional GM EMT CEO Board Ministry of Health Click here to select a date. Click here to select a date. Click here to select a date. Click here to select a date. Click here to select a date. Approval Received Sign off and Submission Deadline Submission Completed Click here to select a date. Date sent Click here to select a date. CDHB Submissions Planning Tool Version 1 (draft) 23/10/13

56 Appendix 4 Submission from Canterbury District Health Board [Month Year] [Title of Consultation]

57 Introduction: The Canterbury District Health Board (CDHB) welcomes the opportunity to comment on the [title of consultation]. The reasons for making this submission are to promote the reduction of adverse environmental effects on the health of people and communities and to improve, promote and protect their health pursuant to the New Zealand Public Health and Disability Act 2000 and the Health Act The CDHB s vision is to promote, enhance and facilitate the health and wellbeing of the people of the Canterbury District. General comments: Specific comments and recommendations: Conclusion Any further clarification on this submission is welcomed. We would also welcome the opportunity to work in partnership with the [organisation or agency] on health issues that arise from the [title of consultation].

58 Details of Submission Person Making Submission [Name of person providing sign-off] [Title of person providing sign-off] Postal Address Community and Public Health Canterbury District Health Board PO Box 1475 Christchurch 8140 Phone (03) Fax (03) Contact Person for this application: [Submission lead / submission coordinator] [Signature of person providing sign-off] Date:

59 HEALTH TARGET REPORT QUARTER 2 TO: SOURCE: Members Canterbury District Health Board Planning and Funding DATE: 13 March 2014 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The purpose of this report is to present the Board with the Canterbury DHB s progress against the national health targets for Quarter 2 (October December 2013). The attached report (Appendix 1) provides a detailed account of the results and the work underway with regard to delivering each health target. DHB performance against the health targets is published each quarter in newspapers and online on the Ministry and DHB websites. The published Quarter 2 health target league table is attached as Appendix RECOMMENDATION That the Board: i. Notes Canterbury s performance against the health targets. 3. SUMMARY In Quarter 2, Canterbury has: Achieved the ED health target, with 95% of people admitted or discharged within six hours. Achieved 102% of the year-to-date electives health target, delivering 8,664 elective surgeries. Achieved the faster cancer treatment health target, with 100% of patients ready for radiotherapy or chemotherapy beginning treatment within 4 weeks. Achieved the immunisation health target, with 93% of eight-month-olds fully immunised (the new national target is 90%). Canterbury also achieved the target for Pacific (97%) children, but did not reach the target for Māori (86%). A working group is reviewing why Māori whānau are declining immunisation and why Māori children are overdue at milestone age to address this issue, in order to develop an action plan to address this issue. Achieved the hospitalised smokers health target for the second consecutive quarter, with 95% of hospitalised smokers having received help and advice to quit. Increased performance against the primary care smokers health target to 49% of smokers expected to attend primary care receiving help and advice to quit. Where appropriate, PHOs are integrating the actions to deliver Better Help for Smokers to Quit with More Heart & Diabetes Checks activity. Canterbury s district-wide recovery plan for both targets was approved by the Ministry in December Key areas of activity in the plan include data sharing and analysis, staff education, IT tools that prompt delivery and facilitate data capture, and increased resourcing (e.g. additional administrative support for patient recall and data collection, Board 2014 Health Target Report Quarter 2 Page 1 of 2 07/03/2014

60 additional consultations, extended hours, free or low cost consultations, mobile nursing and outreach services). Increased performance against the heart checks health target to 45% of the eligible population having had a cardiovascular risk assessment in the past five years. The late inclusion of our largest PHO in the cardiovascular components of the PPP continues to have an effect on results, as cardiovascular risk assessment (CVRA) data for over 75% of our population has only been recorded for the past three years compared with five in other DHBs. However, Quarter 2 has seen increasing uptake of our local solution in Canterbury, with 2,150 clinical conversations recorded in Quarter 2 (up from 546 in the previous quarter). Refer to the previous bullet for actions to deliver both this target and the primary care Better Help for Smokers to Quit target under Canterbury s district-wide recovery plan. 4. APPENDICES Appendix 1: Health Target Report Quarter 2 Appendix 2: Ministry Health Target League Table Quarter 2 Appendix 3: Ministry Health Target Response Canterbury Quarter 2 Report prepared by: Report approved by: Alex Green, Reporting Analyst, Planning & Funding Carolyn Gullery, GM Planning & Funding Board 2014 Health Target Report Quarter 2 Page 2 of 2 07/03/2014

61 National Health Targets Quarter /14 Performance Summary Target Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Target Status Pg Shorter Stays in ED: Patients admitted, discharged or transferred from an ED within 6 hours 94% 95% 94% 95% 95% 2 Improved Access to Elective Surgery: Canterbury s volume of elective surgery 12,641 YTD 17,066 4,388 YTD 8,664 YTD 16,861 4 Shorter Waits for Cancer Treatment: People ready for treatment have cancer radiation therapy or chemotherapy within four weeks Increased Immunisation: Eight month olds fully immunised Better Help for Smokers to Quit: Hospitalised smokers receiving help and advice to quit Better Help for Smokers to Quit: Smokers attending general practice receiving help and advice to quit More Heart and Diabetes Checks: Eligible enrolled adult population having had a CVD risk assessment in the last 5 years 100% 99.5% 99.7% 100% 100% 4 93% 92% 93% 93% 90% 4 90% 93% 95% 95% 95% 6 31% 35% 37% 49% 90% 8 29% 33% 36% 45% 90% 10 CANTERBURY DHB Health Target Report Quarter /14 1 of 12

