Wednesday 29 th June Note: Public Excluded Session 9.45am to 12.15pm Open meeting from 12.45pm

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1 BOARD MEETING Wednesday 29 th June am Note: Public Excluded Session 9.45am to 12.15pm Open meeting from 12.45pm AGENDA Items to be considered in public meeting VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna 1

2 Karakia E te Kaihanga e te Wahingaro E mihi ana mo te ha o to koutou oranga Kia kotahi ai o matou whakaaro i roto i te tu waatea. Kia U ai matou ki te pono me te tika I runga i to ingoa tapu Kia haumie kia huie Taiki eee. Creator and Spirit of life. To the ancient realms of the Creator Thank you for the life we each breathe to help us be of one mind As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware Of the need to be fair and transparent in all we do. We ask this in the name of Creation and the Living Earth. Well Being to All. 2

3 MEETING OF THE BOARD 29 th June 2016 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Tce, Takapuna WDHB BOARD MEMBERS Lester Levy - Chair Max Abbott - WDHB Board Member Kylie Clegg WDHB Board Member Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Tony Norman - WDHB Deputy Chair Morris Pita - WDHB Board Member Christine Rankin - WDHB Board Member Allison Roe - WDHB Board Member Gwen Tepania-Palmer - WDHB Board Member Time: am WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Chief Medical Officer Simon Bowen - Director Health Outcomes Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Cath Cronin Director of Hospital Services Tamzin Brott Director of Allied Health Fiona McCarthy Director Human Resources Peta Molloy - Board Secretary APOLOGIES: James Le Fevre REGISTER OF INTERESTS Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda? PART 1 Items to be considered in public meeting AGENDA TIME 09.45a.m (please note agenda item times are estimates only and that the public excluded session is from 09.45am-12noon) 12.45pm After Hours Care, West Auckland (John Tamihere, Chief Executive, Te Whanau o Waipareira Trust) 1. AGENDA ORDER AND TIMING 09.45am 2. RESOLUTION TO EXCLUDE THE PUBLIC BOARD MINUTES 12.50pm 3.1 Confirmation of Minutes of the Meeting of the Board (25/05/16) Actions arising from previous meetings pm 4. CHAIR S REPORT EXECUTIVE REPORTS 12.55pm 5.1 CEO s Report pm 5.2 Health and Safety Report pm 5.3 Communications Report DECISION PAPERS 1.10pm 6.1 Primary Birthing Facility Consultation Outcome pm Board and Committee Meeting Schedule PERFORMANCE REPORT 1.30pm 7.1 Financial Performance COMMITTEE REPORTS 1.35pm 8.1 Hospital Advisory Committee Meeting (25/05/16) Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting (08/06/16) INFORMATION PAPERS 1.35pm 9.1 Health and Safety Markers Report pm 9.2 Bowel Screening Pilot Update pm 9.3 Waitemata Healthy Food and Drink Policy pm 9.4 Waitemata DHB and the Auckland Regional Tissue Bank Waitemata District Health Board, Meeting of the Board 29/06/16 3

4 Waitemata District Health Board Board Member Attendance Schedule 2016 NAME FEB APRIL MAY JULY AUG SEPT NOV DEC Dr Lester Levy (Chair) Max Abbott Sandra Coney Warren Flaunty James Le Fevre Anthony Norman (Deputy Chair) Morris Pita Christine Rankin * Allison Roe * Gwen Tepania-Palmer Apologies given *Attended part of the meeting only # Absent on Board business ^ Leave of Absence Waitemata District Health Board, Meeting of the Board 29/06/16 4

5 Board/Committee Member Lester Levy - Board Chairman Max Abbott Kylie Clegg REGISTER OF INTERESTS Involvements with other organisations Chair Auckland District Health Board Chairman Auckland Transport Chairman Health Research Council Independent Chairman Tonkin & Taylor Chief Executive New Zealand Leadership Institute Professor of Leadership University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework Pro Vice-Chancellor (North Shore) and Dean Faculty of Health and Environmental Sciences, Auckland University of Technology Patron Raeburn House Advisor Health Workforce New Zealand Board Member, AUT Millennium Ownership Trust Chair Social Services Online Trust Board member Rotary National Science and Technology Forum Trust Board Member Hockey New Zealand Trustee and Chairman the Hockey Foundation Trustee and Beneficiary Mickyla Trust Trustee and Beneficiary M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Trustee and Beneficiary of M&K Investments Trust (owns 99% share in MC Capital Ltd, MC Securities Ltd and MC Acquisitions Ltd) Last Updated 03/02/16 19/03/14 25/11/15 Sandra Coney Chair Waitakere Ranges Local Board, Auckland Council 12/12/13 Warren Flaunty Member Henderson - Massey and Rodney Local Boards, Auckland Council 25/11/15 Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder Green Cross Health Owner Life Pharmacy North West Director Westgate Pharmacy Ltd Chair Three Harbours Health Foundation Director - Trusts Community Foundation Ltd James Le Fevre Emergency Physician Auckland Adults Emergency Department 12/08/15 Pre-hospital Physician Auckland HEMS ARHT/Auckland DHB Co-opted Member Whanganui District Health Board Hospital Advisory Committee Trustee Three Harbours Foundation Member Association of Salaried Medical Specialists Shareholder Pacific Edge Ltd James wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine Anthony Norman Board Chair - Northland DHB 05/11/14 Deputy Board Chairman Director - Health Alliance NZ Ltd Director - Health Alliance (FPSC) Ltd Trustee and Treasurer - Kerikeri International Piano Competition Trust Partner - Mill Bay Haven, Mangonui (accommodation provider) Morris Pita Board Member Auckland District Health Board 13/12/13 Owner/operator Shea Pita and Associates Limited Shareholder Turuki Pharmacy Limited Wife is member of the Northland District Health Board Christine Rankin Member - Upper Harbour Local Board, Auckland Council 15/07/15 Director - The Transformational Leadership Company Allison Roe Member Devonport-Takapuna Local Board, Auckland Council Chairperson Matakana Coast Trail Trust 02/07/14 Gwen Tepania- Palmer Chairperson- Ngatihine Health Trust, Bay of Islands Life Member National Council Maori Nurses Alumni Massey University MBA Director Manaia Health PHO, Whangarei Board Member Auckland District Health Board Committee Member Lottery Northland Community Committee 10/04/13 Waitemata District Health Board, Meeting of the Board 25/05/16 5

