2016 / 2017 WHANGANUI DISTRICT HEALTH BOARD ANNUAL REPORT TE PŪRONGO A-TAU

Transcription

1 2016 / 2017 WHANGANUI DISTRICT HEALTH BOARD ANNUAL REPORT TE PŪRONGO ATAU

2 MIHI HE HONORE HE KORORIA HE MAUNGARONGO KI RUNGA KI TE WHENUA HE WHAKAARO PAI KI NGA TANGATA KATOA HONOUR, PEACE AND GLORY TO ALL MANKIND UPON THIS LAND 2 Annual Report 2016 / 17

3 CONTENTS Our vision & values The population we serve Our opportunities & challenges Our overarching priorities & focus areas Our overview of performance Board Chair and Chief Executive's Report Hauora A Iwi Report Chief Financial Officer's Report Service Performance Overview What we provided in 2016/17 Our organisation Our board Board & committee attendance Our Executive Management Team Our people Statements of Service Quality Statement of Performance System Level Measures & focus area performance Prevention Services Early Detection and Management Services Intensive Assessment and Treatment Services Rehabilitation and Support Services Financial Statements Index & Glossary Following a Silver Award as a firsttime entrant for it's 2014/15 Annual Report, Whanganui DHB's 2015/16 Annual Report was awarded a Gold Award by the Australasian Reporting Awards (ARA). The Australasian Reporting Awards recognise excellence in the communication of business information and financial reporting standards and enable organisations to benchmark the quality of their annual reports against criteria based on world best practice. Reports that achieve a Gold Award satisfy all of the criteria and are model reports for other organisations to follow. Annual Report 2016 / 17 3

4 OUR VISION & VALUES NGA MOEMOEĀ, NGA KAUPAPA Our vision: Better health and independence He hauora pai ake, he rangatiratanga Kaua e rangiruatia te hāpai o te hoe, e kore to tātou waka e ū ki uta. Do not lift the paddle out of unison or our canoe will never reach the shore. We foster an environment that places the patient and their family at the centre of everything we do an environment which values: learning and improvement courage partnering with others building resilience. We are: open and honest respectful and empathetic caring and considerate committed to fostering meaningful relationships familycentred. He wāhi whakamana tangata whaiora, whakamana whānau! Ko te whai anō hoki i ngā waiaro: ka whai matauranga ka whai mana ka toro atu te ringa ka whai rangatiratanga. Koi anei tātou: ka ū ki te pono ka aroha ki te tangata ka manaaki tangata ko te mea nui he tangata, he tangata me ōna āhuatanga katoa ko te whānau te pūtake. 4 Annual Report 2016 / 17 Nothing about me without me, and my whānau/family Ko au ko toku whānau, ko toku whānau ko au

5 THE POPULATION WE SERVE HE TANGATA, HE TANGATA, HE TANGATA One of 20 district health boards (DHBs) in New Zealand, (WDHB) was established under the New Zealand Public Health and Disability Act This Act sets out the roles and functions of DHBs. WHANGANUI DHB REGION TOTAL POPULATION: 62,445 9,742KM 2 WHANGANUIRAETIHI DISTANCE: 90KM CAR TRAVEL: 1HR 20MIN Raetihi Population 1,000 Ohakune Population 980 TAIHAPE RAETIHI DISTANCE: 67KM CAR TRAVEL: 46MIN Taihape Population 1,788 WHANGANUI MARTON DISTANCE: 36KM CAR TRAVEL: 26MIN WHANGANUI Population 38,100 Marton Population 4,550 MARTON TAIHAPE DISTANCE: 72KM CAR TRAVEL: 50MIN 26% 60+ years WDHB age distribution 27% 019 years 26.5% Māori WDHB Ethnicity distribution 8% Quintile 1 Least deprived 10% Quintile 2 WDHB Deprivation distribution 37% Quintile 5 Most deprived 26% 4059 years 2039 years POPULATION AGE DISTRIBUTION NZ 019 years 26% 2039 years 27% 4059 years 26% 60+ years 21% 21% 73.5% Other ETHNICITY DISTRIBUTION NZ Māori 15.8% Other 84.2% 19% 26% Quintile 3 Quintile 4 Annual Report 2016 / 17 5

6 OUR DHB'S POPULATION Whanganui DHB is responsible for ensuring the 62,000 people living in its district have access to a wide range of health and disability support services across primary, secondary and tertiary health care settings. This includes the secondary services provided at Whanganui Hospital as well as funding many primary services delivered in the community and public hospital services delivered to our population outside the Whanganui DHB area. It is responsible for 'improving, promoting and protecting' their health and the health of the communities in which they live. Whanganui DHB has a unique profile in that it has: a declining, rather than growing, population which impacts on the level of funding received high rates of deprivation compared to most other areas of New Zealand poor health status compared to most other areas of New Zealand a high and growing proportion of Māori a high and growing proportion of people aged over 65 a small hospital servicing a widelydispersed, but small, population base large travel distances to the bigger hospitals. NEW ZEALAND HEALTH STRATEGY: The Five Strategic Themes GUIDING PRINCIPLES FOR THE SYSTEM 1. Acknowledging the special relationship between Māori and the Crown under the Treaty of Waitangi 2. The best health and wellbeing possible for all New Zealanders throughout their lives 3. An improvement in health status of those currently disadvantaged 4. Collaborative health promotion, rehabilitation and disease and injury prevention by all sectors 5. Timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay 6. A highperforming system in which people have confidence 7. Active partnership with people and communities at all levels 8. Thinking beyond narrow definitions of health and collaborating with others to achieve wellbeing. CENTRAL REGION Whanganui, MidCentral, Capital & Coast, Wairarapa, Hutt Valley and Hawke's Bay DHBs Improved quality, safety & experience of care The Regional Services Plan is developed collaboratively by the region's six district health boards. The plan's five prority outcomes are aligned to the five themes and associated actions of the New Zealand Health Strategy. Improved system integration & consistency REGIONAL SERVICES PLAN Improved health & equity for all populations Improved clinical & financial sustainability Best value for public health system resources 6 Annual Report 2016 / 17

7 OUR OPPORTUNITIES & CHALLENGES Whanganui DHB operates in a complex and dynamic environment which poses many challenges. However, the environment also offers many opportunities to support our efforts to reduce inequalities and improve the health and wellbeing of our community. SIGNIFICANT ENVIRONMENTAL FACTORS WORKFORCE International labour market HEALTH OF OUR POPULATION Lifestyle and agerelated diseases ECONOMY & DHB FUNDING CHALLENGES: Recruiting and retaining suitable specialist staff. Salary demands exceeding ability to pay. OPPORTUNITIES: To promote lifestyle and costofliving advantages of regional New Zealand. To develop innovative initiatives for 'growing our own' and extending our talent pool. CHALLENGES: Need for services for people with chronic medical conditions and degenerative diseases exceeds ability to provide and/or fund. OPPORTUNITIES: To work collaboratively with other health and social agencies to enhance promotion and protection strategies. To develop models that increasingly empower patients and whānau. To improve service integration across the health and disability continuums. To develop models of care and service delivery which encourage all health professional groups to work to topofscope. Fiscal constraint CHALLENGES: Funding increases will not cover costs. Funding increases will need to be applied to meet demand for health services and reduce disparities. Demand for salary and price increases will likely exceed available funding. Existing business and service model mitigate against service change. Service change will not get political support (local and/or national). OPPORTUNITIES: To review effectiveness and efficiency of current service models to improve productivity and/or new ways of delivering services. To lobby for, and influence the development of, business model changes. To continue with waste elimination, cost reduction and revenue generating initiatives. INCREASED SPECIALISATION Need for centralisation CHALLENGES: Lack of scale leads to clinical and financial unsustainability. Service changes will not get political support (local and/or national). Community resists change. OPPORTUNITIES: To use technology and visiting specialists to enable local delivery of ambulatory services to improve collaboration with other DHBs to ensure best use of physical and human resource across the region. To enhance travel and accommodation options. To improve community understanding of the impacts of specialisation. CONSUMERISM Increasing consumer expectations POLITICAL UNCERTAINTY Change of government and/or change in health policy CHALLENGES: Demand exceeds ability to fund and/or to provide service expectations. OPPORTUNITIES: To increase consumer participation to improve health literacy across the region and to support the Choosing Wisely programme. CHALLENGES: Significant shift in policy direction. Major restructure of the health system. OPPORTUNITIES: To contribute to the development and design of any new structural or policy direction. To prepare for any change from a position of strength. Annual Report 2016 / 17 7

8 OUR OVERARCHING PRIORITIES & FOCUS AREAS It's critical our community and other stakeholders have confidence in our organisation. We have continued to work on 'how the world sees us' through initiatives such as improving our approach to serving, ensuring our physical environment is welcoming to all and having a culture of openness and transparency, especially when we perform below standard. We work hard right across our organisation to maintain the confidence of all those we interact with, from our patients, clients, partner organisations and suppliers, through to the Minister of Health and the Government. In addition to maintaining the confidence of our community, we pay particular focus to the following overarching strategies and priority population groups. Throughout this report, we have employed the symbols associated with each priority and focus area, as set out below, to indicate the activities of relevance to each priority and focus area. 1 2 ADVANCING MĀORI HEALTH We want Māori whānau to want to be as healthy as they can for their future generations and for the health and wellbeing of the whole community. The Board remains committed to Whānau Ora whānau/familycentred care as one of its key principles to accelerate its efforts to improve Māori health outcomes and to improve the health and wellbeing of the whole community. WHANGANUI RISING TO THE CHALLENGE Whanganui Rising to the Challenge focuses on working with our population so they have the tools to weather adversity, actively support each other s wellbeing, and attain their potential within their family/whānau and communities. We work with our population to provide rapid access to support from a range of effective, wellintegrated services that will help them to improve their mental health and wellbeing or address addiction. Through this, Whanganui DHB will endeavour to make best use of public funds and to support the best possible outcomes for those who are most vulnerable. 3 LEADERSHIP IN QUALITY & SAFETY IMPROVING THE PATIENT EXPERIENCE Clinical leadership and patient/family/whānaucentred care and partnership models are internationally recognised as key drivers of improved patient outcomes, improved patient experience of care and provision of effective clinical governance. Clinical governance systems within healthcare form the foundation of safer processes for patients and staff. The aim for Whanganui DHB is to work in partnership with our district partners in care to improve the quality of care we provide to our people and to reduce patient harm. 4 SHIFTING INVESTMENT TO IMPROVE OUTCOMES & LIVE WITHIN OUR MEANS Whanganui DHB is committed to operating within annual funding and to delivering on the agreed financial plan, supported by clinical and executive leadership. The DHB is also committed to improving health and reducing disparities, particularly for Māori. WDHB needs to shift the investment from services that benefit a few, some of the time, to services that benefit many, more of the time. This will contribute to an improvement in health outcomes and reduction in disparities. 5 REGIONAL COLLABORATION Through the centralalliance with MidCentral and collaboration with other DHBs in the wider region, Whanganui DHB aims to achieve improved health outcomes for the population through clinicallyled, collaborative health services, and that more effective and efficient shared support services are developed. Through regional collaboration we aim to have a more integrated system of health service planning and delivery that will lead to ongoing improvements in the sustainablility, quality and accessibility of health services whi8ch provide the right care, in the right place, at the right time, and as close to home as possible. 8 Annual Report 2016 / 17

9 FOCUS AREA 1 A B HEALTH OF WOMEN & CHILDREN Whanganui DHB reconfirmed improving maternal, child and youth health as a key priority for 2016/17. This follows advice received from Hauora A Iwi, our Māori Relationship Board, in 2012 which identified improved maternal and child as a key priority. Promoting healthy women and children is a core goal in empowering parents and families (whānau) to grow and contribute to the community they live in by reducing the negative impact of unmet health need. HEALTH OF OLDER PEOPLE The aim is to maintain a system that provides choice, clear information, protection for vulnerable older people, provides care that maximises an older person's independence and improves quality of life. The DHB is committed to delivering on the government priorities for older people to make sure their needs are met now and in the future. C LONGTERM CONDITIONS Many people suffer from several longterm conditions. Longterm conditions include conditions such as diabetes, cancer, cardiovascular diseases, respiratory diseases, mental illness, chronic pain, chronic kidney disease and dementia. As the population ages and lifestyles change, the health system needs to respond to increasing numbers of people with longterm conditions. FOCUS AREA 2 D EXCELLENCE IN CLINICAL SERVICE DELIVERY Improving the quality and safety of, and the timeliness of access to, clinical services and preventing patient harm is a key priority and commitment for the WDHB. Whanganui DHB recognises that effective clinical leadership and partnering with patients and their whānau/families positively influences the care patients receive, results in fewer adverse events, and improves patient experience. Annual Report 2016 / 17 9

10 10 Annual Report 2016 / 17

11 OUR OVERVIEW OF PERFORMANCE MAHI WHAKARITERITE Annual Report 2016 / 17 11

12 BOARD CHAIR & CHIEF EXECUTIVE'S REPORT Looking back at 2016/17 and looking forward to 2017/18. The board chair and chief executive s reflections and aspirations Our report gives us the opportunity to look back on the activities which shaped the 2016/17 year and how our DHB is going to manage the challenges ahead. This Annual Report is an important document. It is our report back to Government and to the community that we are here to serve. It also gives us the opportunity to publicly acknowledge our staff and our health and social service partners. At the beginning of the 2016/17 year we set a demanding plan for our district. For a small DHB with no population growth, our challenge is meeting the increasing health and disability support needs of our community within the funding parameters. We are delighted to report that we largely achieved our service objectives. We continued with our drive to continuously improve all aspects of our performance, examples of which are included within this report and the companion Quality Account. To improve our focus on workplace wellness, we have recently adopted the WorkWell Programme which, in partnership with the staff, will be the basis of future improvements to our work place. Recruiting staff for the specialist end of our occupational groups, especially doctors, continues to be challenging however, our reliance on shortterm locums has considerably reduced. We continue to support the professional development of the staff, endeavouring to ensure this critical investment achieves better alignment with our organisational objectives. Through our orientation and our cultural competency programme Hapai te Hoe, we can see tangible advances in our commitment to a whānau ora approach underpinning everything we do. As we look forward, we are expecting to be rolling out the Speak Up for Safety training supported by the Cognitive Institute from Queensland. This training will prepare our staff for the introduction of the programme offered by the Institute which is aimed at promoting professional accountability. To each and every staff member, we extend our heartfelt thanks for the commitment and dedication that you show on a daily basis to our community and our organisation. Our 2016/17 story is one we tell with pride. 12 Annual Report 2016 / 17

13 WE ARE PROUD OF THE WORK OF OUR STAFF, IN THE COMMUNITY AND IN THE HOSPITAL, IN CLINICAL AND NONCLINICAL ROLES, AND STRIVE TO ENSURE THAT EVERY STAFF MEMBER HAS A SAFE, ENJOYABLE, CHALLENGING WORK LIFE Achieving our goals and objectives is due to the hard work and commitment of our staff. In a modern health care service the critical success factor is a cooperative, flexible workforce. We acknowledge and thank our dedicated staff for the commitment and loyalty they continuously demonstrate, both to our community and to our organisation. We recognise that our staff are well supported by their respective unions. Management values the constructive working relationships we have with our union partners. To those involved in the union forum, both nationally and locally, especially our local organisers and delegates, we extend our appreciation and thanks. We particularly want to acknowledge the contribution of the NZNO and PSA to the implementation and development of the Care Capacity Demand Management Programme. This programme provides us all with assurance that we are efficiently providing safe, good quality care to patients whilst protecting the health and wellbeing of the staff. This bipartite programme will continue to positively shape our future. For some time now we have been an active member of the Restorative Whanganui movement. As a restorative work place, we endeavour to take a restorative approach to dealing with the multitude of interpersonal relationship challenges that arise in any large organisation. This positive approach to people management looks after the mana of all and has certainly impacted on our organisational culture. This last year has seen our board take a very proactive approach to the changing work place Health and Safety expectations. We have made excellent progress in developing our reporting framework so management and board can exercise appropriate due diligence. We have maintained tertiary status in the ACC Accredited Employers Programme. WE ARE PROUD OF THE DEEPENING RELATIONSHIP OUR ORGANISATION HAS WITH OUR IWI The active contribution that iwi makes to various aspects of our organisation continues to develop each year. We are blessed to have the dedicated service of our kaumatua John Maihi, kuia Jo TakarangiFirmin and Gina Maihi, and Hauora a Iwi, our partnership board. Hauora A Iwi is made up of representatives from the Whanganui, Ngarauru Kitahi, Ngā Wairiki Ngāti Apa, Mokai Patea, Ngāti Hauiti and Ngāti Ranga, and is ably led by Mary Bennett. The two boards meet regularly and Hauora A Iwi s guidance to the board and management, especially related to improving equity and strengthening our whānau ora approach, is invaluable. WE ARE PROUD OF THE POSITIVE, PROGRESSIVE AND TRANSPARENT CULTURE Over recent years we have seen our culture slowly transforming as we have worked to ensure our values underpin all our decisions, action and behaviours. We will not be satisfied until every one of our staff live by our values, all of the time. However, we have made tremendous progress and now consider we have earned the right to call ourselves a 'valuesbased organisation'. A significant contributor to this progress has been the reform of our orientation and the implementation of our cultural awareness programme. Hapai te Hoe, forms part of our orientation and is rolling out across the organisation. The programme, developed and provided by our Māori health team, is being truly transformational for our staff and ultimately impacts on the service we provide. Annual Report 2016 / 17 13

14 WE ARE PROUD OF THE STABLE ENVIRONMENT, SOUND GOVERNANCE AND LEADERSHIP PROVIDED BY OUR BOARD AND MANAGEMENT This last year we farewelled board members Allan Anderson, Kate Joblin, Phil Sunderland and Ray Stevens. All four members served at least two terms and each brought their own unique, valuable contribution to the governance of our organisation, the effects of which will be evident for years to come. We were very saddened by the sudden death of Phil Sunderland shortly after his retirement from our board. Phil always provided wise pragmatism to board deliberation. October saw the board elections, and in December we welcomed new members Annette Main, Charlie Anderson, Darren Hull, Graham Adams, and Dame Tariana Turia. The new members joined returning members Dot McKinnon, Harete Hipango, Jenny Duncan, Judith MacDonald and Stuart Hylton to form our board for the next three years. For a second term, Dot McKinnon was appointed board chair, ably assisted by deputy chair Stuart Hylton. Across all our services, we have continued to grow and develop our leadership. We have developed very competent operational managers in all parts of our organisation. All these leaders interface daily with both the people we serve and the staff providing the service. We are delighted with the intelligence, compassion and integrity that they bring to their critical responsibilities. The executive management team has not changed over the last year. We recognise and thank the executive leaders for the influence they are having individually and collectively on the culture and performance of our organisation. Our team comprised: Julie Patterson, Chief Executive Brian Walden, General Manager Corporate Francois (Frank) Rawlinson, Chief Medical Officer Hentie Cilliers, General Manager Human Resources Kim Fry, Director Allied Health Rowena Kui, Director Māori Health Sandy Blake, Director of Nursing, Patient Safety & Quality Sue Campion, Communications Manager Tracey Schiebli, General Manager Service and Business Planning. The collegial relationships that exist across all levels of DHB leadership continues to be a real strength of our organisation. WE ARE PROUD OF THE CONSTRUCTIVE, PURPOSEFUL RELATIONSHIPS WE HAVE WITH OUR PARTNERS ACROSS THE HEALTH AND SOCIAL SERVICES Our staff work constructively with the wide range of health and disability providers we fund to provide services to our community. Whanganui is well served by the providers across our district. The quality of services provided by the aged care sector (both residental and community), general practice, the Whanganui Regional Health Network, the National Hauora Coalition, the Kaupapa Māori health providers, lead maternity carers, mental health providers, dentists, hospice, community pharmacies, and Belverdale is recognised and appreciated. Within our hospital, we have excellent relationships with Spotless, Medlab Central, Pacific Radiology and SMS Millipaed Ltd. Our hospital services are well served by each of these organisations and for that, we thank you all. We recognise, and would like to continue to grow the work we do with the three district councils and other agencies such as education, housing, social development, justice, corrections, and the Police. These relationships are critical for the health and wellbeing of our community. We are excited by the Government's commitment to a social investment approach and look forward to working even more closely with these agencies this coming year. Thank you all for the contribution you make to the essential work that we jointly do, often for the most vulnerable members of our community. Our organisation has continued its commitment to the regional and national work done collaboratively across the DHB. We are proud of what we contribute to this work and we value the benefits that our collective efforts accrue for and its community. What DHBs can, and do, achieve collaboratively makes a huge difference to a small DHB. The value we get from collaborations such as Allied Laundry, Technical Advisory Services and NZ Health Partnerships is immeasurable and we extend our thanks to the staff and leadership of each of these organisations. 14 Annual Report 2016 / 17

15 WE VALUE THE SUPPORT WE GET FROM THE NATIONAL AGENCIES Our relationship with the Health Quality & Safety Commission (HQSC) continues to grow. We are committed to supporting the Commission through contributions from a number of our staff; acknowledging the real value that this contribution returns to our organisation. It appears to us that the Ministry of Health has had another difficult year however, we have valued the relationship we have with staff across the Ministry and value their support. The Health & Disability Commissioner, ACC and Pharmac all make a significant contribution to our organisation, for which we are grateful. WE ARE PROUD OF THE QUALITY OF SERVICES WE PROVIDE TO OUR COMMUNITY Improving patient safety and the quality of all our services continues as our highest priority. We have been recognised through certification as an organisation committed to continuous improvement. Our work is complex and relies on human systems and processes so regrettably, from timetotime, things do go wrong. We work hard to avoid this but importantly, when things do go wrong we are open and honest with those affected. This last year, we have seen numerous improvements across our clinical services. Behind the clinical services, the same level of improvement has occurred in the essential nonclinical support services. In all, over 50 of these improvements have been entered in our Quality Awards. No matter how small or how large, we are aware that each incremental improvement we make to our clinical and nonclinical services positively impacts on our patients, whānau and wider community. As we move forward, much remains to be done. We have improved the clinical input into our planning and funding function but this needs to further develop. Over the next year, our drive to improve the patient experience through better service integration will continue, especially the integration between primary and specialist services, and those provided for us by MidCentral and Capital & Coast DHBs. Our greatest challenge remains the inequities that exist for a significant proportion of our population, particularly Māori. Whilst we are already investing in addressing this, much is left to understand, let alone overcome this challenge. WE ARE PROUD OF HOW WE MANAGE OUR FINANCES TO LIVE WITHIN OUR MEANS This is the eighth consecutive year that our DHB has ended the year within the approved budget. We are proud of this achievement, which is only possible due to the efforts of every staff member. As a small DHB, with limited population growth, we always receive the minimum funding increase. Meeting budget is always challenging because our annual plan always includes a moderatehigh degree of financial risk. Our operational staff are aware of this and that it is they who drive the costs. Whether they be involved in service planning, service provision or the support services, they demonstrate on a daily basis how prudent they are with taxpayers money. The staff are also aware that whilst we are always seeking ways to eliminate waste, reduce cost, or grow our revenue, we will always find a way to fund innovations that will improve patient safety, service quality, or the work environment for the staff. It is service to our community and a healthy workplace for our staff that drives our fiscal management. Achieving budget will continue to be the most significant challenge our DHB faces. We are however, confident that, based on our history, we will continue to succeed. Dot McKinnon WDHB Board Chair Julie Patterson WDHB Chief Executive Annual Report 2016 / 17 15

16 HAUORA A IWI MĀORI RELATIONSHIP BOARD Our relationship with the six Iwi is strong and continues to grow through the partnership board Hauora A Iwi. Members of Hauora A Iwi have contributed to committee work, and annual and regional planning during the year. The two boards have met together throughout the year. Mary Bennett is chair of Hauora A Iwi and we acknowledge Mary s commitment and leadership. As at 30 June 2017, the members of Hauora A Iwi are: Whanganui: Susan Osborne (vicechair) Keria Ponga Ngā Wairiki Ngāti Apa: James Allen Pahia Turia Ngāti Hauiti: Maria Potaka Ngarauru Kītahi: Hayden Potaka Mary Bennett (chair) Mokai Patea: Barbara Ball Maraea Bellamy Ngāti Rangi: Cassandra Reid. We appreciate this relationship and thank each of the members and their Iwi for their ongoing commitment to improving the community s health and their willingness to contribute to the success of our DHB. We are pleased to include within our Annual Report, a brief report from Hauora A Iwi as follows: HAUORA A IWI REPORT E te Poari, tēnei te reo o ngā mana whenua o tō tātou rohe e maioha atu ana ki a koutou katoa. Ko ngā mate kua huri ki tua o pae maumahara, rātou kua okioki. Ki a tātou, ngā morehurehu, tēnā tātou katoa. It has been an interesting year for Hauora A Iwi. We farewelled longstanding member Susan Osbourne and wish to thank her for her commitment and contribution to Hauora A Iwi and the statutory committees. We welcomed Sharlene TapaMosen to our table. Sharlene brings a wealth of knowledge and experience in the health sector, both locally and regionally. We look forward to the debate and rigour Sharlene will inject into our korero. Hauora A Iwi acknowledge the appointment of the new that took office in December Together we are committed to a mutually respectful relationship built on good faith, honesty and integrity, and open communication. Testament to the relationship has been the negotiation of a new Memorandum of Understanding that focuses on three goals namely Giving effect to Whānau Ora; Achieving health equity for Māori; and Improving capacity and enhancing capability. The goals are broad yet specific, and can be applied in ways that take account of what is happening at either a regional, local or organisational level. For example, Giving effect to Whānau Ora considers delivery of 'the right service, at the right time, in the right place, in the right way' which can be viewed and analysed through any of the three lenses. This particular goal also highlights the work carried out by Māori Health providers in our rohe. Hauora A Iwi wish to acknowledge the hard work of all Māori Health providers, their ongoing commitment and dedication to delivering whānau based and whānau driven solutions to our people. Hauora A Iwi also wish to recognise those working within the Haumoana Service and their ongoing manaaki to our whānau while in hospital. Along side this, they have provided staff and Board members with the opportunity to gain further knowledge and understanding of Te Ao Maori through the inhouse Hapai te Hoe programme. 16 Annual Report 2016 / 17 Hauora A Iwi attended regional health hui throughout the year including the Central Region Combined Boards Symposium. The symposium highlighted the value of regional collaboration on programmes and services. Attendance at this forum provided an opportunity to reconfirm to participants, the need to ensure any new developments and solutions give appropriate consideration and priority to achieving equity in health outcomes for our people. Hauora A Iwi have had input into the development of key documents throughout the year. This included the WDHB s Annual Plan While the Ministry of Health removed the requirement for separate Māori Health Plans for , we are encouraged by the priority the WDHB have given to achieving equity in health outcomes for Māori across all focus areas. We will continue to interrogate and monitor progress against the targets in the Annual Plan, using the Māori Health Plan Indicator Reporting Tool, as this allows for deeper analysis of data. Because its not just about numbers, we will also give attention to the quality of the health outcomes; the experiences our people are having in the system; if and how the overall wellbeing of our people is improving. This year saw the WDHB statutory committess join to become one body known as the Combined Statutory Advisory Committee, another opportunity to express our views. Hauora A Iwi has two representatives on that committee who continue to challenge the status quo and raise awareness around increasing capacity and capability of the Māori workforce. In the coming year, Hauora A Iwi will continue to monitor progress against our Memorandum of Understanding, the WDHB Annual Plan, regional plans, other documents and initiatives that are in place or in development. We will measure the outcomes against a Whānau Ora framework, looking for evidence that the health system, and more particularly the WDHB, is delivering programmes and services in a way that meets the needs of our people. We look forward to supporting the WDHB in their endeavours. Nā Hauora A Iwi

17 CHIEF FINANCIAL OFFICER'S REPORT A successful year for the board has seen financial performance continue close to breakeven, with a small deficit of $0.712 million on total revenue of $242 million. This follows on from last year's result of $0.567 deficit and budgeted deficit for the year of $1.0m. The 2016/17 result has been achieved whilst maintaining service levels similar to 2015/16 levels overall. Some highlights include 4020 elective surgery operations (3.6 percent down on last year); 1296 acute operations (up 2.2 percent), 719 births (down 4.3 percent), 20,695 emergency presentations (down 3.4 percent); and 2,579 patients referred to other centres (down 1.9 percent). Whilst volumes are similar to last year, patient acuity did increase due to the increasing effect of noncommunicable diseases and higher number of patients affected by dementia needing specialist services, thus requiring greater staff resources to keep patients safe. Revenue for the year has increased by $5.34 million (2.2 percent) in 2016/17, while operating costs increased by $5.40 million. Our key cost drivers have been staff costs driven by patient volumes as well as doctor locum costs to sustain safe rosters for medical staff. Clinical supplies growth was driven by higher orthopaedic volumes. Aged care cost growth is again evident, whilst patients referred outofregion are at similar levels to the previous year. DHBs are mitigating activitydriven clinical supply cost growth through national procurement initiatives which are reducing clinical supply prices. Whanganui and five other hospitals in the lower North Island continue to implement the Regional Health Informatics Programme consisting of five regional clinical applications that provide access to patient information regardless of where a patient is, within this hospital network. This is a complex project costing the region $65.3 million, with Whanganui DHB investing $11.5 million across six years. Whanganui is fully live on all regional systems, with other district health boards joining the systems in 2017/18. Access to general practitioner patient shared care records became a reality taking us one step further to joining up clinical information at a patient level across our networks. In 2016/17, we invested $2.4 million in the regional IT programme, as well as $2.9 million in equipment and facilities. The financial position is good with $10.4 million in cash and investments available at yearend to support health services in 2017/18. Intangible assets continue to grow as a result of investment in the Regional Health Informatics Programme. Term loans of $36.7 million have been restructured under Ministry of Health direction through a swap of equity for debt. The 2017/18 year will provide financial challenges as we meet the health needs of an ageing population against a background of modest revenue increases and acceleration of wage growth from national pay agreements. An increased deficit is forecast in 2017/18 as a result. For the detailed financial reporting see the financial statements from page 111. $9.50m Other revenue $8.20m Hospital services provided for other DHBs $15.70m Ministry of Health side contracts $208.8m 2016/17 Appropriation (PBF) $242.2m Revenue $24.5m Other community service $7.6m Mental Health community $20.1m Pharmaceuticals & laboratory $38.3m Hospital service at other DHBs (IDF) $24.5m Health of Older People community $242.9m Expenditure $84.4m Personnel cost (incl. outsourced personnel) $7.5m Outsourced clinical service & other $15.6m Clinical supplies $20.4m Infrastructure & nonclinical supplies Brian Walden General Manager, Corporate (Chief Financial Officer) Annual Report 2016 / 17 17

18 SERVICE PERFORMANCE OVERVIEW Longterm, Whanganui DHB aims to: Improve the life expectancy for the DHB population, with improvement in equity for Māori Reduce mortality rates for the DHB population, with improvement in equity for Māori Improve equity by reducing the health status gap between Māori and nonmāori across all measures, and also between Whanganui and New Zealand. Whanganui DHB has made five specific commitments to support achievement of the vision (see page 8): 1. Advancing Māori health 2. Whanganui Rising to the Challenge 3. Leadership in quality and safety improving the patient experience 4. Shifting investment to improve health outcomes and live within our means 5. Regional collaboration Our focus areas for 2016/17 remained on the priority population groupings of Maternal, Child and Youth, Older People and people with LongTerm Conditions, as well as providing excellence in clinical service delivery. Maternal, Child & Youth Health In the area of Maternal Child and Youth Health, there were positive improvements in the Ambulatory Sensitive Hospitalisation rates for 04 year olds, and the Mean score of Decayed, Missing and Filled Teeth for Year 8 children for both Māori and nonmāori. Growth in antenatal education completion numbers and delivery of mental health services to this population grouping is also pleasing to see. Of particular note, is the high rate of uptake for young Māori woman receiving the HPV vaccine. Challenges still remain in meeting the immunisation targets and improving breastfeeding rates. Work on improving results in these areas through health promotion activities continues. Health of Older People For our older population, good falls prevention work has continued in both the hospital and community settings. Fall rates in the Assessment, Treatment and Rehabilitation Ward dropped by 30 percent in the two years since 2014/15. In 2017/18, work will be done to understand why there is an increase in the number of repeat presentations to Whanganui Hospital's Emergency Department by people living in aged residential care. Excellence in Clinical Service Delivery Whanganui DHB has continued to deliver good results in all areas of service delivery. There are a significant number of initiatives underway to support our commitment improving quality, culture and patient safety in our health system. Future focus The 2016/17 year has seen the introduction of system level measures to provide a wholeofsystem view of health performance. In 2017/18, we want to build on that by developing a cohesive plan that helps guide service delivery and measures health performance through an outcomesbased approach. Our success over the last few years has been achieved in an environment of steady growth in the need for services in primary care and across almost all secondary specialities. This growth is not due to an increasing population, rather the effects of noncommunicable diseases and the degeneration caused by ageing within a population that has a high percentage of people from low socioeconomic circumstances. We are totally committed to reducing the inequities that continue to exist within our system, particularly for Māori. Embedding the Whānau Ora philosophy into organisational culture will help the DHB make improvements in this area, as will building on existing partnerships and shifting investment to improve health outcomes. *2016/17 National Health Target performance Health targets are a set of national performance measures specifically designed to improve the performance of health services that reflect significant public and government priorities. They provide a focus for action. The impact they make can be measured to see how they are improving health for all New Zealanders. The DHB s performance against the health targets, in the four quarters from 1 July 2016 to 30 June 2017, are shown on page 77. LongTerm Conditions There has been an increase in the Ambulatory Sensitive Hospitalisations for the 4564 years age group in 2016/17. Work is continuing to address this trend through health promotion and focused screening activities in 2017/18, such as cardiovascular disease (CVD) screening in Māori men aged 3544, to help improve current and future health outcomes for this group. Whilst the proportion of diabetes patients with HBA1c levels less than 64 mmol/mol has not improved, the number of people with HBA1c levels less than 64 has increased by 27 percent with the target achievement being driven by increased screening having identified more patients with diabetes. It is pleasing to see that the rate for Māori has shown good improvement on 2015/ Annual Report 2016 / 17

19 WHAT WE PROVIDED IN 2016/17 PROVIDER DIVISION (Whanganui Hospital and Waimarino & Rangitikei rural health centres) 20,695 PATIENTS THROUGH EMERGENCY DEPARTMENT 2015/16: 21, FULL TIME EQUIVALENT (FTE) STAFF 2015/16: 830 9,501 INPATIENT STAYS 2015/16: 9,118 52,230 52,532 RADIOLOGY 2015/16: 54, /16: 50,637 OUTPATIENT APPOINTMENTS 253 NEW INPATIENT TESTS 7,823 ADMISSIONS TO MENTAL HEALTH 2015/16: 239 DAY PATIENTS 2015/16: 7, BIRTHS $78.3 m TOTAL WAGE BILL 2015/16: $75m 4,020 IN WHANGANUI HOSPITAL/RURAL HEALTH SERVICE 2015/16: 751 1,296 SUPPORTED 167 PEOPLE WHO DIED IN HOSPITAL 2015/16: PEOPLE REQUIRED ELECTIVE SURGICAL ACUTE EMERGENCY MORE THAN 3 OPERATIONS OPERATIONS ACUTE ADMISSIONS 2015/16: 1, /16: 4, /16: 347 5,316 OPERATIONS 2015/16: 5,436 Annual Report 2016 / 17 19

20 20 Annual Report 2016 / 17

21 OUR ORGANISATION TE RŌPŪ WHAKAHAERE Annual Report 2016 / 17 21

22 PURPOSE & OBJECTIVES is a body corporate owned by the Crown and operates as an agent of the Crown. It was established under the New Zealand Public Health and Disability Act has four key functions or core areas of business: i. Assessment of health needs, planning and monitoring of health and disability services ii. Funding and purchasing health and disability services iii. Providing health and disability services, through a directly managed, Crownowned public hospital, and home and communitybased services iv. Governance, administration and management of the in regard to the function or core business areas above. To carry out its functions and deliver on its core business areas, Whanganui DHB is organised into three divisions: Service and Business Planning Division Provider Division Corporate Services & Governance and Administration. SERVICE AND BUSINESS PLANNING DIVISION The primary responsibility of the Service and Business Planning division is to plan, fund and purchase health and disability services for the community within the Whanganui region with particular attention to: personal health (primary and secondary) mental health Māori health disability support services (people aged 65 and above). This division also funds access to specialist services that are not delivered by the Provider division within the Whanganui region. In these core health and disability services, the Service and Business Planning division undertakes to: determine population health and disability needs develop health improvement strategies monitor service quality and address quality issues ensure service coverage for the resident population manage contracts and funding manage provider relationships. PROVIDER DIVISION (Whanganui Hospital / rural health centres) The Provider division provides secondary and community specialist health services which are funded at a revenue level of about $122m per annum. These secondary level services include: medical, rehabilitation, community and rural surgical maternity and child health public health mental health Māori health disability support: a comprehensive range of diagnostic and commercial services such as medical imaging, laboratory, medical records, building maintenance and finance supports these services. CORPORATE SERVICES DIVISION Corporate Services provides corporate infrastructure and information systems to support both the Service and Business Planning and Provider divisions. The support includes: financial management and payroll services information technology and management legal and commercial risk and quality systems facilities and contract management materials management: supply and distribution. There are a number of other functions that are directly responsible to the chief executive officer and provide a service across both the Service and Business Planning and Provider divisions. These include media and communications, human resources and industrial relations. CORPORATE GOVERNANCE has a set of values that recognise responsibilities to stakeholders, patients, employees, the community and the environment. The board places great importance in the highest standards of governance and continually reviews its governance practices to address s obligations as a responsible corporate citizen. 22 Annual Report 2016 / 17