62 Shorter Stays in Emergency Departments Target: 95% of patients are to be admitted, discharged or transferred from an ED within 6 hours Figure 1: Percentage of patients who were admitted, discharged or transferred from Christchurch or Ashburton ED within six hours 100% 95% 90% 85% 80% 75% Canterbury has returned to achieving the health target, with 95% of patient events admitted, discharged or transferred from ED within 6 hours. The high volumes attending ED during late winter eased during Quarter 2, making it possible to return to target achievement (see Figure 2). However, the profile of attendees has changed, with growth among younger age groups. Figure 2: Total ED attendances since July 2008 all Canterbury Canterbury result NZ result 13/14 target Interpretation The blue line is the actual number of attendances. The green line is the average. The red lines are the upper and lower control limits. The dotted lines indicate the pre quake trend. During the quarter, the relocation of temporary general medical wards and patients (from Princess Margaret Hospital back to Christchurch Hospital) was completed, and systems began working more smoothly. Canterbury continues to focus on its whole of system approach to the health target, addressing preload, contractility and afterload strategies. Strategies to care for patients in their own homes and the community are well embedded. Occupancy rates at Christchurch Hospital remain extremely high due to reduced capacity post quake and have impacted on timely admission to wards. Continued innovation will be required to address the post quake constraints in medical bed numbers, which result in afterload pressure (until more capacity comes on line with the hospital rebuilding programme). CANTERBURY DHB Health Target Report Quarter /14 2 of 12

63 PRELOAD We continue to monitor the Christchurch rebuild population, which has resulted in increased ED attendance by non enrolled 20 to 29 year olds. A number of solutions have been considered, and our initial focus is on promoting access to primary care. Ongoing preload strategies (for reducing ED attendances, primarily through primary health care) include: Nurse led afterhours telephone triage; Ambulance diversion to Accident and Medical Centres; The ambulance referral pathway for patients who can be safely managed in primary care including a dedicated COPD pathway (diverting around 30% of COPD patients to general practice or the 24 Hour Surgery); and Canterbury s highly developed community delivered Acute Demand Management Services (ADMS) with 7,385 referrals for the quarter (see Figure 3). CONTRACTILITY Contractility aims to ensure effective functioning and flow of ED. In addition to capturing the rebuild population (to design appropriate responses), contractility strategies have focused on the use of live visual data displays ( widgets ) to aid workload management, patient flow and the review of performance, processes and procedures in ED by senior ED staff, as well as ensuring appropriate staffing to meet patient needs. AFTERLOAD Figure 3: Referrals to ADMS Managing the afterload phase for ED remains the greatest issue for a constrained system with a very low ratio of beds to population until more capacity is available from the facilities rebuild programme. Analyses demonstrate those patients being admitted (44% of ED attendees) are less likely to meet six hour targets. There are a number of initiatives to ensure rapid turnaround for the patient to be discharged home from ED and the improvement of flow when patients are admitted to the ward. The recent expansion of our Acute Medical Assessment Unit and the return of general medicine wards to Christchurch Hospital have shown signs of improving flow. Supported discharge programmes (CREST and Acute Demand Services) have been expanded significantly helping to ease bed pressures in an integrated system. 3,000 2,500 2,000 1,500 1, CANTERBURY DHB Health Target Report Quarter /14 3 of 12

64 Improved Access to Elective Surgery Target: Canterbury s volume of elective surgery is to be 16,861 in 2013/14 Figure 4: Elective surgical discharges (excluding cardiology and dental) delivered by the Canterbury DHB graphed cumulatively 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Q1 Q2 Q3 Q4 2010/ / / /14 13/14 target To date 8,664 elective surgical discharges have been delivered in 2013/14, representing 102% of our target delivery (147 discharges over target). This is a significant achievement in light of the reduced bed capacity resulting from the earthquakes and the disruptions of earthquake repairs. Shorter Waits for Cancer Treatment Target: 100% of people ready for treatment have radiation or chemotherapy within four weeks Figure 5: Percentage of people in Canterbury ready for radiation or chemotherapy treatment who received it within four weeks 1 100% 95% 90% 85% 80% 75% 12/13 Q1 12/13 Q2 12/13 Q3 12/13 Q4 13/14 Q1 13/14 Q2 Canterbury result NZ result 13/14 target 100% of people ready for radiotherapy or chemotherapy began treatment within four weeks during Quarter 2. 1 The measure does not include instances in which a patient chooses to wait for treatment or there are clinical reasons for delay. Due to the late identification of an administrative error, it was found that five patients treated in Canterbury during 2013/14 waited longer than four weeks for radiotherapy: four patients waited four weeks and one day, and one waited four weeks and three days. This differs from previously published results. CANTERBURY DHB Health Target Report Quarter /14 4 of 12