6 2 Resolution to Exclude the Public Resolution: That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Minutes of the Meeting of the Board with Public Excluded 25/05/16 2. Minutes of the Hospital Advisory Committee with Public Excluded 25/05/16 3. Minutes of the Audit and Finance Committee with Public Excluded 08/06/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Waitemata District Health Board, Meeting of the Board 29/06/15 6

7 General subject of items to be considered 4. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees with Public Excluded 08/06/16 5. Minutes of the Wilson Home Trust 08/04/16 6. Minutes of the Wilson Home Trust 22/04/16 7. Knee Replacement System Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or Waitemata District Health Board, Meeting of the Board 29/06/15 7

8 General subject of items to be considered 8. Colonoscopy and Gastroscopy Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: iii) iv) would disclose a trade secret; or would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. 9. Storage and Dispensing That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 10. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 11. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [Official Information Act 1982 S.9 (2) (b)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 Waitemata District Health Board, Meeting of the Board 29/06/15 8

9 General subject of items to be considered Reason for passing this resolution in relation to each item [NZPH&D Act 2000 Schedule 3, S.32 (a)] 12. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Primary and Community Services Plan [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 14. Capital Budget That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Long Term Investor Plan [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 16. Lease That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under Ground(s) under Clause 32 for passing this resolution S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, Waitemata District Health Board, Meeting of the Board 29/06/15 9

10 General subject of items to be considered Reason for passing this resolution in relation to each item section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. 17. Carparking That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Service Configuration 19. Migrant Health Contract [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 20. Funding Contracts That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Obligation of Confidence The disclosure of information would not be in the public interest because of the Waitemata District Health Board, Meeting of the Board 29/06/15 10

11 General subject of items to be considered 21. Way-finding Upgrade Reason for passing this resolution in relation to each item disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Waitemata District Health Board, Meeting of the Board 29/06/15 11

12 3.1 Confirmation of Minutes of the Board meeting held on 25 th May 2016 Recommendation: That the Minutes of the Board meeting held on 25 th May 2016 be approved. Waitemata District Health Board, Meeting of the Board 29/06/16 12

13 Minutes of the meeting of the Waitemata District Health Board Wednesday 25 May 2016 held at Waitemata DHB, Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 9.36am PART I Items considered in public meeting BOARD MEMBERS PRESENT: Lester Levy (Board Chair) Max Abbott Kylie Clegg Sandra Coney James Le Fevre Tony Norman (Deputy Board Chair) Morris Pita Gwen Tepania-Palmer ALSO PRESENT: Andrew Brant (Acting Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Debbie Holdsworth (Director Funding) Simon Bowen (Director Health Outcomes) Cath Cronin (Director of Hospital Services) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director of Human Resources) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item) PUBLIC AND MEDIA REPRESENTATIVES: APOLOGIES: WELCOME Lynda Williams (Auckland Womens Health Council) (present from 11.19am) Apologies were received and accepted from Warren Flaunty, Christine Rankin, Allison Roe and Dale Bramley, together with an apology for late arrival from Sandra Coney. The Board Chair welcomed those present. The Board Chair and Board acknowledged and thanked Paul Garbett for his work and support in his role as Board Secretary and wished him all the very best in his retirement. DISCLOSURE OF INTERESTS There were no additions or other amendments to the Interests Register. There were no declarations of interest relating to the open section of the agenda. Waitemata District Health Board, Meeting of the Board 29/06/16 13

14 1 AGENDA ORDER AND TIMING Items were taken in same order as listed in the agenda. The public excluded session was held first, from 9.42am to 11.19am 2 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 6-9) Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Minutes of the Meeting of the Board with Public Excluded 06/04/16 2. Minutes of the Hospital Advisory Committee with Public Excluded 06/04/16 3. Minutes of Manawa Ora with Public Excluded 20/04/16 4. Minutes of the Audit and Finance Committee with Public Excluded 27/04/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or Waitemata District Health Board, Meeting of the Board 29/06/16 14

15 General subject of items to be considered 5. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees Meeting 27/04/16 Reason for passing this resolution in relation to each item section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Ground(s) under Clause 32 for passing this resolution disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. 6. Minutes of the ADHB-WDHB Collaboration Committee 24/02/16 [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. 7. Minutes of the Waitemata 2025 Special Committee of the Board That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or Waitemata District Health Board, Meeting of the Board 29/06/16 15

16 General subject of items to be considered 8. Minutes of the Waitemata 2025 Special Committee of the Board 9. Minutes of the Three Harbours Health Foundation 10.Minutes of the Wilson Home Trust 26/02/16 Reason for passing this resolution in relation to each item section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would Ground(s) under Clause 32 for passing this resolution disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information Waitemata District Health Board, Meeting of the Board 29/06/16 16

17 General subject of items to be considered Reason for passing this resolution in relation to each item exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. 11. Leapfrog Programme That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 12. Waitemata 2025 That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] [Official Information Act 1982 S.9 (2) (b)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] 13. Draft Annual Plan That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. Waitemata District Health Board, Meeting of the Board 29/06/16 17

18 General subject of items to be considered 14. Short Stay Ward, North Shore Hospital 15. Draft Primary and Community Services Plan Reason for passing this resolution in relation to each item Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 16. Finance Update That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution [Official Information Act 1982 S.9 (2) (ba)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Carried 9.42am 11.19am public excluded session am pm open session. Waitemata District Health Board, Meeting of the Board 29/06/16 18