23 OUR LEADERSHIP MANA TANGATA Annual Report 2016 / 17 23

24 ROLE OF THE BOARD The board is responsible to its owner, the Crown, through the Minister of Health for the overall governance and performance of. THE BOARD The board primarily represents the longterm interest of shareholders by: providing strategic direction to Whanganui District Health Board through constructive engagement with the executive management team in the development, execution and modification of the District Strategic Plan and WDHB Annual Plan appointing the chief executive officer monitoring the performance of the chief executive officer approving remuneration strategies and policies providing advice and counsel to management reporting to the Minister of Health/Ministry of Health and ensuring that all legislative and regulatory requirements are met ensuring appropriate compliance frameworks and controls are in place approving recommendations regarding major capital expenditure, and significant changes to major financing arrangements making decisions in relation to initiatives or matters otherwise not dealt with as part of the District Strategic Plan and WDHB Annual Plan process approving policies governing the operations of monitoring financial results on an ongoing basis ensuring the board s effectiveness in delivering best practice governance ensuring s business is conducted ethically and transparently reviewing strategic risk management including processes for identifying areas of significant business risk, monitoring risk management policies and procedures, overseeing internal controls and reviewing major assumptions used in the calculation of significant risk exposures listening and responding to the Minister of Health s view on the management and direction of Whanganui District Health Board considering the interest of the community and stakeholders. BOARD COMPOSITION AND SIZE The size of the board is determined through the New Zealand Public Health and Disability Act 2000, which provides for a maximum of 11 board members. Seven members are elected by the community and four are appointed by the Minister of Health. The chairperson and deputy chairperson of the board are appointed by the Minister of Health. HAUORA A IWI has a legislative requirement to build and maintain relationships with Iwi Māori under section 4 of the New Zealand Public Health and Disability Act Hauora A Iwi has been established by Whanganui District Health Board to contribute to the advancement of Māori health outcomes and to ensure access and delivery of health services to Māori. Hauora A Iwi is made up of iwi (tribal entities whom have influence within or partly within the Whanganui District Health Board region) and their organisations that represent tangata whenua. The functions of the Hauora A Iwi Māori Relationship Board is to give advice to Whanganui District Health Board on behalf of the Iwi collectives on the needs and aspirations of the Māori population across our region. acknowledge Hauora A Iwi for their ongoing partnership and support over the 2016/17 financial year. The iwi recognised by under Hauora A Iwi are: Whanganui Ngā Rauru Kitahi Ngā Wairiki Ngāti Apa Mokai Patea Ngāti Hauiti Ngati Rangi. 24 Annual Report 2016 / 17

25 CONDUCT OF BOARD BUSINESS The board normally holds 10 formal meetings each year, and will also meet whenever necessary to carry out its responsibilities. When conducting board business, board members have a duty to question, request information, raise issues of concern, fully canvass all aspects of any issue confronting and vote on any resolution according to their judgement. Board members keep confidential board discussions, deliberations and decisions that are not required to be disclosed publicly. CONFLICT OF INTEREST Board members are required to continually monitor and disclose any potential conflict of interest that may arise. board members must: disclose to the board any actual or potential conflicts of interest that may exist as soon as situations arise take necessary and reasonable steps to resolve any potential conflict of interest within an appropriate period, if required by the board or deemed appropriate by the board member comply with the New Zealand Public Health and Disability Act 2000 and Crown Entities Act 2004 requirements about disclosing interests and restrictions on voting. ACCESS TO INFORMATION Board members are encouraged to access members of the executive management team, through the chief executive, to request relevant information. Board members are entitled to seek independent advice on related matters at the expense of the organisation. Board members must ensure that the costs are reasonable, can be met within budget and must seek the chairperson s approval before the advice is sought. This advice must be made available to the rest of the board. CORPORATE ASSURANCE The board receives regular reports about the financial condition and operational results of Whanganui District Health Board. The board receives and considers annual certification from the chief executive and general manager corporate, stating that: the organisation s financial results present a true and fair view of the financial position and performance the risk management and internal compliance and control systems are sound, appropriate and operating efficiently and effectively in all material aspects. RISK MANAGEMENT The board has overall responsibility for ensuring there is a sound system of risk management and internal compliance and control across the business. It also has responsibility for establishing risk management policies and risk appetite of the organisation and ensuring these are implemented. Specific monitoring and evaluation of the effectiveness of risk management and the internal control environment are delegated to the Risk and Audit Committee. The committee considers accounting policies, reporting practices and WDHB Annual Reports, and monitors the appropriateness of management controls. It considers internal and external audit reports and reviews the adequacy of procedures and internal controls in order to monitor financial risks and major operational risks. The Risk and Audit Committee is ably chaired by former board member Kate Joblin. The board has delegated the chief executive to operate a risk management framework and process in accordance with AS/NZS/ISO 31000:2009 Risk management principles and guidelines. The risk management framework enables the organisation to identify and assess risks and controls, respond promptly and appropriately, and continue to monitor risks and issues as they evolve. Risk and compliance is reported to each meeting of the Risk and Audit Committee and the board, or more urgently, if required. This last year, under the guidance of Risk and Audit, our organisation has undertaken a comprehensive review, and a redesign, of our risk management framework. Annual Report 2016 / 17 25

26 THE COMMITTEES The board has established committees to consider certain issues and functions in further detail. The chairperson of each committee reports on any matter of substance at the next full Board meeting. All committee papers and minutes are made available to the board. There are three standing committees: Combined Statutory Advisory Committee* Risk and Audit Committee Remuneration Committee. * Denotes statutory board committee as per the New Zealand Public Health and Disability Act Other committees may be formed from time to time, as required. Each committee has its own terms of reference, approved by the board and reviewed regularly, with additional reviews when appropriate. The board appoints and reviews membership of external appointees to statutory committees. The structure and membership of the board and its committees is summarised in the diagram below. Committees of the as at 30 June 2017 Chair Board members External members Functions Combined Statutory Advisory Committee Stuart Hylton Jenny Duncan Harete Hipango (on leave) Judith MacDonald Dot McKinnon Philippa BakerHogan Darren Hull Dame Tariana Turia Annette Main Charlie Anderson Graham Adams Frank Bristol Matthew Rayner Susan Osborne Maraea Bellamy Dr Andrew Brown Leslie Gilsenan Assess health needs, disability support needs and health status of the resident population. Advise the board on health funding priorities and promote policy that maximises gains, and improves equity, in health outcomes. Annual purchasing plan and framework as part of business planning. Monitor financial and operational performance of the hospital and related services. Assess strategic issues and governance policy relating to provision of hospital services. Risk and Audit Committee Kate Joblin (Independent chair) Jenny Duncan Dot McKinnon Darren Hull Dame Tariana Turia Annette Main Anne Kolbe Clinical and business risk management framework including compliance and internal controls. Integrity of financial statements and Statement of Performance. Relationship with external auditor. Executive Employment Remuneration Committee Harete Hipango (on leave) Stuart Hylton Graham Adams Effectiveness, integrity and legal compliance of remuneration programmes. Annual review and recommendation of chief executive's remuneration package. 26 Annual Report 2016 / 17

27 WHANGANUI DISTRICT HEALTH BOARD ORGANISATIONAL STRUCTURE as at 30 June 2017 GOVERNANCE BOARD Hauora A Iwi Combined Statutory Advisory Committee Risk and Audit Committee Remuneration Committee MANAGEMENT Clinical Board / Ethics Committee CHIEF EXECUTIVE Kaumatua / Kuia General Manager Corporate Chief Medical Officer General Manager Service & Business Planning Director of Nursing and Patient Safety & Quality General Manager Human Resources & Organisational Development Director Allied Health Director Māori Health Communications Manager Annual Report 2016 / 17 27

28 OUR BOARD DOT McKINNON QSM Board chair "I was appointed to chair Whanganui DHB in December 2013 and in December 2016, was also appointed to chair MidCentral DHB. My roles include being an associate in the legal firm, Moore Law, chair of the Four Regions Trust (formerly Wanganui Powerco Trust), a member of the Health Practitioner s Disciplinary Tribunal, member of the Health Sector Relationship Agreement committee, member of the DHB National Executive, member of the Health Workforce Group. My career has spanned both public and private sectors including being Whanganui s deputy mayor for six years, the managing director of Kingsgate Hotel for 13 years, and a Polytechnic lecturer for seven years. I have been a director or trustee of a number of companies, boards or trusts including Wanganui District Council Holdings Limited, Aubert Home of Compassion Limited, Whanganui College Board of Trustees, ManawatuWhanganui Regional Lotteries, Whanganui Community Foundation, NZ Masters Games Limited, Te Kahui Tupua, Rotary NZ World Community Service, Wanganui Legal Services Committee, UCOL Transition Committee plus various other governance roles in the arts, sport and economic development units." GRAHAM ADAMS "I was first elected to the DHB in 2004 and served just the one term. I was elected again in My entire working career has been in various branches of the finance industry primarily in banking but also as a sharebroker/financial advisor. Although born in Wanganui it was not until 1974 that I first came to live here when I was appointed to manage the National Bank branch, a term lasting 6 years before being appointed Funds Manager in Head Office, Wellington. I resigned in 1984 and returned to live here permanently. My chief interest these days is with the Grey Power organisation, having served a term as national treasurer as well as many years in various capacities in Wanganui where I am currently treasurer of the local association. I am a board member of Age Concern and am also the sole remaining original trustee of the Akoranga Education Trust founded in 1985 whose "raisondetre" is to provide scholarship and other assistance to students who are from the Wanganui district. I look forward with keen anticipation to participating constructively in a governance role in the progress of our DHB." CHARLIE ANDERSON "During the 1970s when there were no dedicated rescue helicopters or fixed wing air ambulances, I was a helicopter pilot who regularly flew sick or injured people to the closest hospital. During my 40year career as a helicopter pilot, I was privileged to witness, and be part of, the establishment and growth of New Zealand s excellent air ambulance and rescue services. In 1996 I was again privileged to be awarded the Queen s Service Medal for my role in rescue work and lifesaving flights. In my time as CEO for Air Wanganui Commuter, we carried out approximately 500 air ambulance flights a year from Whanganui alone. Understandably, I remain committed to the ongoing development of aero medical support, Whanganui s air ambulance service, the and our district s health services overall. In addition to my role as a firstterm WDHB board member, I am also a secondterm district councillor." PHILIPPA BAKERHOGAN "I was elected on the in 2004 and have also been a councillor for the Whanganui District Council since I have over 20 years experience in the health system. I am a qualified medical radiation technologist and am currently managing a primary health practice." DARREN HULL "I was appointed to the in December 2016 following a three year term on the DHB's Risk & Audit Committee, including over two years as Chair. My background includes 14 years in the commercial corporate sector and the same period as a Director in public practice with local business advisory firm, Venter & Hull Chartered Accountants Ltd. As a passionate local who has enjoyed raising a family in our wonderful city, it's a genuine pleasure to assist with governance of our DHB, with the constant challenge to maximise health outcomes and equity for our local population." 28 Annual Report 2016 / 17

29 JENNY DUNCAN "As a second term board member, I was elected to the and the Whanganui District Council in I am an accountant and business coach with wide experience in business and community organisations. A robust and accessible health service is essential to a thriving and equitable community and it is my commitment to the Whanganui region that we retain the best service this community can afford." HARETE HIPANGO (on leave from April 2017) "Whanganui is who I am and where I am from, as is my whānau/family. My whakapapa (ancestral connections) are of Whanganui, Ngati Apa, Nga Rauru. I have a lifelong and livelong investment and commitment in the health and wellness of our people and communities having served for 25+ years in the law, social development, health and justice sectors. As a WDHB member, I strive to espouse the importance and relevance of 'He Korowai Oranga A Cloak of Wellness' where the 'we' factor in 'wellness' is exemplified by a robust, thriving and healthy network of collaborative and engaging relationships in order to improve, enable and sustain the quality of being able to live, stay, be and fare well. As a ministerialappointed member of the WDHB, I am entrusted a responsibility of shaping and ensuring health targets and directives are met whilst keeping focus and target on the implementation and gains of primary (grassroots) health which is aligned and supported by the secondary (hospital) care models of smart, collaborative, innovative, effective, efficient, equitable, connected intersectoral systems of care and treatment delivery accessible to all living in our community to empower, uplift and sustain the best health and wellbeing for all and especially for those of us most in need. Kia ora." STUART HYLTON "I was appointed to the Board in June 2014 and elected for a second term in 2016, appointed as deputy Board chair and chair of the Combined Statutory Advisory Committee. I m Whanganui born and educated and currently run my own consultancy business offering services that include strategic development, business planning, policy advice, regulatory management and waste management advice. I hold the statutory role of Whanganui s District Licensing (Alcohol) Commissioner. My academic qualifications and professional background traverse 25+ years in local government covering a multitude of disciplines. I have held a number of director or trustee roles over the years and are currently involved in both the Central Districts and Whanganui Cancer Society Executive, as well as being a Director in Whanganui Rotary Club, a Waimarie Operations Trustee, a Whanganui Education Trustee and a George Boulton Trustee. I ve always believed that living a healthy, active lifestyle ultimately assists overall health, wellbeing and independence. Therefore, I generally advocate for emphasis within our primary and preventative health care systems. I look forward to serving on the and working with management to continually improve community access to a responsive and integrated health care system." JUDITH MACDONALD "I was elected to the Whanganui District Health board in I have worked in the Whanganui district as a clinician and senior manager since the early 1980s initially at Taihape Hospital and latterly in Whanganui. I hold a range of directorships and chair multiple committees related to health and social issues. Currently, I am a director of Taihape Health, Whanganui Accident and Medical, and Gonville Health Ltd. My family and I have lived in this district all our lives and it is important to me that we have a range of quality health services for our people." ANNETTE MAIN "My election to the WDHB occurred in October 2017 following my decision to step down from my previous position as Mayor of Whanganui. I served as Mayor for six years, following twelve years as an elected member on the Manawatu Whanganui Regional Council. As a business owner and passionate advocate for our regional community, I am now pleased to be contributing in the health area by providing input to the board which assist to maintain existing health services and enhance these to provide equality in access and positive outcomes for our people." DAME TARIANA TURIA Profile not available at time of publication. Annual Report 2016 / 17 29

30 BOARD & COMMITTEE MEMBER ATTENDANCE RECORD 1 July 2016 to 30 June 2017 The Board meets on a sixweekly basis and holds extra meetings when required for planning or other specific issues. Part way through the year the Hospital Advisory Committee, Community and Public Health Advisory Committee, and Disability Support Advisory Committee merged together to establish the Combined Advisory Committee. Board Combined WDHB & HAI Combined Advisory Committee Hospital Advisory Committee CPHAC & DSAC Committees Risk and Audit Committee Number of meetings held 8 4* Board members Dot McKinnon (chair) Stuart Hylton (deputy chair from Dec 16) Philippa BakerHogan Judith MacDonald Jenny Duncan Harete Hipango (on leave from April '17) Graham Adams (from Dec 16) Charlie Anderson (from Dec 16) Annette Main (from Dec 16) Dame Tariana Turia (from Dec 16) Darren Hull (from Dec 16) Allan Anderson (to Dec 16) Kate Joblin (to Dec 16) Ray Stevens (to Dec 16) Phil Sunderland (deputy chair to Dec 16) Barbara Ball (to Dec 16) *3 meetings and 1 workshop Hauora A Iwi (HAI) Mary Bennett (chair) Barbara Ball Maraea Bellamy Keria Ponga Susan Osborne Pahia Turia James Allen Hayden Potaka Cassandra Reid Maria Potaka External committee members Frank Bristol Dr Alan Mangan Matthew Rayner Dr Anne Kolbe Julie Nitschke Dr James Le Fevre Grace Taiaroa Dr Andrew Brown Leslie Gilsenan Annual Report 2016 / 17

31 OUR EXECUTIVE MANAGEMENT TEAM JULIE PATTERSON Chief Executive I have extensive experience working in the New Zealand public health service. I graduated from Wanganui School of Nursing as a registered general and obstetric nurse and also hold a BA and MBA. As well as clinical practice I have experience in training health professionals, health management, policy and regulation, and the planning and funding of health services. As the chief executive officer, I am committed to working with the other health and social services in our district to provide the community with safe, high quality health and disability support services, within the resources available to the district health board. I know the key to safe good quality service is a committed, competent and confident work force, working in an environment that supports and nurtures their development and their professional and personal safety. BRIAN WALDEN General Manager, Corporate & Chief Financial Officer "As a chartered accountant in private sector finance and business roles, I joined the board in 1995 as general manager, finance and planning. I was the general manager, hospital and health services from 1998 to 2004 and then, as general manager, strategic developments I led the redevelopment of hospital facilities, including Taihape Hospital and implementation of the community oral health project, from 2005 through to In 2011, as general manager, corporate, I assumed the responsibilities of chief financial officer, information technology, procurement, supply and nonclinical support service functions. I have been the central region CFO representative on national projects Finance Procurement Supply Chain; National Food Services project; National Linen and Laundry Service; banking and insurance and am a director of Allied Laundry Limited. I am also the lead CFO supporting the Central Region Health Informatics Project. Whanganui led the central region DHB s implementation of the regional Clinical Portal and Radiology Information systems. Continuing transformation of information systems remains a key focus in 2017/18 with replacement of the existing patient management system with the regional webpas system." SANDRA BLAKE Director of Nursing and Patient Safety and Quality "As director of nursing, patient safety & quality, I am accountable operationally and professionally for the standards of nursing care and the patient safety processes and systems in place in the hospital. I am chair of the Central Region Clinical Governance Board, the Central Region Quality and Safety Alliance and am the national clinical lead for the Health Quality and Safety Commission (HQSC) Reducing Harm From Falls programme. I also provide expert advice to the Reportable Adverse Events Team at the HQSC." SUE CAMPION Communications Manager Trained as a newspaper journalist, I worked for two Manawatu newspapers before winning the 1996 Qantas Award for feature writing. From there, I joined The Dominion parttime and established my own communications/ publishing business. "Following my move back to Whanganui in 2009, I produced and published three editions of the Whanganui Matters business and tourism magazine before joining Whanganui DHB fulltime in "My 20year career in communications has seen me working in health, education, local government, tourism, the arts and Corrections. Of all these sectors, health has been the most rewarding. Annual Report 2016 / 17 31

32 HENTIE CILLIERS General Manager, Human Resources and Organisational Development (HROD) My professional qualifications and work experience is in human resources and includes management and leadership roles in public, nonprofit and private organisations in South Africa and New Zealand. I joined Whanganui DHB in 2008 and I am passionate about health & wellbeing and building our workforce to deliver safe quality care for our community. KIM FRY Director of Allied Health "My professional qualification and work experience is in social work, working in both physical and mental health settings as well as social service organisations in New Zealand and London. I have a Bachelor of Social Work and completed a Masters of Social Work after several years of work. My experience also includes management, leadership and coordination roles." ROWENA KUI Director of Māori Health "I am of Te Ātiawa descent. I am a nurse and midwife by training and have an extensive experience in working in Māori health, rural health, and health service planning and development. I enjoy leadership and the opportunity to impart my knowledge and experience to support others to grow and develop. I am passionate about Māori health. I believe that the Māori concept of whānau ora provides the perfect framework for the district health board and community providers to deliver services in such a way that collectively we can make a significantly positive impact on the health of Māori whānau and the health of our most vulnerable population groups." DR FRANK RAWLINSON Chief Medical Officer "I completed medical training at Groote Schuur Hospital in Cape Town gaining MB.ChB. in 1980 and psychiatric training in the UK, gaining MRC.Psych, in I'm married to Rozanna with two daughters, Danya and Zara. Arrived in New Zealand and Whanganui on 8 February 1988 and have lived here since. I view a health literate, activated and engaged patient/community as necessary to enabling ongoing improvements in individual and population health. I'm an active mountain bike track builder promoting development of critical skills, intergenerational social engagement and healthy lifestyle." TRACEY SCHIEBLI General Manager, Service and Business Planning "I trained in commerce, tax law and tax policy however my continued interest in policy development led me to the health sector in the mid1990s. Born in the UK, I have lived in Whanganui for most of my life apart from my five years of University education. Prior to commencing this role in 2006, I held various roles in the health sector focused on business management and service improvement. I worked as an independent consultant for a number of years, working on a range of improvement projects across DHBs and community NGOs. I currently hold a number of national and regional planning portfolios including national health of older people, and regional cardiac service development. I am passionate about health improvement and improving equity, and believe there are still many opportunities to achieve further health gains for our population. I see planning and improvement as a shared responsibility across clinical, business, consumer and community leaders and have enjoyed the opportunity to work in a DHB where this is encouraged." 32 Annual Report 2016 / 17

33 OUR PEOPLE TE HUNGA ORA Annual Report 2016 / 17 33

34 WORKFORCE PROFILE & EQUAL EMPLOYMENT OPPORTUNITIES WDHB workforce profile (as at 30 June 2017) Workforce headcount: 945 employees Age profile Female median age: 48 years Disability profile Male median age: 51 years 12 employees (1.3 percent) identified with a disability The WDHB workforce is made up of Nursing/Midwifery (50.4%), Administration/Management (21.2%), Allied Health (18.7%), Medical (9%), and Support (0.7%) employees. Whanganui DHB continued to enjoy a stable employee complement with an average length of service of 9.85 years. The average organisational employee turnover was 7.23% for the last five years. Employee gender, age, ethnicity and disability information are provided on a voluntary basis. The graphs on this page depict the WDHB s gender, ethnicity, disability and age profile of participating employees, including permanent and temporary employees but excluding casual staff working at the DHB. 16.1% 3039 years 13% 2029 years 1% 70+ years 57.6% NZ European 16.7% 6069 years Employee age distribution (as at 30 June 2017) Ethnicity profile (as at 30 June 2017) Gender profile (as at 30 June 2017) 22.3% 4049 years 30.9% 5059 years 11.0% Māori 6.9% Other 13.2% European 0.7% Pacific 2.2% African 0.2% Middle Eastern 7.8% Asian 81.2% Female 767 employees 18.8% Male 178 employees NATIONALLY & REGIONALLY WDHB works collaboratively with the six DHBs in the central region (MidCentral, Capital & Coast, Hawke's Bay, Hutt Valley and Wairarapa) on regional and vulnerable services, including workforce matters. All 20 DHBs support a strong national workforce and work collaboratively supporting national programmes and policies and promoting health as a career of choice. 34 Annual Report 2016 / 17

35 EQUAL EMPLOYMENT OPPORTUNITIES OUR WORKFORCE COMMITMENT Building a workforce with the right number of people, with the right skills, in the right place, at the right time, with the right attitude, doing the right work, at the right cost and with the right work output (World Health Organisation, 2010 Workload indicators of staffing needs). The executive management team champions equal employment opportunities and leads fair and equal treatment of all employees. We are committed to: an open and transparent organisation a healthy and just workplace ensuring every staff member enjoys coming to work, and goes home feeling stimulated, challenged but professionally rewarded enabling very staff member to grow professionally; to develop and feel physically and emotionally safe at work putting patient safety first and always taking precedence over balancing the budget expecting staff to hold the executive management team to their commitments. OUR LEGAL RESPONSIBILITIES In accordance with section 118 of the Crown Entities Act 2004 the WDHB actively maintains and implements programmes, policies and initiatives to promote equity, fairness and a safe and healthy work environment: Good and safe working conditions An equal employment opportunities programme Impartial selection of suitably qualified persons for appointment Recognition within the workplace of the aims, aspirations and cultural differences of Māori, other ethnic or minority groups, women and persons with disabilities Opportunities for the enhancement of the abilities of individual employees. Policies and procedures for the fair and proper treatment of employees in all aspects of their employment. Controlled documents Formally reviewed Employees and unions are consulted Available on the WDHB intranet Changes communicated to all employees. Key topic in orientation Awareness created through forums, meetings and training sessions Included in staff contracts. We want all our staff to be able to make a personal commitment to practice in a truly patient and family/whānau centred, rather than provider or managementcentred way, and: be part of an organisation that really listens to the voice of patients and their family/whānau put themselves in the shoes of the patient and whānau and want for them what we would want for our own family welcome the community into Whanganui Hospital and encourage family participation in care and decision making give a high level of understanding and support to those who make a mistake, with zero tolerance for hiding or not acknowledging our errors take personal responsibility for having our own voice heard so that every idea to make our environment safer and healthier for patients, families and staff is considered have the personal courage to stand up and speak out against workplace bullying. Annual Report 2016 / 17 35

36 As a good employer, Whanganui DHB is committed to: the equal employment of all employees upholding any legislative requirements in this regard. GOOD EMPLOYER: THE SEVEN KEY ELEMENTS Whanganui DHB continued to invest in the seven elements which make up a good employer. WELLBEING HEALTH SAFETY LEADERSHIP ACCOUNTABILITY CULTURE PREVENTING HARASSMENT BULLYING RECRUITMENT SELECTION INDUCTION REMUNERATION RECOGNITION CONDITIONS DEVELOPMENT PROMOTION EXIT FLEXIBILITY WORK DESIGN 36 Annual Report 2016 / 17

37 The WDHB s ambitions and activities to achieve the seven key elements of being 'a good employer' are summarised below: LEADERSHIP, ACCOUNTABILITY & CULTURE OUR AMBITIONS Employees, patients and community trust in us. Visible clinical and devolved leadership. Governance processes provide assurance. Clear direction and articulation of our strategy. Employees at all levels are engaged. Employees participate at every opportunity. OUR ACTIONS Reporting culture actively encourage patients to complain and staff to report all accidents, incidents and near misses in order to learn and improve our practices, processes and systems. Listening to the voice of our patients and family. Open disclosure conversations with whānau following adverse outcomes. Engaged board and executive management team. Leaders visible in the organisation. Visibility of key organisational activities at executive and governance level i.e. health and safety, patient care, service delivery, system improvement, risks, etc. Vision and values articulated in the annual plan and endorsed by the WDHB board. Whānau ora philosophy and cultural competencies socialised at organisational orientation for all new staff. Suitable appointments at all levels. Continue growing the clinical leadership model across medical, nursing and allied health. Mistakes/problems are remedied promptly, and are respectful of those involved. RECRUITMENT, SELECTION & INDUCTION OUR AMBITIONS Robust and transparent recruitment and selection processes. No barriers or biases to the employment of the best person for the job. WDHB employee demographics appropriately reflect the community it serves. OUR ACTIONS Fair and transparent recruitment and selection to ensure we meet current and future workforce needs and retain employees. Not compromising appointment decisions just for the sake of having someone in the role. Manage shortterm risks of carrying a vacancy, rather than bear the longterm consequences of an unsuitable appointment. Appointments based on values and fit with the WDHB. Grow Māori workforce implementation of Whanganui DHB Māori workforce pipeline and the Ministry of Health's Raranga Tupuake Māori Workforce Development Plan. Proactively promote Health Workforce New Zealand funding for Māori, particularly in kura kaupapa settings. Identified areas of nursing and allied health development to align with health gain areas for the district. Participation in the regularisation of the kaiāwhina workforce in home and community support services. Activities supporting growing our own workforce i.e. health careers promotion in schools and health career days. Annual Report 2016 / 17 37

38 EMPLOYEE DEVELOPMENT, PROMOTION & EXIT OUR AMBITIONS Transparent and fair performance practices. Supporting career growth, creativity, innovation and service delivery. Employees engaged in personal and professional growth. Fostering key clinical and high performing employees. Skills and expertise to ensure quality safe service delivery. Succession planning for key roles. Development of required technical, managerial and leadership skills. Employees speak positively of the WDHB; apply their best efforts to their work, and want to remain part of the WDHB. OUR ACTIONS Equitable training and development opportunities for all employees. Various MECA clauses supporting professional development. Encouraging and supporting formal and informal growth and development opportunities. A focus on growing our own workforce. Career growth opportunities for staff. Support programme for new graduate Māori nurses tuākana tāina. Lowest turnover in five years 5.46 percent in 2016/17. Increased number of applicants for vacancies. Staff who are leaving have the opportunity to provide feedback and suggest improvements. FLEXIBILITY & WORK DESIGN OUR AMBITIONS Employee requirements for work/life balance are respected and taken into consideration. Work design supports healthy and safe workplaces. OUR ACTIONS Fulltime employees account for 39.5 percent of employees; 45.7 percent work parttime and 14.8 percent are casual staff. Actively utilising safer staffing and rostering principles and tools (CCDM and Trendcare) to determine FTE staffing requirements. Dashboards and bed management meetings enable robust conversations regarding staff numbers and skill requirements, underpinned by flexible staffing. Workstation (ergonomic) evaluations and appropriate equipment to support individual health. Availability of job sharing arrangements. Identification and management of fatigue. HARASSMENT & BULLYING PREVENTION OUR AMBITIONS Zero tolerance approach. No harassment or bullying. Employee confidence in WDHB's commitment and actions. 38 Annual Report 2016 / 17 OUR ACTIONS Zero tolerance of all forms of harassment and bullying Managers and employees are trained on their rights and responsibilities. Specific policies and procedures in place for dealing with harassment and/or bullying complaints. Complaints are investigated promptly. Staff accountability and personal courage to stand up and speak out against workplace bullying is supported. A formal internal complaints procedure is in place for employees to report incidents of unacceptable behaviour, harassment or bullying. Provision of appropriate, confidential and accessible support for employees involved in or wishing to report these situations in the workplace.

39 REMUNERATION, RECOGNITION & CONDITIONS OUR AMBITIONS Employees treated as vital and equal partners. Recognition for contribution. OUR ACTIONS All employee groups, with the exception of those Individual Employee Agreements (IEA), are governed by MultiEmployer Collective Agreements (MECAs) and remuneration and conditions are in line with the collective agreements. More than 80 percent of WDHB staff are union members. The WDHB has a transparent, fair, genderneutral remuneration system which is regularly reviewed. Transparent job evaluation criteria are in place for a range of employee groups, including a national programme for job grading of senior nursing positions. Ensuring internal and external equity in remuneration and benefits are fundamental to the WDHB. Annual and sick leave benefits exceed the minimum legislative requirements. The WDHB supports and actively promotes the recognition of professional work days such as International Nurses Day. Nonfinancial staff recognition include team functions, awards, letters of thanks, compliments from patients and visitors, and visibility in newsletters. WELLBEING, HEALTH & SAFE ENVIRONMENT OUR AMBITIONS Proactive approach to employee health and wellbeing. Employee participation. Employees are physically, culturally and psychologically safe. No workplace barriers or obstacles for people with disabilities. OUR ACTIONS Staff, patient, visitor and contractor safety is integral to everything the WDHB does. It is nonnegotiable and the WDHB is relentless in its focus on improving safety through visible leadership, positive behaviour of staff, the work environment and safe systems, practices and procedures throughout the WDHB. Management and disclosure of adverse events to ensure a safe quality working environment. Ongoing training for managers and team leaders regarding their health and safety and injury management responsibilities. Executive management team reviews longterm absences and injury management activities; monitors progress and support. Staff report injuries and incidents on the RiskMan incident database. Investigation of injuries/incidents. Maintained a tertiarylevel ACC accredited employer programme member. Staff returning to work from either a work or nonwork injury or a medical condition are given the same support. Updated hazard management registers. Ongoing manual handling training. Utilisation of new manual handling equipment e.g. hoists, slings and HoverMatts. Commenced implementation of a staff wellbeing approach. Annual Report 2016 / 17 39

40 FUTURE PERSPECTIVE Whanganui DHB, as an equal employment opportunity (EEO) employer, is committed to increasing and developing an inclusive workforce that continues to embrace diversity. Below is a short summary of Whanganui DHB s 2017/18 organisational culture, leadership and workforce development initiatives: Continuing to grow our own future workforce Developing a talent pool of future leaders Aligning our leadership development approach with the national agreed approach Continuing to increase our cultural responsive workforce that reflects our community diversity and needs Refocusing our performance management framework Providing opportunities for staff to embrace technology and change Furthering the enhancement of an organisational culture where all employees are engaged, able to achieve their full potential, work as teams and feel valued and appreciated Implementing the Speaking Up For Safety Programme to further enhance our safety culture Implementing the High Performance, High Engagement (HPHE) Programme to enhance union engagement Clarifying behaviour following the organisation values refresh Rolling out the refreshed WDHB values and behaviour expectations Further increasing staff engagement and implementing a staff wellbeing programme (WorkWell) Utilising restorative practices in the first instance to maintain and improve relationships. 40 Annual Report 2016 / 17

41 STATEMENTS OF SERVICE QUALITY PŪRONGO RATONGA Annual Report 2016 / 17 41

42 3 D TE PUKAEA (WDHB CONSUMER ADVISORY GROUP) IS MAKING A DIFFERENCE In the past 12 months, our consumer council, Te Pukaea, has had significant input into how we provide services and information to our patients and their whānau/families, and importantly, how we can improve the way we work. Te Pukaea spokesperson John Hannifen is quietly confident they're making a difference a sentiment shared by John s fellow Te Pukaea members Linda Burling, Robyn Beattie, Sandy Inness, Sheila Beckers and Tim Tapa. Our job as a consumer group is to provide the perspectives of those who use hospital and health services, Mr Hannifen says. Wearing our consumers hats, we bring to the table ideas based on the practicalities and realities of everyday life outside the hospital with a focus on quality and safety. Understandably, it s not always easy for hospital staff to see an outside pointofview. While providing the best possible care to your patients, it s not easy to step back and ask how the patient might view what you are doing and how it impacts on them. In addition to the care they provide, staff are also responsible for meeting the expectations of the DHB, Ministry of Health, Health Quality & Safety Commission, and Health and Disability Commission. They have a lot going on. So, it s important to have a carefully, and appropriately, selected consumer group who can improve the services provided by health organisations by sharing patient and whānaucentred perspectives. Mr Hannifen believes where Te Pukaea s valuelies, is having the patient and family voice embedded into all levels of service provided to the WDHB community. Te Pukaea members are invited to contribute to every initiative and issue that s considered within the hospital. And crucially, Te Pukaea provide their input to the team who review incidents when something goes wrong for a patient and/or their family such as a delayed or wrong diagnosis, a mistake in surgery, and so on. In the review process, Te Pukaea sit equally with the health professionals (clinicians) and have their unique perspectives and contributions accepted alongside those of the other team members. This is a learning experience for both sides. When taking part in these reviews, I see the important contribution that Te Pukaea can make. Simply being able to ask questions and put relevant points of view that would not otherwise have been considered adds great value. Equally, as a consumer, I see the honest and critical thought provided by clinicians to try and understand what went wrong and how systems can be improved to try and make sure similar incidents don t happen in the future. Te Pukaea means the trumpet used to herald in the new day, to alert people in times of emergency and announce events with a sound that can be heard from afar. Te Pukaea was established by the Whanganui District Health Board in late There are six members, who apart from John Hannifen, have all experienced a serious incident when treatment they or their family received had an adverse impact on them. Each of these five members participated in a review of the incident to ensure that the hospital learnt from that adverse event, dealt with it appropriately and satisfactorily and made sure it was put right. Each of these five Te Pukaea members bring to the table personal experience of when things go wrong in health. The patient safety manager chairs the meeting and is supported by the director Māori health and the customer relations and complaints coordinator. Whanganui DHB recognises that it is critical that senior management support and answer questions and concerns for Te Pukaea members. Te Pukaea meet every six weeks but as with most things in life, the important activities happen away from meetings. While Mr Hannifen firmly believes that having a consumer group is critical to the DHB s success in delivering health services that meet the needs of the consumer, he recognises that, as it is with most large organisations, achieving the simple things can take time which in itself can be challenging. WDHB haumoana navigator Ned Tapa demonstrating the use of a traditional pukaea 42 Annual Report 2016 / 17

43 While I see the investigation of critical or adverse events within the hospital as the biggest contribution I make, the small things count too. A practical suggestion one of our group made was having coat hooks on the back of the hospital s toilet doors so you can hang your bag off the floor when using the toilet. This makes perfect sense to me. During the past 12 months, Te Pukaea have been involved in: a rewrite of the informed consent process with Te Pukaea suggesting that patients be given a copy of the consent form they have signed. giving their views of what is needed in the Patient Travel Information brochure giving their views on staff uniforms considering the information provided in the Fit for Surgery brochures providing advice and feedback on format, design and content of letters to patients which helped guide the work to rewrite all WDHB s patient letters, including appointment letters looking at how spaces are used in the hospital for example, the way waiting areas are set up providing input into work on building a greater understanding of how Whanganui DHB needs to increase patient appointment attendance. WHERE TO NEXT? We have recently had a meeting that included consumers who sit on various committees within Whanganui District Health Board, Mr Hannifen says. The meeting included consumer representatives from Supporting Families, the Clinical Board and mental health. It was great to get a better overview of their contributions and issues." Over the next year I would expect that Te Pukaea might begin to chair our own meetings, using the excellent supports already provided by WDHB. And, we might work to include coordination of all consumer input across Whanganui Hospital and other services. "One thing I do know from my experience is that the WDHB is open and responsive to all suggestions and totally supportive of the work of Te Pukaea. This makes our work that much more enjoyable and constructive. THEATRE SERVICES D ERCP PROCEDURE NOW AVAILABLE AGAIN AT WHANGANUI HOSPITAL Following a 10year hiatus, Whanganui Hospital s surgical team is delighted to again be performing the Endoscopic Retrograde CholangioPancreatography (ERCP) procedure for patients with blocked bile ducts. Using a flexible camera and Xray examination of the main bile duct which drains bile from the liver to the small bowel, ERCP enables the surgical team to remove gallstones, take tissue samples and open up narrowed bile ducts using a stent (a small plastic or metal tube) to help the bile duct drain. In addition to improving the wellbeing of patients, having the procedure performed at Whanganui Hospital saves them and their families having to travel to Palmerston North, Taranaki or Wellington Hospitals. WDHB chief medical officer Frank Rawlinson says the fact that patients can be discharged after one night s stay in hospital, is another winwin for them and the DHB. Some patients with more complex situations will continue to be transferred to tertiary hospitals if that is most appropriate for their health," Dr Rawlinson says. "However, those patients with simple bile duct blockages who are now provided ERCP here in Whanganui no longer need to travel out of our region to get the treatment they need. A wellskilled team of Whanganui Hospital nurses, anaesthetists and surgeons have undertaken additional training to open up the opportunity for ERCP to be offered in Whanganui where we re seeing good results, Frank says. In the 10 months since June 2016, 28 patients have received ERCP treatment which, an audit showed has been positive for all concerned." Instructions for patients following an Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure This brochure contains information for patients and their family/whānau about what to expect following an ERCP procedure and the followup care you ll receive. THEATRE SERVICES Endoscopic Retrograde CholangioPancreatography (ERCP) procedure This brochure contains information for patients and their family/whānau about what to expect during an ERCP procedure. wdhb.org.nz Better health and independence He hauora pai ake, he rangatiratanga wdhb.org.nz Better health and independence He hauora pai ake, he rangatiratanga Annual Report 2016 / 17 43