65 Increased Immunisation Target: 90% of eight month olds are to be fully immunised Figure 6: Percentage of Canterbury eight month olds who were fully immunised 100% 95% 90% 85% 80% 75% 70% 65% 60% The eight month old immunisation health target has increased to 90% for the 2013/14 year. In Quarter 2, 93% of all eight month olds were fully immunised. Opt off 2 (1.4%) and decline (2.8%) rates continue to impact on overall immunisation coverage, and highlight concern for future targets. In total, 60 parents/caregivers declined immunisation for their child or opted their child off the NIR in Quarter 2. Of the remaining 3%: 18 children were fully immunised after turning eight months; 4 children were either on a catch up schedule or awaiting overseas immunisation records, as they were new to New Zealand; and 22 children were overdue, having been contacted multiple times by their general practice and the Canterbury NIR team, and have been referred to Outreach Immunisation Services. RESULTS BY ETHNICITY Total Māori Pacific NZ result (total) 13/14 target Canterbury achieved strong results for Pacific (97%), Asian (96%) and NZ European (96%) children in Quarter 2. However, results were weaker for Māori children (86%). A working group under the Canterbury Immunisation Service Level Alliance is reviewing why Māori whānau are declining immunisation and why Māori children are overdue at milestone age to address this issue, in order to develop an action plan to address this issue. 2 Children s parents can decide (typically at the child s birth) to opt their child off the NIR. These children continue to be counted in the cohort for the DHB of birth, but there is no way to determine or record if they have later been vaccinated, declined or moved out of the DHB area. CANTERBURY DHB Health Target Report Quarter /14 5 of 12

66 Better Help for Smokers to Quit: Hospital Target: 95% of hospitalised smokers are to receive help and advice to quit Figure 7: Percentage of smokers in Canterbury DHB hospitals who were offered advice and help to quit smoking 100% 80% 60% 40% 20% 0% Canterbury has achieved the hospital smoking cessation target for the second consecutive quarter, with 95% of hospitalised smokers offered advice and help to quit in Quarter 2. The smokefree team is working to sustain these gains for future quarters, with an emphasis on data capture, education and support for staff as wards continue to be reconfigured and relocated due to earthquake repairs and facility redevelopment. KEY ACTIVITIES IN QUARTER 2 Documentation has been updated to: facilitate the capture of data in maternity, enable delivery of ABC 3 in each service when there is more than one admission within an episode of care, and provide a location for doctors in Med/Surg to document ABC activity. Maternity have taken firm ownership of their performance, with close oversight by the relevant charge nurses. Maternity staff have received training on the revised documentation processes. The Emergency Department is identifying smokefree champions to ensure that ED is self sufficient in internally monitoring and motivating staff to deliver ABC for every admission. A resource has been developed for pharmacy technicians to enable them to check charting and effective utilisation of NRT in inpatients. Celebrating success: Wards were provided with a graph of the numbers of people they have supported with ABC over 2013, along with a Christmas card to acknowledge the smokefree work they have done. Unsung champions (e.g. the cleaner who empties butt canisters at the entrances) were provided with a small Christmas gift. Teams within SMHS who had a fully smokefree staff were provided with a celebratory morning tea. ONGOING ACTIVITY Total Māori Pacific NZ result (total) 13/14 target Weekly No Advice Given (NAG) reports continue to be analysed to identify the source, and individual support is provided to that person or people. 3 The ABC Strategy for Smoking Cessation involves Asking about smoking status, offering Brief quit advice and referring the patient to Cessation support. CANTERBURY DHB Health Target Report Quarter /14 6 of 12

67 Underperforming wards are identified, and additional support is provided to scrutinise systems, audit processes, train staff, etc. Wards are working to establish individual systems to facilitate effective ABC delivery and documentation. Noticeboards are regularly changed, ward resources updated and supplies maintained. ABC swing cards (reminder cards worn on a lanyard around the neck) are supplied to all staff. Training continues; 237 staff attended 32 ABC/smokefree training sessions during Quarter 2, and there are now 2,958 staff in secondary care who have successfully completed the e learning module. The NRT workbook is provided to staff at all face to face sessions and is available electronically. Utilisation is high. UPCOMING ACTIVITY Our challenge and focus for the next two quarters is to ensure that hospital health target performance can be maintained while resources transition to primary care to lift performance there. Planning is in place to shift responsibility for following up the NAG reports to senior clinical staff in the wards. This transition will require specific training to maintain the current momentum, which will take place over the next quarter. Other strategies will be implemented to ensure that secondary care remains effectively supported with system development, resources and training while the current resource transitions to primary care. These strategies will include development of the interface between primary and secondary care to ensure the most effective transfer of information about identified smokers from secondary to primary care. CANTERBURY DHB Health Target Report Quarter /14 7 of 12

68 Better Help for Smokers to Quit: Primary Care Target: 90% of smokers attending primary care are to receive help and advice to quit Figure 8: Percentage of smokers expected to attend primary care in Canterbury who were offered advice and help to quit smoking 4 100% 80% 60% 40% 20% 0% Canterbury result NZ result 13/14 target Canterbury general practices have reported giving 24,223 smokers brief advice and help to quit in the year to December 2013 up from 19,614 in the year to September The ABC activity during this quarter represents 49% of current smokers expected to be seen in general practice during this period receiving advice and help to quit a 12% increase on the previous quarter. Where appropriate, PHOs are integrating the actions to deliver Better Help for Smokers to Quit with More Heart & Diabetes Checks activity (see next section). KEY ACTIVITIES IN QUARTER 2 IT Systems During Quarter 2, Pegasus liaison staff completed the installation of the Dashboard in Pegasus practices and educated practice staff in its use. This IT tool will prompt, and streamline the recording of, ABC delivery. Over Quarters 1 and 2, Dr Info was installed in Rural Canterbury PHO practices, with training provided to staff on its use. This IT tool will increase the visibility of individual practices delivery in the health target measures. Data Sharing and Analysis During Quarter 2, Canterbury DHB collated data from 1 April 2013 onwards of patients who were discharged from hospital and received ABC. Practices have been provided with lists of their enrolled patients for follow up and recording of ABC as appropriate. Data was also collected on smokers not recorded in general practice as having received brief advice and/or cessation support. This gap analysis is currently being reviewed, with an expectation that the outcomes will guide the future delivery of services. Cessation Support The Flexible Funding Pool Service Level Alliance (FFP SLA) monitors PHO health promotion activity across Canterbury, including smoking cessation. An evaluation of the PHO s existing cessation programmes and services, which includes a literature review of best practice in a primary care context, has recently been 4 Data for this measure is supplied by the Ministry on a quarterly basis from the PHO Performance Programme. CANTERBURY DHB Health Target Report Quarter /14 8 of 12