19 3 BOARD MINUTES 3.1 Confirmation of Minutes of the Board Meeting held on 06 th April 2016 (agenda pages 10-26) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the minutes of the Board meeting held on 06 th April 2016 be approved. Carried Actions arising from previous meetings (agenda page 27) No issues were raised. 4 CHAIR S REPORT The Board Chair did not raise any matters at this point in the meeting. 5 EXECUTIVE REPORTS 5.1 Chief Executive s Report (agenda pages 28-45) Dr Andrew Brant (Acting Chief Executive) summarised the report, matters highlighted included: That the Court of Appeal issued its decision in favour of the Waitemata DHBs Smokefree Policy. In response to a query about this matter later in the meeting, it was noted that it is the hospital sites that are smoke free and that people can leave the site and that this does occur. There are a number of electronic clinical projects underway which are very innovative for the health sector. eprescribing continues with 650 beds now covered. Waitemata DHB showed improvements in the National Inpatient Survey. The Friends and Family Test had a very pleasing 65% increase in response rate following roll out of the Friends and Family postcards. Reports continue to show that being welcoming and friendly is important to the patient experience. The Board Chair noted that with regard to the Sky Bridge on the North Shore Hospital site and access by double decker buses that double decker buses will not travel on the hospital sites as they are only used for rapid transit and arterial routes. There is regulation around roads that double decker buses can travel on. The Board Chair also noted the recent opening of the Department of Medicine and encouraged Board members to visit. The Department is a real exemplar of what can be done to provide appropriate facilities for people to retire to; the area is bright, light and spacious. Andrew Brant further noted that it is also a collaborative environment, connecting teams together. A video of the Well Foundation was viewed. The report was received. Waitemata District Health Board, Meeting of the Board 29/06/16 19

20 5.2 Health and Safety Performance Report May 2016 (agenda pages 46-66) Fiona McCarthy (Director, Human Resources) was present for this item. The Auckland DHB and Waitemata DHB Health and Safety video was viewed. Fiona McCarthy thanked the Board Chair for his role in the video. Fiona McCarthy summarised the report and matters highlighted and responses to questions included: That a number of Health and Safety site visits were held in May, the Board Chair and Chief Executive completed visits of both the North Shore Hospital and Waitakere Hospital sites. The Board also undertook a visit on the 18 th May around hazardous substances. Kylie Clegg expressed her thanks for the visit noting that it gave a real sense of size and scale of the work involved. Morris also acknowledged the opportunity to visit sites that are not normally seen; in particular he noted the hazardous substances safe room and concern that the DHB does not have a similar room at Waitakere Hospital. In response, Fiona noted that a business case for a dangerous good store at Waitakere Hospital is underway. That the top three accident types (aggression; slips, trips and falls and patient handling) while not increasing are also not decreasing, more attention is being paid to these areas, robust targets set and identification of actions to meet those targets. That in response to a question it was noted that the new Hazardous Substances Co-ordinator commenced on 2 nd May. The Co-ordinator will recommence the auditing of the 33 high use areas and another 250 areas that use chemicals; the audits will occur over the next 18 months. That in response to a question, Debbie Holdsworth noted that she had meant with John Rooney (Simpson Grierson) following his external review of the DHB s plan regarding Funder contracts and an external review of the draft capability assessment. John Rooney has identified a number of areas which he considered low risk. The Board Chair noted the need to be prudent and include a clause in the DHBs contracts. Fiona drew the Board s attention to the recommendation for the Board to endorse version two of the notifiable event process. The Board Chair noted the recent health and safety site visits he had undertaken at both the Waitemata and Auckland DHB hospital sites. A key issue highlighted is around staff identification of work that needs to be done to improve an area and the delay for the work to be completed. The Board Chair has requested that a process be put in place to fast track work required; this needs to be a facilitative process with perhaps two Board members and three executive members delegated to approve any health and safety improvement work of up to say $2million in cost. Fiona McCarthy and Robert Paine were requested to formalise this process. Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) a) That the report be received. b) That the notifiable event process is endorsed (Appendix 1). Carried Waitemata District Health Board, Meeting of the Board 29/06/16 20

21 5.3 Communications (agenda pages 67-73) Matt Rogers (Director of Communications) was present for this item. He noted that that there had been a cluster of adverse reports which were predominately around anti-natal care and featured in a number of media outlets. The report was received. 6 DECISION PAPERS There were no decision papers. 7 PERFORMANCE REPORTS 7.1 Financial Performance (agenda pages 74-88) Robert Paine (Chief Financial Officer) presented this item and responded to general questions, it was noted that a table will be provided to the Board demonstrating the long term asset management plan. Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the following performance reports for the month and attachments be received: 1 Financial Overview of the 2015/16 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury Carried 8 COMMITTEE REPORTS (agenda pages ) 8.1 Auckland DHB and Waitemata DHB Disability Support Advisory Committees Meeting 09 th March 2016 Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer) That the draft minutes of the Disability Support Advisory Committee meeting held on 09 th March 2016 be received. Carried Waitemata District Health Board, Meeting of the Board 29/06/16 21

22 8.2 Hospital Advisory Committee Meeting held on 06 th April 2016 Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer) That the draft minutes of the Hospital Advisory Committee Meeting held on 06 th April 2016 be received. Carried 8.3 Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting held on 27 th April 2016 Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer) That the draft minutes of the Community and Public Health Advisory Committee meeting held on 27 th April 2016 be received. Carried 9 INFORMATION PAPERS 9.1 Health and Safety Marker Report - Update April 2016 (agenda pages ) Fiona McCarthy noted that good progress is being made, with required actions continuing to be completed. The Board Chair noted the report as being very helpful. Resolution (Moved Tony Norman/Seconded Max Abbott) That the report be received. Carried The Chair thanked those present. The meeting concluded at pm SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 25 MAY 2016 CHAIR Waitemata District Health Board, Meeting of the Board 29/06/16 22

23 Actions Arising and Carried Forward from Previous Board Meetings as at 23 June 2016 Meeting Date Agenda Ref Topic 24/02/ Health and Safety Markers Person Responsible Expected Report back Comment - To check whether medical trials in hospitals come under the new Health and Safety legislation - A more comprehensive update to be provided for the Board on asbestos risk in the DHB. Fiona McCarthy Fiona McCarthy To be discussed with Worksafe and MoH in May. A verbal report may be available at the meeting. Actioned - information on asbestos management including comment on the new regulations and our asbestos management plan went to the April Audit and Finance Committee meeting. 25/05/ Health and Safety Performance Report Health and Safety facilities group (x2 Board members x3 executive) with delegated authority to approve any health and safety improvement work. Fiona McCarthy/ Robert Paine 20/07/16 Audit and Finance Committee Verbal update to be provided at 29/06/16 Board meeting. Paper to be submitted to 20/07/16 Audit and Finance Committee meeting. Waitemata District Health Board, Meeting of the Board 29/06/16 23