44 1 2 3 D WE NOW HAVE A BETTER UNDERSTANDING OF WHY PEOPLE MISS THEIR APPOINTMENTS Late last year, Whanganui DHB set out to try and understand why some patients did not turn up for their hospital appointments. They were questions Māori Health director Rowena Kui had been asking herself for many years. We needed to understand more about who was missing out, why this was happening and how we can improve our services in a way that helps people attend their appointments, Mrs Kui says. WDHB project manager Eileen O'Leary reviewed threeandahalf years information, and talked to patients, their families, and WDHB staff as well as a local primary school and primary care provider to see if we could find some answers. A primary school principal and staff said in their experience, parents who had missed multiple appointments really did want the best health care for their children but they were not getting the right messages about how to get to appointments, what the appointments were for and why they were necessary. "While we knew this information was a start, we also knew it only told part of the story." Mrs O'Leary talked to a father of a child who had missed many appointments. He talked about a whānau doing its utmost to care and provide for a boy with complex needs while struggling to navigate through the many health services his son needed to visit. He talked about being turned away when he arrived at the wrong reception area only to be rung the next day and asked why they'd missed the appointment. Outpatient Department clinical nurse manager Judie Smith says it is easy to forget that hospital staff use medical language that s not widely understood by people. She s spoken to a mother who didn t know and was embarrassed to ask what ENT (Ear, Nose and Throat) was as she prepared to take her child to an ENT appointment. Another mother whose son had missed many appointments talked about the need to have conditions and options explained in plain English, to be told how long they might have to wait in the waiting room, what appointments were actually for, where they would take place and how to get there. And because it takes considerable effort to attend appointments, she wanted to know if and why the appointment was really necessary if it would be worthwhile and make a difference for her son. WE FOCUSED ON INCREASING APPOINTMENT ATTENDANCE In the 2015/16 year, Whanganui Hospital s Outpatient Department saw 18,700 patients who between them, attended 53,000 appointments. For some patients, it s a regular appointment for treatment or a followup. For others, it s an anxious time awaiting news of the success of treatment, the healing of a wound or to be told more treatment, perhaps surgery, is required. Some walk out greatly relieved to know they will receive surgery, while for others the news they're facing surgery is a unsettling. 44 Annual Report 2016 / 17

45 The need to communicate in plain language came up time and again throughout the review. Overall the message from patients, their families and supporters is for the hospital to improve the way it offers outpatient appointments, Mrs O'Leary says. As well as other letters, we're reviewing all appointment letters sent to patients. With the help of consumer input, we're aiming to produce letters that provide easytounderstand information and a welcoming tone. FUTURE FOCUS Improving hospital signage and maps to make it easier for people to find their way. Providing additional information about patient travel. Following up patients who miss appointments to understand why. Increasing staff awareness of whānaucentred care through our Hapai te Hoe training, which has an emphasis on empathy and the importance of viewing our services from the patient s perspective. More flexible clinic times, locations and days. Increased use of texting and other forms of communication. Exploring opportunities to use more volunteers to support navigation. Exploring how we can improve health literacy. Building on partnerships with community and Māori providers. But for too many, getting to an appointment is the difficult part. Often it is so difficult that they miss out on the health screening or care they need, or end up receiving it later because they missed appointments. The difficulty can be distance but often it s other barriers in their own lives and the way the hospital works and communicates with them. Outpatient receptionist Shelley Vettise has been part of a team working at setting up patients followup appointments as they leave the Outpatients Department. People love it. They appreciate being asked when it would suit for them to come in. Sometimes it s the little things that can make a big difference, Mrs Vettise says. In Raetihi, Te Puke Karanga Hauora s general manager Julie (Pet) McDonnell is doing all she can to help people attend their Outpatient Department appointments in Whanganui. For an elderly Pipiriki man, his regular journey can start with a phone call from Mrs McDonnell. I start by calling him early on the morning of his appointment to check he's OK, had some breakfast and taken his medication, Mrs McDonnell says. He has a 27km trip just to get to Raetihi before carrying on to Whanganui from there. This gentleman needs to be driven because he cannot see to drive home after his appointment so there are a number of things to be taken into consideration. Outpatients clinical nurse manager Judie Smith sums up the work on increasing patient attendance saying, We want people to feel cared for with compassion when coming through our Outpatient Department. A wise kuia once told me people never forget how you made them feel. WDHB public health nurse Maria Potaka echoes this sentiment. We all have responsibility for this. We need every clinician and every administrator to see things from the patient s point of view. Annual Report 2016 / 17 45

46 3 B WE JOINED FORCES TO PREVENT FRAGILITY FRACTURES Evidence shows that an older person who presents with a hip fracture is highly likely to have had a previous fracture called a fragility fracture. And, identifying that first fracture provides a good opportunity for identifying a person s risk for osteoporosis and, if needed, appropriate treatment. Fracture liaison nurse Kerry Watson is employed by Whanganui Regional Health Network to work across all general practices to identify people over 50 years old who have had a fragility fracture. Aware of how debilitating fractured bones are, the Fracture Liaison Service was set up in January 2015, as a Ministry of Health initiative, to achieve the following: Promote and increase awareness of osteoporosis to health professionals and the public. Identify, investigate, intervene and monitor eligible fragility fracture patients. Reduce the incidence of osteoporotic fractures and, in particular, hip fractures. The Fracture Liaison Service works alongside primary health GPs and Whanganui Accident and Medical clinic (WAM) identifying fragility fractures, and within the hospital identifying those admitted with a fragility fracture. Mrs Watson says too many New Zealanders suffer preventable fractures because their osteoporosis was undiagnosed and untreated. Unfortunately fractures come at a cost to patients and the health care system, Mrs Watson says. Identification, investigation, intervention and monitoring will reduce the incidence of fractures because patients who suffer a first fracture are at greater risk of suffering a second, within one to two years of the first. International evidence highlights that half of all hip fracture patients have suffered a previous fracture. The Fracture Liaison Service aims to `capture the fracture in order to prevent a second fracture, and provide a model of care that ensures fragility fractures receive the best osteoporosis care they need. Every person over the age 50 years identified with a fragility fracture is given a risk and bone health assessment which looks at medications, their falls history, health, environment, lifestyle and family history. From these assessments recommendations are made based on the osteoporosis guidelines published by the MoH, ACC and Osteoporosis NZ. These guidelines which are also available to clinicians, include DEXA (bone density) scans and appropriate bone strengthening medications. The lifestyle factors looked at include Polypharmacy, diet including calcium, vitamin D, exercise, alcohol consumption, smoking and maintaining healthy weight. Mrs Watson says falls prevention in homes includes among other things, helping people to reduce clutter they might trip over, removing mats, wearing wellfitting footwear, having eye checks and using appropriate equipment, if needed. 46 Annual Report 2016 / 17

47 3 C D COLE'S STORY MANAGING DIABETES Earlier this year, 12yearold Cole Julian attended a Whanganui District Health Board meeting where he described in detail to board members, how he manages his diabetes. Supported by his parents Zona and Corey, Cole explained how he d been taught to test his blood sugars and give himself insulin almost from the day he was diagnosed. In June 2013, Mrs Julian had taken Cole to his GP who immediately sent him to Whanganui Hospital s Emergency Department which in turn, admitted him to the Children s Ward. During his threeday stay in hospital, Cole was visited by the WDHB s diabetes team a nurse, dietician and paediatrician who Zona can t speak highly enough of. She s particularly grateful to nurse Delia Williams who led the effort to educate Cole. Apart from educating Cole, Delia went to his school to explain to staff what it meant to have diabetes and what Cole needed to do to selfmanage his condition, Mrs Julian says. Her meeting with them was very successful. Three years on, and it was Cole educating our WDHB board members, who were very moved by his story and level of maturity. Mrs Julian says it meant a lot to Cole to have the opportunity to describe what it s like to live with diabetes. It validated for him how much effort he s put into his selfmanagement, which is demanding on anyone with diabetes, let alone a child, she says. Cole has to test his blood sugars every three hours while being constantly aware of how many carbohydrates he s eaten, how much exercise he s done and how much insulin he needs. He has to take his kit and sweets with him wherever he goes and do this around his participation in representative sport and life in general. Mrs Julian says the family s experience with Whanganui DHB and the staff involved with Cole s care couldn t have been better. Employed as a WDHB social worker, she was very grateful to have been given time off in the early stages of Cole s diagnosis to keep an eye on him. She says it took a while to be able to relax and feel confident that Cole could manage his diabetes no matter where he was and what he was doing. Having the support of the diabetes team gave her great comfort and she speaks highly of diabetes nurse practitioner Pauline Giles the second nurse in New Zealand to register as a diabetes nurse practitioner. Pauline's been amazing, she says. We re very lucky to have her support and the expertise she brings to her role. Cole Julian (left) and with his brother Flynn Annual Report 2016 / 17 47

48 3 D HOSPITAL AT A GLANCE PROVIDING 'BIG PICTURE' One of the more visible developments to take place in the Whanganui District Board s (WDHB) 2016/2017 year was the installation of Hospital at a Glance (HaaG) software which staff can view on a hospital intranet as well as a continuous display on a large screen in Whanganui Hospital s Integrated Operations Centre. Installed as part of the Care Capacity Demand Management (CCDM) Programme (a programme designed to match staffing resource to patient need), the software provides staff with an atthemoment view of the number of beds available, the number that are occupied and how much capacity the staff have to care for more patients. It s the first time that all staff members have been able to see on their computer screens, how busy inpatient areas are throughout the hospital and managers can work to ensure the staffing numbers meet the patient's needs. CCDM coordinator Dianne Kerr says the installation of large television screens in the clinical areas where staff, patients and visitors can view them will be an exciting and welcome move. The information on the screen is discussed at the twicedaily bed management meetings and staff redeployed as required. Surgical Ward clinical nurse manager Maria McDermott says she believes giving the clinical staff the ability to see at a glance what is happening in other areas, has fostered better collaboration across the organisation and more willingness to help when needed. In the past most units/wards worked independently with few people knowing what was occurring across the hospital at any given time, Mrs McDermott says. We now have the ability to think big picture which benefits staff and patients. Being able to see that the Emergency Department is at capacity puts the onus on wards with capacity to offer to admit patients sooner. I ve had a manager of another ward ask if there are any patients who are suitable to move to their ward to assist with freeing up beds to enable high needs surgical patients to be admitted to my ward. I support any initiative that encourages us to work together as a collective to deliver the best possible healthcare to our region. Care Capacity Demand Management Programme coordinator Dianne Kerr with one of the Hospital at a Glance (HaaG) screens 48 Annual Report 2016 / 17

49 3 A D WE CELEBRATED A RISE IN BABY HIP CHECKS Changes made to the way Whanganui s newborn babies have their hips checked has seen the number of babies screened by the (WDHB) almost double from 49 percent to 94 percent in the space of six months. While it s been found as few as one baby in every thousand is born with hips that will dislocate, identifying those babies is very important. Dislocated hips can lead to limping and early degenerative arthritis in young adults. Because orthopaedic consultants and registrars are not always able to check a baby before it leaves the Maternity Ward, and the parents of babies born in rural settings are not always able to attend their Outpatient Department appointments, babies were slipping through the net unchecked, WDHB nurse coordinator, quality Ulyses Espiritu says. When Outpatient Department registered nurse Charlene Sagad and myself noticed an increase in the number of referrals to our orthopaedic outpatient clinic we became concerned and started looking for solutions with our Maternity Ward colleagues. Because baby hip checks are included in midwives scope of practice, we decided (with the support of our orthopaedic consultants and registrars) that midwives would do the checks and if a midwife felt there was a problem with a baby s hips only then, would a baby be referred to the Outpatient Department s orthopaedic clinic. The trial began in October last year and by early this year the results were so encouraging it was decided to officially hand the responsibility to our midwives working in the Maternity Ward and in rural settings. Mr Espiritu says another positive change has been that when it s decided that a baby needs to be seen by an orthopaedic consultant or registrar, the Outpatient Department booking is made on the spot with the midwife rather than having the Outpatient Department clinic send the parents a letter at a later date. He says it s important that parents know that several treatments are available for babies with dislocated placed hips. WDHB brochures are provided in the newborn care package given to parents one which explains why the checks are done and the other backgrounds the treatments available. WDHB midwife Jo McDonnell checks baby Hauiti Karena s hips Annual Report 2016 / 17 49

50 2 3 A WE JOINED FORCES TO OFFER THERAPEUTIC HORSE RIDING A new programme designed to encourage Whanganui children to ride horses to help their emotional wellbeing is having a significant impact on participants as well as the (WDHB) and Jigsaw Whanganui staff responsible for running it. WDHB Infant, Child and Adolescent Mental Health and Addictions Service (icamhas) and Jigsaw Whanganui have joined forces to deliver therapeutic horse riding and basic horsemanship skills to children and young people with emotional and behavioural difficulties. Called Riding Experiences Inspiring Next Successes (REINS), the programme is run by icamhas social worker Stephanie Robinson and several Jigsaw Whanganui equine specialist facilitators who are helping the children develop their social skills and emotional awareness through horse riding. icamhas clinical manager Janice Bowers says it s wonderful seeing the way children and parents/caregivers communicate and celebrate a child s new skills. Other benefits for children enrolled in REINS include: learning to reflect on how their behaviour affects the horse s behaviour providing a safe space for those finding it difficult to form relationships to practice their social skills learning to trust learning practical skills which help boost the child s confidence and selfesteem reducing stress levels in children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) taking responsibility, demonstrating empathy and building relationships with horses while brushing and caring for them learning to problem solve. While REINS was established back in 2014, it s wonderful knowing that more children can access it now that Jigsaw and icamhas are running it together, says Mrs Robinson. Until icamhas came on board the programme was only available to those children being supported by Jigsaw social workers. icamhas has a history of successfully using animals to work with children. Our therapy dog Bentley has been a huge success with children experiencing communication difficulties. To work with horses was a natural step for us to take. PARTICIPANT FEEDBACK: I learned not to be worried and to keep trying. 10 year old boy I learned I was confident. 8 year old boy We listen to each other more. Parent Better behaviour; before and after. Parent There is something about the outside of a horse that is good for the inside of a man. Winston Churchill 50 Annual Report 2016 / 17

51 2 3 WE MADE 'SELF CARE' INFORMATION MORE ACCESSIBLE During 2015, local child and youth service providers, service users and pregnant women provided feedback to Whanganui DHB that there was a general lack of knowledge about services available for youth and the wider public to access. In addition, consultation undertaken during the development of Whanganui DHB s CoExisting Problems Proposal indicated that all service providers (including nonhealth agencies) involved with youth, believed having uptodate information available would be of significant value. This was of great interest to the DHB due to the fact that, at the time, a webbased, long term conditionsfocused service directory ( already existed. In response, a refresh of the ManageMe website was planned. The primary purpose of the project was to build and deliver an online service directory website which: provides information and raises public awareness of relevant Whanganui DHB area health providers and support groups, etc and those service s contact details is easy for users to navigate and for site administrators to maintain. The redeveloped version of the website went live in December As part of this shift, the ManageMe website became a more secure, reliable and userfriendly website, regardless of whether users visit the website from their desktop PC, tablet or smartphone. As it was previously, the new website is a Whanganui DHBfunded online service directory designed to make it easier for our population to find information about community groups and service providers. In addition to this, users can now also access healthy living/selfcare information about a variety of topics to help our people to be better informed, take better care of themselves, and live healthier and more fulfilling lives. Manageme.org.nz now also has a parallel site, which is dedicated to providing content that s more focused to the needs of young adults. Annual Report 2016 / 17 51

52 3 B AGED CARE FINDS WALKING IN ANOTHER'S SHOES COMFORTING Whanganui aged residential care (ARC) provider Masonic Court has put a number of their staff through the Walking in Another s Shoes programme and they re delighted that they ve done so. Developed by a Canterbury DHB psychogeriatrician and occupational therapist, Walking in Another s Shoes is designed to help ARC staff understand what it s like to live with dementia and how to better understand those with the condition. While Masonic Court doesn t have a designated dementia facility, they do have a number of residents with mild dementia, who manager Victoria Morris wants to support in every way she can. To do that, she enrols her staff in Walking in Another s Shoes to encourage them to relate better to their residents, to understand their needs and be able to empathise. It s quite a commitment for Mrs Morris and her colleagues who have to backfill their staff when they attend training at Whanganui Hospital but it's a commitment they believe is well worthwhile. We've built a sensory room at Masonic Court as a result of what our staff have learnt on the programme, Mrs Morris says. The sensory room is used and enjoyed by all the residents. In the four years since Whanganui DHB launched its programme, 66 caregivers and diversional therapists, as well as 19 registered and enrolled nurses working in aged residential care, have completed the course. WDHB dementia educator Olive Redfern says the training provides staff with new skills and a greater understanding of the pivotal role they play in the move towards more personcentred care for people living with dementia. It s a model of care that helps rest home staff, friends, family/whānau members and acquaintances have a more positive view of the condition and the care provided, Mrs Redfern says. From left to right: Tina van Bussell, Maxine Hardy, Suzanne Poynter, Aljon Pelayo, Jo Green, Sonia Welch, Olive Redfern. Absent: Taralee McNeil What makes Walking in Another's Shoes special is that in addition to teaching rest home staff to view challenging behaviour as a communication of unmet needs, it also has a strong focus on caring for the carer. Staff who have completed the training talk about feeling they re doing a better job and the trainers talk about how much they appreciate the measures available to gauge the programme's effectiveness. "It s an eightmonth programme which includes a monthly workshop, individual coaching sessions for each student, and guest speakers discussing their areas of specialty. Mrs Redfern says that while the programme complements other aged care training programmes, the fact that the dementia educator works alongside the carer and the person with dementia makes it different. Four years on, we really are seeing a new understanding about dementia. There s certainly an appreciation for the need to deliver personcentred care to enhance the lives of dementia patients and for programmes such as this to support the effort to remove the stigma around the condition. I m continually impressed by the people who work in aged care. Their passion and dedication is admirable so it s wonderful to have this programme to support their efforts. Mrs Redfern says it's vitally important to the programme s success to have ARC managers who support and understand what the programme is designed to achieve. To follow up the training we do with ARC facilities, a series of master classes are run which cover different aspects of personcentred care to ensure the learnings continue to be embedded into practice. These are open to everyone who has completed the programme. Additionally, consultations are provided to ARC facilities who are experiencing challenges in providing care for specific residents. These consultations include the multidisciplinary team involved in the care of the residents. We get to know the residents life story and aspects that might help in providing them with care that is right for them. 52 Annual Report 2016 / 17

53 3 D WDHB PRESENT CARE WITH DIGNITY WORKSHOPS ACROSS NZ Following an invitation from the Health Safety & Quality Commission, clinicians from throughout New Zealand have been introduced to a model of care developed by Whanganui DHB. Care with Dignity was developed to improve care for patients who have cognitive impairment and help prevent them from falling and suffering harm. In midapril, two senior WDHB nurses presented workshops to more than 400 people interested in hearing how Whanganui Hospital s Medical Ward cares for their patients who have dementia and other forms of cognitive impairment. Medical Ward clinical nurse manager Colleen Hill and Medical Services nurse manager Wendy StanbrookMason discussed examples of how the Care with Dignity model of care had resulted in farreaching benefits for their staff, patients and whānau/family members in the twoandahalf years since it was introduced. Colleen talked about real patient stories and I discussed the evidence and what the information we collected told us Mrs StanbrookMason says. We explained how, by having our health care assistants provide close care for cognitively impaired patients, the Medical Ward has not had one fall with harm in this very vulnerable patient group since late Because Care with Dignity requires health care assistants to provide close care of our patients, we will soon be changing the name to Close Care with Dignity which will also help to distinguish the difference between our model, and one used by the UK s National Health Service. Mrs StanbrookMason says besides the devastating impact a fracture has on a patient and their family, repairing a fractured hip can cost $47,000 and result in long hospital stays. And if it s a hip fracture with complications and discharge to an aged residential care facility, the costs can be as much as $135,000. Money aside, it s all about preserving a person s quality of life. We know people with cognitive impairment are more likely to have a fall. In the UK, it s been shown that a patient with dementia is three times more likely to have a fall that results in a fracture, than someone who is cognitively well. An added benefit of providing close care is that patients feel safer which, in turn, decreases the need for medications often used to calm those who become aggressive as a result of the confusion that patients who have cognitive impairment can experience. Back: WDHB clinical nurse manager, Medical Ward Colleen Hill & WDHB nurse manager, Medical Services Wendy StanbrookMason. Front: Whanganui Hospital Medical Ward health care assistants Brenda Spicer & Betty Kaata Annual Report 2016 / 17 53

54 3 5 C WE DELIVERED RENAL SERVICES CLOSER TO HOME Until recently, Karen* would regularly take a day off work to travel to attend her nephrology clinic appointment at Palmerston North Hospital. Today, she takes a long lunch to attend her appointment at Whanganui Hospital where she meets with renal nurse practitioner Albert Robertson who now travels from Palmerston North to see her. This is what bringing care closer to home is all about and Albert and Karen* couldn t be more pleased with the way it s working. Formerly employed as a fulltime renal clinical nurse specialist at MidCentral DHB, Mr Robertson has been contracted by Whanganui DHB since June 2016 to work 20 hours a week supporting renal patients across Whanganui s primary and secondary healthcare services. It s the first time we ve had a dedicated renal nurse practitioner in our district. * The patient's real name has been changed to protect their privacy Below: Renal nurse practitioner Albert Robertson speaks with a patient Besides working alongside Medical Services clinical director Dr Tom Thompson at Whanganui Hospital, Mr Robertson also: holds a weekly nurseled renal clinic for patients referred for specialist assessment and management support provides expert advice and supports GP practices with the management of high risk chronic kidney disease (CKD) in order to slow progression of the disease upskills primary care health professionals in effective management of CKD and works with patients and their whānau/family to help them understand CKD provides education on the use of tools for early detection and management of chronic kidney disease in the community works to improve health literacy and raise awareness of kidney disease and kidney health. Mr Robertson s role enables him to drill down on districtwide data and identify areas where we can improve such as making sure we re classifying each person with CKD correctly. Whanganui Regional Health Network clinical director primary care Julie Nitschke says having Mr Robertson working in Whanganui has certainly raised the focus and knowledge of CKD among health professionals. It concerns Mr Robertson greatly that one out of 10 New Zealanders has some form of kidney disease and that the incidence of diabetes keeps rising. Kidney disease can be debilitating for some patients, but until we succeed in reducing diabetes, we're not going to see a decline in numbers, Mr Robertson says. Once you develop kidney disease the damage is permanent and incurable end stage kidney disease where people need dialysis, it has a profound effect on their quality of life. To help prevent this, Mr Robertson encourages people to eat healthily, exercise, not smoke and to attend events such as the Kidney Health Day that Whanganui Regional Health Network and Kidney Health New Zealand jointly hosted on 7 February this year. These educational programmes are provided annually for the general public, patients affected by CKD and health professionals working with affected patients and their whānau. 54 Annual Report 2016 / 17

55 5 D Albert s role has been to focus on people with advanced stage CKD. In doing this, he s highlighted the importance of increasing education and awareness for those with renal disease. It s about focusing on the patient/family and looking at how we can provide services closer to home. We're also investing in supporting people at an earlier stage in the disease process, and ensuring patients and their family/whānau fully understand the condition and the options open to them. Retired Whanganui resident Bill Greening has been a renal patient for three years. His first encounter with the renal service was at Palmerston North Hospital where he found the renal staff, including Mr Robertson, to be very supportive. Mr Robertson visited his home in Whanganui to see what they could do to support him. Until recently, Mr Greening would travel to Palmerston North every three months for checkup consultations. These visits have now been reduced to twice a year. Having Albert come to me has made an extraordinary difference to my sense of wellbeing, Mr Greening says. Not having to travel to Palmerston North is very helpful but Albert is also extremely knowledgeable and understanding. He s an outstanding man. What he brings to any meeting we have is himself and his extraordinary level of empathy which is priceless. Springvale Medical Centre practice partner Dr Johanita Engelbrecht shares Mr Greening s sentiments. Albert s availability for consultation and advice regarding patients with chronic renal problems has been very beneficial for GPs managing these patients, Dr Engelbrecht says. Patients find him very supportive and his consultations with Whanganui patients mean some don t need to travel to Palmerston North." epharmacy GETS THE 'THUMBS UP' Early 2017, saw the implementation of the new electronic epharmacy system used by Whanganui Hospital s Pharmacy to order and dispense medications prescribed to patients. The six central region DHBs (Whanganui, Capital & Coast, Hutt Valley, Wairarapa, MidCentral and Hawke's Bay) had planned to move their pharmacy management services to epharmacy for several years to enable improved patient safety and medicines management. Whanganui DHB was using an old system which hadn t been upgraded for more than 20 years and was well and truly showing its age, says WDHB pharmacy manager Megan Geertson. We required an integrated and futureproofed electronic system that would enable us to participate in emedicines Management initiatives and allow us to streamline pharmacy services, enable the hospital to see how it s medication budget is being spent, and ensure patients are prescribed the right medicine, in the right dose, at the right time. As we share the epharmacy system with MidCentral DHB, our pharmacy team worked closely with MidCentral staff, vendors and the Whanganui DHB IT and Finance teams to successfully launch epharmacy earlier this year. And, the hard work paid off when epharmacy was implemented without a hitch. Mrs Geertson says her team now has improved reporting with increased visibility on medication use, both financially and clinically. epharmacy also enables the pharmacy team to send orders electronically directly to wholesalers (rather than via fax) and to use handheld scanners to assist refilling the hospital ward's medication supplies and improve medication management. Annual Report 2016 / 17 55

56 1 2 3 A OUR CHILDREN'S TEAM LEAD PROFESSIONALS ARE MAKING A DIFFERENCE In the two years since Whanganui's Children s Team was launched, Whanganui DHB has appointed five staff in lead professional roles staff who work with families, vulnerable children and young people. WDHB health promotion manager Marama Cameron says collectively, the lead professionals from the health, education, primary care, Iwi services, Police, whānau social services and nongovernment organisations (NGOs) are achieving improved outcomes for children and whānau living in the Whanganui DHB region. Our lead professionals are responsible for ensuring that a child is at the centre of every decision made on their behalf, by the Children s Team, says Mrs Cameron. They make sure that every child they work with has a voice and that their 'voice' is heard. The Children s Team prepare an individualised action plan for every child. This plan identifies the challenges they and their whānau face to ensure the right services are delivered to meet their needs. The child and their whānau are then supported to lead the change to improve their overall wellbeing. Mrs Cameron says the practitioner must value whānaungatanga (the links and connectedness between family members), and have the ability to work within a whānaucentred approach. The lead professional also coordinates the network of services and professionals working with the child and their whānau, so that wellplanned interventions are delivered effectively and designed to reduce overlap and inconsistency with other practitioners and services. WDHB lead professional Mandy Musa knew when she took on the role that the families assigned to her would be complex and require support from many agencies. But what excited her about being a lead professional was the opportunity to use her skills in child and adolescent mental health to promote positive change to the families and individuals she would work with. My approach is strengthbased, Mrs Musa says. By that I mean, my approach involves identifying the families strengths to bring about positive change. It s about getting families to recognise their strengths and build on them. Mrs Musa says a good example is a family who identifies their strength to be their desire for their child to have the best education possible. This child may have a long history of truancy so I will work with the family and appropriate agencies to see how we can draw up a plan and set achievable goals to make sure the child attends school. We want to empower the family to make the changes we all agree are needed to get their child to school. WDHB Children's Team lead professional Mandy Musa 56 Annual Report 2016 / 17

57 I ve worked with families who have struggled with their child/children s school attendance for a long time, but by all working together we have seen those children attending school and we celebrate that. While it might sound simple to get a child to go to school, it can actually take months for us to reach that point but we do get there, and it s very rewarding for everyone involved seeing the change happen. It might involve the parents committing to getting up with their children, giving them breakfast and walking them to school on time. And it might involve getting the school principal on board to call the family if the child fails to turn up. For some families, it means making a huge change which is brought about through a team approach. Another example where Mrs Musa has made a difference is working with a disabled child who needed glasses. When talking to the child s mother, Mrs Musa learnt that the child had not attended two, if not three, appointments with the WDHB s eye clinic which were booked during a time when the mother was in hospital being treated for a serious injury. As soon as Mrs Musa learnt this she arranged for a fourth appointment to be made, checked with the mother that the time, date and place suited her, and now the child has glasses. It s all about building relationships based on trust and selfempowerment for my families, Mrs Musa says. "Everyone wants what s best for their children but some need help to achieve this and that s what I see myself facilitating. Mrs Musa says while she knows it may not be possible for every lead professional to be flexible with their time, she feels fortunate to be able to work her hours around her clients. I normally work Monday through to Thursday but if I have a family who really needs my help on a Friday, I will do my best to move my hours which the WDHB is very supportive of me doing. In April 2015, an Expert Advisory Panel undertook a review of the way vulnerable children and young people were being protected and cared for. Two years later, Oranga Tamariki Ministry for Vulnerable Children was inaugurated a new standalone ministry which incorporates the Children s Action Plan Directorate who oversee New Zealand's 10 Children s Teams. Under the new Ministry, the Government has demanded a new way of working whereby everyone has a hand in. They've asked for creativity and innovation and for all services to work together to support our vulnerable children so they can thrive achieve and belong. Why? Because child abuse in New Zealand is ashamedly worsening with, on average, one child dying at the hands of abuse every five weeks. Most of these children under the age of five. Whanganui DHB staff contribute to Whanganui's Children s Team at all levels including lead professionals, a health broker, panel members and governance representation. Annual Report 2016 / 17 57

58 2 5 A WE EMBRACED THE HEALTHY FAMILIES NZ INITIATIVE One of the best decisions Whanganui DHB has made in recent years was to support and partner with Healthy Families NZ an initiative which aims to help people make healthier choices for themselves and their families. Six organisations are represented on the Healthy Families Whanganui Rangitikei Ruapehu (HFWRR) leadership group: Te Oranganui Sport Whanganui Rangitīkei District Council Ministry of Health Ruapehu Whanau Transformation Group. WDHB Service and Business Planning general manager Tracey Schiebli says building resilient communities requires focusing on the places where we live, learn, work and play. Healthy Families Whanganui Rangitikei Ruapehu, for which Te Oranganui is the lead provider agency, helps us do this, Ms Schiebli says. One outstanding initiative that s come of this collaborative approach is the 'Water Only' initiative. SCHOOL AND COMMUNITIES APPLAUDED FOR SUPPORTING 'WATER ONLY' EVENTS HFWRR and Whanganui DHB are delighted with the number of school and community events across the region that have chosen to be water only. Since the first 'Water Only' event took place (the Paetamariki Primary Schools Kapa Haka competition run by Upokongaro School in 2016), the region has seen increasing numbers of event planners opting for water only a response WDHB nutrition and physical activity health promoter Karney Herewini has been working hard to encourage. The work that s been undertaken with 'Water Only' schools has highlighted an opportunity for the initiative to extend outside of the school gates, Mr Herewini says. It s great to see our community being proactive about making the healthier choice easier for everyone. When access to water was identified as a key barrier for 'Water Only' events, five 'Water Only' event resource kits were developed and are housed across the region by local community organisations. We wanted a realtime solution that was simple, practical and accessible to people in our large geographic area, says HFWRR team leader DebbieJane Viliamu. The working group is focused on creating sustainable solutions for increasing access to water, in sport and recreation spaces across the region, in a collaborative approach with the three local territorial authorities. This year, 36 events (with an estimated 11,290 participants) have used the resource kits which include four 20litre water containers, 'Water Only' signage and a table. The kits have been used for events as big as the National Secondary Schools Triathlon Championships held in Whanganui, and as small as community celebrations for 50 people. The 'Water Only' resource kits housed in Ohakune, Taihape, Marton and Whanganui can be booked online via the HFWRR website. Event planners can also find on the website, a 'Water Only' event tip sheet, key messages and the 'Water Only' logos to further support their event. Feedback regarding the resource kits from event organisers has been very good, Mr Herewini says. They re being put to good use, rubbish has decreased, and the fact we re providing a free, healthy alternative to the sugarsweetened beverages traditionally associated with many of our events is viewed as a real positive. 58 Annual Report 2016 / 17

59 USING A COLLABORATIVE MODEL TO DELIVER THE WORKWELL PROGRAMME During the past 12 months, Whanganui DHB s Public Health Centre, HFWRR and the Whanganui Regional Health Network have worked collaboratively to deliver the WorkWell programme to workplaces that have registered their interest in Whanganui, Rangitīkei, Ruapehu and Taihape. WorkWell is a free, workplace wellbeing initiative designed to support workplaces to work better through wellbeing. Developed by Toi Te Ora Public Health Service in the Bay of Plenty, WorkWell can be adapted to any workplace. With stepbystep support and mentoring from an assigned WorkWell advisor, easy to use resources, workshops, networking opportunities and recognition through accreditation, WorkWell can help create a happier, healthier and more productive workplace. The WorkWell team has begun to engage with targeted population groups businesses of 20plus employees with a high number of Māori and Pacific Island staff. These businesses have been identified in the first instance through the work HFWRR has completed through mapping of local businesses. The three organisations delivering the programme work alongside Toi Te Ora and a WorkWell advisor to ensure the quality and integrity of the programme. All are committed to ensuring this is ongoing and that we make a difference to workplaces in our region. New World Ohakune owners Annie & Dan Rolls WORKWELL'S IMPACT ON NEW WORLD OHAKUNE New World Ohakune owners Dan and Annie Rolls liked the WorkWell programme as soon as they began exploring it. They ve always had a strong interest in supporting the health and wellbeing of their staff but they particularly liked the WorkWell programme s focus on encouraging staff to engage in and drive their own efforts. As soon as they signed up in 2016 they surveyed their staff to see where they saw themselves in terms of their health and wellbeing. The results surprised us, says Mrs Rolls. By including a financial component to see if there was a correlation between how our staff manage their finances and their ability to manage their health positively, it was clear there were four areas to focus on physical activity, healthy eating, financial literacy and mental health." The way they saw it, all four were closely linked so the next step saw them working alongside three young employees keen to provide their colleagues with information and resources. When looking at physical activity, they realised that while they have always provided their staff with gym memberships, staff found it hard to fit gym sessions into their schedules. A lot of their work is quite physical so some felt too tired to go to the gym and for others, their work hours made it difficult, Mrs Rolls says. So the three employees suggested walking sessions in staff breaks might work and they began mapping walks that would allow staff to fit in both eating and walking in their lunchtimes. In supporting healthy eating, they provide information about healthy food choices, encourage their staff to eat well by setting a good example and encourage them to bring healthy options for shared morning/ afternoon teas and lunches. Working closely with the Ruapehu Whanau Transformation Plan, they explored ways to help their staff achieve home ownership. By assisting staff with savings accounts and budgeting advice specifically targeted at their personal goals, one staff member and their family became home owners in July this year, and two others had house deposits as a result of this encouragement. To support mental health, the Rolls encourage/insist their staff take annual leave and, on a daytoday basis, their breaks. We also believe healthy eating and physical activity play a big part in supporting the mental health of our staff, Mrs Rolls says. At this point New World Ohakune staff are aiming to achieve bronze in the WorkWell accreditation programme but given their enthusiasm, they may well go for silver and gold after that. Annual Report 2016 / 17 59

60 D OUR HAUMOANA CONTINUED PROVIDING VALUABLE SUPPORT TO ALL PATIENTS & FAMILIES Hospital is a strange place for most whānau (all patients and their families). They often find it difficult to speak up about their concerns and do not ask many questions. The haumoana team, which is available to help all families/whānau that need them 24 hours a day seven days a week, is proving more and more valuable in helping those using our services. Haumoana navigator surgical services team Kiri Thompson says it s important for whānau that they understand the information they ve been given and understand the conversations they re having with the people who are caring for them. It s a real privilege to work with our patients and I find it very rewarding and satisfying to be in a position to help them and their families in what are often stressful times, Kiri says. Sometimes it s the little things that help the most such as making sure whānau know they can stay at the bedside with their loved one and help care for them if they want to. The haumoana team can help by arranging meetings between the health care team and whānau, sit in on the meeting and help whānau understand what is being talked about as well as the treatment and plans that may be needed when they go home. And also help patients and their families navigate/access our services including following up whānau who have missed their outpatient appointments and helping them get another appointment at a time they are able to attend. We re connected to our community and know a lot of the Māori whānau that come into our hospital, and they know us, which helps them feel more relaxed and confident, which in turn, helps them when they re receiving care and treatment, says Reneti Tapa, haumoana navigator emergency department. And being able to advise and assist our colleagues, so that the cultural values and beliefs of the Māori whānau they care for are acknowledged and respected, can only help whānau to feel more comfortable while they re with us. Staff working in the hospital afterhours really appreciate the support they receive from the haumoana team. Having the support of the haumoana team is wonderful, we know we can call them anytime when families need assistance. Sadly, that is sometimes when a family member has passed away or if we need advice to help us provide the best care for whānau, says the duty nurse manager. Families also appreciate the support the haumoana provide including Mauri Ora the house used as emergency accommodation for families from out of town with loved ones in Whanganui Hospital. Although Mauri Ora and the haumoana service, as a whole, are looked after by Te Hau Ranga Ora (Māori Health Services), both are available to all families who need their assistance and support. WE CONTINUED TO GROW OUR CULTURAL KNOWLEDGE AND AWARENESS Over the past 18 months, almost 600 of our staff have attended the Hapai te Hoe cultural education programme introduced in This programme has been developed to help our staff grow their Māori cultural awareness and knowledge and feel more confident when they are partnering with Māori patients and their families (whānau). In turn, Māori whānau appreciate the efforts staff are making to acknowledge the importance of Māori values and beliefs when they are caring for them in hospital. Whānau feel vulnerable when they, or one of their whānau, are unwell. Understanding and being cared for in a way that takes into account their personal cultural values and beliefs is important and contributes to the overall wellness of whānau, says Ned Tapa, WDHB haumoana educator. We want whānau to feel respected and understood and to engage freely in their cultural practices while they are in hospital or using any other district health board services says Rihi Karena kaitakitaki, Te Hau Ranga Ora clinical services manager. Our powhiri and Hapai te Hoe programme is the beginning of four days of orientation for every new staff member joining the district health board, no matter where in the organisation they work, Rihi says. It s about making sure our staff are informed and work ready. The programme is delivered in a relaxed environment using stories of local Māori history, examples of lived realities of whānau, reflection on current practices, cultural mythbusting, and the positive impact on health outcomes when health care teams are true partners with whānau. "A very unique way of experiencing, building understanding of Māori culture. Love that it was in the context of our community. Thank you for sharing your knowledge." Hapai te Hoe attendee 60 Annual Report 2016 / 17