69 completed. The outcomes of this evaluation will be provided to the FFP SLA and inform the future design and delivery of Canterbury s cessation services. Electronic referrals from general practice to other cessation providers (SmokeChange, Aukati Kaipaipa, Can Breathe and Pacific Trust Canterbury; e referral to Quitline was already in place) have been established in Quarter 2 to facilitate referral to cessation providers that align with specific patient needs. Christchurch PHO has continued to pilot a text initiative, through which smokers are invited to engage in free cessation support. In Quarter 2, one practice sent texts to all its Māori, Pacific and Quintile 5 patients. (All other practices continue to use Txt2 Remind, phone messages and letters to contact and recall smokers.) ONGOING ACTIVITY The CDHB Smokefree Manager continues to work with all three PHOs to develop and monitor ABC systems, activities, education and training in general practice. Quarterly meetings with the three PHOs, the Smokefree Manager and Planning and Funding have continued as a means of sharing activities and strategies and further developing a system wide view on improving performance. Strategies for improving ABC delivery that apply to all three PHOs include: text to remind available to all practices to gather smoking status and offer support; monitoring of results and identification of current smokers who have not received ABC; regular visits to practices to train staff in systematic delivery and coding of ABC; and a variety of training opportunities available and promoted to all practices (e.g. online ABC e learning, National Heart Foundation courses, ABC update sessions via the Pegasus education programme, ABC training and support from the Canterbury DHB Smokefree Educator). In addition, each PHO has its own systems, tools and support staff for prompting and capturing cessation interventions. ACTIVITIES BEYOND GENERAL PRACTICE Christchurch PHO continues to manage the ABC Pharmacy Initiative, through which 73 Quit Card trained pharmacists are providing smokers with ABC. In Quarter 2, pharmacists provided 215 people with help to quit; work is continuing on identifying the most effective way this activity can be captured in primary care. In December 2013, general practices were provided with consolidated lists of their enrolled patients who had received ABC support from a community pharmacist from January These patients are being followed up by their general practice team. We are also exploring data sharing between other providers of smoking cessation activity (e.g. Green Prescription, Smoke Change, Aukati Kaipaipa) and up skilling Green Prescription staff in ABC and the pathways to engage people in cessation support. Rural Canterbury PHO continues to attend community events and workplaces with the aim of reaching people who are infrequent attendees at general practice. During Quarter 2, RCPHO practice teams attended A & P shows in Amberley and Rangiora and were available to provide smoking cessation advice. CANTERBURY DHB Health Target Report Quarter /14 9 of 12

70 More Heart and Diabetes Checks Target: 90% of the eligible enrolled population are to have had a CVD risk assessment in the last 5 years Figure 9: Percentage of the eligible enrolled population in Canterbury having had a CVD risk assessment in the last 5 years 5 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Canterbury NZ result (total) Māori Pacific 13/14 target Canterbury has increased performance to 45%. As reported previously, the late inclusion of Canterbury s largest PHO (with over 75% of the DHB s enrolled population) in the cardiovascular components of the PHO Performance Programme (PPP) has an ongoing impact on Canterbury s result against this health target. Data reporting only commenced in the past three years compared to over five years in most DHBs. CLINICAL CONVERSATION LOCAL SOLUTION Following the approval of the Ministry of Health, two methods for recording cardiovascular risk assessment (CVRA) activity in general practice have been available since December 2012: CVRAs where a risk calculator is used (captured within the PPP); and CVRAs that focus on systematic data collection followed up by clinical conversations about the implications of those results (captured in an alternate database). As this change has become embedded in general practices, there has been a substantial increase in use of the alternate recording method, with 2,150 clinical conversations recorded in Quarter 2, compared with just 546 the previous quarter (Figure 10). Figure 10: Clinical conversation CVRAs recorded by quarter 2,500 2,150 2,000 1,500 1, /13 Q3 12/13 Q4 13/14 Q1 13/14 Q2 5 Data for this measure is supplied by the Ministry on a quarterly basis from the PHO Performance Programme. CANTERBURY DHB Health Target Report Quarter /14 10 of 12