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27 The Controller and Auditor-General Tumuaki o te Mana Arotake Good Practice for Managing Public Communications by Local Authorities April

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29 Foreword We first published our Suggested Guidelines for Advertising and Publicity by Local Authorities in We published a revised version of those Guidelines in Since 1999, a number of factors have contributed to significant change in the environment in which local authorities are involved in advertising and publicity. Probably the two major factors are the advances in communications technology and the rate of adoption of the new technology, and (more recently) the enhanced requirements for communication in the Local Government Act We saw as a consequence of that significant change the clear need to revisit the Guidelines to reassess their validity and determine what changes might be needed to preserve their usefulness. This publication reflects the fresh approach we have taken to the subject still principlesbased, but with an emphasis on the wider concept of communication rather than advertising and publicity. As previously, this update represents what we believe is a code of good practice. The guidance it contains is no more authoritative than that. Further, the guidance is intended neither to be an operating manual nor to cover every conceivable situation. Local authorities will have to determine what practical application they make of our good practice guidance in particular situations. To do so, and to reflect the more open approach to disclosing how local government manages itself, we recommend that the adoption and application of the guidance in this publication be incorporated in a formal communications policy. K B Brady Controller and Auditor-General 14 April

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31 Contents Page 1 Introduction 7 The importance of Council communications 7 Why this guide? 7 The objects and scope of the guide 8 What is the status of the guide? 9 2 Scope What are Communications? 10 3 Communications Whose Responsibility? 12 4 Principles and Practice 14 Legitimacy and justification 14 Collective position 16 Standards of communication 17 Consultation and public debate 17 Communications by Members 19 Members personal profile 21 Communications in a pre-election period 22 5 Other Commonly Arising Issues 25 Use of surveys and market research 25 Joint ventures and sponsorship 25 Appendices 1 Principles of the Local Electoral Act Statistics New Zealand Principles Applicable to the Production of Official Statistics

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33 1 Introduction The importance of Council communications 1.1 Communication with the public is a major part of any Council s activities. It can consume large amounts of ratepayers money. 1.2 Some types of public communications are mandatory for example, notifying Council meetings, or issuing a statutory plan for consultation. Others are discretionary for example, a Council-funded newsletter, a media release explaining a recent decision, or a pamphlet about disposal of household waste. 1.3 Councils communicate with the public by many different means. For any communication, a Council has a broad range of choices both as to the medium to be used (e.g. whether to pay for newspaper advertising or use the Council s web site) and the degree of sophistication involved. 1.4 Choice introduces judgment and subjectivity. The dilemma of the communicator is in reconciling the potentially conflicting criteria of: making the communication attractive so that the audience will give it their attention, absorb it, understand it, and (if that is what is expected) act on it; meeting acceptable standards of probity; and presenting accurate, complete, and fairly expressed information. 1.5 The skill required of the communicator is to observe the relevant principles and apply the highest possible standards, and, importantly, to learn from experience. Why this guide? 1.6 Communication of information at public expense or in an official capacity always carries the risk of criticism. The commonest complaints (except for statutory notifications) are that a communication is unnecessary, unbalanced, or politically biased. The best defence to any complaint is that the communication meets acceptable standards. 1.7 The Auditor-General is often asked to express a view on whether a particular communication is acceptable. Some requests come from the Council, before publication. Others come from members of the public afterwards, complaining about what has been done. 7 33

34 1.8 Until 1996, there was no authoritative guidance as to what standards were acceptable in Council communications. Our suggested guidelines first published in that year, and now updated for the second time have aimed to fill that vacuum. Just as we bring an independent perspective to our job as the auditor of local authorities, we try to describe good practice that reflects not only the theory and practice of communications but also the expectations of the public. 1.9 We derive our guidance from: our knowledge of the kinds of official communications that may cause concern in both the central and the local government sectors; our experience, not only in giving help to communicators but also in dealing with complaints from the public; and our consultations with a range of Council communications staff and advisers and with Local Government New Zealand The feedback we received from our consultations was that independent guidance is a valuable and necessary aid, not only for Council Members but also for communications staff and advisers. Guidance can: provide a general framework for the conduct of a Council s communications activities; help with clarifying roles and responsibilities especially as between Members and communications staff and advisers; and set benchmarks for particular types of communications especially as to what is acceptable in the political context and at critical times such as during a pre-election period. The objects and scope of the guide 1.11 The statements of good practice in this guide are designed to meet three objectives in relation to a Council s communications practices: to ensure that Council communications resources are applied effectively and efficiently, and in a manner that produces good value for money; to ensure that those who are permitted to use Council communications facilities do so for legitimate purposes; and to promote appropriate standards of conduct by those who consume Council communications resources, or use Council facilities, or otherwise communicate on behalf of the Council. 8 34

35 1.12 This wide scope is consistent with our role as the auditor of local authorities, which includes examining the extent to which they, and their members and staff: carry out activities effectively and efficiently, consistent with Council s own policies; comply with statutory obligations; avoid wasteful use of resources; and act with probity and financial prudence The guide itself is produced under the authority of section 21 of the Public Audit Act, as a report on matters arising out of the performance and exercise of those functions. What is the status of the guide? 1.14 Our guidance is not binding on Councils. Each Council is free to adopt its own standards which must of course be consistent with the relevant principles of the Local Government Act 2002 (LGA) We recommend that every Council consider adopting a formal communications policy framed to suit its particular needs. The policy should: embrace these guidelines or a variation of them (stricter or otherwise) that the Council considers appropriate to its circumstances; and clearly direct Members and communications staff and advisers 3 on how the policy is to be applied in particular cases Although this guide is not binding on Councils, they and the public should be aware that it establishes the criteria that we will use in future in order to form a view on the appropriateness of a Council s public communications Public Audit Act 2001, section 16. Section 14 of the LGA. Including those engaged as consultants. 9 35