61 3 D WE MADE OUR RISK ASSESSMENT LESS REPETITIVE Whanganui DHB strives every day to keep our patients safe from harm. To help us reduce patient harm, we must understand more about each individual patient, their medical history, the health issues they currently have and any factors that put them at higher risk of suffering harm. An important way to gain this knowledge and understanding is through nurses assessing the degree of risk individual patients may present with on admission. In the past, different types of risk were assessed using different types of risk assessments. This meant nurses asking patients and families the same type of question repetitively and extensive time taken filling out several forms. The Whakataketake (the name gifted by the DHB's kaumatua meaning information from many sources) is a single nursing assessment form completed for every patient. This new computerised assessment tool has replaced multiple paper assessments previously used. By asking questions only once, nursing staff can see when a risk identified in one area helps us recognise a risk in another. For example, an elderly patient who has unexpected weight loss is highly likely to be at risk of falling as well as at risk of suffering a pressure injury. Nurses can now consider all the risks together and spend more time partnering with the patient and their family/whānau to develop an action plan that will help keep them safe. The Whakataketake acknowledges that no two patients are the same so the care that results from this assessment process can be individualised. 1 FALLS PRESSURE INJURIES MUST SMOKEFREE MOBILITY I have so many assessments to complete, I often don t have a chance to finish them. Every time we have an audit it shows this up. I feel like I m letting the patients I care for down. PATIENT The nurse asks me the same question over and over. Why don t they just write my answer down? NURSE 2 3 I understand you need to keep me safe and well while in hospital, but why do I have so many questions repeated? If we combine all the assessments into one, the repeated questions can be removed and we can ask questions that are not on other assessments. You are right. PATIENT The level of risk does not matter. What matters is that staff see all your risks, big and small and we do all we can to reduce them all. It s not the assessments but the actions we put in place that keep you safe. We can use an electronic platform for nurses, this will enable easy auditing and speed up documentation for nurses. D.O.N 4 COMBINED RISK ASSESSMENT 6 Combined risk assessment/ Whakataketake completed. Including falls, pressure injuries, high risk of delayed discharges, flag for mobility and manual handling, smokefree assessments and MUST (nutrition screening tool). 5 PATIENT I enjoyed the chat with my nurse. We talked about lots of things but I didn t have to repeat any important information I d told other staff. There were certain services, like Te Hau Ranga Ora, I wanted to see. Because we d done the whakataketake, these services knew automatically to come and see me. That s right. Rather than doing lots of things that only look at part of your needs, we now gather your whole story and offer your whānau the opportunity to contribute. This helps us identify the areas where you will need support, such as falls or the need for cultural support service or assistance on discharge. NURSE COMBINED RISK ASSESSMENT Annual Report 2016 / 17 61

62 62 Annual Report 2016 / 17

63 STATEMENT OF PERFORMANCE PŪRONGO MAHI Annual Report 2016 / 17 63

64 POPULATION HEALTH CONTINUUM OF CARE HEALTH PROMOTION & DISEASE PROVENTION General population living healthy and well Output Class 1: PREVENTION SERVICES Preventative services are publicly funded services that protect and promote health in the whole population or identifiable subpopulations comprising of services designed to enhance the health status of the population as distinct from treatment services which repair/support health and disability dysfunction. On a continuum of care these services are public wide preventative services. $4m expenditure EARLY DETECTION & INTERVENTION ASSESSMENT, DIAGNOSIS & TREATMENT SUPPORT, HABILITATION & REHABILITATION PALLIATIVE CARE At risk population keeping healthy Individuals developing and managing early health conditions Individuals with long term conditions preventing deterioration/complications Individuals with end stage conditions being supported Output Class 2: EARLY DETECTION & MANAGEMENT SERVICES Early detection and management services are delivered by a range of health and allied health professionals in various private, notforprofit and government service settings. They include: general practice, community and Māori health services, community diagnostic and pharmacy services and child and adolescent oral health services. These diagnostic and treatment services are focused on, and delivered to, individuals and smaller groups of individuals. $55m expenditure Output Class 3: INTENSIVE ASSESSMENT & TREATMENT SERVICES Intensive assessment and treatment services are delivered by a range of secondary and tertiary providers using public funds. These services are usually integrated into facilities that enable colocation of clinical expertise and specialised equipment such as a hospital. These services are generally complex and provided by health care professionals that work closely together. Whanganui DHB provides a wide range of intensive assessment and treatment services to its population. The DHB also funds some intensive assessment and treatment services for its population that are provided by other DHBs. These services are at the complex end of treatment services and focused on individuals. $147m expenditure Output Class 4: REHABILITATION & SUPPORT SERVICES Rehabilitation and support services are delivered following a needs assessment process and coordination input by Needs Assessment and Service Coordination (NASC) Services for a range of services such as homebased support services and residential care services for older people. This output class also includes palliative care services for people with endstage conditions and services that support people with a disability. Whanganui DHB contracts for the provision of these services from a wide range of providers, including Hospice Wanganui, rest homes and homebased support agencies. These services are focused on, and delivered to, individuals. $37m expenditure 64 Annual Report 2016 / 17

65 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 TO WHANGANUI DHB, ACHIEVEMENT MEANS: people enjoy healthy lifestyles within a healthy environment the healthy will remain well health and disability services are accessible and delivered to those most in need the health and wellbeing of Māori is improved the quality of life is enhanced for people with diabetes, cancer, respiratory illness, cardiovascular disease and other chronic (long duration) conditions people experiencing a mental illness receive care that maximises their independence and wellbeing the needs of specific agerelated groups, e.g. older people, children/youth, are addressed the wider community and family supports and enables older people and the disabled to participate fully in society and enjoy maximum independence oral health is improved people s journey through the health system is well managed and informed. Each year the sets out its plans for the coming 12 months in its Statement of Performance Expectations. This statement captures the level of service the DHB expects to provide, together with the expected impact and outcomes that contribute towards achieving its vision of 'Better health and independence through integrity fairness looking forward innovation. The Statement of Performance describes the WDHB s nonfinancial performance against forecasts described in the Statement of Performance Expectations. The 2016/17 WDHB Annual Plan describes three populations groupings which the WDHB provides particular focus on improving health outcomes. These are women and children, older people and those people with longterm conditions. The Statement of Performance has four parts, reflecting the key categories of services or outputs provided. These are: Prevention Services Early Detection and Management Intensive Assessment and Treatment Rehabilitation and Support. These categories reflect the full health and wellbeing continuum: from keeping people healthy, identifying and treating illness, through to supporting people to age well. In presenting our performance it would be overwhelming to show every output delivered. We have therefore selected those measures that have the greatest potential to contribute towards the achievement of the WDHB s vision. Often providing the service to the right people is more important than just the volume of services delivered. We have therefore presented a range of measures that provide a broader picture of the service than just the volume delivered. Those measures shaded in grey attempt to demonstrate the impact on the region s population of the services Whanganui DHB outputs. STATEMENT OF PERFORMANCE GUIDE PERFORMANCE TREND In evaluating the performance of, it is useful to understand the general trend of performance of a period longer than the current and previous year performance for applicable measures. For these measures, a colour key has been included to indicate general trends over at least the last four years. It is important to note this is not an indication of meeting, or not meeting, targets. For example, even if the target is not met but the general trend is improved performance, the trend of the measure will show with a green swatch. Focus area 3 D Measure Percentage of resourced elective theatre time utilised Percentage of people who receive their planned surgery within 4 months 2015/ / / /18 T performance performance target target Achieved Com 98% Achievement Achieved T Trend Improving trend 3 3 D D Faster Cancer treatment (new Health Target 2015 ) 100% 80% Total 92% Māori 90% Other 92% 83% 100% 85% 100% 85% Almost achieved (within 5% of target) Not achieved Steady trend Declining trend BASELINE TO BE ESTABLISHED MEASURES Some measures are being reported for the first time and while the baseline data for the 2016/17 period has been reported for most, the targets for these measures are yet to be established, therefore achievement is not indicated. Where this is the case, the comment 'Baseline to be established' has been stated. EQUITY RATIO Reducing inequalities in health outcomes, in particular health inequalities experienced by Māori, is a key priority identified in the National Health Strategy and a key priority for the Whanganui DHB. To help understand the inequality in health outcomes between Māori and nonmāori, an equity ratio has been included with some measures. The equity ratio illustrates the relative gap between the health outcomes measured for Māori and nonmāori. A ratio of 2 for a disease state shows that Māori are twice as likely to have the disease. A ratio of 2 for a screening service illustrates that the nonmāori population are screened at twice the rate of Māori. A lower ratio indicates relatively reduced inequality. A ratio of 1 illustrates that health outcomes and service measures for Māori and nonmāori are the same. Annual Report 2016 / 17 65

66 SYSTEM LEVEL MEASURES One of the five themes of the New Zealand Health Strategy (the Strategy) is value and high performance which places an emphasis on measuring the performance of the whole system as well as component parts. The Strategy recommends the development of an outcomesbased approach to performance measurement that will guide the delivery of constantly improving health services. The Ministry of Health has worked with the sector to codevelop a suite of system level measures to support this wholeofsystem view of performance. Whanganui's System Level Measures plan is developed in partnership with its governance partner, Hauora a Iwi, and the two PHOs (Whanganui Regional Health Network and National Hauora Coalition) and aligns to the national System Level Measures Framework. Performance against our local System Level Measures Plan is reported on the following pages. AMBULATORY SENSITIVE HOSPITALISATIONS (ASH) 04 YEARS The longterm outcomes we are looking for This measure is about keeping our tamariki out of the hospital. As a Whanganui health system, we want our children to have a healthy start in life, so we can reduce the burden of disease in childhood with a strong focus on health equity. We want equitable outcomes for Māori tamariki as a high variance among priority populations according to social gradient exists. The 2016/17 target set for this measure was to reduce the Whanganui Māori 04 years nonstandardised ASH rate per 100,000 from 12,312 to 12,189. Results This target has been achieved with a decrease in admission rates to 7,101 per 100,000. The results also indicate a marked improvement in the equity between Māori and nonmāori with the equity ratio being the lowest in the last five years. The ambulatory sensitive hospital (ASH) admissions have returned to a level more consistent with previous years. There are many factors that can influence this result as the measure covers a wide range of conditions. The introduction of the rotavirus vaccine has however seen a reduction in gastrointestinal admissions. 14,000 12,000 10,000 8,000 6,000 4,000 2, /13 (12 months to 31 March 2013) Nonstandardised ASH rate per 100,000 population, 04 years 2013/14 (12 months to 31 March 2014) 2014/15 (12 months to 31 March 2015) 2015/16 (12 months to 31 March 2016) Total Māori Other National Total Equity Ratio 2016/17 (12 months to 31 March 2017) Equity Ratio ACUTE HOSPITAL BED DAYS PER CAPITA The longterm outcomes we are looking for This measure is about using our health resources effectively. As a Whanganui health system, we want our population to be well in the community, and supported to receive appropriate care when they are not well. We want to reduce the amount of time people need to spend in hospital through good upstream primary care, and discharge and transition planning. This requires good communication and cooperation between primary and secondary care. We know that better prevention and management of longterm conditions is essential to support improvement against this target in the long term. We will give particular attention to older people who make up the majority of our acute admissions. The current data includes intermediate care bed days provided by aged residential care providers. Whanganui DHB rates will come down significantly once this data is separated out. Results The target set for this measure for 2016/17 was to reduce the Whanganui total standardised acute bed days rate per 1,000 from 421 to 379. This target has not been achieved, with acute bed days increasing to 443 per 1,000 days. This has mainly be driven by increased days in the 8084 age group receiving rehabilitation type services. With the removal of the intermediate care bed days, the result is within the target at approximately 374 bed days per 1,000. Heart failure, cardiovascular disorders and respiratory disorders make up a significant portion of acute bed days Standardised acute bed days per 1,000 population Māori Pacific Other Total 12 months to March months to March months to March Annual Report 2016 / 17

67 AMENABLE MORTALITY The longterm outcomes we are looking for This measure is about prevention and early detection to reduce premature death. Amenable mortality is defined as premature deaths (deaths under age 75) that could potentially be avoided, given effective and timely health care. That is, early deaths from causes (diseases or injuries) for which effective health care interventions exist and are accessible to New Zealanders in need. Not all deaths from these causes could be avoided in practice, for example, because of comorbidity, frailty and patient preference. However, a higher than expected rate of such deaths in a DHB may indicate that improvements are needed with access to care, or quality of care. We know the prevention and management of risk factors is essential in reducing the development of morbidity. Improvements in this measure need to be viewed over a longer period than by single year. Whanganui DHB s strategic intent is to shift investment toward health gain and advance Māori health. This will require investment in health promotion, and primary and community services, so that health can make a greater contribution to improving the determinants of health and wellbeing, and build resilient communities. Results In the first year, the DHB set a target of maintaining the amenable mortality rate at the 2013 rate. Performance against this measure is only evident when data becomes available as the data for this measure is produced from the Mortality Data Collection. At the time of print, no further data was available. The 2013 rate of per 100,000 people was an improvement on the 2012 result of The average amenable mortality rate over the period 2009 to 2013, is 2.6 times higher for Māori at compared to for nonmāori. Amenable mortality deaths, 074 year olds Calculated using estimated resident population as at 30 June Northland Waitemata Auckland CountiesManakau Waikato Lakes Bay of Plenty Tairawhiti Hawkes Bay Taranaki MidCentral Whanganui Capital & Coast Hutt Valley Wairarapa NelsonMarlborough West Coast Canterbury Sth Canterbury Otago Southland Overseas & undefined Total New Zealand Number of deaths Age standardised rate Average 4 highest PATIENT EXPERIENCE OF CARE The longterm outcomes we are looking for This measure is about our commitment to whānau, personcentred care. As a Whanganui health system, we encourage patient involvement and feedback to support service development and improvement, to lead to improved patient experience of care. We recognise that how people experience health care can be influenced by all parts of the system and the people who provide the care. As it is difficult to understand how well integrated a system is until you are a user of the system, we want to get a better understanding of the patient experience from the patients and their whānau themselves. We are committed to making sure our services are responsive to those with the highest needs, as we know that if we get it right for this group, we are well on the way to getting it right for everyone. As a district with a high Māori population, and high levels of social deprivation, there is a strong emphasis on making sure services are culturally appropriate. Results The shortterm target we set ourselves in relation to this measure was that 90 percent of general practices participate in the primary care survey during 2016/17. Results for 2016/17 indicated 40 percent of practices were participating. Issues with the National Enrolment Service (NES) have delayed implementation across general practice. Once the issues with the NES were resolved, progress continued towards achieving the target. The target is expected to be achieved in 2017/18. Patient Experience of Care survey GP practice participation 2016/17 target 90% 2016/17 performance 40% Annual Report 2016 / 17 67

68 OUR FOCUS AREA PERFORMANCE The following section outlines performance measures against key services grouped into focus areas. The focus areas identified for 2016/17 provide an integrated service for the priority population groups of Maternal, Child and Youth Health, Health of Older People, People with LongTerm Conditions including mental health, along with delivering excellence in clinical services. Whanganui DHB expects, that over time, a focus on these areas will make a significant difference to the health and wellbeing of the population it serves. A MATERNAL, CHILD & YOUTH This focus area is about keeping our tamariki out of the hospital. As a Whanganui health system, we want our children to have a healthy start in life, so we can reduce the burden of disease in childhood with a strong focus on health equity. We want equitable outcomes for Māori tamariki as there exists a high variance among priority populations according to social gradient. INFANT HEALTH In recognition of the critical importance of the early years in shaping resilience and setting patterns of future behaviour, infant health services aim to protect from preventable diseases, maintain good wellbeing and ensure infants receive the care they need in order to have the best possible start in life. As the data below indicates, we have made improvements in many areas during the 2016/17 period with immunisation coverage being the biggest challenge for us to make substantive improvements on. Overall, coverage of fully immunised 8month olds has declined slightly (by 1%) from our 2015/16 result. This performance decline predominantly occurred within the latter part of the 2016/17 period and coincided with significant publicity around immunisation safety. With a reduced media focus, it is anticipated that the delivery of immunisation education will return to health professionals and be based on facts and evidence. The DHB can celebrate having the best levels of immunisation among Māori, with 60% of Māori being immunised (vs 54% for the total population). This has been achieved through good communications and proactive work from our primary care practices and Iwi organisations to ensure uptake of the influenza vaccination was maximised. The ambulatory sensitive hospital (ASH) admissions have returned to a level more consistent with previous years. There are many factors that can influence this result as the measure covers a wide range of conditions. The introduction of the rotavirus vaccine has however seen a reduction in gastrointestinal admissions. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Raising Healthy Kids National Health Target 2016/17 7 Percentage of obese children identified in the B4 School Check programme offered referral to a health professional for clinical assessment and familybased nutrition, activity & lifestyle interventions 10% 100% 8% 83.9% 74.5% 47.5% Quarter 1 Quarter 2 Quarter 3 Actual result Target ( ) Quarter 4 6% 4% 2% 0% 5.5% Proportion of eligible children on NIR who are recorded as 'declined' at milestone ages (8 month target 3.6% 24 month target 5.0%) 2014/15 6.0% 5.5% 5.0% 4.5% 2015/ /17 5.9% 8 months 24 months 8 mth target 3.6% 24 mth target 5.0% 14,000 12,000 10,000 8,000 6,000 4,000 2,000 Nonstandardised ASH rate per 100,000 population, 04 years System Level Measure Equity Ratio /13 (12 months to 31 March 2013) 2013/14 (12 months to 31 March 2014) 2014/15 (12 months to 31 March 2015) 2015/16 (12 months to 31 March 2016) 2016/17 (12 months to 31 March 2017) 0 Total Māori Other National Total Equity Ratio 68 Annual Report 2016 / 17

69 CHILD HEALTH Child services strive to keep our children healthy and grow into the best they can be. This is achieved by ensuring children receive regular health promotion and screening for common causes of reduced wellbeing. A preventative focus continues with the provision of oral health services and HPV vaccinations, as well as schoolbased health services. The DHB is pleased that the longterm trend continues to demonstrate better outcomes for children. The continued decline in Mean Score of Decayed, Missing and Filled Teeth of Year 8 Children and the high rate of HPV vaccination for Māori are pleasing to see. We will continue to focus on the inequity between ethnicities. Percentage of 5 year old children who are caries free Mean score of Decayed, Missing & Filled Teeth of Year 8 children 70% (Dec 2015 target 54%) % 50% 40% 30% 20% 10% 54% 32% 63% 53% 35% 62% 56% 35% 66% 53% 35% 62% Equity Ratio Equity Ratio 0% Dec 2013 Dec 2014 Dec 2015 Dec Dec 2013 Dec 2014 Dec 2015 Dec Total Māori Other Target (Dec 2016) Equity Ratio Total Māori Other Target (Dec 2016) Equity Ratio Proportion of young women who have received the HPV vaccine % 90% 80% 89% 70% 60% 50% 66% 74% 40% 30% 20% 10% 0% Māori Other Total Target ( 65%) YOUTH HEALTH Services for youth continue to be well utilised by youth and accessible to them. The steadily increasing volumes of youth accessing mental health services is expected, and reflects unmet need rather than an actual increase in need. This trend is expected to continue into 2017/18 as the DHB and Government continue to recognise the importance of early intervention and access to preventative services. Building on our commitment under Rising to the Challenge, the DHB believes the community will have an increasingly healthy and resilient population as a result of this increased focus on youth mental health needs. Proportion of adolescent population utilising DHBfunded dental services Proportion of population seen per annum by mental health & addiction services (019 year olds) 100% 90% 80% 70% 60% 50% 78% 79% 81% 79% 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 3.70% 3.20% 3.90% 3.50% 4.17% 3.76% 4.85% 4.46% 40% 2.0% 30% 1.5% 20% 1.0% 10% 0.5% 0% 2013/ / / /17 0% 2013/ / / /17 Total Target ( 85%) Total Māori Target ( 4.5%) Annual Report 2016 / 17 69

70 MATERNAL HEALTH Maternity services within Whanganui continue to deliver a first class service to our population for both primary and secondary care women. The outcomes of these services is on par with all other maternity centres. The lead maternity carers (LMCs) within our district are sufficient in number so that all women are able to engage during their first trimester of pregnancy and do receive the full menu of antenatal care available. Uptake of antenatal education has increased during the 2016/17 period although levels of Māori participation remain inequitable to that of the wider population. Strategies to increase equity include restructuring classes to meet the differing needs for education across the community rather than relying on a single syllabus. Breastfeeding levels within Whanganui DHB continue to prove a challenge for the sector. Factors influencing this are complex and often highly individualised. What we do know is that a vast majority of mothers are breastfeeding at the time of discharge from their LMC but this drops substantially by the time the baby is three months old. Reasons for stopping breastfeeding vary and are often very personalised, however common themes have been identified. These themes include: Wishing to return to normal after being pregnant Cultural expectations of sharing the care of babies with wider family Adoption of activities where risks to the baby via milk such as alcohol and drugs consumption is increased Demands of work/study and breastfeeding being incompatible many mothers are time poor for effective breastfeeding. Whanganui has a high level of young parents who are predominantly Māori, which is the cohort that is the most likely to be impacted by all of the factors above. 80% Proportion of infants fully or exclusively breastfed at 6 weeks Antenatal education completed 70% 72% 60 60% 50% 40% 30% 20% 10% 0% 68% 63% 2013/14 61% 55% 52% 51% 48% 2014/ / /17 Total Māori Target (68%) Number of clients Quarter 1 Quarter 2 Quarter 3 Quarter /16 Other Quarter 1 Quarter 2 Quarter 3 Quarter /17 Māori Cervical Screening 3Year Coverage Rate (2569 years) 100% % % % 60% 50% 40% 75% 67% 77% 78% 72% 80% 78% 71% 80% Equity Ratio 30% % % % 2014/ / / Total Māori Other 2016/17 Target (80%) Equity Ratio 70 Annual Report 2016 / 17

71 B HEALTH OF OLDER PEOPLE POPULATION According to Census 2013, there were 11,000 persons aged 65 years and over in our district. This includes about 5,000 over 75 years, and a further 1,400 over 85 years. Projections for 2017 raise this population to just over 12,000. WDHB has an older population relative to New Zealand nationally. Māori make up about 10 percent of our over 65s, but just three percent of our over 85s. Overall, Māori make up a much greater proportion (25%) of our population when compared to the national population. The piechart (below) shows that two out of three people aged over 65 in our district live within the Whanganui City area, while one in five live in smaller towns, like Marton, Bulls, or Raetihi. One in eight live in a rural setting (Census 2013). 20% 15% 10% 5% 0% Percentage Whanganui DHB population (65+ years) 18.18% 7.46% 2.33% Whanganui DHB (2013 Census) 14.31% 6.15% years years 85+ years 1.73% NZ population (2013 Census) Māori & nonmāori as a proportion of WDHB 65+ years population 18% Rural towns 100% 90% 80% 70% 12% Rural 65+ year olds Geographic location (Census 2013) 60% 50% 40% 30% 20% 70% Urban 10% 0% 65+ years 75+ years 85+ years Other Māori Proportion of population aged 65+ years receiving DHB funded support in ARC facilities over the year 8% With the changing demographics of an increased number of older people who are living longer, it is a pleasing result to have maintained the same proportion of people in longterm aged residential care. It demonstrates that our initiatives, such as the individual rehabilitation programme and intermediate care, are achieving the desired result of supporting people to remain in their own home. 7% 6% 5% 4% 3% 2% 3.3% 5.4% 1% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 53% 47% Distribution of clients receiving longterm funded support 42% 58% 42% Aged Residential Care 58% 42% 58% Homebased Support Services 2013/ / / /17 0% 7.4% 7.2% 7.0% 6.8% 6.6% 6.4% 6.2% 6.0% 5.8% 2012/ / / / /17 Māori Other Total Proportion of population aged 65+ years receiving DHB funded homebased support over the year 6.5% 2012/ / / / /17 7.0% Māori Other Total Annual Report 2016 / 17 71

72 Certification is an indication of the quality of an aged residential care facility s care provision and a threeyear plus certification period is a positive indicator. While 85 percent of the DHB s aged residential care providers are certified for three years is a satisfactory outcome, we hope to see this improve. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 85% Percentage of aged residential care facilities with threeyear certification 93% 2012/ / / / /17 Total 100% Target ( 90%) 92% 85% There has been an increase in the number of residents having repeat emergency department attendances which has resulted in the higher number of overall attendances. A more targeted approach to residents who present more than twice needs to occur and will be incorporated into future planning Number of Aged Residential Care residents presenting at the Emergency Department visits Two or less visits 2015/ Total This is a disappointing result overall and indicates that more work needs to be done with the DHB s general practices for this older population group. Proportion of enrolled population aged 65+ years who have received flu vaccination A continued positive trend is the reducing rate of falls for older people in the inpatient ATR Unit. The DHB has a strong focus on falls prevention in inpatient services including ATR and the strategies are clearly working. Occurence rate of falls by people aged 65+ years, per 1,000 inpatient ATR bed days 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 72% 73% 72% 72% 77% 75% 70% 63% 60% 54% 2012/ / / / / % / / / / /17 Māori Total Target ( 75%) Total Target ( 9.5%) 72 Annual Report 2016 / 17

73 C LONGTERM CONDITIONS Longterm conditions account for a significant proportion of health care spend and hospitalisations, as well as being a barrier to full participation and independence in the workplace and society by affected individuals and their family/whānau. Whanganui DHB aims to enhance the quality of life for people with diabetes, cancer, respiratory illness, cardiovascular disease and other chronic (long duration) conditions as well as ensuring the care delivered to people experiencing a mental illness maximises their independence and wellbeing. Nonstandardised ASH rate per 100,000 population, 4564 years 14,000 Source: Ministry of Health , , ,000 6, Equity Ratio 4, , /13 (12 months to 31 March 2013) 2013/14 (12 months to 31 March 2014) 2014/15 (12 months to 31 March 2015) 2015/16 (12 months to 31 March 2016) 2016/17 (12 months to 31 March 2017) 0 Total Māori Other National Total Equity Ratio Better Help for Smokers to Quit Hospital Better Help for Smokers to Quit Maternity 100% 90% 80% 70% 96% 94% 94% 97% 97% 100% 90% 80% 70% 100% 100% 100% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% Q4 2014/15 Q4 2015/16 Q4 2016/17 Total Māori 2016/17 Target () 0% Q4 2014/15 Q4 2015/16 Q4 2016/17 Total 2016/17 Target (90%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Better Help for Smokers to Quit Primary Care 94% 88% 86% Q4 2014/15 Q4 2015/16 Q4 2016/17 Total 2016/17 Target (90%) Whanganui DHB is showing consistent performance over many of the measures for LongTerm Conditions. The ambulatory sensitive hospital (ASH) admission rates for both Māori and non Māori have increased slightly against last year s result. There are many factors that can influence this result as the measure covers a wide range of conditions however, cardiovascular disease is a primary contributor. The equity ratio, which indicates the relative gap between Māori and nonmāori health outcomes has slightly increased, indicating a gradually widening gap in health outcomes represented by this measure. Whanganui DHB s focus on reducing inequality aims to reduce this disparity. Through cardiovascular risk assessment, people are identified as at risk of CVD or diabetes to enable timely assessment, diagnosis and management of conditions and practices continue to maintain focus and commitment to achieving the targets. The proportion of enrolled patients with diabetes who have a HBA1c of less than 64 mmol/mol has remained below target primarily due to screening processes identifying an increased number of people with diabetes. The focus of screening in 2017/18 is on 3544 year old Māori men to help improve the health outcomes in this group. Annual Report 2016 / 17 73

74 Proportion of eligible population who have had their cardiovascular risk assessed in the last five years 100% % 80% 70% 91% 87% 92% 91% 87% 91% 91% 89% 92% 91% 89% 92% % 50% 40% Equity Ratio 30% % % % 2013/ / / / Total Māori Other 2016/17 Target ( 90%) Equity Ratio Percentage of people who were referred to, and attended, a cardiac rehabilitation & education class Proportion of PHO enrolled patients with diabetes who have a HBA1c of <64mmol/mol at last review 50% 100% 90% 40% 30% 20% 10% 41% 36% 41% 41% 80% 70% 60% 50% 40% 30% 20% 66% 76% 63% 64% 38% 43% 45% 40% 10% 0% 2013/ / / /17 0% 2013/ / / /17 Total Target ( 34%) Māori Total Target ( 53%) Percentage of population registered for LTC medicine management Percentage of longterm clients with mental illness who have an uptodate relapse prevention plan (Adult) 3.5% 100% 3.0% 2.5% 2.0% 1.5% 2.8% 2.9% 2.7% 2.7% 2.6% 90% 80% 70% 60% 50% 40% 100% 100% 100% 100% 100% 1.0% 30% 0.5% 20% 10% 0% 2012/ / / / /17 0% 2012/ / / / /17 Total Target ( 2.9%) Total Adult Target ( ) A number of initiatives are in place to support patients to manage their longterm conditions, including selfmanagement programmes, medication management and access to specialist services. The promotion of healthy lifestyles continues to be a priority and increasing health literacy through awareness and education empowers patients to understand their conditions and support selfmanagement. Smoking contributes to an increased risk of developing stroke, heart disease and cancers and is the single biggest cause of preventable deaths in New Zealand. Reducing the prevalence of smoking through a reduction in tobacco uptake and increased cessation will contribute to improved outcomes. The overall results for helping smokers to quit have achieved the national target except in primary care due to a number of factors including data issues. The forward focus will continue to support general practice through outreach to contact patients and ensure smoking status is recorded accurately, as well as provide training and development of general practice teams. 74 Annual Report 2016 / 17

75 D EXCELLENCE IN CLINICAL SERVICE DELIVERY Providing excellent clinical services is key for Whanganui DHB. Equitable, timely access to intensive assessment and treatment services can significantly improve people s quality of life. Responsive services and timely treatment support improvements across the whole system to give people confidence that complex intervention is available when needed. Quality improvement in all aspects of service delivery can improve patient safety and improve outcomes for people in our services. The following measures provide a dashboard of results over a number of key areas of focus for Whanganui DHB. Whanganui DHB is maintaining a high level of clinical excellence meeting the targets in most of the areas in service delivery. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Hand Hygiene compliance with the 'Five moments of hand hygiene' Source: Health Quality & Safety Commission Whanganui DHB rate National rate Proportion of patients attending the Emergency Department who are admitted, discharged or transferred within six hours Percentage of resourced elective theatre time utilised 100% 90% 80% 70% 96% 100% 90% 80% 70% 96% 87% 98% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 2013/ / / /17 0% 2012/ / / / /17 Total Target ( ) Total Target ( ) 100% 90% 80% 70% 60% 50% 40% 30% Percentage of people who receive their First Specialist Assessment within four months 100% 100% 100% 99% 100% 90% 80% 70% 60% 50% 40% 30% Acute Cardiac Services 70 percent of patients will receive an angiogram within three days of admission 61% 73% 70% 20% 20% 10% 10% 0% 2013/ / / /17 Total Target (100%) 0% 2014/15 Total 2015/16 Target ( 70%) 2016/17 Annual Report 2016 / 17 75

76 Percentage of patients who have accepted a CT scan referral and receive their scan within six weeks Percentage of patients who have accepted a MRI scan referral and receive their scan within six weeks 100% 90% 80% 70% 98% 98% 100% 90% 80% 70% 83% 79% 98% 97% 98% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 2014/ / /17 0% 2014/ / /17 Total Māori Other Target ( ) Total Māori Other Target ( 85%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percentage of stroke patients admitted to a stroke unit or organised stroke service with a demonstrated stroke pathway 97% 88% 88% 2014/15 Total 2015/16 Target ( 80%) 2016/17 The measures included provide a view of service performance across five priority areas in clinical service delivery: Shorter stays in the Emergency Department Improved access to elective surgery Cardiac services Improved access to diagnostic services Stroke services. The performance in these measures was commendable, with the achievement of all bar one of the targets, and then only narrowly missing the target for providing elective services within four months of their first specialist assessment. This illustrates the excellent service delivery the WDHB provides its community. These results have been driven out of a continued focus on quality improvement and patient safety initiatives. Some of the initiatives that support the achievement of the positive outcomes for our patients include: Care Capacity Demand Management exploiting existing information systems to put the right nursing staff in the right place at the right time. Changing how we talk and listen improving our health literacy and that of our patients and population. Orthopaedic Outpatients Initiative improving our thinking about cancellations and delays, and the impact they have on our patients. A similar pilot will follow for the Audiology Service. Looking at our District Nursing Service and how much time they travel if we reduce this we can provide more clinician to patient time. Alcohol and Other Drugs Relapse Prevention taking the concept of prevention seriously, and providing better services in the community. Tracer Audit Initiative changing staff perceptions around clinical audits using auditing to showcase our exemplary services. 76 Annual Report 2016 / 17

77 Annual Report 2016 / National Health Target results Whanganui DHB, Quarter 4, Apr June 2017 National Health Target results Whanganui DHB, Quarter 3, Jan Mar 2017 National Health Target results Whanganui DHB, Quarter 2, Oct Dec 2016 National Health Target results Whanganui DHB, Quarter 1, July Sept % Target: 100% 94 % Target: 94 % Target: /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids 47 % Target: 85 % Target: 90% 2016/17 HEALTH TARGET PERFORMANCE 76 % Target: 85% 111 % Target: 100% 95 % Target: 93 % Target: 75 % Target: 85 % Target: 90% 74 % Target: 85% 109 % Target: 100% 94 % Target: 93 % Target: Target: 84 % Target: 90% 69 % Target: 85% 107 % Target: 100% 95 % Target: 87 % Target: 84 % Target: 86 % Target: 90% 64 % Target: 85% /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? This information should be read in conjunction with the details on the website 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau Hutt Valley Hawke s Bay 65 All DHBs 82 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral Northland Southern 75 All DHBs 86 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland Bay of Plenty West Coast 80 All DHBs 93 Health target results are sourced from individual DHB reports, national collections systems and information provided by primary care organisations. 00 District Health Board 00 DHB current performance GOAL Ranking How to read the graphs Progress performance (%) Emergency Departments Shorter stays in Emergency Departments Shorter stays in 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. Elective Surgery Improved access to Progress against plan (discharges) 100% Improved access to elective surgery The target is an increase in the volume of elective surgery by an average of 4,000 discharges per year. DHBs planned to deliver 97,092 discharges for the year to date, and have delivered 3,300 more. Faster cancer treatment The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Results cover those patients who received their first cancer treatment between 1 July and 31 December Cancer Treatment Faster Immunisation Increased Increased immunisation The national immunisation target is 95 percent of eightmontholds have their primary course of immunisation at six weeks, three months and five months on time. This quarterly progress result includes children who turned eightmonths between October and December 2016 and who were fully immunised at that stage. Raising healthy kids The target is that by December 2017, 95 percent of obese children identified in the Before School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. Data is based on all acknowledged referrals for obese children up to the end of the quarter from Before School Checks occurring in the six months between 1 June to 30 November * This result is based on low volumes, six children identified as obese were not referred. Smokers to Quit Better help for 90% Better help for smokers to quit The target is 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland Capital & Coast Waikato 88 All DHBs 94 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast Canterbury South Canterbury 93 All DHBs Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki Bay of Plenty West Coast * 0 All DHBs 72 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids /17 QUARTER TWO (OCTOBER DECEMBER 2016) RESULTS How is My DHB performing? 1 Waitemata 90 2 South Canterbury 90 3 Auckland 88 4 Lakes 88 5 Waikato 86 6 Canterbury 85 7 Nelson Marlborough 84 8 Bay of Plenty 84 9 Southern Northland Wairarapa Capital & Coast MidCentral Tairawhiti Taranaki West Coast Whanganui Counties Manukau 74 1 West Coast 91 2 Lakes 90 3 Bay of Plenty 90 4 Counties Manukau 89 5 Waitemata 88 6 Hutt Valley 88 7 Auckland 88 8 Wairarapa 88 9 South Canterbury Hawke s Bay Nelson Marlborough Waikato Tairawhiti Capital & Coast Taranaki Canterbury Whanganui MidCentral 84 1 Hutt Valley 97 2 Auckland 95 3 Hawke s Bay 95 4 Wairarapa 95 5 Capital & Coast 95 6 MidCentral 95 7 Canterbury 95 8 Counties Manukau 94 9 Southern Lakes Whanganui Taranaki Waitemata South Canterbury Waikato Nelson Marlborough Tairawhiti Northland 89 Emergency Departments Shorter stays in Emergency Departments Shorter stays in Elective Surgery Improved access to Progress against plan (discharges) 100% Cancer Treatment Faster Immunisation Increased Smokers to Quit Better help for 90% 85% 1 West Coast 99 2 Waitemata 97 3 South Canterbury 96 4 Bay of Plenty 96 5 Nelson Marlborough 96 6 Counties Manukau 96 7 Hutt Valley 95 8 Wairarapa 95 9 Tairawhiti Auckland Hawke s Bay Canterbury Whanganui Taranaki Southern Lakes MidCentral Northland 93 1 Northland Taranaki Whanganui Tairawhiti Counties Manukau Nelson Marlborough MidCentral West Coast Waitemata Waikato Bay of Plenty Lakes Hutt Valley Hawke s Bay Southern Auckland Wairarapa Capital & Coast 95 1 Waitemata Auckland 97 3 Hutt Valley 91 4 MidCentral 89 5 South Canterbury 87 6 Waikato 79 7 Canterbury 78 8 Wairarapa 76 9 Lakes Whanganui Northland Tairawhiti Southern Counties Manukau Capital & Coast Hawke s Bay Nelson Marlborough Taranaki 36 Raising Healthy Kids 100 % STATEMENT OF PERFORMANCE For the year ended 30 June 2017