71 SUMMARY OF ACTIONS FOR MORE HEART & DIABETES CHECKS Canterbury s district wide recovery plan for both the primary care ABC and CVRA health targets was approved by the Ministry in December Current progress against key actions from the plan is summarised below. Clinical engagement Delivery of CVRA and health target results continues as a regular agenda item in all PHO clinical governance group meetings. Information was sent to practices outlining the importance of health target delivery and providing an update on the recording of this activity. Education 500 clinicians (general practitioners, practice nurses and pharmacists) attended a small group round in November 2013 on CVRA. In conjunction with the Heart Foundation, Rural Canterbury (practice staff in Ashburton and Rangiora) and Christchurch (20 practice nurses from member practices) PHOs provided training in CVRA and ABC delivery. IT tools to prompt, capture and audit the delivery PHOs continue to upgrade, train staff in, and monitor the use of IT systems that prompt the delivery and streamline the capture of both primary care targets. Pegasus Health (Charitable) Ltd completed the rollout of the Dashboard in October 2013 and continues to monitor its use. Rural Canterbury completed the installation of Dr Info in all practices; this IT tool will assist practices to monitor their performance. Retrospective coding and follow up General practices were provided with lists of their enrolled patients who were discharged from hospital with an assumed clinical CVD risk of >20%. The follow up and coding of these patients commenced in Quarter 2 and will be completed in the following quarter. Increased resourcing in primary care PHOs are continuing to work with practices to identify additional activities suited to the specific needs of the practice to increase their delivery and recording of CVRA, including: Increasing the role of administration to assist with data collection and the recall of patients; Providing additional GP and/or nurse consultations, including appointments in extended hours; Providing low cost or free consultations; and Engaging mobile nurse or outreach services to access hard to reach/high needs patients. Increased visibility Visibility of health target performance has increased throughout Canterbury s health system. PHOs are monitoring their delivery of CVRA and ABC at least monthly, and meeting with the DHB to discuss these results. PHOs are providing general practice with regular (at least monthly) reports on their health target delivery, with the results benchmarked against other practices in the PHO and the New Zealand average. An analysis of the eligible population not recorded as having received a CVRA by age, ethnicity and location commenced in Quarter 2 and will be completed in the following quarter. It is anticipated that this will inform the ongoing health target delivery and implementation of further initiatives. CANTERBURY DHB Health Target Report Quarter /14 11 of 12

72 Incentives to general practice Rural Canterbury and Christchurch PHOs have expanded their current programmes incentivising general practices delivery of the health targets; Pegasus is finalising details of their incentive framework, with the rollout of the programme expected in the following quarters. Services to support high risk populations CVD risk assessment results to date indicate increasing delivery and recording of CVRA in all (Māori, Pacific, high needs and others) populations groups. In addition to the activities listed above, the following initiatives are expected to influence the high needs populations results: PHOs are supporting practices to systematically contact and recall eligible patients who are yet to receive a CVRA. Rural Canterbury practices have targeted their high needs populations for this recall; Christchurch PHO has provided practices with the support of a mobile nurse to assist practices to engage and provide CVRA to hard to reach patients; and By providing general practice with lists of their enrolled population discharged from hospital with a clinical risk of >20%, Canterbury DHB is helping engage high risk patients with their general practice team for follow up and ongoing management. CANTERBURY DHB Health Target Report Quarter /14 12 of 12

73 Quarter two performance How to read the graphs My District 00 District Health Board 00% Health Board 2013/14 QUARTER TWO (OCTOBER-DECEMBER) RESULTS Ranking DHB current performance GOAL Progress Shorter stays in Emergency Departments Shorter stays in Emergency Departments The target is 95 percent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours. The target is a measure of the efficiency of flow of acute (urgent) patients through public hospitals, and home again. Quarter two performance (%) Change from previous quarter 1 West Coast Waitemata 96 3 Whanganui 96 4 South Canterbury 96 5 Wairarapa 96 6 Counties Manukau 96 7 Tairawhiti 96 8 Canterbury 95 9 Auckland Nelson Marlborough Hutt Valley Northland Taranaki Waikato Hawke s Bay Capital & Coast Lakes Bay of Plenty Southern MidCentral 89 Improved access to Elective Surgery Improved access to elective surgery The target is an increase in the volume of elective surgery by at least 4000 discharges per year. DHBs planned to deliver 76,231 discharges for the year to date, and have delivered 3554 more. Quarter two performance (%) Progress against plan (discharges) 1 Lakes Northland Counties Manukau Waikato Hutt Valley Taranaki Bay of Plenty Waitemata MidCentral Whanganui Wairarapa Canterbury South Canterbury Southern Tairawhiti Auckland Capital & Coast West Coast Hawke s Bay Nelson Marlborough 92 Shorter waits for Cancer Treatment Shorter waits for cancer treatment The target is all patients, readyfor-treatment, wait less than four weeks for radiotherapy or chemotherapy. Six regional cancer centre DHBs provide radiation oncology services. These centres are in Auckland, Hamilton, Palmerston North, Wellington, Christchurch and Dunedin. Medical oncology services are provided by the majority of DHBs. Quarter two performance (%) Change from previous quarter 1 Northland Waitemata Auckland Counties Manukau Waikato Lakes Bay of Plenty Tairawhiti Hawke s Bay Taranaki MidCentral Whanganui Capital & Coast Hutt Valley Wairarapa Nelson Marlborough West Coast Canterbury South Canterbury Southern 100 All DHBs 94 All DHBs 105 All DHBs % 100% 100% Increased Immunisation Increased Immunisation The national immunisation target is 90 percent of eightmonth-olds have their primary course of immunisation at six weeks, three months and five months on time by July 2014 and 95 percent by December This quarterly progress result includes children who turned eight-months between October and December 2013 and who were fully immunised at that stage. Quarter two performance (%) This information should be read in conjunction with the details on the website Change from previous quarter 1 South Canterbury 96 2 Wairarapa 96 3 MidCentral 95 4 Hawke s Bay 95 5 Auckland 94 6 Canterbury 93 6 Whanganui 93 8 Southern 93 9 Hutt Valley Capital & Coast Waitemata Counties Manukau Nelson Marlborough Lakes Tairawhiti Taranaki Waikato Bay of Plenty Northland West Coast 84 Better help for Smokers to Quit Better help for smokers to quit The target is 95 percent of patients who smoke and are seen by a health practitioner in public hospitals, and 90 percent of patients who smoke and are seen by a health practitioner in primary care, are offered brief advice and support to quit smoking. Change from previous quarter Hospitals Quarter two performance (%) Primary care Change from previous quarter 90 1 Wairarapa South Canterbury Whanganui MidCentral Hawke s Bay Nelson Marlborough Bay of Plenty Northland Capital & Coast Taranaki Counties Manukau Waikato Southern Hutt Valley Auckland West Coast Tairawhiti Waitemata Lakes Canterbury 49 Heart and Diabetes Checks More heart and diabetes checks This target is 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years to be achieved by July Quarter two performance (%) All DHBs All DHBs 66 All DHBs 73 90% 95% 90% 90% Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. Change from previous quarter 1 Wairarapa 84 2 Auckland 83 3 Counties Manukau 83 4 MidCentral 82 5 Capital & Coast 80 6 Taranaki 80 7 Bay of Plenty 80 8 Northland 80 9 Waikato Waitemata Tairawhiti Lakes Hawke s Bay Whanganui South Canterbury West Coast Nelson Marlborough Southern Hutt Valley Canterbury 45