36 2 Scope What are Communications? 2.1 Our guidance applies to any communication by a Council, or a Member or employee or office holder of a Council, or a Member of a Community Board, where: the Council meets the cost (wholly or in part); or the person making the communication does so in an official capacity on behalf of the Council or a Community Board. 2.2 We make no distinction between: mandatory and discretionary communications; communications in the Council s own publications and the news media generally; Council-funded advertisements and other forms of publicity; or electronic (including web site or ) and hard copy publication. The underlying principles are the same in each case. 2.3 Common examples of communications by Councils include: statutory documents such as draft, final, and summary versions of the Long Term Council Community Plan or an Annual Report under the LGA; information on a web site, or in a poster or pamphlet, about Council services available to the public, or the rights, entitlements, and responsibilities of people affected by a Council activity; newspapers and newsletters reporting Council news and activities; material explaining a particular proposal, decision, policy, or bylaw of the Council; marketing material promoting the Council, its communities, or a regional brand; Council-funded advertising about a particular event, proposal, or Council policy; educational material about issues affecting the community; and media releases initiating or responding to public comment about matters affecting the Council or its communities

37 2.4 In a different category are communications by Members using Council resources or facilities. We address this type of communication in paragraphs on pages The guide does not apply to: normal day-to-day correspondence between Members and their constituents on appropriate matters, except during a pre-election period when the content of the correspondence should not be inconsistent with Principle 12 on page 22; and communications by Members using their own resources

38 3 Communications Whose Responsibility? 3.1 Corporate governance principles stress the different roles of the governing body and the management of an organisation. For local authorities, section 39 of the LGA reflects these principles. 3.2 Members (i.e. the governing body) and management of a Council share different elements of the communications function. In essence: Members are accountable to the community for the Council s decisions and actions. What the Council says in its communications is, therefore, ultimately the Members responsibility. The mechanics of communications are operational activities, which form part of the everyday business of the Council. Moreover, effective communication often requires professional input. Most Councils employ (or engage on contract) professional advice and assistance for some or all of their communications activities. The chief executive is responsible for the effective and efficient management of those people and their activities. Communications is also an area of risk. Those who are authorised to communicate on behalf of a Council, and those who exercise editorial or quality control, need to have access to sources of professional advice when necessary (including legal and strategic communications advice). Obtaining that advice is also a management responsibility. 3.3 The communications function thus straddles the divide between governance and management in the Council organisation. Each Council should allocate the respective roles and responsibilities according to its own size and needs. For example, in a small Council the Mayor might be the primary spokesperson on all issues, whereas in a larger Council the role might be shared between the Mayor and a communications manager. 3.4 The governance/management divide also affects the crucial elements of policy development, quality control, and editorial supervision. We think these elements are best regarded as management functions, for which the chief executive is responsible. 3.5 The respective roles and responsibilities need to be well understood by all concerned and put into practice effectively. 4 This is especially important when the Council employs professional communications staff who could, for example, feel undermined by Members intervening in editorial decisions. 4 See section 39(e) of the LGA. The local governance statement required by section 40 of the LGA could be the appropriate place to record particulars of the division of roles and responsibilities

39 3.6 A useful approach is to regard the roles of Members and management as complementary, and to encourage everyone to work together in partnership for the good of the Council and the community

40 4 Principles and Practice 4.1 In this section we set out 13 principles that we believe should underpin a Council s policy and practice on communications. We supplement each of the principles with commentary. 4.2 We stress that the principles are intended as general statements, which are to be applied in a flexible and common sense manner. Likewise, the commentary cannot expect to foresee all possible situations that might arise. Legitimacy and justification Principle 1 A Council can lawfully, and should, spend money on communications to meet a community s (or a section of a community s) justifiable need for information about the Council s role 5 and activities. 4.3 Communications are a necessary and legitimate Council expense. Councils are also justified in employing, or otherwise engaging, professional advice and assistance for their communications activities. 4.4 However, no communication should be undertaken without justification or regard for the cost. 4.5 The main elements of justification are: establishment of an identifiable need for information on the part of a particular audience; the chosen method of communication should be one that is effective in reaching those who have the need; and once the method has been identified, the communication should be made in the most cost-efficient manner. 4.6 Consideration should also be given to evaluating the effectiveness of the communication. What is known to have been an effective communication supports the justification for that communication and can be a benchmark to support future communications. 5 The role of a local authority is to (a) give effect, in relation to its district or region, to the purpose of local government ; and (b) perform the duties, and exercise the rights, conferred on it by or under this Act and any other enactment. (LGA, section 11) 14 40

41 4.7 A communication will be lawful when it: is authorised by a Council resolution or under a delegation; and complies with any specific legal requirements as to form, content 6, timing, or method of publication A Council can also exercise significant power over individuals and groups in the community. Consequently, a Council has an obligation to ensure those people know how they are being affected by the Council s actions, and what their rights and responsibilities are in relation to those actions. 4.9 Council communications are all the more important in the environment of the LGA. Consultation with the community is fundamental to the working of the Act, and effective communication is vital to effective consultation. Principle 2 Communications should be consistent with the purpose of local government 8 and in the collective interests of the communities the Council serves A Council is a corporate entity, with statutory role and purpose. The role and purpose include promoting the well-being of communities in its district or region. A Council may serve many communities, both in the geographical sense and in the sense of communities of interest. It should always act within the scope of its role and purpose, and in the collective interests of its communities Sometimes, a Council will need to communicate with only some of its communities about a particular issue, or with part of a community. But it should always be able to justify any communication as being in the collective interests of them all Including the avoidance of defamatory comment, or misleading or deceptive conduct under the Fair Trading Act E.g. use of the special consultative procedure under the LGA. The purpose of local government is (a) to enable democratic local decision-making and action by, and on behalf of, communities; and (b) to promote the social, economic, environmental, and cultural well-being of communities, in the present and for the future. (LGA, section 10) 15 41