78 STATEMENT OF PERFORMANCE Financial Summary for the year ended 30 June 2017 in thousands of New Zealand dollars FINANCIAL STATEMENTS BY OUTPUT CLASS 2017 Actual Prevention Services Early detection & management Intensive assessment & treatment Rehabilitation & support Total Revenue Crown Other income Interdistrict inflow 3, , , , 965 1, 533 5, , , 646 1, 966 7, 618 Total revenue 3, , , , , 230 Expenditure Personnel Capital charge Depreciation Other expense Other provider payments Interdistrict outflow (1, 254) (21) (15) (414) (2, 398) (32) (8, 977) (345) (428) (5, 251) (37, 329) (2, 987) (64, 217) (1, 838) (4, 147) (34, 183) (10, 185) (32, 312) (3, 832) (218) (97) (2, 623) (26, 917) (2, 922) (78, 280) (2, 422) (4, 687) (42, 471) (76, 829) (38, 253) Total expenditure (4, 134) (55, 317) (146, 882) (36, 609) (242, 942) Net surplus / (deficit) (246) (964) 689 (191) (712) 2017 Budget Prevention Services Early detection & management Intensive assessment & treatment Rehabilitation & support Total Revenue Crown Other income Interdistrict inflow 3, , , , 633 1, 437 4, , , 357 1, 762 7, 171 Total revenue 3, , , , , 290 Expenditure Personnel Capital charge Depreciation Other expense Other provider payments Interdistrict outflow (1, 315) (13) (14) (382) (2, 630) (33) (9, 352) (334) (502) (5, 070) (37, 800) (2, 041) (63, 308) (2, 412) (4, 812) (33, 347) (11, 036) (32, 005) (3, 314) (215) (93) (2, 228) (26, 012) (3, 031) (77, 289) (2, 974) (5, 421) (41, 027) (77, 478) (37, 110) Total expenditure (4, 387) (55, 099) (146, 920) (34, 893) (241, 299) Net surplus / (deficit) (528) (1, 589) (1, 009) 78 Annual Report 2016 / 17

79 STATEMENT OF PERFORMANCE Financial Summary for the year ended 30 June 2017 in thousands of New Zealand dollars 2016 Actual Prevention Services Early detection & management Intensive assessment & treatment Rehabilitation & support Total Revenue Crown Other income Interdistrict inflow 3, , , , 849 1, 969 4, , , 366 2, 430 7, 180 Total revenue 3, , , , , 976* Expenditure Personnel Capital charge Depreciation Other expense Other provider payments Interdistrict outflow (1, 386) (21) (21) (445) (2, 142) (34) (8, 515) (367) (440) (4, 890) (37, 607) (2, 281) (61, 746) (2, 426) (3, 994) (34, 325) (10, 090) (32, 795) (3, 331) (215) (86) (2, 401) (25, 189) (2, 796) (74, 978) (3, 029) (4, 541) (42, 061) (75, 028) (37, 906) Total expenditure (4, 049) (54, 100) (145, 376) (34, 018) (237, 543) Net surplus / (deficit) (253) (1, 138) 1, 093 (269) (567) * Includes $90k share of profit of associates Annual Report 2016 / 17 79

80 80 Annual Report 2016 / 17

81 PREVENTION SERVICES What are prevention services? Preventative services are publiclyfunded services that protect and promote health in the whole population or identifiable subpopulations; comprising of services designed to enhance the health status of the population as distinct from treatment services which repair/support health and disability dysfunction. On a continuum of care these services are publicwide preventative services. Why are prevention services significant? The DHB will support people to take more responsibility for their own health and reduce the prevalence and impact of longterm illness or disease. Reducing risk factors such as tobacco smoking, poor nutrition, low levels of physical activity and alcohol consumption, together with health and environmental protection factors, will contribute to an improved health status of our population overall and reduce the potential for untimely and avoidable death. What outcomes are we contributing to? People enjoy healthy lifestyles within a healthy environment. The needs of specific agerelated groups, e.g. older people, children/youth, are addressed. The healthy will remain well. Annual Report 2016 / 17 81

82 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 HEALTH PROMOTION & EDUCATION Health promotion services empower individuals, families/whānau and communities to take control over the factors that influence their health. Health promotion staff utilise the Ottawa Charter and Te Tiriti o Waitangi as frameworks to improve health and reduce inequality, focusing both on healthy lifestyles and the physical and social environments in which people live, work and play. This involves advocacy for healthy public policy and healthy, sustainable communities, as well as providing education around risk factors and behaviours. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment C Proportion (%) of smokers offered advice and support to quit smoking PRIMARY 88% 86% 90% 90% See summary A C Proportion (%) of smokers offered advice and support to quit smoking MATERNITY 96% 100% C Proportion (%) of smokers offered advice and support to quit smoking SECONDARY 92% Total 97% Māori 97% Other 96% C Increased proportion of Whanganui DHB population identifying as ex smokers at time of Census, by key age groups and total group 8.1% 25.4% 22.1% Total 24% % % % 7% 26% 20% 7% 26% 20% Based on 2013 Census data A Number of year 914 students assessed by SBHS requiring treatment by other health services Activity measure Reported by calendar year JanDec 2016 A Percentage of year 914 students assessed by SBHS requiring treatment by other health services 19.7% 18.9% Activity measure Year 914 students enrolled in school A Number of Year 9 & 10 students who received a health assessment (HEEADSSS) by SBHS who recorded a BMI score within 5th 85th percentile Total 71 Māori 20 Other 51 Baseline to be established Baseline to be established New measure Reported by calendar year JanDec 2016 A Proportion of Year 9 & 10 students who received a health assessment (HEEADSSS) by SBHS who recorded a BMI score within 5th 85th percentile 26% Baseline to be established Baseline to be established New measure Reported by calendar year JanDec 2016 A Number of Year 9 students who received a health assessment (HEEADSSS) by SBHS Reported by calendar year JanDec 2016 A Number of Year 9 students who received a health assessment (HEEADSSS) by SBHS recorded as 'Never having smoked' 208 Baseline to be established Baseline to be established New measure Reported by calendar year A Percentage of Year 9 students who received a health assessment (HEEADSSS) by SBHS within the school year 93% Reported by calendar year JanDec 2016 A Number of Decile 14 schools engaged with health promoting schools See summary A Proportion of decile 14 schools engaged with Health Promoting Schools at the end of each calendar year 34% 50% 75% 75% See summary C Participants are more active after 68 months of receiving their green prescription (new measure) 64% 50% 50% Data not available at time of publication C Participants have made changes to their diet since receiving their green prescription (new measure) 71% 50% 50% Data not available at time of publication C Green prescription Total referrals for the year 1538 Total 1374 Māori 417 Other C Green prescription Total direct referrals for the year See summary C Green Rx proportion referrals direct 59% 60% 75% 75% See summary A Proportion of infants fully and exclusively breastfeed at 6 weeks Total 55% Māori 48% Total 52% Māori 51% Other 57% 68% 68% See summary A Proportion of infants fully and exclusively breastfeed at 3 months Total 39% Māori 32% Total 35% Māori 35% Other 43% 57% 57% See summary 1 A Number of Pepipods distributed to mothers Activity measure 82 Annual Report 2016 / 17

83 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 PERFORMANCE SUMMARY Breastfeeding Breastfeeding levels within Whanganui DHB continue to prove a challenge for the sector. Factors influencing this are complex and often highly individualised. What we do know is that a vast majority of mothers are breastfeeding at the time of discharge from their LMC but this drops substantially by the time the baby is three months old. Reasons for stopping breastfeeding are varied and often very personalised, however common themes have been identified. These themes include: Wishing to return to normal after being pregnant. Adoption of activities where risks to the baby via milk, such as alcohol and drug consumption. Cultural expectations of sharing the care of babies with wider family. Demands of work/study and breastfeeding incompatible many mothers are time poor for effective breastfeeding. Whanganui has a high level of young parents who are predominantly Māori; this is the cohort that is the most likely to be impacted by all of the factors above. Smoking cessation While the target for the number of smokers offered advice and support to quit smoking in primary care has not been achieved, there have been improved results. The focus for primary care has continued to support general practice with outreach to contact patients and ensure smoking status is recorded accurately and provide training and development of general practice teams. The development of the Regional Stop Smoking Service provides support for the community to become smokefree. This service links in with general practice teams to provide the behavioural support offered alongside pharmacological interventions. Health Promoting Schools The significant increase in the number of schools engaged in Health Promoting Schools in 2016/17, compared to 2015/16, is pleasing. This is progress in the right direction towards meeting the target. Public Health nurses visit all the Decile 14 schools and continue to promote the adoption of the Health Promoting Schools approach. Green Prescription Total direct referrals for the year was down on the 2015/16 but only five referrals short of the 2016/17 target. Total referrals however, remain above target and reflects the continued need to support people into healthy lifestyle choices. Annual Report 2016 / 17 83

84 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 HEALTH PROTECTION, REGULATION, ENVIRONMENTAL HEALTH AND COMMUNICABLE DISEASE Health protection services work within the framework created by the various healthrelated Acts including the Health Act (1956), Food Act (1981), Sale and Supply of Alcohol Act (2012) and Smokefree Environments Act (1990) and their associated regulations. The emphasis is around increasing compliance with the legislation in order to protect the health of individuals and communities. This involves working to maintain a healthy physical environment, ensuring food and water are safe to consume, that communities are protected from hazardous substances, and are prepared for emergencies such as earthquakes, floods and pandemics. Surveillance and control of communicable diseases such as tuberculosis, measles and influenza are also important functions. Focus area B B A A A A A Measure Number of tobacco retailers' premises visited during controlled purchase operations Number of premises visited as part of controlled purchase operations carried out on liquor retailers. Number of liquor licences held by retailers suspended Number of educational visits to liquor retailers Percentage of liquor licences held by retailers suspended Percentage of ARC facilities requiring outbreak control measures to be instituted over the year Percentage of aged residential care facilities audited in the calendar year that complied with the Infection Prevention & Control Standard Number of first contacts seen by DHB sexual health clinic Number of sexually transmitted infections screenings performed on young persons by DHBfunded NGO youth services Rate of sexually transmitted infections seen by Sexual Health Clinic per 10,000 persons screened Percentage of young persons screened by DHB funded NGOs youth services for sexually transmitted infections Percentage of young persons screened by DHB funded NGO youth services for sexually transmitted infection where a positive screening is returned Percentage of people on registered supplies who have bacteriologicallycompliant drinkingwater (Whanganui district) Number of drinking water supply systems with compliance reports completed by Public Health Service on an annual basis (excluding MCDHB) Number of premises licenced to sell psychoactive substances Communicable disease notifications per 10,000 populations. 2015/16 performance No data No data 0% 0% 92% % 13% No data /17 performance 2016/17 target 2017/18 target Achieved T Comment 20 Baseline to be Baseline to be New measure established established % 8% 100% 450 Total 248 Māori 75 Other Total 2.1% Māori 1.6% Other 2.5% Total 12% Māori 24% Other 6% Baseline to be established Baseline to be established Baseline to be established 15% 100% Baseline to be established Baseline to be established Baseline to be established Baseline to be established 96% 44 Baseline to be established Baseline to be established Baseline to be established 15% 100% Baseline to be established Baseline to be established Baseline to be established Baseline to be established 96% 44 Activity measure New measure New measure New measure Activity measure New measure New measure New measure New measure See summary See summary Activity measure Activity measure PERFORMANCE SUMMARY MidCentral DHB assist us in providing health protection services to our district this year, 20 controlled purchase operations on tobacco retailers, and 26 on those selling alcohol were carried out. No licences were suspended. In protecting us from communicable diseases, sexual health clinics saw 450 persons for the first time, and screened 248 young persons. The disease rate per 10,000 persons was 35.0, against the estimate of 50. Twelve percent of young persons screened had a positive result, a slight decrease on the year before. The target for this measure in previous years erroneously counted the number of reports written about water supply systems, rather than the number of systems reported against. Thus the target of 44 was created based on an incorrect metric. The measure is intended to demonstrate that PHU are reporting against all 14 water supply systems on an annual basis.

85 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 POPULATIONBASED SCREENING Screening programmes can detect some conditions and reduce the chance of developing or dying from some conditions. In some cases (for example, breast screening), screening may detect cancer at an early stage. In others (such as newborn metabolic screening), screening may find conditions which can be treated before the baby develops a preventable illness or disability. Cervical cancer is one of the most preventable of all cancers. Screening tests (regular cervical smear tests, which are offered free to all eligible women) reduce the risk of women developing cervical cancer. Breast cancer is the most common cancer in New Zealand women. The risk of developing breast cancer increases with age. Free breast screening is offered to all eligible women aged 4569 years. Breast screening using mammography followed by appropriate treatment is the best way of reducing the chance of dying from breast cancer. The Universal Newborn Hearing Screening and Early Intervention Programme has become the expected standard of care internationally. The programme became available in New Zealand from Free screening is available to all eligible babies and is aimed at identifying newborns with hearing loss early so they can access appropriate assistance as soon as possible which leads to better outcomes for these children, as well as their families/whānau. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment A Number of women Breast screened last 12 months 3789 Total 3810 Māori 453 Other 3357 No target No target A Number of women Breast screened last 24 months 6582 Total 6645 Māori 1082 Other See summary A Breast screening two year coverage rate for eligible women (aged 5069 years) Total 78% Māori 71% Other 79% Total 78% Māori 71% Other 79% 70% 70% A Number of women cervical screened in the last three years Total Māori 2590 Other See summary A Cervical screening three year coverage rate for women aged 2069 years Total 78% Māori 62% Other 80% Total 78% Māori 71% Other 80% 80% 80% See summary A Number of newborn hearing screenings completed A Proportion of registered newborns offered hearing screening who are screened within one month of birth (excluding declines) 89% 88% A Number of newborns enrolled with primary care services Total 225 Māori 93 Other 132 Baseline to be established Baseline to be established New measure A Number of antenatal HIV screenings 564 Baseline to be established Baseline to be established Data not available at time of publication PERFORMANCE SUMMARY While target achievement has been maintained for breast screening, there has been an overall decrease in screening rates which requires a number of actions to improve results. The momentum of breast screening has slowed however, this is expected to be addressed with additional resource which will provide an integrated approach to support women to engage in the national screening programmes. The development of the One Stop Shop breast screening service has provided women with better access to a comprehensive range of services and proactive invitation and recall, outreach support and increased opportunities for screening continue. A number of actions have been identified to improve screening rates going forward. These include improving the profile of screening through targeted health promotion and availability of information, provision of cervical screening opportunities after hours and in other settings, and developing a standardised recall process across general practice. Targeted approaches for Māori, Pacific and Asian women will include focusing on the general practices with the highest number of priority women and linking through appropriate community networks and other settings including workplaces. The Whanganui DHB region includes a large rural area which creates challenges in being able to reach and screen the hearing of babies born in the more remote areas. We are confident newborns in the Whanganui area are having their hearing screened, albeit sometimes not quite within the target one month time period. Annual Report 2016 / 17 85

86 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 IMMUNISATION SERVICES Immunisation is a way of preventing infectious diseases. Free vaccinations listed on the National Immunisation Schedule are offered to babies, children and adults to protect against serious and preventable diseases, such as whooping cough, pneumococcal disease, mumps, measles, rubella, tetanus and Hepatitis B. Improved immunisation coverage leads directly to reduced rates of vaccine preventable disease and consequently better health and independence for children, contributing to longer healthier lives. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment A Increased immunisation coverage rates at 24 months for all ethnicity groups Total 90% Māori 89% Other 91% Total 91% Māori 93% Other 90% See summary A Increased immunisation coverage rates at 8 months for all ethnicity groups Total 94% Māori 92% Other 96% Total 91% Māori 90% Other 92% See summary A Proportion of eligible children on NIR that are recorded as 'declined' at milestone ages 8 Months 5.5% 4.5% 3.6% 3.6% See summary A Proportion of eligible children on NIR that are recorded as 'declined' at milestone ages 24 Months 5.0% 5.9% 5.0% 5.0% See summary A Proportion of children with incomplete immunisation schedules (excluding active declines) referred to GP teams or Outreach Immunisation Services 100% 101% Derived from two data collection systems where 812 children generated 828 referrals B Number enrolled population aged 65+ years who have received flu vaccination 7624 Total 6618 Māori 683 Other See summary B Proportion of enrolled population aged 65+ years who have received flu vaccination 63.4% Total 53.9% Māori 60.4% Other 53.3% 75% 75% See summary A Number of young women who have received HPV vaccine (new measure) Total 271 Māori 114 Other 142 Total 282 Māori 124 Other 158 Baseline to be established Baseline to be established New measure A Proportion of young women who have received HPV vaccine (new measure) Total 74% Māori 89% Other 66% 65% 65% New measure A Proportion of total Ambulatory Sensitive Hospitalisations for vaccine preventable disease and pneumonia, aged 04 years Total 5.0% Māori 3.5% Other 7.4% Total 4.9% Māori 3.8% Other 6.2% 7.5% 7.5% PERFORMANCE SUMMARY Immunisation of children within the DHB is a priority. During the 2016/17 period, the landscape of childhood immunisation changed with introduction of HPV vaccination for males for our schoolbased services, and the community s awareness of perceived (and unfounded) dangers of immunisation influencing our performance within the primary care setting. Overall, coverage of fully immunised 8montholds has declined slightly (by 1%) from our 2015/16 result. This performance decline predominantly occurred within the latter part of the 2016/17 period and coincided with significant publicity around immunisation safety. With a reduced media focus, it is anticipated that the delivery of immunisation education will return to health professionals and be based on facts and evidence. Meeting the target of for twoyearolds and fiveyearolds will continue to prove a challenge for some time. Excluding declines, the number of children not receiving their full course of immunisation on time in 2016/17 by the respective age marker is 30 for 8montholds and 16 for 24montholds. The immunisation outreach team follow up with all these children to ensure they have the best opportunity to ensure their immunisation programme is completed. Vaccination of over 65 year olds within Whanganui DHB has not been as high as normal this year. Factors that may influence this are likely to be the same as those that have influenced immunisation of eightmontholds during the Quarter 4 period. These influences include heightening antivaccination publicity on social media and increased demand on practice nurse capacity. The DHB can celebrate having the best levels of immunisation among Māori, with 60% of Māori being immunised (vs 54% for the total population). This has been achieved through good communications and proactive work from our primary care practices and Iwi organisations to ensure uptake of the influenza vaccination was maximised. 86 Annual Report 2016 / 17

87 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 WELL CHILD / TAMARIKI ORA SERVICES The Well Child/Tamariki Ora service framework covers screening, education and support services offered free to all New Zealand children from birth to five years, and their families/whānau. Well Child services include health education and promotion, health protection and clinical assessment, and family/whanāu support. The services also ensure that parents are linked to other early childhood services such as early childhood education and social support services, if required. The B4 School Check aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child s ability to get the most benefit from school, such as a hearing problem or communication difficulty. These are important in reducing the impact of any health issue so that children enter school ready to learn. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment A Number of high needs (Quintile 5) receiving B4 school checks A Number of children receiving B4 school checks A Percentage of high needs (Quintile 5) of children who have received B4 School Checks 116% 98% 90% 90% A Percentage of children receiving B4 school checks 106% 92% 90% 90% A Number of children receiving B4 School check referred on to other services (new measure) Baseline to be established Baseline to be established New measure A Percentage of children receiving B4 School check referred on to other services (new measure) 83% 71% Baseline to be established Baseline to be established New measure 1 A Average number of children enrolled with Well Child/Tamariki Ora service at end of each quarter 504 Total 556 Māori 480 Other See summary 1 A Percentage of children receiving their core checks within their first year 68% 68% Data not available at time of publication PERFORMANCE SUMMARY During the 2016/17 year, there were 556 children enrolled in Well Child / Tamariki Ora services. Although the target was not achieved, it is pleasing to see a modest increase of the total roll from the previous year, despite slightly fewer newborns registered. A lower number of registered newborns has an impact on our ability of the target to be achieved. The 2016/17 year has been a successful year for B4 School Checks with all children turning four years old having the opportunity to receive a check, and a large majority of them receiving their checks within six months of their fourth birthday. It is especially pleasing that our hardest to reach population were significantly overdelivered to by the service. The service continues to focus on working partnership with Plunket to access joint training, education and resources. Focus areas for the upcoming year will be increasing additional checks, data collection for smoke free, and completing the five core checks in the first year, on time. Annual Report 2016 / 17 87

88 88 Annual Report 2016 / 17

89 EARLY DETECTION & MANAGEMENT SERVICES What are early detection and management services? Early detection and management services are delivered by a range of health and allied health professionals in various private, notforprofit and government service settings. They include: general practice, community and Māori health services, community diagnostic and pharmacy services and child and adolescent oral health services. These diagnostic and treatment services are focused on, and delivered to, individuals and smaller groups of individuals. Why are early detection and management services significant? For most people, their general practice team is their first point of contact with health services. Primary care is also vital as a point of continuity and effective coordination across the continuum of care with the ability to deliver services sooner and closer to home. Supporting primary care are a range of health professionals including midwives, community nurses, social workers, aged residential care providers, Māori health providers and pharmacists who work in the community, often with the neediest families. What outcomes are we contributing to? Health and disability services are accessible and delivered to those most in need. The health and wellbeing of Māori is improved. The needs of specific agerelated groups, including older people, vulnerable children and youth, and people with chronic conditions are addressed. The quality of life is enhanced for people with diabetes, cancer, respiratory illness, cardiovascular disease and other chronic (long duration) conditions. Annual Report 2016 / 17 89

90 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 PRIMARY & COMMUNITY SERVICES Primary and community services support people to access intervention, diagnostics and treatment, and to better manage illness or longterm conditions. These services assist people to detect health conditions earlier, making treatment and interventions easier and reducing the complications of injury and illness. For most people, their general practice team is their first point of contact with health services. Primary care can deliver services sooner and is one of the most effective ways to prevent disease through screening, early detection and timely provision of treatment. Primary care is also vital as a point of continuity and effective coordination across the continuum of care, and for improving the management of care for people with longterm conditions. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment Number of Whanganui DHB population enrolled with PHO Total Māori Other Percentage of Whanganui DHB population enrolled with PHO 98% Total 97% Māori 93% Other 99% 100% 100% A Number of young persons under the age of 13 who are enrolled with GP services where their GP visits are free Total Māori 4641 Other 6608 Baseline to be established Baseline to be established New measure A Percentage of young persons under the age of 13 who are enrolled with GP services where GP visits are free 100% Total 100% Māori 100% Other 100% Baseline to be established Baseline to be established New measure C Number of eligible population who have had their cardiovascular risk assessed in the last 5 years Total Māori 4315 Total Māori 4434 Other C Proportion of eligible population who have had their cardiovascular risk assessed in the last 5 years Total 91% Māori 89% Total 91% Māori 89% Other 92% 90% 90% C Number of PHO enrolled patients with diabetes who have a HBA1c of <64 mmol/ mol during the past 12 months Total 1249 Māori 315 Total 1582 Māori 463 Other C Proportion of PHO enrolled patients with diabetes who have a HBA1c of <64 mmol/ mol during the past 12 months (MoH Virtual Diabetes Register) Total 43% Māori 38% Total 40% Māori 48% Other 39% 53% 53% See summary C Stanford Self management training offered (2 specific to Māori health requirements) 10 Total 13 Māori 4 Other C Ambulatory sensitive hospitalisations (standardised discharge ratio) for specified conditions aged 4564 years Total 150% Māori 238% Other 128% Total 152% Māori 254% Other 129% 134% 134% See summary Percentage of Whanganui DHB population attending the Emergency Department who are admitted to hospital Total 10% Māori 9% Other 11% Total 11% Māori 9% Other 11% Activity measure Percentage of Whanganui DHB population attending the Emergency Department Total 21% Māori 20% Other 21% Total 21% Māori 19% Other 21% Activity measure A Percentage increase/decrease each year in number attendances of children aged 05 years at the Emergency Department between 2100 and 0800 hours 12.0% increase Total 4.2% Māori 5.9% Other 11.5% 3.5% decrease 3.5% decrease Number of avoidable (Primary Care appropriate) presentations to ED between 9pm and 8am Total 3117 Māori 898 Other 2219 Baseline to be established Baseline to be established New measure B Number of persons who have sustained a fragility fracture who are seen by the Fracture Liaison Service Baseline to be established Baseline to be established New measure 90 Annual Report 2016 / 17

91 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment B Percentage of persons who have sustained a fragility fracture who are seen by Fracture Liaison Service 52% 51% Baseline to be established Baseline to be established New measure B Percentage of people aged 65 years or older dispensed a high number of discrete medicines (11 or more medicines) 2% Baseline to be established Baseline to be established New measure A Number of pregnant women accessing DHB funded parenting and pregnancy education Total 178 Māori 57 Other 121 Baseline to be established Baseline to be established New measure A Proportion of pregnant women accessing DHB funded parenting and pregnancy education 22% Baseline to be established Baseline to be established New measure PERFORMANCE SUMMARY Whanganui DHB is committed to achieving better outcomes for people and to ensure primary interventions are provided as early as possible to reduce risk factors associated with diabetes, cardiovascular disease and other long term conditions. The key action areas have focused on prevention (promotion of healthy lifestyles), early detection and screening, supported selfmanagement, and ensuring effective links between primary and secondary care including development of clinical pathways. Developing and supporting a welleducated and skilled workforce also continues to be a priority. The WDHB has set an aspirational target of having it s entire population enrolled in a primary health organisation (PHO). Enrolment in a PHO is a positive step towards better health management for the population, through a continuation of care provided by general practice as the health care home. The percentage of our population enrolled with a PHO has remained stable, however the number of enrolments has increased, reflecting the increase in total population. The proportion of enrolled patients with diabetes who have a HBA1c of less than 64 mmol/mol has remained below target primarily due to screening processes identifying an increased number of people with diabetes. Screening in 2017/18 focuses on Maori men aged 3544 years to help improve the health outcomes in this group. The ambulatory sensitive hospital (ASH) admission rates for both Māori and nonmāori aged 4664 years have increased slightly against last year s result. There are many factors that can influence this result as the measure covers a wide range of conditions. However, cardiovascular disease is a primary contributor. The Whanganui DHB s focus on reducing inequality aims to reduce the disparity between Māori and nonmāori. Whilst there has been an increase in the number of attendances at the Emergency Department by those aged 05 years between 2100 and 0800, it is pleasing to see there has been a decrease in the number of Māori children. Annual Report 2016 / 17 91

92 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 ORAL HEALTH Child and adolescent oral health services cover the provision of a range of dental care to assist the maintenance of healthy teeth and to bring about an improvement in the oral health status of the population. It includes preventive care, oral health promotion and education, treatment of oral disease, and the restoration of tooth tissue. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment A Number of 04 year old children enrolled 4282 Total 4450 Māori 1940 Other A Proportion of preschool and primary school children examined according to planned recall period Total 99% Māori 99% Other 99% Total 97% Māori Other 99% A Number of preschool and primary school children who have not been examined according to their planned recall period Total 148 Māori 64 Total 352 Māori 254 Other A Percentage of children who DNA to DHBfunded dental service appointment 9% 10% 8% 8% See summary A Percentage attendances to DHB funded dental service appointment whose parent or guardian attend No data 19% Baseline to be established Baseline to be established New measure A Percentage of 5 year old children who are caries free Total 56% Māori 35% Other 66% Total 53% Māori 35% Other 62% 54% 58% See summary A Number of adolescents accessing DHBfunded adolescent oral health services See summary A Proportion of adolescent population utilising DHBfunded dental services 81% 79% 85% 85% See summary A Mean score of Decayed, Missing & Filled Teeth of Year 8 children Total 0.96 Māori 1.39 Other 0.75 Total 0.95 Māori 1.28 Other *Dental services data is based on calendar year intervals as this is better suited to activities occuring within the school year. PERFORMANCE SUMMARY Oral health status results for 2016 were better than target in a number of the measures, particularly in Mean Decayed, Missing and Filled Teeth for Year 8 Children. This reflects the enhanced prevention provided to childrens permanent teeth by our Community Oral Health Service during the time they spend at primary and intermediate school. This is an excellent result for a region with nonfluoridated water. The percentage of 5yearolds who are cariesfree has declined since This reflects the increase in the number of preschoolers being assessed by the service. WDHB has the highest percentage of enrolment of preschoolers amongst all DHBs, and one of the lowest levels of patients not seen within the required recall period. The more preschoolers we assess, the more decay we uncover and this reduces the percentage of cariesfree and increases the mean decayed, missing and filled teeth. Adolescent oral heath enrolment is at a high level. Those enrolled in 2016 with the WDHB provider division represents a 48% increase in adolescent enrolments with the service since 2011, reflecting the efforts of our adolescent oral health facilitator who works in a collaborative way with secondary schools and our Community Oral Health Services staff to ensure youngsters enrol and attend our onsite services within secondary schools. Whilst the national target of 85 percent for adolescent utilisation of dental services was not met, Whanganui DHB achieved the third highest utilisation rates in the country. In terms of improving inequalities, it is important to note that 53% of Māori teenagers in the WDHB region are accessing their oral health care from the WDHB provider division, as are 42% of Pacific teenagers. This reflects the hard work of oral health staff in enrolling and treating these teenagers, as well as the WDHB provider division efforts to ensure onsite access within secondary schools, particularly in Whanganui city. The Community Oral Health Service made 43,000 appointments during the 2016/2017 period. Overall, 10% of the appointments made by the Service turned out to be failed to attend appointments. Māori were twice as likely to not attend an appointment as nonmāori. Preschool failed to attend appointments produced the worst percentage of all age groups, particularly for Māori (61%). This contrasts starkly with failed appointments within the schoolage (Māori 4%) highlighting the importance of the service provision for schoolage and adolescents being schoolbased. Whanganui DHB is conducting a project to better understand the reasons why service users are not able to attend appointments with a view to improving service provision and service user experience. 92 Annual Report 2016 / 17

93 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 COMMUNITY PHARMACY Community pharmacies dispense medicines and provide medicine management services to people living in the community. Whanganui DHB funds community pharmacies to assess an individual person s need for a medicine, assist with the selection of a medicine appropriate for the individual s needs, prepare and supply subsidised medicine(s) to eligible people, and provide assistance to people so that outcomes from medicines are optimised. The National Pharmacy Services Agreement that took effect on 1 July 2012 has changed the focus of the services provided by community pharmacists and encouraged a greater link between the general practice team and the community pharmacist. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment C Number of LTC registrations for medicine management (no target) Activity measure C Percentage of population registered for LTC for medicine management 2.7% 2.6% 2.9% 2.9% See summary Number of routine audits of community pharmacies undertaken by Medsafe D Critical or high risk criteria identified through MedSafe audits of community pharmacies audited over the year 2 2 Activity measure PERFORMANCE SUMMARY The number of persons assisted with longterm conditions (LTC) medicines management is similar to the previous year at 1,660. The introduction of mental health patients with complex medicine needs to the scheme in 2017/18 should see the numbers increase in future. There were four pharmacies audited through Medsafe, of which two had at least one criteria identified as high risk. These issues were resolved through the audit process. Annual Report 2016 / 17 93

94 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 COMMUNITY TESTING & DIAGNOSTIC SERVICES A range of diagnostic services is provided on direct referral from general practitioners and certain other health professionals to help diagnose a condition or as part of treatment. They include radiology, laboratory and various other speciality diagnostic tests. Diagnostic imaging services provide images of bodily structure and function to aid diagnosis and treatment. Laboratory services provide diagnostic laboratory testing for patients referred by general practitioners, private medical specialists, oral and maxillofacial surgeons, oral surgeons, midwives and certified cervical smear takers. The communityreferred testing services provide a range of clinical testing and measurement services to assist communitybased providers with the diagnosis and management of a range of conditions. These include testing and measurement of cardiovascular, respiratory, neurological, gastrointestinal, urological, endocrine, eye, ear, nose and throat, and other systems. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment D Total volume of community referred tests (no target) Total Māori 2593 Other Activity measure D Average reporting time for community referred radiology examinations (Whanganui Hospital) 3.2 days Total 1.9 days Māori 1.8 days Other 2.0 days 5.0 days 5.0 days 3 D Percentage routine community referred ultrasounds provided within two months of referral (Whanganui Hospital) 92% Total 63% Māori 50% Other 65% See summary 3 D Percentage of patients who have an accepted referral for a CT scan who receive their scan within 6 weeks 98% Total Māori Other 3 D Percentage of patients who have an accepted referral for an MRI scan who receive their scan within 6 weeks 79% Total 98% Māori 97% Other 98% 85% 85% PERFORMANCE SUMMARY Whilst the number of community referred tests continues to rise, they are all delivered and reported on in a timely manner. For 2016/17 there has been a significant improvement in the percentage of MRI scans completed within six weeks of referral. New Zealand carries a general shortage in availability of sonographers, and this impacts on our ability to meet the challenges of a varying demand. 94 Annual Report 2016 / 17

95 INTENSIVE ASSESSMENT & TREATMENT SERVICES What are intensive assessment and treatment services? Intensive assessment and treatment services are delivered by a range of secondary and tertiary providers using public funds. These services are usually integrated into facilities that enable colocation of clinical expertise and specialised equipment such as a hospital. These services are generally complex and provided by health care professionals that work closely together. Whanganui DHB provides a wide range of intensive assessment and treatment services to its population. The DHB also funds some intensive assessment and treatment services for its population that are provided by other DHBs. These services are at the complex end of treatment services and are focused on, and delivered to, individuals. Why are intensive assessment and treatment services significant? Equitable, timely access to intensive assessment and treatment can significantly improve people s quality of life. Responsive services and timely treatment support across the whole system give people confidence that complex intervention is available when needed. Quality improvement in service delivery, systems and processes will improve the effectiveness of clinical practices and patient safety, reduce the number of events causing injury or harm and provide improved outcomes for people in our services. What outcomes are we contributing to? Health and disability services that are accessible and delivered to those most in need. The health and wellbeing of Māori is improved. The quality of life is enhanced for people with diabetes, cancer, respiratory illness, cardiovascular disease and other chronic (long duration) conditions. People experiencing a mental illness received care that maximises their independence and wellbeing. Annual Report 2016 / 17 95

96 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 MENTAL HEALTH & ADDICTION SERVICES Specialist mental health and addiction services are delivered to those eligible people who are most severely affected by mental illness or addiction. Currently, the expectation in the National Mental Health Strategy is that specialist services will be available to three percent of the population. However, it is recognised that a focus on early intervention strategies will mean services may be delivered to people who are at greater risk of developing more severe mental illness or addiction. To the extent that funding for specialist mental health and addiction services does not support coverage for all target populations, it is expected that DHBs will have criteria in place for prioritising the provision of services, to people with the highest level of need. The services include assessment, diagnosis, treatment and rehabilitation, as well as crisis response when needed. Mental health and addiction services aim to reduce the impact of mental illness and reduce harm caused by drug and alcohol dependency or addiction through a recoveryfocused, consumeroriented approach to early assessment and treatment. In addition to the provision of specialist services, connections with primary care, population health approaches, housing, employment, physical health, and an emphasis on social connectedness and participation all have a significant impact on mental health and wellbeing. It is unlikely that any single provider will deliver the full range of services, therefore all services in the mental health and addiction sector must work collaboratively and cooperatively to provide a wellintegrated and seamless continuum of care. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 2 A B Number of people seen on average per annum by Mental Health and Addiction Services Total 809 Māori 311 Other C Total 2417 Māori 859 Other Total 318 Māori 17 Other A B Proportion of population seen per annum Total 4.2% Māori 3.8% 019 Total 4.9% Māori 4.5% Other 5.1% 4.5% 4.5% C Total 6.8% Māori 9.6% 2064 Total 7.2% Māori 10.1% Other 6.2% 5.4% 5.4% Total 2.4% Māori 1.2% 65+ Total 2.6% Māori 1.5% Other 2.7% 1.8% 1.8% 2 A C Number of uptodate relapse prevention plans for clients with a long term mental illness Adult 218 Child A C Percentage of long term clients with mental illness who have an uptodate relapse prevention plan 100% 100% Adult 99% Child 100% 2 A B C Proportion of people referred for nonurgent mental health and addiction services seen within three weeks (all services) 67% 85% 96% % % % 80% 80% 80% 80% 80% 80% 2 A C Number of contact hours with child and youth mental health serviceuser participation ( new measure KPI 34) 3411 Total 4262 Māori 1013 Other A C Percentage of total contact hours with child and youth mental health serviceuser participation ( new measure KPI 34) 75% Total 84% Māori 82% Other 84% Activity measure 96 Annual Report 2016 / 17

97 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 2 A C Number of clients rereferred to child and youth mental health services within 90 days discharge (new measure KPI 37) Total 47 Māori 12 Other 35 Activity measure 2 A C Percentage of clients rereferred to child and youth mental health services within 90 days discharge (new measure KPI 37) Total 14% Māori 13% Other 14% Activity measure 2 C Number of persons committed to compulsory treatment orders (whanau ora) Total 74 Māori 27 Other 47 Baseline to be established Baseline to be established New measure 2 C Proportion of persons committed to compulsory treatment orders (whanau ora) Total 2.1% Māori 2.3% Other 2.0% Baseline to be established Baseline to be established New measure 2 C KPI 18 Preadmission community care Proportion of inpatients seen by CMH teams in 7 days prior to acute admission Total 54% Māori 41% Other 60% 80% 80% See summary 2 C KPI 19 Post discharge community care Proportion of inpatients seen by CMH teams in 7 days post discharge from acute admission Total 73% Māori 74% Other 73% See summary PERFORMANCE SUMMARY There has been an increase in demand for specialist mental health and addiction services. Data suggests an increase in new and acute referrals. Significant areas of improvement focus for the mental health and addiction service for the following year are: Implementation of the integrated community network model for adult community mental health and addiction. Implementation of the Substance Addiction (Compulsory Assessment and Treatment) Act within a regional/subregional model. Adoption of the zero suicide approach for patients known to specialist mental health and addiction services. Equally Well Programme. Seclusion hours continue to reduce in the adult acute inpatient unit, Te Awhina. Stanford House have maintained their no seclusion policy over the past 12 months. It is now four years since this practice was last utilised. The introduction of the Safe Practice Effective Communication Programme to staff of both inpatient units and duly authorised officers. In addition to this professional development that will focus on talking therapies, sensory modulation, trauma informed care, and other therapies will continue. Child and Adolescent Mental Health and Addiction Service rereferral data will be scrutinised to establish what themes or trends contribute to these outcomes. Performance against the KPI18 and KPI19 target for 2016/17 has not been achieved. A process in now in place to ensure allocation of a keyworker within 24 hours of discharge and face to face contact with a medical officer within 7 days of discharge. An internal auditing process is in place that generates data to better understand the circumstances where the target is not achieved. Annual Report 2016 / 17 97