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77 QFARC COMMITTEE - -REVIEW OF TERMS OF REFERENCE TO: SOURCE: Chair and Members Canterbury District Health Board Corporate Services DATE: 13 March 2014 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT. The purpose of this report is to seek confirmation of the revised terms of reference (TOR) for the Quality, Finance Audit and Risk Committee as recommended by that Committee and discussed at its meeting of 25 February RECOMMENDATION That the Board, as recommended by the Quality, Finance Audit and Risk Committee: i. Confirms the revised Terms of Reference for the Quality, Finance Audit and Risk Committee attached as Appendix 1 and SUMMARY The current TOF for the QFARC Committee were adopted by the Board in February 2011 with amendments in February They provided for a review to be undertaken in February At its meeting on 25 February 2014 the Committee considered a revised draft terms of reference which took account of the revised governance structure adopted by the Board at its meeting on 13 February 2014 and the prior establishment of the Facilities Development Partnership Group. This was discussed by the Committee and two further amendments were made to the draft document to take account of the Committee s changed role in respect to Canterbury DHB staff health and wellness and its role in respect to major IT projects. Attached as Appendix 1 and 2 are copies of the revised TOF for the Committee showing both tracked and accepted changes. The revised TOR are placed before the Board for its formal confirmation. 4. APPENDICES Appendix 1: Appendix 2: Revised TOR QFARC Committee (Tracked changes) Revised TOR QFARC Committee (accepted changes) Board March 2014 Review of TOR Report Page 1 of 2 07/03/14

78 Report prepared by: Kevin Roche, Assistant Board Secretary Report approved for release by: Justine White, General Manager Finance Item 9 - Baord 13 March 2014 QFARC Review TOR doc.doc Page 2 of 2 07/03/14

79 TERMS OF REFERENCE QUALITY, FINANCE, AUDIT AND RISK COMMITTEE INTRODUCTION APPENDIX 21 The Quality, Finance, Audit and Risk Committee is a sub-committee of the Board of the Canterbury DHB established in terms of Section 38 of Schedule 3 of the New Zealand Public Health and Disability Act 2000 (The Act). These Terms of Reference are supplementary to the provisions of the Act and to the Standing Orders of the Canterbury DHB and are effective from 16 February March FUNCTIONS The functions of the Quality, Finance Audit and Risk Committee of the Board are to: Monitor the overall financial performance and financial position of the Canterbury DHB (which incorporates the funder, hospital and specialist service and associated subsidiaries); and Review any additional budget requests above the Chief Executive s limit and make recommendations to the Board on these; and Monitor the financial separation of the funder and hospital and specialist service of the Canterbury DHB; and Monitor the financial and non-financial risks, of the Canterbury DHB both as funder and provider, including Major Property Projects (MPPs); and Monitor the effectiveness of the internal audit functions and review and approve the relevant audit plans and progress made by management in implementing recommendations that arise from both internal and external audits, including audits of non government providers ; and Monitor and ensure that the clinical risks relative to the responsibilities of the Canterbury DHB funder and provider arms are appropriately monitored, addressed and mitigated. Support, promote and monitor the development and continuance of a quality and safety environment across the Canterbury DHB in order to ensure the sustainable provision of patient centred, quality and safety focused, evidence based and systems minded health care to the population served by the Canterbury DHB. Oversee the effectiveness of management control of Canterbury DHB assets (and MPPs excluding those projects that may be overseen by the Facilityies Development Project Group Committee under authority from the Board); and Make recommendations on approval of MPPs (with budgets exceeding $1m); excluding Facility Development Master Plan Projects overseen by the Facilityies Development Project Group; Committee under authority from the Board; and Monitor the planning and construction process for MPPs; and Monitor the performance of MPPs against budget, programme and specifications and management s compliance with tendering, purchasing and probity policies; and Make recommendations on disposal of surplus land of the Canterbury DHB. Receive and if appropriate endorse decisions by the Chief Executive in respect to the appointment and remuneration of directors and chairpersons to Canterbury DHB subsidiary companies as outlined in the Policy on the Appointment of Directors to Canterbury DHB Subsidiary Companies To monitor and ensure appropriates policies are in place within the Canterbury DHB for staff health and safety in the workplace. To monitor major IT projects (receiving quarterly updates) in respect to; delivery, strategic direction and implementation and recommend /report to the Board on these. It will also be a function of the Quality, Finance, Audit and Risk Committee to make recommendations to the Board: Page 1 of 5