42 Principle 3 Communications should comply with any applicable Council policies and guidelines as to process (including authorisation) and content We encourage all Councils to adopt a policy on communications: see paragraph 1.15 on page 9. Collective position Principle 4 Communications on Council policies and decisions should reflect the collective position of the Council Wherever possible, the Council should speak with one voice, and its communications should represent the corporate or collective position A communication by an authorised spokesperson appointed by the Council (whether that person is a Member or an employee) should identify that person in his or her official capacity (for example, as a Committee chairperson). The purpose of the communication should always be to meet the Council s, not the spokesperson s, communications objectives. The person responsible should be careful to ensure that what is being said is portrayed as the Council s position, not the personal views of the spokesperson Some Councils allow the Mayor to produce a regular column in a Councilfunded or other local publication, or to make regular broadcasts on local radio or television. The purpose of such communications should be to give voice to the Council s corporate position on its activities, through the elected leader Communication of a Member s personal perspective, views or opinions (including in a regular column, broadcast, etc) should be the exception rather than the rule, and should be subject to Principles 9 to 11 (see pages 19-21). Principle 5 Communications on Council business should always be clearly attributed to the Council as the publisher A communication might, for example, identify the Council by reference to the name of the Council or by use of its corporate logo. A communication designed to meet the Council s statutory obligations (such as a draft annual plan) should not only say who authorised its publication (usually the chief executive officer) but also identify the statutory provision under which it is being published

43 4.18 For commentary about the identification of sponsors, see paragraphs on pages Standards of communication Principle 6 Factual and explanatory information should be presented in a way that is accurate, complete, fairly expressed, and politically neutral Accurate means what it says. That which is held out to be true should be founded on ascertainable facts, and be carefully and precisely expressed consistently with those facts. No claim or statement should be made that cannot be substantiated A communication will be complete when it consists of all the information necessary for the audience to make a full and proper assessment of the subject matter Information will be fairly expressed when it is presented in an objective, unbiased, and equitable way. In particular: the audience should always be able to distinguish facts from analysis, comment, or opinion; and when making a comparison, information should state fully and accurately the nature of what is being compared, and inform the audience of the comparison in a way that does not mislead or exaggerate Information will be politically neutral when it presents the Council s collective position, or, where there is no collective position, sets out the issues in a manner that does not refer to the positions taken by any individual Member or political party or group of Members. Consultation and public debate Principle 7 Communications about matters that are under consideration by the Council, or are otherwise a matter of public debate, should present the issues in an evenhanded and non-partisan way Communications about matters that will be the subject of a future decision by the Council should be distinctly different from those that follow a decision

44 4.24 In the before phase, all relevant facts and other considerations should be taken into account, and all significant points of view should be aired. The aim is to enable the Council to make itself aware of, and then to have regard to, the views of all its communities in relation to a particular decision 9, while also meeting all its statutory obligations in respect of consultation In particular, a before phase communication should: avoid the appearance and reality of bias or pre-determination especially when summarising facts or arguments; present the issues in an objective manner, avoiding subjective opinion or comment; and mention both the advantages and the disadvantages of particular options Mention of individual Members or political parties positions should always be avoided In the after phase, the emphasis should be on what has been decided and its implications for the Council and its communities This principle applies whether the purpose of the communication is to satisfy LGA requirements, or otherwise. Principle 8 If engaging in public debate with an interest group or a section of the community, a Council should use the news media (rather than a Council funded publication) and designated spokespersons (rather than professional communications advisers) unless there is a particular justification for not doing so A Council may be justified in responding to publicity that is unfair, unbalanced, or inaccurate. The object should be to put the record straight, including a measure of rebuttal But it is important to keep a balance and perspective. Council resources should not be used merely to engage in a public argument The preferred approach in such cases should be to make use of the news media, through release and publication of a written statement or making an authorised spokesperson available for interview. Use of Council-funded publications or professional advisers to engage in debate with interest groups could create the perception that Council resources are being used for the benefit of one section of the community against another, or in a way that results in an unequal public relations contest LGA, sections 14(1)(b) and 78. LGA, sections

45 4.32 An example of where a Council-funded publication to engage with an interest group could be justified is when the group has issued public statements encouraging citizens to commit acts of civil disobedience or to actively break the law. Communications by Members Principle 9 If the Council s Communications Policy permits them, communications by Members of their personal perspective, views or opinions (as opposed to communication of Council matters in an official capacity) should: be clearly identified as such; and be confined to matters that are relevant to the role of local authorities Members are collectively responsible for Council decisions. Communication of Council business to the community often falls to a designated spokesperson. See Principle 4 and paragraphs on page But Members are also individually responsible to the communities that elected them. It is for the Council to decide whether and, if so, on what terms to make resources available to Members to communicate with constituents or the wider community in their capacity as individual Members An example of a communication that could involve a Member expressing personal views is a Members column in a Council-funded newspaper or on a Council web site It is important that the Communications Policy, and the relevant part of the communications budget, also sets out clearly the limits in relation to such communications. The policy should say: What types of communications are permitted and in what circumstances, and the range of permitted subject matter. Whether the material can or should be subject to editing and, if so, by whom. What procedures apply in respect of authorisation, attribution, and editorial and quality control. These are for the Council to determine. However, whether or not material is edited, the Member must formally subscribe to what is being published. 11 Under sections 10 and 11 of the LGA see footnotes 5 (page 14) and 8 (page 15)

46 4.37 Note, however, that a Member s freedom to talk about Council business is subject to confidentiality requirements (such as under Standing Orders) and the Council s Code of Conduct especially as regards Members conduct towards each other and their disclosure of Council information Here are our views on some other examples of a Member communicating personally: It is not appropriate for a Member to use a Council newsletter or web site to express views on a matter of central government responsibility (such as defence and foreign relations) that has no direct bearing on the Council s activities. It may be appropriate (but only when the Council is undertaking no formal consultation process) for a Member to use Council facilities to consult with the public on an issue under consideration by the Council, or to explain his or her position on a contentious decision, but not to seek political support on an issue that the Council has not considered. References to, or the use of a logo or slogan of, a political party or grouping are unacceptable. Members should not be permitted to use Council communications facilities for political or re-election purposes. (See Principles 12 and 13 on pages for more information on communications in the preelection period.) Staff protocols on the use of the Internet, , and other communications facilities for personal purposes should also apply to Members. The minimal cost of allowing use of such facilities can easily be outweighed by the perception that public resources are being misused. Principle 10 Politically motivated criticism of another Member is unacceptable in any Council-funded communication by a Member Neither the inherently adversarial nature of much Council politics nor the right of free speech can justify Council communications resources being used to enable one Member to engage in political debate with, or to criticise, another Member. Preventing such misuse should be an objective of the Council s policy on where editorial control and the power to authorise communications should lie Members are, of course, free to use their own resources for such purposes. 12 LGA, Schedule 7, clause