98 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 ACUTE SERVICES Specialist (acute) medical and surgical services are provided to people of all ages whose condition is of such severity or complexity that it is beyond the capacity and technical support of the referring service. Services are intended to achieve an integrated continuum of care that provides effective shared care across all settings from primary to tertiary, and includes cure of disease, relief of pain, effective screening and prevention of unnecessary or longterm complications and access to information by patients and other practitioners. Hospital acute services will also advise and plan for care that prevents or reduces acute exacerbation of chronic disease to minimise likelihood of inappropriate hospital admissions and promote improved quality of life. Whanganui Hospital Whanganui DHB s base hospital provides a range of acute medical, surgical and associated services. Some hospitalbased services are provided by other district health boards upon specialist referral, where a higher degree of specialisation and/or technical equipment and support is required (tertiary services), such as paediatric oncology, cardiac surgery, neurosurgery and plastic surgery. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 3 D Percentage of ED presentations seen within the appropriate timeframe Immediate 84% Emergency 60% Urgent 55% 100% 80% 75% 100% 80% 75% New measure See summary Number of Emergency Department attendances Total Māori 4986 Other Activity measure Number of acute inpatient discharges (excluding emergency medicine) 408 ATR Total 419 Māori 25 Other 394 Activity measures 3279 Medical Total 3680 Māori 889 Other Surgical Total 2495 Māori 508 Other Average inpatient length of stay acute services Improved result, very close to target 3 Number of medical first specialist assessments 2597 Total 2385 Māori 418 Other See summary 3 Proportion of patients attending the Emergency Department who are admitted, discharged or transferred within six hours Total Māori Other 3 D Proportion of patients admitted with acute stroke & transferred to inpatient rehab services within 7 days of acute admission 74% 80% 80% See summary 3 Proportion of repeat presenters and people with long term conditions who have care plans in place Baseline to be established Baseline to be established New measure Data not available at time of publication 98 Annual Report 2016 / 17

99 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 3 D Rate of hospital acquired staphylococcus aureus bacteraemia per 1,000 discharges Central Line Acquired Bacteraemia (CLAB) incidents per 1000 line days Number of clinical personnel vaccinated against influenza through the WDHB staff vaccination programme 553 Activity measure Percentage of clinical staff* vaccinated against influenza through the WDHB staff vaccination programme 71% Baseline to be established Baseline to be established New measure 3 Percentage of surgical procedures where the level of team engagement with the surgical safety checklist were at 5 or above Sign in: 92% Time out: 88% Sign out: No data Baseline to be established Baseline to be established New measure 3 Proportion of patients with an acute readmission to hospital within 28 days of a previous discharge (standardised rate) 6.9% 6.0% 6.0% 6.0% PERFORMANCE SUMMARY Acute services performed well this period. Inpatient volumes increased significantly, particularly within the medical inpatient service. There were lesser increases within the AT&R and surgical services. 4 National Patient Experience Score Domain categories Communication rating out of 10 WDHB Quarter WDHB Quarter WDHB Quarter WDHB Quarter While volumes through ED are down on the previous year, the more urgent triage categories had over 900 further presentations. Staff in ED managed to process the same number of patients within time as last year, but did not achieve target. Emergency Department management are confident that considerably more Participation rating out of 10 Coordination rating out of 10 Physical and emotional rating out of 10 patients were seen within time than is expressed, however dataentry delays by clinicians impacted on the overall rate reported. Overall, WDHB achieved the 95 percent national health target for patients within ED being treated within six hours. Pressures experienced in Whanganui Hospital's Emergency Department mirror those experienced around New Zealand. Alternative triage methodologies are being developed The AT&R Ward houses a comprehensive stroke unit with acute stroke and rehabilitation colocated in the same ward. The same staff provide care for both services. The service did not achieve the target for patients admitted with acute stroke being transferred to inpatient rehabilitation within seven days of admission. This was partly due to a number of patients who had experienced large stroke and whose suitability for rehabilitation was unclear within the sevenday period. These patients remained in the Acute Stroke Unit until their suitability for rehabilitation was clear. Clinically there was no impact or delay on the patients receiving the appropriate care. Overall, acute services performed well with increased acuity and volumes, while maintaining acceptable length of stay levels and not impacting on unplanned readmissions. Key measures of clinical sustainability and excellence remain positive. Hospitalacquired infections virtually eliminated during the year. Patient experience measures also demonstrate that staff were attentive and appropriate in their communications and in providing for both their physical and emotional needs. Annual Report 2016 / 17 99

100 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 ELECTIVE SERVICES Elective services are medical or surgical services which will improve quality of life for someone suffering from a significant medical condition, but that can be delayed because they are not required immediately. A service becomes known as an 'elective' if it is provided seven or more days after the decision to proceed with treatment. Electives do not include services such as disability support, maternity, mental health, primary health or public health programmes. Access to elective services is based on a referral from a general practitioner, and gives priority to those most in need and who will benefit most. A booking system is therefore used. The referral guidelines and access criteria are part of the national electives programme overseen by the Ministry of Health. A key priority of Government is to ensure equitable access to elective services, deliver more elective surgery as well as to reduce waiting times. Some hospitalbased services are provided by other district health boards upon specialist referral, where a higher degree of specialisation and/or technical equipment and support is required (tertiary services), such as paediatric oncology, cardiac surgery, neurosurgery and plastic surgery. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment D Number of Whanganui DHB residents discharged for elective surgery D Percentage of elective surgery procedures that are completed on the same day of admissions 98% Total 98% Māori 98% Other 98% D Number of first specialist assessments (surgical services) Activity measure 3 D Percentage of people who receive their first specialist assessment within 4 months 100% 99% 100% 100% See summary 3 D Unplanned returns to theatre within same admission (for an elective procedure) 0.0% Total 0.0% Māori 0.0% Other 0.0% 0.5% 0.5% 3 D Acute readmissions to hospital within 28 days for people discharged with a prior elective episode (Whanganui Hospital) 4.3% 6.9% 6.0% 6.0% See summary 3 D Percentage of resourced elective theatre time utilised 98% 3 D Percentage of people who receive their planned surgery within 4 months 100% Total 92% Māori 90% Other 92% 100% 100% See summary 3 D Faster Cancer treatment (new Health Target 2015 ) 80% 83% 85% 85% Improved result 3 5 D Standardised intervention rates for specific orthopaedic, cardiac and ophthalmology services, per 10,000 population Cardiac 5.7 (National 6.1) Major joint 29.6 (National 23.1) Cataracts 45.7 (National 33.7) Angiography 26.5 (National 34.0 ) Angioplasty 11.2 (National 12.7) Cardiac 4.5 (National 6.0) Major joint 28.0 (National 23.6) Cataracts 32.5 (National 35.1) See summary PERFORMANCE SUMMARY WDHB met our elective target for the 16/17 year. The DHB set a stretch target of providing elective services within 120 days of referral. Although this target has not been achieved the DHB met the Ministry of Health elective service performance targets and achieved at risk funding. The standardised invention rate for orthopaedics indicates that WDHB was ranked one for orthopaedic delivery overall, however ranked second for the subset major joint replacement. This is a pleasing result as WDHB has reduced joint replacement but kept it at an acceptable access level whilst maintaining good access to smaller procedures. Ophthalmology access has declined with access ranked 13th for ophthalmology delivery overall. Ophthalmology has experienced a decline in service delivery as a result of ophthalmologist vacancies. Recruitment is ongoing. Whanganui DHB did not achieve the national intervention rates for angiography, angioplasty and cardiac surgery for 2016/17. Cardiac services have been included in the Regional Service Plan with a view to providing better access to a range of cardiac services. 100 Annual Report 2016 / 17

101 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 FACILITYBASED MATERNITY SERVICES Maternity services that are funded by DHBs include primary, secondary and tertiary maternity care for pregnant women and their babies until six weeks after the birth. The service supports continuity of care, and is delivered in community, outpatient and inpatient settings. The National Maternity Referral Guidelines identify clinical reasons for consultation with a specialist and are published by the Ministry of Health from time to time. Hospitalbased maternity services are provided at primary, secondary and tertiary levels. Secondary maternity services are those provided where women and/or their babies experience complications that need additional maternity care involving obstetricians, paediatricians, other specialists and secondary care teams. Tertiary maternity services are additional maternity care provided to women and their babies who have highly complex clinical needs and require consultation with and/or transfer of care to a multidisciplinary specialist team. Primary maternitylevel care is provided at Taihape Health Centre. Lead maternity carers have access under agreement (Schedule 3 of the Primary Maternity Services Notice, 2007) to the health centre/hospital facility for acute clinical examinations and monitoring progress of labour through to delivery. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment A Total number of hospital births, Whanganui DHB residents 780 Total 775 Māori 299 Other 476 Activity measure A Total number of (all) maternity inpatient discharges from Whanganui DHB facilities 892 Total 995 Māori 393 Other 602 Activity measure A Proportion of women discharged with breastfeeding established 88% 96% 90% 90% A Proportion of women birthing who had epidural anaesthesia in labour Total 15% Māori 9% Other 19% Activity measure A Proportion of total Births that were a caesarean section 18% Total 18% Māori 20% Other 19% 18% 18% PERFORMANCE SUMMARY Maternity services within Whanganui continue to deliver a firstclass service to our population for both primary and secondary care women. The lead maternity carers (LMCs) within our district are sufficient in number so that all women are able to engage during their first trimester of pregnancy and that they do receive the full menu of antenatal care available. At a district level, Whanganui compares very favourably with the rest of NZ, in particular with the high numbers of babies receiving hearing screening, the volume of pepipods distributed to atrisk infants, and the community's awareness of avoiding overheating babies using polar fleece blankets. Whanganui DHB birthing facility statistics compared to the national average continue to highlight that normal (vaginal) birth rates are high, and caesarean and epidural rates are low. This year has seen an increase in the rate of women discharged with breastfeeding established. Annual Report 2016 /

102 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 ASSESSMENT, TREATMENT & REHABILITATION SERVICES Assessment, treatment and rehabilitation (ATR) is for people with complex medical, cognitive, functional and social needs with the aim of enabling them to live independently in the community. Includes aged, physical, sensory and intellectual ATR services. The ATR service aims to improve functional independence of patients in usual agerelated roles and activities and/ or return to the workforce or other activity with limitation of disease progression by active risk factor management and early, effective rehabilitation. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment B Number of inpatient discharges (geriatric ATR) 408 Total 419 Māori 25 Other 394 Activity measure B Proportion of older people discharged from ATR services to independent living (not ARC) 88% Total 94% Māori 100% Other 94% 88% 88% B Inpatient average length of stay for ATR (geriatric) services 19 days Total 18 Māori 17 Other days 18 days 3 B Acute readmissions to hospital within 28 days for those discharged from ATR services (Whanganui facility) 18.6% Total 16.0% Māori 7.1% Other 16.8% 18.0% 17.0% 3 B Occurrence of falls by people aged 65+ years within a hospital setting, per 1,000 inpatient ATR bed days 1.6 Total 1.48 Māori 1.61 Other PERFORMANCE SUMMARY Assessment, Treatment and Rehabilitation Services achieved all targets this year, with the exception of the sevenday stroke pathway (see the Acute Services Performance Overview). AT&R services deliver a comprehensive clinical programme to a varied, complex, and at times frail patient group with a range of comorbidities. It is very pleasing that the team have achieved some notable successes against the increasing volumes being admitted acutely into hospital. There has been a modest increase in discharges, with no discernable increase in readmissions, and good management of patient length of stay. Incidents resulting in falls (within a clinical setting) are well below target and improved against last year. Most pleasing is the outstanding rate at which older persons are discharged from this service direct to independent living, responding to everyone s need to live autonomously. There are no issues of equity between Māori and nonmāori. While Māori volumes appear low, they are accurately reflective of the ethnicity distribution for the age group concerned. 102 Annual Report 2016 / 17

103 REHABILITATION & SUPPORT SERVICES What are rehabilitation and support services? Rehabilitation and support services are delivered following a needs assessment process and coordination input by Needs Assessment and Service Coordination (NASC) Services for a range of services such as homebased support services and residential care services for older people. This output class also includes palliative care services for people with endstage conditions and services that support people with a disability. Whanganui DHB contracts for the provision of these services from a wide range of providers, including Hospice Wanganui, rest homes and homebased support agencies. These services are focused on, and delivered to, individuals. Why are rehabilitation and support services significant? Older people (aged 65+ years) have higher rates of mortality and hospitalisations for most chronic conditions, some infectious diseases and injuries (often from falls), all of which have a significant impact, not only for the individual and their family/whānau, but also on the capacity of health and social services to respond to the demands. For people living with a disability or agerelated illness, it is important they are supported to maintain their best possible functional independence and quality of life. It is also important that people who have endstage conditions and their families are appropriately supported by palliative care services, so that the person is able to live comfortably, have their needs met in a holistic and respectful way, and die without undue pain and suffering. Whanganui DHB is keen to place an emphasis on an increased proportion of older people living in their own home with their natural support system and if necessary supplemented by subsidised homebased support services, before aged residential care is pursued. What outcomes are we contributing to? The needs of specific agerelated groups, including older people, vulnerable children and youth, people with chronic conditions are addressed. The wider community and family support and enable older people and the disabled to participate fully in society and enjoy maximum independence. Annual Report 2016 /

104 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 NEEDS ASSESSMENT & SERVICE COORDINATION Needs assessment is a process of determining the current abilities, resources, goals and needs of a person and defining those needs which are most important to the person. Needs assessment is provided to: a person who has been identified as having a physical, intellectual, sensory or agerelated disability (or a combination of these); and which is likely to continue for a minimum of six months; and results in a reduction of independent function to the extent that ongoing support is required. Service coordination is a process of identifying, planning and reviewing the packages of services required to meet the priorities, needs and goals of the person assessed. The process also determines which of these needs can be met by funded services and which can be met by other services. The process explores all options and linkages for addressing the person s prioritised needs and goals. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment B Number of new InterRAI assessments completed by ATR Services for people aged 65+ years 727 Total 885 Māori 77 Other 808 Activity measure 3 B Proportion of people 65 years & older who have had an InterRAI assessment and care plan within the agreed timeframe Crisis (less 48 hours) 93% High risk (15 days) 89% Medium risk (Max. 10 days) 83% Low risk (Max. 15 days) 82% Baseline to be established Baseline to be established New measure 3 B Proportion of new people accessing long term home support services, aged 65 and older who have had an InterRAI assessment and care plan 100% Total 100% Māori 100% Other 100% 100% 100% Activity measure 3 B Proportion of ARC facilities using, or training nurses to use the InterRAI LTCF assessment tool 100% Baseline to be established Baseline to be established New measure PERFORMANCE SUMMARY It is pleasing to see all clients who access longterm support services have had a comprehensive clinical assessment undertaken (interrai Homecare). 104 Annual Report 2016 / 17

105 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 AGED RESIDENTIAL CARE BEDS Agerelated residential care (ARRC) beds comprise stage II rest home care beds, stage III dementia care beds, hospital continuing care and specialist hospital care beds. Psychogeriatric assessment beds are also available. Whanganui DHB currently has 13 providers delivering the full range of services. These facilities are located throughout the district in Whanganui and Marton. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment B Number of Emergency Department attendances by people with an identified aged residential care facility address Activity measure 2015/16 revised calculation method B Aged residential care facility residents who present to Emergency Department Total visits 32 2 visits 216 Total visits 50 2 visits 197 Activity measure B Number of ambulatory sensitive admissions to hospital by older persons living in supported aged residential care settings 92 Total 140 Māori 11 Other 129 Baseline to be established Baseline to be established New measure B Proportion of older persons living in aged residential care settings who are admitted to hospital for ambulatory sensitive conditions 10% Total 17.5% Māori 24% Other 17.1% Data not available at time of publication B Proportion of population aged 65+ years receiving DHB funded support in ARC facilities over the year 5.4% Total 5.2% Māori 3.3% Other 5.4% Activity measure B Percentage of people in aged residential care by facility and DHB who have a subsequent InterRAI long term care facility (LTCF) assessment completed within 230 days of the previous assessment 82% 100% 100% See summary B Number of aged residential care facilities with at least three year certification Target not achievable as 1 facility closed in 2015/16 3 B Percentage of aged residential care facilities with at least three year certification 92% 85% 90% 90% See summary PERFORMANCE SUMMARY From a regulatory and quality perspective, 11 out of 13 DHBfunded aged residential care facilities having threeyear Ministry of Health Healthcert certification is still a good result despite this being achieved by one fewer facility than the previous year. The percentage of people who have a subsequent InterRAI long term care facility assessment within 230 days has not met the target of 100 percent. The DHB will follow up with providers with less than 70 percent compliance with a view that there will be a better result for the next year. With the changing demographics of an increased number of older people who are living longer, it is a pleasing result to have maintained the same proportion of people in longterm aged residential care. It demonstrates that our initiatives, such as the individual rehabilitation programme and intermediate care, are achieving the desired result of supporting people to remain in their own home. Annual Report 2016 /

106 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 HOMEBASED SUPPORT The purpose of home support services is to promote and maintain the independence of people who are experiencing difficulty caring for themselves because of an illness or chronic medical condition, or as a result of hospitalisation. The Home Support Service is longterm support provided by support workers for people with chronic health conditions in their own home or other private accommodation in the community. The service is delivered by private organisations, upon authorised referral following confirmation of eligibility and an individual needs assessment process, and is accountable for the quality of services delivered. The services have a restorative focus that promotes and maintains the independence of the service user. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment B Total number of clients who have been assessed with a home support service coordination outcome 648 Total 634 Activity measure B Percentage of clients with a home support service coordination outcome compared to total clients in homebased support or aged residential care 58% Total 58% Māori 67% Other 57% Activity measure B Total number of new clients who have been assessed for the first time with a home support service coordination outcome during the year 239 Total 459 Māori 33 Other B Percentage of clients assessed with home support service coordination outcome during the year where their Support Package Allocation is high or above 48% Total 54% Māori 69% Other 53% Activity measure B Number of referrals to Alzheimers Society Wanganui from GPs and others Activity measure PERFORMANCE SUMMARY While there has been a slight reduction in the proportion of the population aged 65 years and over receiving DHBfunded homebased support, the DHB had experienced unprecedented growth in the previous year and had put some proactive rehabilitation initiatives in place to ensure people had an opportunity to be rehabilitated before longterm supports were put in place. 106 Annual Report 2016 / 17

107 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 REHABILITATION SERVICES These services restore or maximise people s health or functional ability following a healthrelated event. They include community rehabilitation programmes, access to specialist support services, physical or occupational therapy, treatment of pain or inflammation and retraining to compensate for specific lost functions. Success is measured through increased referral of the right people to these services. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 3 C Number of DSS accredited equipment assessments Activity measure C Number of patients deemed appropriate for cardiac rehabilitation and education classes Activity measure C Number of patients seen by cardiac rehabilitation and education team whilst in hospital Activity measure C Percentage of people referred for a cardiac rehabilitation and education class who attend 41% 41% 34% 34% A Number of child health development service first attendances Activity measure A Proportion of new clients seen in the year by Child Health Development Service who have a diagnosis of autism spectrum disorder 9.0% 12.0% Activity measure PERFORMANCE SUMMARY It is pleasing to see that attendance rates continue above target at 41 percent, particularly when New Zealand and international average rates are around 30 to 35 percent. As part of our hospital role we also see patients with other cardiac conditions, such as atrial fibrillation, pericarditis, pacemaker patients, and heart failure. Patients with heart failure, who are deemed suitable, are invited to cardiac classes which offer, among other things, exercise. This is a priority for patients with heart failure so that functional capacity and fitness is not lost. The local primary care, medical and nursing communities are encouraged to invite patients who have not had a cardiac event, but have manifestations which represent a high risk of future cardiac morbidity, so they can receive advice and support. It is pleasing to see results continue in line with the previous year. Annual Report 2016 /

108 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 PALLIATIVE CARE SERVICES Specialist palliative care is palliative care provided by those who have undergone specific training and/or accreditation in palliative care or medicine, and who are working in the context of an expert interdisciplinary team of palliative care health professionals. Specialist palliative care may be provided by hospices (community), hospitalbased palliative care services, or paediatric specialist palliative care teams. Specialist palliative care provision works in two ways. It works directly by providing direct management and support to people, their families and whanau where complex palliative care need exceeds the resources of the generalist provider. The involvement of specialist palliative care with any person and their family and whanau can be continuous or episodic, depending on their assessed changing need. Complex need in this context is defined as a level of need that exceeds the resources of the generalist team: this may apply in any of the domains of care physical, psychosocial, spiritual or cultural, for example: It works indirectly by providing advice, support, education and training to other health professionals and volunteers to support their generalist provision of palliative care. Generalist palliative care is provided for those affected by lifelimiting illness as an integral part of standard clinical practice by any health care professional who is not part of a specialist palliative care team. It is provided in the community by general practice teams, Māori and Pacific health providers, allied health teams, district nurses, residential care staff, community support services, and community paediatric teams. It is provided in hospitals by general adult and paediatric medical and surgical teams, as well as disease specific teams for instance, oncology, respiratory, renal, intensive care and cardiac teams. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 3 C Number of patients supported by Specialist Palliative Care Services Number of long term residents living in aged residential care facilities who die in acute settings See summary 3 C 28 Total 20 Māori 1 Other PERFORMANCE SUMMARY Supporting aged residential care providers to ensure their residents have endoflife plans continues. This has to be alongside managing family expectations and aged care clinicians having confidence in managing endoflife care. Innovations by specialist palliative care providers, Hospice Wanganui and Arohanui Hospice, include building the capability of aged residential care with the aim of improving the quality of endoflife care. 108 Annual Report 2016 / 17

109 STATEMENT OF PERFORMANCE For the year ended 30 June 2017 RESPITE CARE & DAY SERVICES Respite care services Respite care services for people with chronic health conditions are based on a 24hour, 7 dayaweek service. The service provides both planned and emergency (or crisis) respite care for primary carers / family / whānau who care for family members with chronic health conditions and longterm support needs. The duration of respite is shortterm and intermittent, or episodic for the service user. Access to respite care is determined by the DHB approved Needs Assessment and Service Coordination (NASC) service. Day services Day programme services for older people are planned activities that meet the specific needs and interests of older people, where welltrained staff will assist service users in a stimulating and safe environment. Day programme services are aimed at assisting to maintain independence for older people, are closely integrated with other community support services available to older people and are also a form of support for carers of older people. Focus area Measure 2015/16 performance 2016/ / /18 T performance target target Achieved Comment 3 C Number of respite bed days paid per annum 1339 Total 1356 Māori 149 Other C Complaints received from family/whānau/ service users regarding ability to access respite care services Total number of whole day attendances by individuals at DHB funded day programmes, over the year (no target) C No target Total 1235 Māori 122 Other 1113 Activity measure PERFORMANCE SUMMARY Respite care and day services are cornerstones for the DHB approach to supporting carers and maintaining an older person at home. Carers are allocated days and it's important that they utilise fully this support. Utilisation of allocated services does not align with reporting periods and this may result in significant fluctuations from year to year, which balance out over time. purchases Whānau Ora Services from Whanganui iwi provider, Te Oranganui Trust Incorporated. The DHB has included 'Kaumatua Luncheon' as a funded day activity programme for older Māori as part of whānau ora. The luncheons address social isolation and loneliness for some of their people and also improves wellness. The activities also include waiata and exercise. Annual Report 2016 /

110 110 Annual Report 2016 / 17

111 FINANCIAL STATEMENTS PŪRONGO PŪTEA Annual Report 2016 /

112 FINANCIAL STATEMENTS CONTENTS AUDIT REPORT STATEMENT OF RESPONSIBILITY STATEMENT OF COMPREHENSIVE REVENUE AND EXPENSE STATEMENT OF FINANCIAL POSITION STATEMENT OF CHANGE IN EQUITY STATEMENT OF CASH FLOWS RECONCILIATION OF NET SURPLUS/(DEFICIT) TO NET CASH FLOW FROM OPERATING ACTIVITIES NOTES TO FINANCIAL STATEMENTS Note 1 Note 1a Note 1b Note 1c Note 2 Note 3 Note 4 Note 5 Note 6 Note 7 Note 8 Note 9 Note 10 Note 11 Note 12 Note 13 Note 14 Note 15 Note 16 Note 17 Note 18 Note 19 Note 20 Note 21 Note 21a Note 21b Note 21b Note 22 Revenue Revenue from nonexchange transaction Revenue from exchange transaction Other revenue Personnel cost Capital charge Finance cost Other expenses Cash and cash equivalent Receivables Investments Inventories Property, Plant and equipment Intangible assets Investment in associates Other financial assets Payables Borrowings Employee benefits Contingent liability and contingent assets Capital commitments Related party transaction Event after balance date Financial instruments Financial instrument categories Fair value Financial instrument risk Explanation of financial variance from budget Annual Report 2016 / 17

113 AUDIT REPORT INDEPENDENT AUDITOR S REPORT TO THE READERS OF WHANGANUI DISTRICT HEALTH BOARD S FINANCIAL STATEMENTS AND PERFORMANCE INFORMATION FOR THE YEAR ENDED 30 JUNE 2017 The AuditorGeneral is the auditor of (the Health Board). The AuditorGeneral has appointed me, Bruno Dente, using the staff and resources of Deloitte Limited, to carry out the audit of the financial statements and the performance information, including the performance information for appropriations, of the Health Board on his behalf. We have audited: the financial statements of the Health Board on pages 118 to 149, that comprise the statement of financial position as at 30 June 2017, the statement of comprehensive revenue and expense, statement of changes in equity and statement of cash flows for the year ended on that date and the notes to the financial statements that include accounting policies and other explanatory information; and the performance information of the Health Board on pages 63 to 109. Opinion Unmodified opinion on the financial statements In our opinion, the financial statements of the Health Board on pages 118 to 149: present fairly, in all material respects: its financial position as at 30 June 2017; and its financial performance and cash flows for the year then ended; and comply with generally accepted accounting practice in New Zealand in accordance with Public Benefit Entity Reporting Standards. the performance information of the Health Board on pages 63 to 109: presents fairly, in all material respects, the Health Board s performance for the year ended 30 June 2017, including: for each class of reportable outputs: its standards of delivery performance achieved as compared with forecasts included in the statement of performance expectations for the financial year; and its actual revenue and output expenses as compared with the forecasts included in the statement of performance expectations for the financial year; what has been achieved with the appropriations; and the actual expenses or capital expenditure incurred compared with the appropriated or forecast expenses or capital expenditure; and complies with generally accepted accounting practice in New Zealand. Annual Report 2016 /

114 Our audit of the financial statements and the performance information was completed on 13 October This is the date at which our opinion is expressed. The basis for our opinion is explained below. In addition, we outline the responsibilities of the Board and our responsibilities relating to the financial statements and the performance information, we comment on other information, and we explain our independence. Basis for our opinion We carried out our audit in accordance with the AuditorGeneral s Auditing Standards, which incorporate the Professional and Ethical Standards and the International Standards on Auditing (New Zealand) issued by the New Zealand Auditing and Assurance Standards Board. Our responsibilities under those standards are further described in the Responsibilities of the auditor section of our report. We have fulfilled our responsibilities in accordance with the AuditorGeneral s Auditing Standards. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our qualified opinion. Responsibilities of the Board for the financial statements and the performance information The Board is responsible on behalf of the Health Board for preparing financial statements and performance information that are fairly presented and comply with generally accepted accounting practice in New Zealand. The Board is responsible for such internal control as they determine is necessary to enable them to prepare financial statements and performance information that are free from material misstatement, whether due to fraud or error. In preparing the financial statements and the performance information, the Board is responsible on behalf of the Health Board for assessing the Health Board s ability to continue as a going concern. The Board is also responsible for disclosing, as applicable, matters related to going concern and using the going concern basis of accounting, unless there is an intention to liquidate the Health Board or there is no realistic alternative but to do so. The Board s responsibilities arise from the Crown Entities Act 2004, the New Zealand Public Health and Disability Act 2000 and the Public Finance Act Responsibilities of the auditor for the audit of the financial statements and the performance information Our objectives are to obtain reasonable assurance about whether the financial statements and the performance information, as a whole, are free from material misstatement, whether due to fraud or error, and to issue an auditor s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit carried out in accordance with the Auditor General s Auditing Standards will always detect a material misstatement when it exists. Misstatements are differences or omissions of amounts or disclosures, and can arise from fraud or error. Misstatements are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of readers taken on the basis of these financial statements and the performance information. For the budget information reported in the financial statements and the performance information, our procedures were limited to checking that the information agreed to the Health Board s statement of performance expectations. We did not evaluate the security and controls over the electronic publication of the financial statements and the performance information. 114 Annual Report 2016 / 17

115 As part of an audit in accordance with the AuditorGeneral s Auditing Standards, we exercise professional judgement and maintain professional scepticism throughout the audit. Also: We identify and assess the risks of material misstatement of the financial statements and the performance information, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. We obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Health Board s internal control. We evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the Board. We evaluate the appropriateness of the reported performance information within the Health Board s framework for reporting its performance. We conclude on the appropriateness of the use of the going concern basis of accounting by the Board and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast a significant doubt on the Health Board s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor s report to the related disclosures in the financial statements and the performance information or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor s report. However, future events or conditions may cause the Health Board to cease to continue as a going concern. We evaluate the overall presentation, structure and content of the financial statements and the performance information, including the disclosures, and whether the financial statements and the performance information represent the underlying transactions and events in a manner that achieves fair presentation. We communicate with the Board regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit. Our responsibilities arise from the Public Audit Act Other Information The Board is responsible for the other information. The other information comprises the information included on pages 4 to 62, but does not include the financial statements and the performance information, and our auditor s report thereon. Our opinion on the financial statements and the performance information does not cover the other information and we do not express any form of audit opinion or assurance conclusion thereon. In connection with our audit of the financial statements and the performance information, our responsibility is to read the other information. In doing so, we consider whether the other information is materially inconsistent with the financial statements and the performance information or our knowledge obtained in the audit, or otherwise appears to be materially misstated. If, based on our work, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Annual Report 2016 /

116 Independence We are independent of the Health Board in accordance with the independence requirements of the AuditorGeneral s Auditing Standards, which incorporate the independence requirements of Professional and Ethical Standard 1(Revised): Code of Ethics for Assurance Practitioners issued by the New Zealand Auditing and Assurance Standards Board. Other than the audit, we have no relationship with, or interests in, the Health Board. Bruno Dente for Deloitte Limited On behalf of the AuditorGeneral Hamilton, New Zealand 116 Annual Report 2016 / 17

117 STATEMENT OF RESPONSIBILITY For the year ended 30 June 2017 The board and management of Whanganui District Health Board are responsible for the preparation of the financial statements and statement of performance and for the judgements made in them. The board and management of Whanganui District Health Board are responsible for any endofyear performance information provided by under section 19A of the Public Finance Act The board and management of Whanganui District Health Board are responsible for establishing and maintaining a system of internal controls designed to provide reasonable assurance as to the integrity and reliability of financial and nonfinancial reporting. In the opinion of the board and management of the, the financial statements and statement of performance for the year ended 30 June 2017, fairly reflect the financial position and operations of the. Signed on behalf of the board and management by: Dot McKinnon Board Chair Julie Patterson Chief Executive Brian Walden General Manager, Corporate Darren Hull Board member Dated: 13 October 2017 Annual Report 2016 /

118 STATEMENT OF COMPREHENSIVE REVENUE AND EXPENSE For the year ended 30 June 2017 in thousands of New Zealand dollars Note 2017 Actual 2017 Budget 2016 Actual Revenue Revenue from nonexchange transactions Revenue from exchange transactions Other revenue 1a 1b 1c 213, , , , , , Total revenue 242, , , 886 Expenses Personnel costs Outsourced services Depreciation and amortisation expense Capital charge Finance costs Other expenses (78, 280) (13, 590) (4, 687) (2, 422) (967) (142, 996) (77, 289) (12, 694) (5, 421) (2, 974) (1, 546) (141, 375) (74, 978) (13, 861) (4, 541) (3, 029) (1, 548) (139, 586) Total expenses (242, 942) (241, 299) (237, 543) Share of profit of associate (Deficit) / Surplus (712) (1, 009) (567) Other comprehensive revenue and expense Gain on property revaluation Total other comprehensive revenue and expense Total comprehensive revenue and expense (712) (1, 009) (567) Explanations of major variances against budget are provided in Note 22. The notes and statement of accounting policies form part of, and should be read in conjunction with these financial statements. 118 Annual Report 2016 / 17

119 STATEMENT OF FINANCIAL POSITION For the year ended 30 June 2017 in thousands of New Zealand dollars Note 2017 Actual 2017 Budget 2016 Actual Assets Current assets Cash and cash equivalents Receivables from nonexchange transactions Receivables from exchange transactions Prepayments Investments Inventories Trust / special funds Patient and restricted trust funds , , , 000 1, , , , , , , 000 1, Total current assets 19, , , 000 Noncurrent assets Property, plant and equipment Intangible assets Investments in associates , 624 9, 209 1, , , 330 1, , 959 6, 722 1, 126 Total noncurrent assets 80, , , 807 Total assets 100, , , 807 Liabilities Current liabilities Payables under nonexchange transactions Payables under exchange transactions Borrowings Employee entitlements , , , 695 2, , , 902 2, , , 982 Total current liabilities 25, , , 029 Noncurrent liabilities Borrowings Employee entitlements , , Total noncurrent liabilities 1, , , 141 Total liabilities 26, , , 170 Net assets 73, , , 637 Equity Contributed capital Accumulated surplus / (deficit) Property revaluation reserve Hospital special funds 105, 884 (49, 409) 16, , 193 (49, 833) 16, , 342 (48, 722) 16, Total equity 73, , , 637 Explanations of major variances against budget are provided in Note 22. The notes and statement of accounting policies form part of, and should be read in conjunction with these financial statements. Annual Report 2016 /

120 STATEMENT OF CHANGES IN EQUITY For the year ended 30 June 2017 in thousands of New Zealand dollars Contributed capital Balance at 1 July Capital contribution Repayable of capital Balance at 30 June Accumulated surplus / (deficit) Balance at 1 July Other reserved movements Surplus / (Deficit) for the year Balance at 30 June Property and plant revaluation reserves Balance at 1 July Revaluation Balance at 30 June Property and plant revaluation reserves consist of: Land Buildings Total property and plant revaluation reserves Hospital special funds Balance at 1 July Transfer from retained earnings in respect of: Interest Donations and funds received Transfer from retained earnings in respect of: Funds spent Balance at 30 June Total equity 2017 Actual 69, , 700 (158) 105, 884 (48, 722) 25 (712) (49, 409) 16, , , , (29) , Actual 69, 500 (158) 69, 342 (48, 120) (35) (567) (48, 722) 16, , , , (1) , 637 Explanations of major variances against budget are provided in Note 22. The notes and statement of accounting policies form part of, and should be read in conjunction with these financial statements. 120 Annual Report 2016 / 17

121 STATEMENT OF CASH FLOWS For the year ended 30 June 2017 in thousands of New Zealand dollars Note 2017 Actual 2017 Budget 2016 Actual Cash flows from operating activities Receipts from the Crown Interest received Receipt from other revenue Payment to suppliers Payment to employees Interest paid Payment of capital charge GST (net) Net cash inflow / (outflow) from operating activities 240, , 392 (159, 634) (77, 495) (1, 208) (2, 422) 89 2, , , 112 (154, 237) (76, 885) (1, 544) (2, 974) 40 4, , , 597 (153, 631) (75, 596) (1, 548) (3, 029) (150) 1, 792 Cash flows from investing activities Receipts from sale of property, plant and equipment Purchase of property, plant and equipment Purchase of intangible assets Acquisition of investment Net appropriation from trust funds Net cash inflow / (outflow) from investing activities (2, 884) (2, 487) 26 (5, 345) (4, 566) (5, 044) (9, 610) 13 (2, 307) (2, 315) (3, 000) (33) (7, 642) Cash flows from financing activities Capital contribution Loan raised Payment of finance lease Repayment of capital Payment of loans (33) (158) (136) 1, 009 (36) (158) (134) 676 (3) (158) (34) Net cash inflow / (outflow) from financing activities (327) Net (decrease) / increase in cash and cash equivalents Cash and cash equivalents at beginning of year Cash and cash equivalents at end of year 6 (3, 501) 10, 907 7, 406 (4, 685) 13, 214 8, 529 (5, 369) 16, , 907 RECONCILIATION OF NET SURPLUS / (DEFICIT) TO NET CASH FLOW FROM OPERATING ACTIVITIES 2017 Actual 2016 Actual Net surplus / (deficit) (712) (567) Add / (less) noncash items Depreciation and amortisation expense 4, 687 4, 541 Total noncash items 4, 687 4, 541 Add / (less) items classified as investing or financing activities (Gains) / losses on disposal of property, plant and equipment Surplus / (deficit) from associates Payable movements attributed to capital purchase 8 (476) (4) (90) Total items classified as investing or financing activities (468) (94) Add / (less) movements in statement of financial position items Receivables Inventories Payables Employee entitlements (957) 34 (1, 094) 681 (1, 232) (19) (219) (618) Net movements in working capital items (1, 336) (2, 088) Net cash flow from operating activities 2, 171 1, 792 Explanations of major variances against budget are provided in Note 22. The notes and statement of accounting policies form part of, and should be read in conjunction with these financial statements.