80 On the robustness of the financial and risk components of the Canterbury DHB s Annual Plan (AP), and associated plans and Regional Health Services Plan. On the Canterbury DHB s financial statements and disclosures; and On those finance-related policies which require Board approval, including delegation of authority policies. ACCOUNTABILITY The Quality, Finance, Audit and Risk Committee is a sub-committee of the Board and as such its members are accountable to the Board and will report regularly to the Board. The Board may delegate to the Quality, Finance Audit and Risk Committee the authority to make decisions or take action on its behalf, or if it deems appropriate any of the functions, duties or powers of the Board (note: in the event of the Board delegating decisions to the Committee the requirements of Schedule 3, Clause 5 of The Act will apply to the Committee). Members of the Quality, Finance, Audit and Risk Committee are to carry out an assessment and monitoring role but are not to be advocates of any one health sector group. They are to act in an impartial and objective evidence based manner for the overall aims of the Committee. Legislative requirements for dealing with conflicts of interest will apply to all Quality, Finance, Audit and Risk Committee members and members will abide by the Canterbury DHB s Media Policy, its Probity Policy and with its Standing Orders. The Committee Chair will annually review the performance of the Quality, Finance, Audit and Risk Committee and members. LIMITS ON AUTHORITY The Quality, Finance, Audit and Risk Committee must operate in accordance with directions from the Board and unless the Board delegates decision making power to the Committee it has no delegated authority except to make recommendations or provide advice to the Board The Quality, Finance, Audit and Risk Committee provides advice to the Board by assessing and endorsing recommendations on the reports and material submitted to it. Requests by the Quality, Finance, Audit and Risk Committee for work to be done by management or external advisors should be made by the Chair and directed to the Chief Executive or their delegate (the Principal Administrative Officer). There will be no alternates or proxy voting of Committee members. All Quality, Finance, Audit and Risk Committee members must comply with the provisions of Clause 38, Schedule 3 and Clauses 38 and 39 of Schedule 4 of the New Zealand Health and Disability Act RELATIONSHIPS The Quality, Finance, Audit and Risk Committee is to be cognisant of the work being undertaken by the other committees of the Canterbury DHB to ensure a cohesive approach to health and disability planning and delivery and as such will be required to develop relationships with: - the Board - Management of the Canterbury DHB - Manawhenua Ki Waitaha - the Community of the Canterbury DHB - other Committees of the Canterbury DHB. TERM Page 2 of 5

81 These terms of reference shall apply until February at which time they will be reviewed by the newly elected Board of the Canterbury DHB who will also review the membership of the Committee. (Note: as resolved by the Board on 21 October 2011 membership of this Committee will be reviewed in July 2012 for the 2013 year) It is appropriate that membership is reviewed by newly elected Boards to consider the skills-mix of the committee and allow for a diverse and representative cross section of the community to have input into decision making. MEMBERSHIP OF THE COMMITTEE The Chairperson of the Quality, Finance, Audit and Risk Committee will be a member of the Board and will be appointed by the Board. The Board may also appoint a Deputy Chairperson to the Committee. Note: as resolved at the meeting of the Board on 21 October 2011 all Board members will be members of the Quality, Finance, Audit and Risk Committee for the 2012 year. Other Mmembers of the Quality, Finance, Audit and Risk Committee will be appointed by the Board and may be both CDHB Board members or external members who will supplement the skills, knowledge and experience of Board members. The Board who will comply with the requirements of the Act and endeavour, where appropriate, to ensure representation of Maori on the Committee. The Chair and Deputy Chair of the Board will be ex-officio members of the Committee (if not appointed to the Committee by the Board) and will have full speaking and voting rights at all meetings of the Committee. Board members who are not members of the Committee will receive copies of agendas and minutes of all meetings and may attend any meetings of the Committee with speaking rights for those meetings that they attend. The Board will not appoint to the Quality, Finance, Audit and Risk Committee any member who is likely to regularly advise on matters relating to transactions in which that member is specifically interested. All members of the Quality, Finance, Audit and Risk Committee must make appropriate disclosures of interest. The Board may appoint additional members to the Committee from time to time, for specific periods, as it deems necessary, to assist in the work of the Committee. The Chair, Deputy Chair and members of the Quality, Finance, Audit and Risk Committee will continue in office for the period specified by the Board; or until such time as: - the Chair, Deputy Chair or member resigns; or - the Chair, Deputy Chair or member ceases to be a member of the Quality, Finance, Audit and Risk Committee in accordance with clause 9 of Schedule 4 of the Act; or - the Chair, Deputy Chair or member is removed from office by notice in writing from the Board. All Quality, Finance, Audit and Risk Committee members must comply with the provisions of Schedule 4 of the Act relating in the main to: The term of members not exceeding three years A conflict of interest statement being required prior to nomination. Remuneration Resignation, vacation and removal from office The Board may appoint advisors to the Quality, Finance, Audit and Risk Committee from time to time, for specific periods, to assist the work of the Committee. The Committee may also, through management, request input from advisors to assist with their work. Such advisors will not be members of the Committee and will not have voting rights.. Page 3 of 5