47 Members personal profile Principle 11 Care should be exercised in the use of Council resources for communications that are presented in such a way that they raise, or could have the effect of raising, a Member s personal profile in the community (or a section of the community). In permitting the use of its resources for such communications, the Council should consider equitable treatment among all Members Two related objectives underlie this principle: It is important that the public know who their Councillors are. Councils are justified in using, or in some circumstances permitting Members to use, Council facilities for communications that have the objective of raising a Member s personal profile. Giving a human face to a piece of information can be an effective communications strategy to attract attention and make the information relevant and understandable to its audience It is acceptable for Councils to use photographs of Members, personal quotes/attributions, and other standard journalistic techniques provided they are consistent with these objectives. However, Councils need to bear in mind the inherent risks of favouritism and unequal treatment of members For example, a photo opportunity shot, in a Council-funded publication, of a Mayor or Committee Chairperson announcing a Council decision helps to draw the reader s attention to the decision, and thereby improve the effectiveness of its communication, but could also have an unintended and beneficial spin-off effect for the Member s personal or political profile in the community Allowing Members representing a particular Ward to issue their own newsletter to constituents could have a similar effect. There is nothing wrong with such an idea in principle. However, the principle of equitable treatment makes it important that the same communications opportunity is available to Members representing other Wards. Matters such as editorial and quality control and attribution should also rest with the Council s communications staff in accordance with Council policy

48 Communications in a pre-election period 13 Principle 12 A local authority must not promote, nor be perceived to promote, the re-election prospects of a sitting member. Therefore, the use of Council resources for re-election purposes is unacceptable and possibly unlawful Promoting the re-election prospects of a sitting Member, directly or indirectly, wittingly or unwittingly, is not part of the proper role of a local authority A Council would be directly promoting a Member s re-election prospects if it allowed the member to use Council communications facilities (such as stationery, postage, internet, , or telephones) explicitly for campaign purposes Other uses of Council communications facilities during a pre-election period may also be unacceptable. For example, allowing Members access to Council resources to communicate with constituents, even in their official capacities as members, could create a perception that the Council is helping sitting Members to promote their re-election prospects over other candidates For this reason, we recommend that mass communications facilities such as Council-funded newsletters to constituents; and Mayoral or Members columns in Council publications be suspended during a pre-election period Promoting the re-election prospects of a sitting Member could also raise issues under the Local Electoral Act For example: Local elections must be conducted in accordance with the principles set out in section 4 of the Local Electoral Act see Appendix 1 on page 27. The principles apply to any decision made by a Council under that Act or any other Act, subject only to the limits of practicality. A breach of the principles can give rise to an irregularity which could result in an election result being overturned By pre-election period we mean the three months before the close of polling day for the purposes of calculating electoral expenses : see Local Electoral Act 2001, section 104. However, a Council may decide to apply restrictions over a longer period. See Aukuso v Hutt City Council (District Court, Lower Hutt, MA 88/03, 17 December 2003)

49 The publication, issue, or distribution of information, and the use of electronic communications (including web site and communication), by a candidate are electoral activities to which the rules concerning disclosure of electoral expenses apply Electoral expenses 15 include: the reasonable market value of any materials applied in respect of any electoral activity that are given to the candidate or that are provided to the candidate free of charge or below reasonable market value; and the cost of any printing or postage in respect of any electoral activity A Member s use of Council resources for electoral purposes could therefore be an electoral expense which the Member would have to declare unless it could be shown that the communication also related to Council business and was made in the candidate s capacity as a Member. Principle 13 A Council s communications policy should also recognise the risk that communications by or about Members, in their capacities as spokespersons for Council, during a preelection period could result in the Member achieving electoral advantage at ratepayers expense. The chief executive officer (or his or her delegate) should actively manage the risk in accordance with the relevant electoral law Curtailing all Council communications during a pre-election period is neither practicable nor (as far as mandatory communications, such as those required under the LGA, are concerned) possible. Routine Council business must continue. In particular: Some Councils publish their annual reports during the months leading up to an October election, which would include information (including photographs) about sitting Members. Council leaders and spokespersons need to continue to communicate matters of Council business to the public. 15 Also defined in section

50 4.53 However, care must be taken to avoid the perception, and the consequent risk of electoral irregularity, referred to in the commentary to principle 12. Two examples are: journalistic use of photographic material or information (see paragraph 4.42 on page 21) that may raise the profile of a Member in the electorate should be discontinued during the pre-election period; and access to Council resources for Members to issue media releases, in their capacities as official spokespersons, should be limited to what is strictly necessary to communicate Council business Even if the Council s Communications Policy does not vest the power to authorise Council communications solely in management at normal times, it should do so exclusively during the pre-election period

51 5 Other Commonly Arising Issues Use of surveys and market research 5.1 Councils should target their communications resources to best effect. In appropriate cases, professional advice should be sought, and soundly obtained survey and market research information may be used. 5.2 Councils should meet acceptable standards in survey and market research information. To assist Councils to meet those standards: we reproduce in Appendix 2 on page 28 the ten principles identified by Statistics New Zealand underpinning its Protocols for Official Statistics; and they can find useful guidance in the Statistics New Zealand publication A Guide to good survey design 16. Joint ventures and sponsorship 5.3 Many Councils seek to be involved with their communities, and may engage in collaborative ventures with other public agencies and business and community groups. 17 Communication (for example, to promote public education or changes in people s behaviour) may be a feature of such ventures. 5.4 There is no reason in principle why a Council should not join with another agency or group to publish information for the benefit of the community provided the activity is consistent with the Council s role and purpose. The use of private or community sponsorship for a Council communication may be a feature of such co-operation. 5.5 Examples of joint communication could include: a joint venture with the Police to issue information about individual and community safety in the Council s district; and the use of business sponsorship for a Council advertisement of a community event ISBN ; revised July Copies can be ordered through the Statistics New Zealand web site at: vey+design+(2nd+edition) Section 14(1)(e), LGA