122 STATEMENT OF SIGNIFICANT ACCOUNTING POLICIES For the year ended 30 June 2017 REPORTING ENTITY is a Crown entity as defined by the Crown Entities Act 2004 and is domiciled and operates in New Zealand. 's ultimate parent is the New Zealand Crown. Whanganui District Health Board is a reporting entity for the purposes of the New Zealand Public Health and Disability Act 2000, the Financial Reporting Act 2013, the Public Finance Act 1989 and the Crown Entities Act 's primary objective is to provide health, disability and mental health services to the New Zealand public. does not operate to make a financial return. has designated itself as a public benefit entity (PBE) for financial reporting purposes. The group consists of and its associated entity Allied Laundry Services Limited (18.25% owned, 2016: 19.1% owned), as disclosed in Note 12. There is also an investment in Central Region s Technical Advisory Services Limited (TAS) (16.7% owned), as disclosed in Note 13. In addition, funds administered on behalf of patients have been reported within the Statement of Changes in Equity. The financial statements for Whanganui District Health Board are for year ended 30 June 2017, and were authorised by the board on 13 October BASIS OF PREPARATION The financial statements have been prepared on a going concern basis, and the accounting policies have been applied consistently throughout the period. Statement of compliance The financial statements of have been prepared in accordance with the requirements of the Crown Entities Act 2004, which includes the requirement to comply with generally accepted accounting practice in New Zealand (NZ GAAP). The financial statements have been prepared in accordance with Tier 1 Public Benefit Entity (PBE) accounting standards. Standards issued and not yet effective and not early adopted Interests in other entities In January 2017, the XRB issued new standards for interests in other entities (PBE IPSAS 34 38). These new standards replace the existing standards for interests in other entities (PBE IPSAS 6 8). The new standards are effective for annual periods beginning on or after 1 January 2019, with early application permitted. The WDHB plans to apply the new standards in preparing the 30 June 2020 financial statements. WDHB has not yet assessed the effects of these new standards. Financial instruments In January 2017, the External Reporting Board issued PBE IFRS 9 Financial Instruments. This replaces PBE IPSAS 29 Financial Instruments: Recognition and Measurement. PBE IFRS 9 is effective for annual periods beginning on or after 1 January 2021, with earlier application permitted. The main changes under the standard are: New financial asset classification requirements for determining whether an asset is measured at fair value or amortised cost. A new impairment model for financial assets based on expected losses, which may result in the earlier recognition of impairment losses. Revised hedge accounting requirements to better reflect the management of risks. WDHB plans to apply this standard in preparing its 30 June 2022 financial statements. WDHB has not yet assessed the effects of the new standard. Impairment of revalued assets In April 2017, the XRB issued Impairment of Revalued Assets, which now clearly scopes in revalued property, plant, and equipment into the impairment accounting standards. Previously, only property, plant, and equipment measured at cost were scoped into the impairment accounting standards. Under the amendment, a revalued asset can be impaired without having to revalue the entire class ofasset to which the asset belongs. WDHB plans to apply this standard in preparing its 30 June 2020 financial statements. These financial statements comply with Public Benefit Entity accounting standards. Presentation currency and rounding The financial statements are presented in New Zealand dollars and all values are rounded to the nearest thousand dollars ($000). 122 Annual Report 2016 / 17

123 STATEMENT OF SIGNIFICANT ACCOUNTING POLICIES For the year ended 30 June 2017 GOING CONCERN The going concern principle has been adopted in the preparation of these financial statements. The Whanganui District Health Board (DHB), after making enquiries, has a reasonable expectation that the DHB has adequate resources to continue operations for the foreseeable future. The board has reached this conclusion having regard to circumstances which it considers likely to affect the district health board for the foreseeable future from the date of signing the 2016/17 financial statements, and to circumstances which it knows will occur after that date which could affect the validity of the going concern assumption (as set out in its current Statement of Performance and Statement of Financial Position). BASIS FOR CONSOLIDATION ASSOCIATES Associates are those entities in which Whanganui District Health Board has significant influence, but not control, over the financial and operating policies. Whanganui District Health Board has shareholdings in an associate Allied Laundry Services Limited, and participates in commercial and financial policy decisions of that company. The accounts of the associate company are audited. The financial statements include Whanganui District Health Board s share of the total recognised gains and losses of associates on an equity accounted basis, from the date that significant influence commences until the date that significant influence ceases. After initial recognition, associates are measured at their fair value with gains and losses recognised in other comprehensive revenue and expense, except for impairment losses that are recognised in the surplus or deficit. On derecognition, the cumulative gain or loss previously recognised in other comprehensive revenue and expense is reclassified to the surplus or deficit. If s share of losses exceeds its interest in an associate, s carrying amount is reduced to nil and recognition of further losses is discontinued except to the extent that Whanganui District Health Board has incurred legal or constructive obligations or made payments on behalf of an associate. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Significant accounting policies are included in the notes to which they relate. Significant accounting policies that do not relate to a specific note are outlined below. COMPARATIVE FIGURES Comparative figures in the statement of comprehensive revenue and expense, statement of changes in equity and statement of cash flows are presented for the 12 months operations from 1 July 2015 to 30 June The comparative figures in the Statement of Financial Position are presented as at 30 June BUDGET FIGURES The budget figures are those approved by the DHB in the WDHB's Annual Plan and included in the statement of performance tabled in Parliament. The budget figures have been prepared in accordance with NZGAAP. GOODS AND SERVICES TAX All amounts are shown exclusive of Goods and Services Tax (GST), except for receivables and payables which are stated inclusive of GST. Where GST is irrecoverable as an input tax, it is recognised as part of the related asset or expense. The net amount of GST recoverable from, or payable to, the IRD is included as part of receivables from nonexchange or exchange transactions or payables under nonexchange or exchange transactions in the Statement of Financial Position. The net GST paid to, or received from, the IRD, including the GST relating to investing and financing activities, is classified as a net operating cash flow in the Statement of Cash Flows. Commitments and contingencies are disclosed exclusive of GST. INCOME TAX is a Crown entity under the New Zealand Public Health and Disability Act 2000 and is exempt from income tax under section CB3 of the Income Tax Act The associate company Allied Laundry Services Limited, is exempt from income tax under section CW31 (2) of the Income Tax Act FOREIGN CURRENCY TRANSACTIONS Foreign currency transactions (including those subject to forward foreign exchange contracts) are translated into NZ$ (the functional currency) using the spot exchange rates at the dates of the transactions. Foreign exchange gains and losses resulting from the settlement of such transactions and from the translation at yearend exchange rates of monetary assets and liabilities denominated in foreign currencies are recognised in the surplus or deficit. Annual Report 2016 /

124 STATEMENT OF SIGNIFICANT ACCOUNTING POLICIES For the year ended 30 June 2017 FINANCIAL INSTRUMENTS Nonderivative financial instruments Nonderivative financial instruments comprise receivables from exchange and nonexchange transactions, cash and cash equivalents, other investments, interest bearing loans and borrowings, and payables under exchange and nonexchange transactions. Nonderivative financial assets are recognised initially at fair value plus transaction costs except for those financial assets classified as fair value through other comprehensive revenue and expense. Nonderivative financial liabilities are recognised initially at fair value plus transaction costs. Subsequent to initial recognition nonderivative financial instruments are measured as described below and in Note 21. A financial instrument is recognised if Whanganui District Health Board becomes a party to the contractual provisions of the instrument. Financial assets are derecognised if 's contractual rights to the cash flows from the financial assets expire or if the Whanganui District Health Board transfers the financial asset to another party without retaining control or substantially all risks and rewards of the asset. Purchases and sales of financial assets are accounted for at trade date, i.e. the date that the Whanganui District Health Board commits itself to purchase or sell the asset. Financial liabilities are derecognised if the Whanganui District Health Board's obligations specified in the contract expire or are discharged or cancelled. CHANGE IN ACCOUNTING POLICIES The accounting policies adopted in these financial statements are consistent with those of the previous financial year, unless otherwise stated. PROVISIONS A provision is recognised when Whanganui District Health Board has a present legal or constructive obligation as a result of a past event, and it is probable that an outflow of economic benefits will be required to settle that obligation. If the effect is material, provisions are determined by discounting the expected future cash flows at a pretax rate that reflects current market rates and, where appropriate, the risks specific to the liability. EQUITY Equity is measured as the difference between total assets and total liabilities. Equity is disaggregated and classified into the following components. contributed capital; accumulated surplus/(deficit); property revaluation reserves; and hospital special funds. Property revaluation reserve This reserve relates to the revaluation of property, plant, and equipment to fair value. Hospital special funds Special funds are funds donated or bequeathed for a specific purpose. The use of these assets must comply with the specific terms of the sources from which the funds were derived. The revenue and expenditure in respect of these funds is recognised in the surplus or deficit. An amount equal to the expenditure is transferred from the Trust fund component of equity to retained earnings. An amount equal to the revenue is transferred from retained earnings to Trust funds. All hospital special funds (Trust) are held in bank accounts that are separate from s normal banking facilities. COST OF SERVICE (Statement of Performance) The cost of service statements, as reported in the statement of performance, report the net cost of services for the outputs of and are represented by the cost of providing the output less all the revenue that can be allocated to these activities. Cost allocation has arrived at the net cost of service for each significant activity using the cost allocation system outlined below. Cost allocation policy Direct costs are charged directly to output classes. Indirect costs are charged to output classes based on cost drivers and related activity and usage information. Criteria for direct and indirect costs Direct costs are those costs directly attributable to an output class. Indirect costs are those costs that cannot be identified in an economically feasible manner with a specific output class. Cost drivers for allocation of direct and indirect costs Direct costs are charged directly to outputs. Depreciation is charged on the basis of asset utilisation. Personnel costs are charged on the basis of actual time incurred. Property and other premises costs, such as maintenance, are charged on the basis of floor area occupied for the production of each output. The cost of indirect costs (internal services) not directly charged to outputs is attached as overheads using appropriate cost drivers such as actual usage, staff numbers and floor areas. There have been no changes to the cost allocation methodology since the date of the last audited financial statements. 124 Annual Report 2016 / 17

125 STATEMENT OF SIGNIFICANT ACCOUNTING POLICIES For the year ended 30 June 2017 CRITICAL ACCOUNTING ESTIMATES AND ASSUMPTIONS In preparing these financial statements, Whanganui District Health Board has made estimates and assumptions concerning the future. These estimates and assumptions may differ from the subsequent actual results. Estimates and assumptions are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances. The estimates and assumptions that have a significant risk of causing a material adjustment to the carrying amounts of financial assets and liabilities within the next financial year are: Revenue recognised and income in advance refer Note 1. Useful lives and residual values of property, plant, and equipment refer Note 10. Fair value of land and buildings refer Note 10. Useful lives of software assets refer Note 11. Retirement and long service leave refer Note REVENUE ACCOUNTING POLICIES The specific accounting policies for significant revenue items are explained below: Revenue is measured at the fair value of consideration received or receivable. Crown funding is primarily funded through revenue received from Crown under a Crown Funding Agreement. This funding is restricted in its use for the purpose of meeting the objectives specified in its founding legislation and the scope of the relevant appropriations of the funder. considers there are no conditions attached to the funding and it is recognised as revenue at the point of entitlement. This is considered to be the start of the appropriation period to which the funding relates. The fair value of revenue from the Crown has been determined to be equivalent to the amounts due in the funding arrangements. Goods sold and services rendered Revenue from goods sold are recognised when Whanganui District Health Board has transferred to the buyer the significant risks and rewards of ownership of the goods and does not retain either continuing managerial involvement to the degree usually associated with ownership nor effective control over the goods sold. Revenue from these services are recognised, to the proportion that a transaction is complete, when it is probable that the payment associated with the transaction will flow to and that payment can be measured or estimated reliably, and to the extent that any obligations and all conditions have been satisfied by. Donated assets Where a physical asset is gifted to or acquired by Whanganui District Health Board for nil consideration or at a subsidised cost, the asset is recognised at fair value and the difference between the consideration provided and fair value of the asset is recognised as revenue. The fair value of donated assets is determined as follows: For new assets, fair value is usually determined by reference to the retail price of the same or similar assets at the time the asset was received. For used assets, fair value is usually determined by reference to market information for assets of a similar type, condition, and age. Donated services Certain operations of are reliant on services provided by volunteers. Volunteer services received are not recognised as revenue or expenditure by. Interest revenue Interest received and receivable on funds invested, are calculated using the effective interest rate method, and are recognised as a revenue in the financial year in which they are incurred. Grants / revenue relating to service contracts is required to expend all funding appropriated within certain contracts during the year in which it is appropriated. If this is not done the contract may require repayment of the money or an agreement with the Ministry of Health, to expend it on specific services in subsequent years. The amount unexpended is recognised as a liability only where there is sufficient certainty of a specific obligation to repay. Annual Report 2016 /

126 in thousands of New Zealand dollars 1 REVENUE (continued) CRITICAL ACCOUNTING ESTIMATES AND ASSUMPTIONS APPLYING POLICIES Revenue recognition and income in advance In determining whether or not revenue has been earned, a degree of judgement is required based on information included within the funding agreements. Where the funding agent has the right to demand repayment, income in advance is recognised for the unearned portion of the funding received. BREAKDOWN OF REVENUE AND FURTHER INFORMATION 1a. REVENUE FROM NONEXCHANGE TRANSACTIONS 2017 Actual 2016 Actual Health and disability services (Crown appropriation revenue)* Ministry of Health other revenue Other revenue Total revenue from nonexchange transactions 208, 746 5, , , 202 5, , 031 1b. REVENUE FROM EXCHANGE TRANSACTIONS 2017 Actual 2016 Actual Ministry of Health other revenue ACC contract Inter District Patient Inflows Other Government Other revenue Finance income Total revenue from exchange transactions 10, 527 7, 064 8, , , 914 8, 598 6, 727 7, , , 512 1c. OTHER REVENUE 2017 Actual 2016 Actual Rental revenue Total other revenue * Performance against this appropriation is reported in the Statement of Performance on pages The appropriation revenue received by Whanganui District Health Board equals the Government s actual expenses incurred in relation to the appropriation, which is a required disclosure from the Public Finance Act. 2 PERSONNEL COSTS ACCOUNTING POLICIES Superannuation schemes Defined contribution schemes Obligations for contributions to KiwiSaver, the Government Superannuation Fund, are accounted for as defined contribution superannuation schemes and are recognised as an expense in the surplus or deficit as incurred. BREAKDOWN OF PERSONNEL COSTS AND FURTHER INFORMATION Salaries and wages Defined contribution scheme employer contributions Increase / (decrease) in employee entitlements Total personnel costs 2017 Actual 75, 715 2, , Actual 72, 383 2, , 978 Employer contributions to defined contribution schemes include contributions to KiwiSaver and the Government Superannuation Funds. 126 Annual Report 2016 / 17

127 in thousands of New Zealand dollars EMPLOYEE REMUNERATION (over $100,000) Number of employees 100, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 999 Total employees 2017 Actual Actual Medical staff make up 68 (2016: 61) of the 107 (2016: 96) people in these bands. If the remuneration of the parttime employees were grossed up to a fulltime equivalent (FTE) basis, the total number of employees with FTE salaries of $100,000 or more would be 110 (2016: 99) compared with the actual number of employees of 107 (2016: 96). The chief executive s remuneration is in the $370,000 to $379,999 band (2016: $370,000 to $379,999). This includes the value of the district health board s contribution to KiwiSaver and car allowance. Noncash benefits are not included in the salary data for other employees. Severance payments One employee received severence payments in 2017 (2016: nil). Employees received compensation and other benefits in relation to termination of their employment or change in contractual conditions totalling $7k (2016: nil). Annual Report 2016 /

128 in thousands of New Zealand dollars 3 CAPITAL CHARGE ACCOUNTING POLICIES The capital charge is recognised as an expenditure in the financial year to which the charge relates. Further information on the capital charge The DHB pays a capital charge to the Crown on its equity (adjusted for memorandum accounts) as at 30 June and 31 December each year. The capital charge rate for the year ended 30 June 2017 was 7% from 1 July 2016 to 31 December 2016 and then 6% from 1 January 2017 ( %). 4 FINANCE COSTS ACCOUNTING POLICIES Financing costs comprise interest paid and payable on borrowings calculated using the effective interest rate method, and are recognised as an expenditure in the financial year in which they are incurred. BREAKDOWN OF BORROWING / FINANCING COSTS Interest on secure loans Total finance costs 2017 Actual Actual 1, 548 1, OTHER EXPENSES BREAKDOWN OF OTHER EXPENSES AND FURTHER INFORMATION Fees to Auditors Fees for audit of financial statements Audit related fee internal (for assurance related services) Board members fees Board member expenses Operating lease expenses (Reversal of) / impairment of receivables (Gain) / loss on disposal of property, plant and equipment Inventories consumed Clinical & infrastructure and nonclinical expenses Inter district outflow Payments to nonhealth board providers Other expenses Total other expenses 2017 Actual , , , , , Actual (2) (4) 6, , , , , Annual Report 2016 / 17

129 in thousands of New Zealand dollars 5 OTHER EXPENSES (continued) BOARD MEMBER REMUNERATION 2017 Actual 2016 Actual Mrs Dot McKinnon Mr Stuart Hylton (deputy Board chair) Mrs Philippa BakerHogan Mrs Judith MacDonald Ms Jenny Duncan Ms Harete Hipango Mr Philip Sunderland (to December 2016) Mr Allan Anderson (to December 2016) Ms Kate Joblin (to December 2016) Mr Ray Stevens (to December 2016) Mrs Barbara Ball (to December 2016) Mr Graham Adams (from December 2016) Mr Charlie Anderson (from December 2016) Ms Annette Main (from December 2016) Hon Dame Tariana Turia (from December 2016) Mr Darren Hull (from December 2016) Total board member remuneration does not provide a deed of indemnity to directors for certain activities undertaken in the performance of the 's functions. No board members received compensation or other benefits in relation to cessation (2016: nil). Payments made to committee members appointed by the board totalled $29k (2016:$27k). Operating leases as lessee ACCOUNTING POLICIES Operating lease An operating lease is a lease that does not transfer substantially all the risks and rewards incidental to ownership of an asset to the lessee. Lease payments made under operating leases are recognised as an expenditure on a straightline basis over the term of the lease. Lease incentives received are recognised in the surplus or deficit over the lease term on a straightline basis as well as an integral part of the total lease expense. THE FUTURE AGGREGATE MINIMUM LEASE PAYMENTS TO BE PAID UNDER NONCANCELLABLE OPERATING LEASES ARE AS FOLLOWS 2017 Actual 2016 Actual Noncancellable operating leases Less than one year One to two years Two to three years Total There are no restrictions placed on by any of its leasing arrangements. leases a number of vehicles, clinical and office equipment (mainly photocopiers and printers) under operating leases. The leases typically run for a period of three to five years with an option to renew the lease after that date. None of the leases include contingent rentals. Annual Report 2016 /

130 in thousands of New Zealand dollars 6 CASH AND CASH EQUIVALENTS ACCOUNTING POLICIES Cash and cash equivalents comprise cash on hand, a demand fund held with NZ Health Partnerships (NZHP) and other highly liquid investments with maturity of no more than three months from the date of acquisition. Bank overdrafts are shown within borrowings in current liabilities in the Statement of Financial Position. BREAKDOWN OF CASH AND CASH EQUIVALENTS AND FURTHER INFORMATION Cash on hand Demand funds held with NZHP Total cash and cash equivalents 2017 Actual 5 7, 401 7, Actual 5 10, , 907 Working capital facility is a party to the DHB Treasury Services Agreement between NZ Health Partnerships (NZHP) and the participating DHBs. This agreement enables NZHP to sweep DHB bank accounts and invest surplus funds. The DHB Treasury Services Agreement provides for individual DHBs to have a debit balance with NZHP, which will incur interest at the credit interest rate received by NZHP plus an administrative margin. The maximum debit balance that is available to any DHB is the value of provider division s planned monthly Crown revenue, used in determining working capital limits, is defined as one12th of the annual planned revenue paid by the funder division to the provider division as denoted in the most recently agreed WDHB Annual Plan inclusive of GST. For that equates to $10.611m (2016: $10.443m). This is undrawn at the balance date. 7 RECEIVABLES ACCOUNTING POLICIES Receivables are recognised at the fair value less any provision for impairment. A receivable is considered impaired when there is evidence that will not be able to collect the amount due. The amount of the impairment is the difference between the carrying amount of the receivable and the present value of the amounts expected to be collected. Overdue receivables that have been renegotiated are reclassified as current (that is, not past due). Bad debts are written off during the period in which they are identified. BREAKDOWN OF RECEIVABLES AND OTHER INFORMATION 2017 Actual 2016 Actual Receivables Other (gross) Ministry of Health (gross) Less: provision for impairments Total receivables Total receivables comprises: Receivable from nonexchange transactions Receivable from exchange transactions 3, 313 3, 674 (347) 6, , 424 3, 908 2, 949 (347) 6, , Annual Report 2016 / 17

131 in thousands of New Zealand dollars 7 RECEIVABLES (continued) The ageing profile of receivables at yearend is detailed below: Not past due Past due 1 30 days Past due days Past due days Past due over 360 days Gross Impairment Net Gross Impairment Net , 461 (14) 6, 447 6, 238 (9) 6, (48) (7) (51) (41) (41) (54) (193) 242 (236) 6 Total 6, 987 (347) 6, 640 6, 857 (347) 6, 510 All receivables greater than 30 days in age are considered to be past due. The impairment assessment is generally recognised when debt is overdue and based on historical experience or an assessment of the particular receivable, it is deemed to not be recoverable. When the receivable is not collectable, it is written off and any provision against this receivable reversed. Overdue receivables that have been renegotiated are reclassified as current (that is not past due). MOVEMENTS IN THE PROVISION FOR IMPAIRMENT OF RECEIVABLES ARE AS FOLLOWS: Balance as at 1 July Additional provisions made during the year Receivables written off during the year Receivables recovered during the year Impairment losses reversed Total 2017 Actual Actual 349 (2) INVESTMENTS ACCOUNTING POLICIES Bank term deposits Investments in bank term deposits are initially measured at the amount invested. After initial recognition, investments in bank deposits are measured at amortised cost using the effective interest method, less any provision for impairment. BREAKDOWN OF INVESTMENT AND FURTHER INFORMATION 2017 Actual 2016 Actual Current portion Term deposit Total current portion 3, 000 3, 000 3, 000 3, 000 Noncurrent portion Term deposit Total noncurrent portion Total investment 3, 000 3, 000 The carrying amounts of term deposits with maturities less than 12 months approximate their fair value. Annual Report 2016 /

132 in thousands of New Zealand dollars 9 INVENTORIES ACCOUNTING POLICIES Inventories held for distribution in the provision of services that are not supplied on a commercial basis are stated at cost, adjusted where applicable for any loss of service potential. Cost is based on weighted average cost. Inventories are held for the DHB's own use and are not supplied on a commercial basis. Inventories are stated at cost and adjusted where applicable for any loss of service potential. The amount of any writedown for the loss of service potential or from cost to net realisable value is recognised in surplus or deficit in the period of the writedown. Inventories acquired through nonexchange transactions are measured at fair value at the date of acquisition. Obsolete inventories are written off. BREAKDOWN OF INVENTORIES AND FURTHER INFORMATION Held for distribution inventories Central stores Pharmaceuticals Theatre supplies Other supplies Total inventories 2017 Actual , Actual , 361 Writedown of inventories amounted to $41k (2016: $28k). There have been no reversals of writedowns. No inventories are pledged as security for liabilities (2016: nil) but some inventories are subject to retention of title clauses (Romalpa clauses). The value of stocks subject to such clauses cannot be quantified due to the inherent difficulties in identifying the specific inventories affected at yearend. 132 Annual Report 2016 / 17

133 in thousands of New Zealand dollars 10 PROPERTY, PLANT AND EQUIPMENT ACCOUNTING POLICIES Classes of property, plant and equipment The major classes of property, plant and equipment are as follows: Land, at fair value. Buildings and improvements, at fair value less accumulated depreciation. Plant and equipment, at cost less accumulated depreciation and impairment losses. Vehicles, cost less accumulated depreciation and impairment losses. Leased assets, cost less accumulated depreciation and impairment losses. Revaluations Land and buildings are revalued, with sufficient regularity to ensure the carrying amount is not materially different to fair value, and at least every three years. The carrying values of revalued assets are assessed annually to ensure that they do not differ materially from fair value. If there is evidence supporting a material difference, then the offcycle asset classes are revalued. Land and building revaluation movements are accounted for on a classofasset basis. The net revaluation results are credited or debited to other comprehensive revenue and expense and are accumulated to an asset revaluation reserve in equity for that class of asset. Where this would result in a debit balance in the asset revaluation reserve, this balance is recognised in the surplus or deficit. Any subsequent increase on revaluation that reverses a previous decrease in value recognised in the surplus or deficit will be recognised first in the surplus or deficit up to the amount previously expensed, and then recognised in other comprehensive revenue and expense. Additions The cost of an item of property, plant, and equipment is recognised as an asset only when it is probable that future economic benefits or service potential associated with the item will flow to and the cost of the item can be measured reliably. Disposal Gains and losses on disposals are determined by comparing the proceeds with the carrying amount of the asset. Gains and losses on disposals are reported net in the surplus or deficit. When revalued assets are sold, the amounts included in revaluation reserves in respect of those assets are transferred to the accumulated surplus / (deficit) within equity. Subsequent costs Subsequent costs are added to the carrying amount of an item of property, plant and equipment when that cost is incurred if it is probable that the service potential or future economic benefits embodied within the new item will flow to and the cost of items can be measured reliably. The costs of daytoday servicing of property, plant, and equipment are recognised in the surplus or deficit as they are incurred. Depreciation Depreciation is charged to surplus or deficit. Depreciation is provided on a straightline basis on all property, plant, and equipment other than land and motor vehicles. Land is not depreciated. Motor vehicles are depreciated using diminishing value basis. Depreciation is set at rates that will write off the cost or fair value of the assets, less their estimated residual values, over their useful lives. The major classes of estimated useful lives are as follows: Class of asset Land Buildings & improvements Plant & equipment Vehicles Leased assets Estimated life Indefinite 2 59 years years 4 7 years 4 8 years Depreciation rate 1.32% 20% 2.5% 33% 10% 40% 14.3% The residual value and useful lives of assets is reassessed annually. Work in progress is not depreciated. The total cost of a project is transferred to the appropriate class of asset on its completion and then depreciated. In most instances, an item of property, plant, and equipment is initially recognised at its cost. Where an asset is acquired through a nonexchange transaction, it is recognised at its fair value as at the date of acquisition. Work in progress is recognised at cost less impairment and is not depreciated. Work in progress includes the cost of direct materials, direct labour and an appropriate share of overheads. Annual Report 2016 /

134 in thousands of New Zealand dollars Restrictions does not have full title to Crown land it occupies, but transfer is arranged if and when land is sold. Some of the land is subject to Waitangi Tribunal claims. The disposal of certain properties may be subject to the provision of section 40 of the Public Works Act Titles to land transferred from the Crown to Whanganui District Health Board are subject to a memorial in terms of the Treaty of Waitangi Act 1975 (as amended by the Treaty of Waitangi (State Enterprises) Act 1988). The effect on the value of assets resulting from potential claims under the Treaty of Waitangi Act 1975 cannot be quantified. There are no other restrictions on property, plant & equipment. Impairment of property, plant and equipment does not hold any cashgenerating assets. Assets are considered cashgenerating where their primary objective is to generate a commercial return. Noncashgenerating assets Property, plant, and equipment held at cost that have a finite useful life are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. If any such indication exists, the assets recoverable amounts are estimated. An impairment loss is recognised for the amount by which the asset s carrying amount exceeds its recoverable service amount. The recoverable service amount is the higher of an asset s fair value less costs to sell and value in use. Value in use of noncash generating assets is determined as the present value of the remaining service potential using either the depreciated replacement cost approach, the restoration cost approach or the service units approach. The most appropriate approach used to measure value in use depends on the nature of the impairment and availability of information. If an asset's carrying amount exceeds its recoverable service amount, the asset is regarded as impaired and the carrying amount is writtendown to the recoverable amount. The total impairment loss is recognised in the surplus or deficit. The reversal of an impairment loss is recognised in the surplus or deficit. KEY ACCOUNTING ASSUMPTIONS AND ESTIMATES Estimated useful lives of property, plant and equipment At each balance date, the useful lives and residual values of property, plant, and equipment are reviewed. Assessing the appropriateness of useful life and residual value estimates of property, plant, and equipment requires a number of factors to be considered such as the physical condition of the asset, expected period of use of the asset by Whanganui District Health Board, and expected disposal proceeds from the future sale of the asset. has not made significant changes to past assumptions concerning useful lives and residual values. Estimating the fair value of land and buildings Valuation The last valuation of land and buildings was performed 30 June 2015 by Telfer Young Limited. A 2017 review of the carrying value of buildings has been undertaken using capital goods price index for nonresidential buildings. The results indicate the carrying value is unlikely to be materially different to the fair value. Land Land is valued at its fair value using marketbased evidence based on its highest and best use with reference to comparable land value. Buildings Specialised buildings are valued at fair value using depreciated replacement cost because no reliable market data is available for such buildings. Depreciated replacement cost is determined using a number of significant assumptions. Significant assumptions include: The replacement asset is based on the reproduction cost of the specific assets with adjustments where appropriate for optimisation due to overdesign or surplus capacity. The replacement cost is derived from recent construction contracts of similar assets and Property Institute of New Zealand cost information. For s earthquakeprone buildings that are expected to be strengthened, the estimated earthquakestrengthening costs have been deducted off the depreciated replacement cost in estimating fair value. The remaining useful life of assets is estimated. Straightline depreciation has been applied in determining the depreciated replacement cost value of the asset. Nonspecialised buildings (for example, residential buildings) are valued at fair value using marketbased evidence. Market rents and capitalisation rates were applied to reflect market value. 134 Annual Report 2016 / 17

135 in thousands of New Zealand dollars BREAKDOWN OF PROPERTY, PLANT AND EQUIPMENT AND FURTHER INFORMATION Movements for each class of property, plant and equipment are as follows: 30 June 2016 Cost / valuation Accumulated depreciation Carrying amounts Additions Transfer Disposals Revaluation increase Depreciation expenses Elimination on disposal Elimination on revaluation Cost / valuation Accumulated depreciation Land Buildings & improvements Plant & equipment Leased assets Motor vehicles 1, , , , July June 2016 (1, 804) (15, 933) (37) (796) 1, , 937 6, , (20) (1, 359) (2, 510) (1, 591) (17) (131) 20 1, 347 1, , , , 834 (4, 294) (16, 177) (54) (927) 92, 480 (18, 570) 73, 910 2, 310 (1, 379) (4, 249) 1, , 411 (21, 452) Work in progress Buildings & improvements Total 92, 480 (18, 570) 73, 910 2, 310 (1, 379) (4, 249) 1, , 411 (21, 452) 30 June 2017 Cost / valuation Accumulated depreciation Carrying amounts Additions Transfer Disposals Revaluation increase Depreciation expenses Elimination on disposal Elimination on revaluation Cost / valuation Accumulated depreciation Land Buildings & improvements Plant & equipment Leased assets Motor vehicles 1, , , , July June 2017 (4, 294) (16, 177) (54) (927) 1, , 392 6, , 406 1, 081 (291) (2, 510) (1, 515) (17) (169) 283 1, , , , 915 (6, 804) (17, 409) (71) (1, 096) 93, 411 (21, 452) 71, 959 2, 884 (291) (4, 211) , 004 (25, 380) Work in progress Buildings & improvements Total 93, 411 (21, 452) 71, 959 2, 884 (291) (4, 211) , 004 (25, 380) Carrying amounts 1, , 392 6, , , 959 Carrying amounts 1, , 279 5, , , , 624 Annual Report 2016 /

136 in thousands of New Zealand dollars 11 INTANGIBLE ASSETS ACCOUNTING POLICIES Initial recognition Intangible assets that are acquired by Whanganui District Health Board are stated at cost less accumulated amortisation and impairment losses. Work in progress is disclosed separately where the software development or project has not been completed at balance date. Software acquisition and development Acquired computer software licenses are capitalised on the basis of the costs incurred to acquire and bring to use the specific software. Costs that are directly associated with the development of software for internal use are recognised as an intangible asset. Direct costs include software development employee costs and an appropriate portion of relevant overheads. Staff training costs are recognised as an expense when incurred. Costs associated with maintaining computer software are recognised as an expense when incurred. Amortisation The carrying value of an intangible asset with a finite life is amortised on a straightline basis over its useful life unless such lives are indefinite. Amortisation begins when the asset is available for use and ceases at the date that the asset is derecognised. The amortisation charge for each financial year is recognised in the surplus or deficit. Intangible assets with an indefinite useful life are tested for impairment annually. The useful lives and associated amortisation rates of major classes of intangible assets have been estimated as follows: Type of asset Software RHIP RHIP local cost FPSC rights Estimated life 4 10 years Work in progress 10 years Indefinite Amortisation rate 10 25% Nil 10% Nil Previously the amortisation policy for software was an estimated useful life of 4 to 5 years, however it was discovered in 2016 that most legacy clinical systems have a useful life of 10 years. Therefore, the amortisation policy was updated in 2016 to 4 to 10 years. Realised gains and losses arising from disposal of intangible assets are recognised surplus or deficit in the period in which the transaction occurs. KEY ACCOUNTING ASSUMPTIONS AND ESTIMATES Estimating useful lives of software assets s internally generated software largely arises from local development of regional clinical systems for radiology, clinical support (Clinical Portal) and patient administration (webpas) as part of Whanganui District Health Board s regulatory functions. Internally generated software has a finite life, which requires Whanganui District Health Board to estimate the useful life of software assets. In assessing the useful lives of software assets, a number of factors are considered, including: the period of time the software is intended to be in use; the effect of technological change on systems and platforms; and the expected timeframe for the development of replacement systems and platforms. An incorrect estimate of the useful lives of software assets will affect the amortisation expense recognised in the surplus or deficit, and the carrying amount of the software assets in the Statement of Financial Position. FPSC rights (NZ Health Partnerships Limited) The WDHB has invested in the National Oracle Solution (NOS) facilitated by New Zealand Health Partnerships Limited, a company collectively owned by the 20 DHBs, to provide a finance, procurement and supply chain (FPSC) system and return significant procurement savings to the sector. The investment rights is considered to have an indefinite life as the DHBs have the ability and intention to review the service level agreement indefinitely and the fund established by NZHP through the oncharging of depreciation on the FPSC assets to the DHBs will be used to, and is sufficient to, maintain the FPSC assets standard of performance or service potential indefinitely. As the FPSC rights are considered to have an indefinite life, the intangible asset is not amortised and will be tested for impairment annually. As at 30 June 2017, had contributed a total of $983k (2016: $983k) to NZHP in relation to the FPSC programme, which was included in work in progress at year end. The investment has been tested for impairment during the year by the DHB. At this stage, based on the information available, no impairment is required. Impairment of intangible assets Refer to the policy for impairment of property, plant, and equipment in Note 10. The same approach applies to the impairment of intangible assets. 136 Annual Report 2016 / 17

137 in thousands of New Zealand dollars Regional Health Informatics Programme (RHIP) RHIP is a programme to move the Central Region District Health Boards from a current state of disparate, fragmented and, in some cases obsolescent, clinical and administrative information systems to a future state of shared, standardised and fully integrated information systems that will enhance clinical practice, drive administrative efficiencies, enable regionalisation of services and reduce current operational risks. It was originally agreed that Central Region Technical Advisory Services Limited (CTAS) would create the RHIP assets and provide services in relation to those assets to the DHBs. Each DHB would provide funding to CTAS and in return for the funding relating to capital items the DHBs would be provided with Class B Redeemable Shares in CTAS. The agreement to provide the RHIP assets and services was amended on 1 December 2014 to transfer the ownership of RHIP assets to the DHBs jointly. As at 30 June 2017, 's had invested a total of $7.3m (2016: $4.9m) in the RHIP programme, which has been recognised as work in progress in respect of intangible assets. The investment has been tested for impairment during the year by the DHB. The district health boards in the central region continue to support the project, and consequently the WDHB considers the regional clinical systems will come online, and that no impairment of the assets is necessary. Annual Report 2016 /

138 in thousands of New Zealand dollars BREAKDOWN OF INTANGIBLE ASSETS AND FURTHER INFORMATION Movements for each class of intangible assets are as follows: 30 June 2016 Cost / valuation Accumulated amortisation Carrying amounts Additions Transfer Disposals Amortisation Elimination on disposal Cost / valuation Accumulated amortisation Carrying amounts Software Regional Health Informatics Programme (RHIP) 5, July June (4, 039) (98) 1, (243) (49) 5, (4, 282) (147) , 630 (4, 137) 1, (292) 5, 729 (4, 429) 1, 300 Work in progress Regional Health Informatics Programme (RHIP) FPSC rights Total 2, , 206 8, 836 (4, 137) 2, , 206 4, 699 2, 216 2, 216 2, 315 (292) 4, , , 151 (4, 429) 4, , 422 6, 722 There are no restrictions over the title of intangible assets, nor are any intangible assets pledged as security for liabilities. 30 June 2017 Cost / valuation Accumulated amortisation Carrying amounts Additions Transfer Disposals Amortisation Elimination on disposal Cost / valuation Accumulated amortisation Carrying amounts Software Regional Health Informatics Programme (RHIP) 5, July June 2017 (922) 922 (4, 282) (147) (375) (101) 4, 961 1, 086 (3, 735) (248) 1, , 729 (4, 429) 1, (922) (476) 922 6, 047 (3, 983) 2, 064 Work in progress Regional Health Informatics Programme (RHIP) FPSC rights Total 4, , , 151 (4, 429) 4, , 422 6, 722 2, 088 2, 088 2, 963 (365) (365) (922) (476) 922 6, , , 192 (3, 983) 6, , 145 9, 209 There are no restrictions over the title of intangible assets, nor are any intangible assets pledged as security for liabilities. 138 Annual Report 2016 / 17

139 in thousands of New Zealand dollars 12 INVESTMENT IN ASSOCIATES 2017 Actual 2016 Actual Summary of financial information on associate entities (100 percent) Assets Liabilities Equity Revenue Surplus / (deficit) Allied Laundry Services Limited 10, 497 (4, 095) (6, 402) (10, 432) % 10, 418 (4, 429) (5,989) (9, 239) % Investment in associates Balance as at 1 July Dividends Share of profit Other movements Total investment in associates 1, 126 1, 126 1, 092 (56) 90 1, OTHER FINANCIAL ASSETS holds a 16.7% (2016: 16.7%) shareholding in Central Region s Technical Advisory Services Limited (TAS) and participates in its commercial and financial policy decisions. The five other district health boards in the region each hold 16.7% (2016: 16.7%) of the shares. Central Region s Technical Advisory Services Limited was incorporated on 6 June The total share capital of $600 remains uncalled and as a result no investment has been recorded in the Statement of Financial Position for this investment. 14 PAYABLES ACCOUNTING POLICIES Trade and other payables are generally settled within 30 days so are recorded at their face value. BREAKDOWN OF PAYABLES UNDER NONEXCHANGE AND EXCHANGE TRANSACTIONS 2017 Actual 2016 Actual Payables under nonexchange transaction Creditors Tax payables (GST, PAYE) ACC levy Income in advance Other Total payables under nonexchange transaction 58 1, , , , , 004 Payables under exchange transaction Creditors Income in advance Accrued expense Total payables under exchange transaction Total payables 1, , , , 795 3, , , , 889 Annual Report 2016 /

140 in thousands of New Zealand dollars 15 BORROWINGS ACCOUNTING POLICIES Borrowings are initially measured at fair value, plus transaction costs. Subsequent to initial recognition, all borrowings are stated at amortised cost with any difference between cost and redemption value being recognised in the surplus or deficit over the period of the borrowings on an effective interest basis. Interest due on the borrowings is subsequently accrued and added to the accrued expense. Borrowings are classified as current liabilities unless has an unconditional right to defer settlement of the liability for at least 12 months after balance date. Finance lease A finance lease is a lease that transfers to the lessee substantially all the risks and rewards incidental to ownership of an asset, whether or not title is eventually transferred. At the commencement of the lease term, finance leases whereby is the lessee are recognised as assets and liabilities in the Statement of Financial Position at the lower of the fair value of the leased item or the present value of the minimum lease payments. The finance charge is charged to the surplus or deficit over the lease period so as to produce a constant periodic rate of interest on the remaining balance of the liability. The amount recognised as an asset is depreciated over its useful life. If there is no reasonable certainty as to whether will obtain ownership at the end of the lease term, the asset is fully depreciated over the shorter of the lease term and its useful life. BREAKDOWN OF BORROWINGS AND FURTHER INFORMATION Current portion Secured loan (Ministry of Health) The Energy Efficiency and Conversation Authority Finance lease Total current portion Noncurrent portion Secured loan (Ministry of Health) The Energy Efficiency and Conversation Authority Finance lease Total noncurrent portion Total borrowings 2017 Actual Actual , , , 395 The New Zealand Government has changed its policy on the capital financing of all district health boards. From 15 February 2017, DHBs no longer have access to Crown debt financing for funding of capital investment. Instead, the Crowns contribution to DHB capital will now be solely funded via Crown equity injections. In addition, the existing Crown debts held by DHBs have also been converted into equity. On 15 February 2017, had existing Crown borrowings of $36.7m which were converted into equity. The conversion of the borrowing into equity has changed s financial position, increasing the crown equity balance and decreasing borrowings. This transaction was actioned via simultaneous accounting journals to convert the Ministry of Health borrowing to equity. No cash payment was required to settle this transaction. However, $432k cash was paid by on 15 February 2017 to settle interest owing to the Crown on the borrowings up until this date. The transition of 's borrowings to Crown equity has increased the ongoing cost of the capital charge, as the Crown's capital charge rate is higher than the Crown borrowing rate. Ministry of Health has funded the increased cost though a funding increase. Whanganui District Heath Board received an interest free loan of $642k in January 2016 from Energy Efficiency and Conservation Authority to upgrade of infrastructure for energy efficiency. NZ Health Partnerships overdraft facility had in place an unused overdraft facility of $10.611m (2016: m). Interest rates The Ministry of Health loan facility has fixed rate interest. NZ Health Partnerships over draft has oncall interest rate plus an administrative margin. This is disclosed in Note 21c.