82 MEETINGS The Quality, Finance, Audit and Risk Committee will meet monthly as determined by the Board with the frequency/timing taking into account the times and dates of the other Advisory Committee meetings, and the Board meetings, but primarily the availability of relevant financial reports of the Canterbury DHB. Meetings shall be held in accordance with Schedule 4 of the New Zealand Public Health and Disability Act and the Canterbury DHB s Standing Orders. It is not a requirement that these Quality, Finance, Audit and Risk Committee meetings are held as public meeting unless the requirements of Schedule 3, Clause 5 of The Act apply in respect to delegated authority to make decisions on behalf of the Board being delegated to the Committee. Minutes and rreports of the Committee will, however, be recorded as appropriate within the public open and public excluded sections of the Board agenda in accordance with Section 32 of Schedule 3 of the New Zealand Public Health and Disability Act 2000 REPORTING FROM MANAGEMENT Management will provide appropriate reporting to the Quality, Finance, Audit and Risk Committee to measure against financial performance, management controls, internal and external audits, contract performance and both clinical and non-clinical risk and quality as required. MANAGEMENT SUPPORT In accordance with best practice and the delineation between governance and management, key support for the Quality, Finance, Audit and Risk Committee will be from staff designated from the Chief Executive Officer from time to time who will assist in the preparation of agendas, reports and provision of information to the Committee in liaison with the Chair of the Committee. The Board may appoint advisors to the Quality, Finance, Audit and Risk Committee from time to time, for specific periods, to assist the work of the Committee. The Committee may also, through management, request input from advisors to assist with their work. Such advisors will not be members of the Committee and will not have voting rights.. REMUNERATION OF COMMITTEE MEMBERS In accordance with ministerial Cabinet guidelinesdirectionand the CDHB Board s Fees and Expenses Policy, members of the Quality, Finance, Audit and Risk Committee will be remunerated for attendance at meetings at the rate of $250 per meeting, up to a maximum of ten meetings per annum, total payment per annum ($2,500). The Committee Chair will be remunerated for attendance at meetings at the rate of $ per meeting, again up to a maximum of ten meetings total payment per annum ($3,125). Ex-officio members will not be paid a meeting attendance fee. These payments may be reviewed by Ministerial direction from time to time and will be revised to comply with any Cabinet/Ministerial amendments. Any officer or elected representative of an organisation who attends committee meetings which their organisation would expect their officer or elected representative to attend as a normal part of their duties, and who is paid by them for that attendance, should not receive payment. The Fees Framework for Crown Bodies includes the underlying principle that any employees of Crown Bodies should not receive remuneration for attendance at Committee meetings whilst being paid by their employer. Page 4 of 5

83 Reasonable attendance expenses (ie: reasonable travel-related costs) for Committee members may be paid. Members should adhere to the Canterbury DHB s travel and reimbursement policies. Adopted Board 18 February 2011 Amended Board 16 February 2012 Amended Board xxxxx 2014 Page 5 of 5

84 TERMS OF REFERENCE QUALITY, FINANCE, AUDIT AND RISK COMMITTEE INTRODUCTION APPENDIX 2 The Quality, Finance, Audit and Risk Committee is a sub-committee of the Board of the Canterbury DHB established in terms of Section 38 of Schedule 3 of the New Zealand Public Health and Disability Act 2000 (The Act). These Terms of Reference are supplementary to the provisions of the Act and to the Standing Orders of the Canterbury DHB and are effective from 13 March 2014 FUNCTIONS The functions of the Quality, Finance Audit and Risk Committee of the Board are to: Monitor the overall financial performance and financial position of the Canterbury DHB (which incorporates the funder, hospital and specialist service and associated subsidiaries); and Review any additional budget requests above the Chief Executive s limit and make recommendations to the Board on these; and Monitor the financial separation of the funder and hospital and specialist service of the Canterbury DHB; and Monitor the financial and non-financial risks, of the Canterbury DHB both as funder and provider, including Major Property Projects (MPPs); and Monitor the effectiveness of the internal audit functions and review and approve the relevant audit plans and progress made by management in implementing recommendations that arise from both internal and external audits, including audits of non government providers ; and Monitor and ensure that the clinical risks relative to the responsibilities of the Canterbury DHB funder and provider arms are appropriately monitored, addressed and mitigated. Support, promote and monitor the development and continuance of a quality and safety environment across the Canterbury DHB in order to ensure the sustainable provision of patient centred, quality and safety focused, evidence based and systems minded health care to the population served by the Canterbury DHB. Oversee the effectiveness of management control of Canterbury DHB assets (and MPPs excluding those projects that may be overseen by the Facilities Development Project Group ); and Make recommendations on approval of MPPs (with budgets exceeding $1m); excluding Facility Development Master Plan Projects overseen by the Facilities Development Project Group; and Monitor the planning and construction process for MPPs; and Monitor the performance of MPPs against budget, programme and specifications and management s compliance with tendering, purchasing and probity policies; and Make recommendations on disposal of surplus land of the Canterbury DHB. Receive and if appropriate endorse decisions by the Chief Executive in respect to the appointment and remuneration of directors and chairpersons to Canterbury DHB subsidiary companies as outlined in the Policy on the Appointment of Directors to Canterbury DHB Subsidiary Companies To monitor and ensure appropriates policies are in place within the Canterbury DHB for staff health and safety in the workplace. To monitor major IT projects (receiving quarterly updates) in respect to; delivery, strategic direction and implementation and recommend /report to the Board on these. It will also be a function of the Quality, Finance, Audit and Risk Committee to make recommendations to the Board: On the robustness of the financial and risk components of the Canterbury DHB s Annual Plan (AP), and associated plans and Regional Health Services Plan. On the Canterbury DHB s financial statements and disclosures; and Page 1 of 4