141 in thousands of New Zealand dollars MINISTRY OF HEALTH LOANS PAYABLE AS FOLLOWS: Less than one year One to two years Two to three years Three to four years Four to five years Over five years Total 2017 Actual 2016 Actual 7, 700 7, 820 5, 000 4, , , 700 ENERGY EFFICIENCY & CONVERSATION AUTHORITY LOAN PAYABLE AS FOLLOWS: Less than one year One to two years Two to three years Three to four years Four to five years Over five years Total 2017 Actual Actual ANALYSIS OF FINANCE LEASE AS FOLLOWS: Minimum lease payments payables Less than one year Between one and five years More than five years Total minimum lease payments Less: Future finance charges Present value of minimum lease payments 2017 Actual Actual PRESENT VALUE OF MINIMUM LEASE PAYMENTS PAYABLE: Minimum lease payments payables Less than one year Between one and five years More than five years Total minimum lease payments Less: Future finance charges Present value of minimum lease payments 2017 Actual Actual finance lease liabilities are effectively secured as the rights to the leased asset revert to the lessor in the event of default. The has entered into finance lease for clinical equipment. The equipment lease is for an initial period of five years ending April 2018, with right of renewal for a further one year. Annual Report 2016 /

142 in thousands of New Zealand dollars 16 EMPLOYEE BENEFITS ACCOUNTING POLICIES Shortterm employee entitlements Employee benefits that are due to be settled within 12 months after the end of the period in which the employee renders the related service are measured based on accrued entitlements at current rates of pay. These include salaries and wages accrued up to balance date and annual leave earned to but not yet taken at balance date and sick leave. A liability for sick leave is recognised to the extent that absences in the coming year are expected to be greater than the sick leave entitlements earned in the coming year. The amount is calculated based on the unused sick leave entitlement that can be carried forward at balance date, to the extent that it will be used by staff to cover those future absences. The liability and an expense are recognised for bonuses where it is a contractual obligation or where there is a past practice that has created a constructive obligation and reliable estimate of the obligation can be made. The private and public sector have experienced widespread payroll issues relating to the Holiday s Act and employment agreements. This is particularly for a workforce with rostered employees working on varying work patterns. A proactive approach to finding a long term pay process solution is currently being undertaken by management to identify risk areas focusing on systems, reporting & analytics, people and processes. Since the issues are currently being reviewed the holiday pay provision recognised is estimated based on the best information available at the date of this annual report. Once the issues have been resolved the actual liability may be different. Longterm employee entitlements Employee benefits that are due to be settled beyond 12 months after the end of period in which the employee renders the related service, such as long service leave and retirement gratuities, have been calculated using projected unit credit method and discounted to its present value. The calculations are based on: likely future entitlements accruing to staff, based on years of service, years to entitlement, the likelihood that staff will reach the point of entitlement, and contractual entitlement information; and the present value of the estimated future cash flows. Presentation of employee entitlements Sick leave, annual leave, sabbatical and vested long service leave are classified as a current liability. Nonvested long service leave and retirement gratuities expected to be settled within 12 months of balance date are classified as a current liability. All other employee entitlements are classified as a noncurrent liability. Key accounting assumptions in measuring retirement and long service leave obligations The present value of retirement and long service leave obligations depend on a number of factors that are determined on an actuarial basis. Two key assumptions used in calculating this liability include the discount rate and the salary inflation factor. Any changes in these assumptions will affect the carrying amount of the liability. Expected future payments are discounted using forward discount rates derived from the yield curve of New Zealand government bonds. The discount rates used have maturities that match, as closely as possible, the estimated future cash outflows. The salary inflation factor has been determined after considering historical salary inflation patterns. A weighted average discount rate of 2.81% (2016: 2.6%) and an inflation factor of 3% (2016: 3%) were used. BREAKDOWN OF EMPLOYEE ENTITLEMENTS Current portions Accrued salaries and wages Annual leave Sick leave Retirement gratuities Long service leave Sabbatical leave Other leave Continuing medical education leave Total current portion Noncurrent portions Retirement gratuities Long service leave Total noncurrent portion Total employee entitlements 2017 Actual 2, 330 6, , , Actual 2, 035 6, , , Annual Report 2016 / 17

143 in thousands of New Zealand dollars 17 CONTINGENT LIABILITIES AND CONTINGENT ASSETS Contingent liabilities are recorded in the Statement of Contingent Liabilities at the point at which the contingency is evident. Contingent liabilities are disclosed if the possibility that they will crystallise is not remote. has no contingent liabilities (2016: nil), there are three open personal grievance files in 2017 which are unlikely to have any material impact. has no contingent assets (2016: nil). 18 CAPITAL COMMITMENTS Capital commitments Buildings and improvements Plant and equipment Intangible assets Total 2017 Actual 304 3, 391 3, Actual , 261 2, Actual 2016 Actual Capital commitments Less than one year One to two years Total 3, 695 3, 695 1, , 131 Capital commitments represent capital expenditure contracted for at balance date but not yet incurred. 19 RELATED PARTY TRANSACTION is a wholly owned entity of the Crown. Related party disclosures have not been made for transactions with related parties that are within a normal supplier or client/ recipient relationship on terms and conditions no more or less favourable than those that it is reasonable to expect Whanganui District Health Board would have adopted in dealing with the party at arm s length in the same circumstances. Further, transactions with other government agencies (for example, Government departments and Crown entities) are not disclosed as related party transactions when they are consistent with the normal operating arrangements between government agencies and undertaken on the normal terms and conditions for such transactions. KEY MANAGEMENT PERSONNEL COMPENSATION Board members Remuneration Fulltime equivalent members 2017 Actual Actual Executive team Remuneration Fulltime equivalent members Total key management personnel compensation Total full time equivalent personnel 1, , , , The fulltime equivalent for board members has been determined based on the frequency and length of board meetings and the estimated time for board members to prepare for meetings. An analysis of board member remuneration is provided in Note 5. Annual Report 2016 /

144 in thousands of New Zealand dollars 20 EVENTS AFTER THE BALANCE DATE There were no significant events after the balance date. 21 FINANCIAL INSTRUMENTS Financial instruments initial recognition and subsequent measurement A financial instrument is any contract that gives rise to a financial asset of one entity and a financial liability or equity instrument of another entity. Financial assets Initial recognition and measurement Financial assets are classified, at initial recognition, as financial assets at fair value through surplus or deficit, loans and receivables, or held to maturity investments as appropriate. All financial assets are recorded initially at fair value, plus in the case of financial assets not recorded at fair value through surplus or deficit, transaction costs that are attributable to the acquisition of the asset. The DHB s financial assets include cash and cash equivalents, receivables, and held to maturity investments. Subsequent measurement Financial assets at fair value through surplus or deficit include financial assets held for trading and financial assets designated upon initial recognition at fair value through surplus or deficit. Financial assets are classified as held for trading if they are acquired for the purpose of selling or repurchasing in the near term. The DHB has not designated any financial assets at fair value through surplus or deficit. Loans and receivables Loans and receivables are nonderivative financial assets with fixed or determinable payments that are not quoted in an active market. After initial measurement, such financial assets are subsequently measured at amortised cost using the effective interest rate method, less impairment. Amortised cost is calculated by taking into account any discount or premium acquisition and fees or costs that are an integral part of the effective interest rate. The effective interest rate amortisation is included in finance income in the statement of financial performance. The losses arising from impairment are recognised in the statement of financial performance in finance costs for loans and in expenses for receivables. Held to maturity investments Nonderivative financial assets with fixed or determinable payment and fixed maturities are classified as held to maturity when the DHB has positive intention and ability to hold them to maturity. After initial measurement, held to maturity investments are measured at amortised cost using the effective interest rate method, less impairment. Amortised cost is calculated by taking into account any discount or premium acquisition and fees or costs that are an integral part of the effective interest rate. The effective interest rate amortisation is included in finance income in the statement of financial performance. The losses arising from impairment are recognised in the statement of financial performance as finance costs. Derecognition A financial asset is recognised primarily when: The rights to receive cash flows from the asset have expired, or The DHB has transferred its rights to receive cash flows from the asset or has assumed an obligation to pay the received cash flows without material delay to a third party under a pass through arrangement. The DHB assesses, at reporting date, whether there is objective evidence that a financial asset or group of financial assets is impaired. An impairment exists if one or more events that has occurred since the initial recognition of the asset has an impact on the estimated future cash flows of the financial asset or the group of financial assets that can be reliably estimated. 144 Annual Report 2016 / 17

145 in thousands of New Zealand dollars Financial liabilities Initial recognition and measurement Financial liabilities are classified, at initial recognition, as financial liabilities at fair value through surplus or deficit, payables, or loans and borrowings as appropriate. All financial liabilities are recorded initially at fair value and, net of directly attributable transaction costs. Subsequent measurement Financial liabilities measured at amortised cost After initial recognition, trade and other payables and borrowings are subsequently measured at amortised cost using the effective interest rate method. Gains and losses are recognised in surplus or deficit when the liabilities are derecognised as well as through the effective interest rate amortisation process. The effective interest rate amortisation is included as finance costs in the statement of financial performance. Trade and other payables are unsecured and usually paid within 30 days of recognition. Due to their shortterm nature, they are not discounted. Amortised cost is calculated by taking in to account any discount or premium on acquisition and fees or cost that are an integral part of the effective interest rate. Derecognition A financial liability is derecognised when the obligation under the liability is discharged or cancelled, or expires. When an existing financial liability is replaced by another form the same lender on substantially the same terms, or the terms of an existing liability are substantially modified, such an exchange or modification is treated as the derecognition of the original liability and the recognition of the new liability. The difference in the respective carrying amounts is recognised in the surplus or deficit. The carrying amounts of financial assets and liabilities in each of the financial instrument categories are as follows: 21a FINANCIAL INSTRUMENT CATEGORIES Loans and receivables Cash and cash equivalents Receivables (Gross) Total loans and receivables 2017 Actual 7, 406 6, , Actual 10, 907 6, , 764 Held to maturity Investment term deposit Total held to maturity Financial liabilities measured at amortised cost Payables (excluding income in advance, taxes payable and grants received subject to conditions) Borrowings Ministry of Health Borrowings Energy Efficiency and Conservation Authority Finance leases Total financial liabilities measured at amortised cost 3, 000 3, , , 200 3, 000 3, , , , 123 Annual Report 2016 /

146 in thousands of New Zealand dollars 21b FAIR VALUE ESTIMATION OF FAIR VALUES ANALYSIS The following summarises the major methods and assumptions used in estimating the fair values of financial instruments reflected in the table. Notes Carrying amount Fair value 30 June 2016 Financial assets Cash and cash equivalents Receivables (Gross) Investment term deposit , 907 6, 857 3, , 907 6, 857 3, 000 Financial liabilities Payables (excluding income in advance, taxes payable and grants received subject to conditions) Borrowings Ministry of Health Borrowings Energy Efficiency and Conversation Authority Finance lease liabilities , , , , June 2017 Financial assets Cash and cash equivalents Receivables (Gross) Investment term deposit , 406 6, 987 3, 000 7, 406 6, 987 3, 000 Financial liabilities Payables (excluding income in advance, taxes payable, and grants received subject to conditions) Borrowings Ministry of Health Borrowings The Energy Efficiency and Conversation Authority Finance lease liabilities , , Interestbearing loans and borrowings Fair value is calculated based on discounted expected future principal and interest cash flows. Finance lease liabilities The fair value is estimated as the present value of future cash flows, discounted at market interest rates for homogeneous lease agreements. The estimated fair values reflect change in interest rates. Receivables / payables / cash and cash equivalents For receivables / payables /cash and cash equivalents with a remaining life of less than one year, the notional amount is deemed to reflect the fair value. All other receivables / payables / cash and cash equivalents are discounted to determine the fair value. Interest rates used for determining fair value The calculation of fair market value of the loans is based on the government loan rate plus 15 basis points, which is based on midmarket pricing. Other investment The fair value of other financial assets cannot be reliably measured and therefore have been excluded from the table. Investment Short term investments with a remaining life of less than one year, the notional amount is deemed to reflect fair value. 146 Annual Report 2016 / 17

147 in thousands of New Zealand dollars 21c FINANCIAL INSTRUMENT RISK 's activities expose it to a variety of financial instrument risks, including market risk, credit risk, and liquidity risk. has a Risk and Audit Committee that provides oversight of risk management activities and also has a series of policies to manage the risks associated with financial instruments and seeks to minimise exposure. These policies do not allow any transactions that are speculative in nature to be entered into. MARKET RISK Fair value interest rate risk Interest rate risk is the risk that a financial instrument will fluctuate, due to changes in market interest rates. Whanganui District Health Board s exposure to fair value interest rate risk is limited to its bank deposits which are held at fixed rates of interest. does not actively manage its exposure to fair value interest rate risk as investment and borrowings are generally held to maturity. Cash flow interest rate risk Cash flow interest rate risk is the risk that the cash flows from a financial instrument will fluctuate because of changes in market interest rates. Bank deposit and borrowings issued at variable interest rates expose to cash flow interest rate risk. s investment policy requires a spread of investment maturity dates to limit exposure to shortterm interest rate movements. currently has no variable interest rate investments. 's borrowing policy requires a spread of interest rate repricing dates on borrowings to limit the exposure to shortterm interest rate movements. Due to the timing of its cash inflows and outflows, Whanganui District Health Board invests in surplus cash with registered banks. has experienced no defaults of interest or principal payments for term deposits. s borrowing policy does not permit the use of interest rate derivatives to manage cash flow interest rate risk. The exposure to interest rate risk arises from NZ Health Partnerships sweep account facility which attracts an oncall interest rate. Bank deposit and the Ministry of Health loan are held at fixed rate of interest. In respect of incomeearning financial assets and interestbearing financial liabilities, the following table indicates their effective interest rates at the statement of financial position date and the periods in which they reprise. Effective interest rate % Total 1 12 months 1 2 years 2 5 years More than 5 years 30 June 2016 Cash on hand Demand funds held with NZHP Investment term deposit 3.58% 5 10, 902 3, , 902 3, 000 Borrowings Ministry of Health Borrowings Energy Efficiency & Conservation Authority Finance leases 4.20% 0.00% 36, , , , June 2017 Cash on hand Demand funds held with NZHP Investment term deposit 3.48% 5 7, 401 3, , 401 3, 000 Borrowings Ministry of Health Borrowings Energy Efficiency & Conservation Authority Finance leases 0.00% Annual Report 2016 /

148 in thousands of New Zealand dollars Sensitivity analysis In managing interest rate risks aims to reduce the impact of shortterm fluctuations on s earnings under their adopted Treasury Policy. Over the longer term, however, permanent changes in interest rates would have an impact on consolidated earnings. At 30 June 2017, it is estimated that a general increase of one percentage point in interest rates would have minimal impact on earnings in 2016/17, as most of the district health board s term debt is at fixed rates, and only the net interest from cash holdings and the NZ Health Partnerships sweep would be affected. Credit risk Credit risk is the risk that a third party will default on its obligation to the, causing it to incur a loss. In the normal course of business, is exposed to credit risk from cash and term deposits with banks and receivables. For each of these, the maximum credit exposure is best represented by the carrying amount in the Statement of Financial Position. 's shared banking arrangement with NZHP results in credit risk exposure to Whanganui District Health Board. NZHP is indemnified by all DHBs for any default by banks holding cash on deposit from NZHP. NZHP will pass on any losses it incurs as a result of default by banks. NZHP manages credit risk by investing in NZ incorporated banks with a minimum credit rating of A+. The has counterparty credit risk for foreign currency and interest rate derivatives as this transaction is undertaken by the bank. The money with NZHP is classified under counterparties without credit rating. Concentrations of credit risk from accounts receivable are limited due to the large number and variety of customers. The Ministry of Health is the largest single debtor approximately at 55% (2016: 46%). The Ministry of Health is assessed to be a low risk and highquality entity due to its nature as the government funded purchaser of health and disability support services. At the Statement of Financial Position date there were no significant other concentrations of credit risk. The maximum exposure to credit risk is represented by the carrying amount of each financial asset. Liquidity risk Liquidity risk is the risk that the encounters difficulty raising liquid funds to meet commitments as they fall due. Prudent liquidity risk management implies maintaining sufficient cash, the availability of funding through an adequate amount of committed credit facilities, and the ability to close out market positions. The mostly manages liquidity risk by continuously monitoring forecast and actual cash flow requirements, maintaining an overdraft facility and management of the maturities of Ministry of Health loans. Contractual maturity analysis of financial liabilities, excluding derivatives The table below analyses the s financial liabilities into relevant maturity groupings based on the remaining period at balance date to the contractual maturity date. Future interest payments on floating rate debt are based on the floating rate on the instrument at balance date. The amounts disclosed are the contractual undiscounted cash flows and include interest payments. Carrying amount Contractual cash flow 1 12 months 1 2 years 2 5 years More than 5 years 30 June 2016 Payables (excluding income in advance, taxes payable & grants received subject to conditions) Borrowings Ministry of Health Borrowings Energy Efficiency & Conservation Authority Finance leases Total 13, , , , , 728 1, , , , , , , 428 9, , , June 2017 Payables (excluding income in advance, taxes payable & grants received subject to conditions) Borrowings Ministry of Health Borrowings Energy Efficiency & Conservation Authority Finance leases Total 11, , , , , , Annual Report 2016 / 17

149 in thousands of New Zealand dollars Capital management s capital is its equity, which comprises Crown equity, accumulated funds, revaluation reserves and Trust/Special funds as disclosed in the Statement of Financial Position. Equity is represented by net assets. is subject to the financial management and accountability provisions of the Crown Entities Act 2004, which impose restrictions in relation to borrowings, acquisition of securities, issuing guarantees and indemnities, and the use of derivatives. has complied with the financial management requirements of the Crown Entities Act 2004 during the year. manages its equity as a byproduct of prudently managing revenues, expenses, assets, liabilities, investments, and general financial dealings to ensure that effectively achieves its objectives and purpose, while remaining a going concern. The policies in respect of capital management are reviewed regularly by the board. There have been no material changes in the s management of capital during the period. 22 EXPLANATION OF FINANCIAL VARIANCE AGAINST BUDGET Statement of Comprehensive Revenue and Expense Exchange revenue and nonexchange revenue exceeded budget by $2m due to funding related to additional side contracts, which was offset by increased costs and interest revenue. Personnel cost exceeded budget by $0.9m mainly due to high acuity impacting mainly on nursing costs. Outsourced services exceeded budget by $0.9m due to higher than anticipated use of locum medical staff and outsourced clinical services to meet higher than expected clinical demand. Other expenses exceeded budget by $1.6m due to increased interdistrict outflow and increased demand in residential care and homebased support. Statement of Financial Position Receivables exceeded budget by $1.6m, due to increase in Pharmac rebate, inbetween travel funding, and interdistrict flow provision. Investment exceeded budget by $3m, due to changes in DHB shared banking cash retention protocols. This has allowed to invest cash outside of the sweep arrangements, allowing the DHB to gain maximum returns. Property, plant and equipment less than budget by $3.1m, due to timing delays of capital expenditure programmes. Intangible assets less than budget by $2.1m, due to the delay of the Regional Health Informatics Programme (RHIP). Payable under nonexchange and exchange transactions less than budget by $1.2m due to a decrease in interdistrict outflow and demand driven expenditure provision. Employee entitlements exceeded budget by $0.7m mainly due to increased personnel cost leading to greater than expected entitlements owing at yearend. Borrowing is less than budget by $36.7m as the government changed its policy on capital financing for district health boards as disclosed in Note 15. Statement of Change in Equity Statement of Changes in Equity exceeded budget by $36.1m due to conversion of capital borrowing to Crown equity as disclosed in Note 15. Statement of Cash Flows Cash and cash equivalents less than budgeted by $1.1m, mainly due to WDHB not receiving $1m equity support as the DHB did not request the funding, as planned. In addition, WDHB experienced higher costs due to health of older people support, higher acuity and orthopaedic surgery added additional clinical supplies costs, which was partly offset by delays in capital expenditure. 23 COMPLIANCE WITH LEGISLATION Crown Entities Act 2004 There were no breaches noted of the Crown Entities Act in 2017 (2016: nil). New Zealand Public Health and Disability Act 2000 There were no breaches noted of the NZPHD Act in 2017 (2016: nil). Annual Report 2016 /

150 INDEX Acute Services 98, 99 Mental health & addiction services 96, 97 Aged residential care beds 105 National Health Targets 77 Assessment, treatment & rehabilitation services 102 Needs assessment & service coordination 104 Audit report 113 New Zealand Health Strategy 6 Board members 28, 29 Objectives 22 Chief Financial Officer's Report 17 Opportunities & challenges 7 Combined Statutory Advisory Committee 26, 27 Oral health 92 Community Pharmacy 93 Organisational Structure 25 Corporate Governance 22 Overarching priorities 8 Corporate Services Division 22 Palliative care services 108 Directory 155 Performance overview 11 Early detection & management services 8994 Population Health Continuum of Care 64 Elective Services 100 Population we serve 5 Environmental factors 7 Populationbased screening 85 Equal Employment Opportunities 34, 35 Prevention Services 8188 Equity Ratio 65 Primary & community services 90, 91 Excellence in Clinical Service Delivery focus area 9, 75, 76 Provider Division 22 Executive Employment Remuneration Committee 26, 27 Purpose 22 Executive Management Team 31, 32 Regional Services Plan 6 Facilitybased maternity services 101 Rehabilitation & support services Financial Performance by output class 78, 79 Rehabilitation services 107 Financial statements Respite care & day services 109 Focus areas 9 Risk management 25 Glossary Risk and Audit Committee 26, 27, 30 Good Employer Elements 3640 Role of the Board 24 Hauora a Iwi 16, 24, 25, 28 Service and Business Planning Division 22 Health of Older People focus area 9, 71, 72 Service Performance Statements Health of Women & Children focus area 9, 6870 Service Performance Overview 18 Health promotion 82, 83 Service Quality Statements 4161 Health protection 84 System Level Measures 66, 67 Homebased support 106 Testing & diagnostic services 94 Immunisation Services 86 Values 4 Intensive assessment & treatment services Vision 4 Longterm conditions focus area 9, 73, 74 Well Child/Tamariki Ora Services 87 Meeting attendance 30 Workforce profile Annual Report 2016 / 17

151 FINANCIAL STATEMENTS INDEX Annual leave 142 Basis of consolidation 123 Basis of preparation 122 Borrowings 140 Budget figures 123 Capital management 149 Capital Commitments 143 Cash and cash equivalents 126 Commitments 129, 143 Capital commitments 143 Operating leases 129 Contingent 143 Compliance with legislation 149 Cost allocation 124 Critical accounting estimates and assumptions 125 Estimating the fair value of land, buildings 134 Estimating useful lives of software assets 136 Key accounting assumption in measuring 142 retirement and long service leave obligations Depreciation amortisation 133, 135, 136, 138 Employee entitlements / benefits 124 Equity 120, 124, 125 Accumulated surplus / (deficit) 120, 124 Capital contribution 120, 124 Repayable of capital 120 Property and plant revaluation reserve 120, 124 Events after balance date 144 Fees to auditor 128 Finance costs 128 Financial assets 144 Financial instruments 124 Financial instrument categories 145 Financial instrument risks 147 Cash flow interest rate risk 147 Credit risk 148 Fair value interest rate risk 147 Liquidity risk 148 Maturity analysis 148 Financial liabilities 123 Foreign currency transaction 145 Hospital special funds 120 Impairment of intangible assets 136 Impairment of property, plant, and equipment 134 Intangible assets 136 Inventory 132 Income tax 123 Investments 131 Key management personnel remuneration 143 Leases 129, 140 Finance leases 140 Operating leases as lessee 129 Long service leave 142 Overdraft facility 140 Payables 139 Personnel costs 126 Presentation currency and rounding 120 Property, plant, and equipment 133 Receivables 130 Reconciliation of surplus/(deficit) to net cash flow 121 from operating activities Related party transactions 143 Remuneration 127, 129 Remuneration by band disclosures 127 Reporting entity 122 Retirement gratuities 142 Revenue 125, 126 Sabbatical leave 142 Sensitivity analysis for financial instruments 148 Severance payments 127 Sick leave 142 Software 136, 138 Standards issued and not yet effective and not 122 early adopted Statement of Accounting Policies 122 Statement of Cash Flows 121 Statement of Changes in Equity 120 Statement of Comprehensive Revenue and Expense 118 Statement of Financial Position 119 Superannuation schemes 126 Variances against budget 149 Annual Report 2016 /

152 GLOSSARY ACC Accident Compensation Corporation Acute Acute care is a secondary health care service, where a patient receives active but shortterm treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. Admission Admission to hospital services Ambulatory Sensitive Hospitalisation (ASH) Acute admissions that are considered potentially reducible through interventions deliverable in a primary care setting Ambulatory services Medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services Annual Report Under section 150 of the Crown Entity Act, DHB's are obliged to prepared an annual report. Annual reports are prepared annually for each financial year ending 30 June. The purpose of the annual report is to compare activities performed with those intended in the annual plan. ARC Aged Residential Care Assets Resources owned by the DHB. Assets can be divided into categories such as current assets and noncurrent assets B4 School Check The B4 School Check is a free health and development check for 4yearolds Balance date A balance date is the end of an accounting (financial) year. DHB's balance date is 30 June. Bed days The total number of bed days of all admitted patients during the reporting period. It is taken from the count of the number of inpatients at midnight (approximately) each day. Details for Same Day patients are also recorded as Occupied Bed Days where one Occupied Bed Day is counted for each Same Day patient. Bed Occupancy The available beds which have been occupied over the year. It is a measure of the intensity of the use of hospital resources by inpatients. Capital charge Capital charge is a fixed percentage charge on net assets of the DHB. Charging this helps makes explicit the true costs of the taxpayers investment in each of the DHB's and ensures that DHB's make decisions based on the full cost of the services they provide. Also creates an incentive for DHB's to make the most efficient use of their working capital. Capital charge payments are payable to the Crown. Capital expenditure (Capex) Capital expenditure, or CapEx, are funds used by a organisation to acquire or upgrade physical assets such as property,plan and equiment. These used for more than one year in the operations of a business. Capital expenditures can be thought of as the amounts spent to acquire or improve a organisation fixed assets. Caries Tooth decay or cavities Carrying Amount The value at which an asset or liability is carried at on the balance date. CCDM Care Capacity and Demand Management Programme centralalliance Collaborative agreement between Whanganui and MidCentral DHBs Chronic disease A chronic disease is one lasting 3 months or more Communicable diseases An infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual's discharges or by indirect means Community Services Health services generally delivered in a community setting Comorbidities The presence of one or more additional diseases or disorders cooccurring with a primary disease or disorder Crown Funding Agreement The Crown Funding Agreement (CFA) is the agreement between the Minister of Health and DHBs. Through the CFA the Crown agrees to provide funding in return for service provision as specified in the CFA. Crownowned/Crown entity A generic term for a diverse range of entities within one of the five categories referred to in section 7 of the CE Act, namely: statutory entities, Crown entity companies, Crown entity subsidiaries, school boards of trustees, and tertiary education institutions. Current assets An asset that can readily be converted to cash or will be used to repay a liability within 12 months of balance date. Current liabilities A liability that is required to be discharged/settled within 12 months of balance date. Depreciation (amortisation) An expense charged each year to reflect the estimated cost of using assets over their lives. Amortisation relates to intangible assets such as software (as distinct from physical assets, which are covered by depreciation). Derivative financial instruments Conventions, and rules accountants follow in recording and summarising transactions, and in the preparation of financial statements. Discharge Discharge from hospital services Dividends Payment per share to shareholders as a return on their investment Elective surgery (service) Elective service are medical and surgical service for people who do not need to be treated right away. Emergency Department Medical treatment department specialising in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance Employee Assistance Programme (EAP) A programme available for WDHB employees which provides confidential support for both personal and workrelated issues. 152 Annual Report 2016 / 17

153 Family/whānaucentred Refers to staff working alongside the patient and their whānau/family in a collaborative manner so that everyone understands the needs of the patient and whānau/family as selfdetermined by them to improve their health and overall wellbeing. FSA First Specialist Assessment GAAP Generally Accepted Accounting Principles. These include standards, conventions, and rules accountants follow in recording and summarising transactions, and in the preparation of financial statements. General practice Medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients Green Prescriptions A health professional's written advise to become more physically active as part of their overall health management. GST Goods and service tax. In New Zealand the current GST rate is 15 percent. Hapai Te Hoe Whanganui DHB cultural awareness programme Haumoana Māori health worker. A member of the Te Hau Ranga Ora (WDHB Māori health services) working with patients and their whānau/families and colleagues as part of the health care team. Hauora a Iwi Iwi Māori Relationship Board. Whanganui DHB governance partner Health care assistant Heath care assistants work under the supervision of nurses and other health professionals to carry out a variety of tasks Health Promoting Schools An approach where the whole school community works together to address the health and wellbeing of students, staff and their community. Health protection Health protection services work within the framework created by the various healthrelated Acts including the Health Act (1956), Food Act (1981), Sale and Supply of Alcohol Act (2012) and Smokefree Environments Act (1990) and their associated regulations. Health Quality & Safety Commission Crown entity, objective are to work with clinicians, providers and consumer to improve in quality and safety across the health and disability sector. HPV Human papilloma Virus IEA Individual Employment Agreement Impairment A reduction in the recoverable value of a noncurrent asset below its carrying value Inpatient services The care of patients whose condition requires admission to a hospital Intangible assets Intangible assets are those fixed assets that have no physical existence, such software, patents, copyrights, goodwill, etc. Inter District Flow (IDF) Health services provided by DHB's to patients domiciled to another DHB's population. Can result in either revenue inflow (health services delivered to patients domiciled at another DHB) or outflow (our population receiving health services at another DHB). interrai interrai is an electronic assessment tool used by health professionals working with older people Iwi Tribe Kaiāwhina Māori health worker assistant; helper; advocate Kaupapa Purpose; theme Kohanga reo Māori language nest preschool LMC Lead maternity carer Length of stay Length of stay (LOS) is a term to describe the duration of a single episode of hospitalisation. Inpatient days are calculated by subtracting day of admission from day of discharge. Locum A locum is someone who temporarily fulfills an employment role / duties of another. For example a locum doctor (Medical personnel) works in the place of a regular/permanent doctor when they are absent or when a DHB is short of staff. WDHB uses the term locum to refer to all such arrangments of clinical personnel where WDHB are invoiced for these services rather than a salary paid. Longterm conditions Long term conditions account for a significant proportion of health care spend and hospitalisations, as well as being a barrier to full participation and independence in the workplace and society by affected individuals and their family/whānau. Mahi whakariterite Our priorities and performance Mana tangata Our leadership; prestige, integrity, leadership Marae Māori meeting place MECA Multi Employee Collective Agreement Mihi Greeting, acknowledgement National Hauora Coalition One of the two local Primary Health Organisations (PHO) Net assets The value of a DHB's total assets less the value of its total liabilities. New Zealand Health Partnerships Operates as a multiparent crown subsidiary, created by the 20 DHBs. The aim of the entity is to work collaboratively to identify and build shared services for the benefit of the health sector Nga moemoeā, nga kaupapa Our vision and purpose NGO Nongovernment organisation NIR National Immunisation Schedule Noncurrent assets Noncurrent assets are assets which represent a longerterm investment and cannot be converted into cash quickly. They are likely to be held by a DHB for more than a year. Noncurrent liabilities A liability that is not required to be discharged/settled within 12 months of balance date. OraCare Existing Patient Administration System Output Class Four output classes are to be used by all DHBs to reflect the nature of services provided. The output class categories are Prevention; Early Detection and Management; Intensive Assessment and Treatment; Rehabilitation and Support. Annual Report 2016 /

154 Pepipod Baby bassinet used to help reduce Sudden Unexpected Death in Infancy (SUDI) Primary Health Organisation Primary health organisations (PHOs) are funded by district health boards to support the provision of essential primary health care services through general practices to those people who are enrolled with the PHO Primary Services Professional health care provided in the community Pūrongo arotake pūtea Audit Report Pūrongo mahi Statement of Performance Pūrongo pūtea Financial Statements Pūrongo ratonga Statements of Service Quality Regional Health Informatics Programme (RHIP) Central Region clinical IT application programme of work RiskMan Risk management IT application Screening services Screening programmes can detect some conditions and reduce the chance of developing or dying from some conditions. Secondary services Medical care that is provided by a specialist or facility upon referral by a primary care physician and that requires more specialised knowledge, skill, or equipment Standardised Intervention Rate A health intervention rate that has been standardised against a particular population Statement of Performance Expectations A document that sets out the service performance expectaions for the upcoming year and provides a base for actual performance to be assessed SUDI Sudden Unexpected Death in Infancy Tamariki Child/children Tangata whenua People of the land Te Hau Ranga Ora Whanganui DHB's Māori Health Service Te Hunga Ora Our people Te Paori o Whanganui Te Pukaea WDHB Consumer Advisory Group Te Pūrongo atau Annual Report Te rōpū whakahaere Our organisation Te Tiriti o Waitangi Treaty of Waitangi Tertiary services Specialised consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment. TrendCare Patient Acuity Tool which helps inform the management of the clinical workforce Triage The assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. VLCA Very Low Cost Access WALT Whanganui Alliance Leadership Team WDHB WDHB provider division Whanganui DHB's service delivery arm webpas Future Patient Administration System Whānau Family Whānau ora Healthy family/families. An inclusive approach to providing services / opportunities for families, partnering with families, based on Māori concepts and values. Whanganui Regional Health Network One of the two local Primary Health Organisations (PHO) 154 Annual Report 2016 / 17

155 DIRECTORY BOARD MEMBERS Mrs Dot McKinnon Chair Mr Stuart Hylton Deputy chair Mr Graham Adams Mr Charlie Anderson Mrs Philippa BakerHogan Mrs Jenny Duncan Mrs Harete Hipango (on leave from April 2017) Mr Darren Hull Mrs Judith MacDonald Mrs Annette Main Dame Tariana Turia HAUORA A IWI MEMBERS Mrs Mary Bennett Chair Mr James Allen Mrs Barbara Ball Mrs Maraea Bellamy Mrs Keria Ponga Mr Hayden Potaka Mrs Maria Potaka Mrs Cassandra Reid OUR EXECUTIVE MANAGEMENT TEAM Mrs Julie Patterson Mrs Sandy Blake Mrs Sue Campion Mr Hentie Cilliers Ms Kim Fry Mrs Rowena Kui Dr Francois Rawlinson Ms Tracey Schiebli Mr Brian Walden Chief Executive Director of Nursing, and General Manager, Patient Safety and Quality Communications Manager General Manager, Human Resources and Organisational Development Director Allied Health Director Māori Health Chief Medical Officer General Manager, Service and Business Planning General Manager, Corporate (Chief Financial Officer) BANKERS Westpac NZ Level 15, Westpac House 318 Lambton Quay Wellington 6140 Ministry of Health No. 1 The Terrace Wellington AUDITOR Mr Bruno Dente Deloitte Limited PO Box 17 Hamilton on behalf of the AuditorGeneral REGISTERED OFFICE Private Bag Heads Road Whanganui Phone Fax BOARD SECRETARY Horsley Christie 14 Victoria Avenue Whanganui SOLICITORS Buddle Findlay 1 Willis Street Wellington Horsley Christie 14 Victoria Avenue Whanganui Annual Report 2016 /

156 find us follow us find us on whanganuidhb 100 Heads Road, Private Bag 3003, Whanganui 4540, New Zealand wdhb.org.nz