52 5.6 The Council s Communications Policy should, if the Council wishes to involve a partner, address: the types of communications for which joint ventures or sponsorship are appropriate; and the controls and procedures designed to manage the associated risks such as perception of Council capture by a business or community group, actual or potential conflict of interest, and community attitude to the nature of the problem. 5.7 As a minimum, the Communications Policy should: require all mandatory communications to be funded solely by Council; require every communication joint venture or sponsorship proposal to be supported by a sound business case that is approved at an appropriate level within the Council organisation; set out the criteria for selecting a communication joint venture partner or sponsor, in order to avoid conflict of interest and prevent a partner or sponsor from gaining (or being perceived to gain) inappropriate commercial or political advantage; require both the Council and the joint venture partner or sponsor to adhere to the principles (including those in respect of editorial control) that it has adopted in the Communications Policy; and contain clear guidance as to the placement of logos, slogans, and other sponsorship references

53 Appendix 1 Principles of the Local Electoral Act Principles (1) The principles that this Act is designed to implement are the following: (a) fair and effective representation for individuals and communities: (b) all qualified persons have a reasonable and equal opportunity to (i) cast an informed vote: (ii) nominate 1 or more candidates: (iii) accept nomination as a candidate: (c) public confidence in, and public understanding of, local electoral processes through (i) the provision of a regular election cycle: (ii) the provision of elections that are managed independently from the elected body: (iii) protection of the freedom of choice of voters and the secrecy of the vote: (iv) the provision of transparent electoral systems and voting methods and the adoption of procedures that produce (v) certainty in electoral outcomes: the provision of impartial mechanisms for resolving disputed elections and polls. (2) Local authorities, electoral officers, and other electoral officials must, in making decisions under this Act or any other enactment, take into account those principles specified in subsection (1) that are applicable (if any), so far as is practicable in the circumstances. (3) This section does not override any other provision in this Act or any other enactment

54 Appendix 2 Statistics New Zealand Principles Applicable to the Production of Official Statistics 1 The need for a survey must be justified and outweigh the costs and respondent load for collecting the data. 2 A clear set of survey objectives and associated quality standards should be developed, along with a plan for conducting the many stages of a survey to a timetable, budget and quality standards. 3 Legislative obligations governing the collection of data, confidentiality, privacy and its release must be followed. 4 Sound statistical methodology should underpin the design of a survey. 5 Standard frameworks, questions and classifications should be used to allow integration of the data with data from other sources and to minimise development costs. 6 Forms should be designed so that they are easy for respondents to complete accurately and are efficient to process. 7 The reporting load on respondents should be kept to the minimum practicable. 8 In analysing and reporting the results of a collection, objectivity and professionalism must be maintained and the data impartially presented in ways which are easy to understand. 9 The main results of a collection should be easily accessible and equal opportunity of access is enjoyed by all users. 10 Be open about methods used; documentation of methods and quality measures should be easily available to users to allow them to determine if the data is fit for their use. A full copy of Protocols for Official Statistics can be obtained by contacting Statistics New Zealand through its web site

55 4.1 Chief Executive s Report Recommendation: That the Chief Executive s Report be received. Prepared by: Dr Dale Bramley (Chief Executive Officer) 1. News and events summary A number of events of significance took place across the DHB over the past six weeks: The new Sky Bridge linking the main North Shore Hospital tower block with the Elective Surgery Centre (ESC) was officially opened by the Prime Minister, Rt Hon John Key, and the Minister of Health, Hon Dr Jonathan Coleman, on 21 June. The covered link between two of our major facilities is the latest major capital project completed by the DHB to meet the health care needs of the fastest-growing population in the country and is one of the key projects under our Waitemata year plan. Sky Bridge allows the DHB to perform a greater volume and complexity of surgeries at ESC as it allows for fast and direct patient transfers, with direct links to the high dependency and intensive care units in the main hospital. The project has come together very quickly, with works having only started in February. Sky Bridge promotes an integrated approach to patient care through faster patient transfers and an improved experience for those undergoing treatment in various hospital buildings. It also allows for increased staff transfers. Although the bridge is not available for general public access, whanau/family can accompany patients across the bridge during transfer. Sky Bridge follows the completion of other major construction projects, such as He Puna Waiora mental health inpatient facility, Hine Ora women s ward, the new Department of Medicine and the Spiritual Centre. The next major project due for completion will be the Waitakere Hospital Emergency Department expansion, scheduled for August. Prime Minister John Key and CEO Dr Dale Bramley officially opening the Sky Bridge Waitemata District Health Board, Meeting of the Board 29/6/16 55

56 During his visit to the North Shore Hospital campus, the Prime Minister also took the opportunity to communicate directly with Waitemata DHB staff. Mr Key s CEO Lecture Series address outlined the Government s policy direction for health care in New Zealand and how fast-growing populations like ours will access care into the future. More than 300 staff attended the lecture in-person and via video link to our Waitakere campus, making it one of the biggest audiences in the history of the series. The Prime Minister attended at my invitation and it was a wonderful opportunity for the Waitemata team to understand the Government s big picture vision for the health sector and how this would benefit the people it aimed to serve. Mr Key was very generous with his time and demonstrated a keen interest in our strategies for managing increasing demand for care while also demonstrating prudent fiscal management. The Chair and I also escorted the Prime Minister and the Minister of Health on a short tour of some of our recent major building developments as part of his official visit and he remarked on the patient-centred design of facilities such as ESC, He Puna Waiora and Hine Ora. Prime Minister John Key delivering his CEO Lecture Series address Our Mason Clinic campus marked an important milestone on 10 June, with the blessing of the re-built Te Miro unit. Te Miro is one of several buildings on the Regional Forensic Psychiatry Service site in Point Chevalier to have been affected by water damage. By mid- 2021, a total of nine buildings on the site are set to have undergone major repair or replacement, with Te Miro being the first completed, along with the Kowhai administration block. This particular project began in mid-august 2015 and involved a total re-build from the existing concrete pad to the same design as the original structure due to the extent of building decay. Te Miro unit is not used to accommodate patients but provides Tangata whai iti ora and Pacifica service-users a place where they can participate in a range of cultural activities. The Te Miro redevelopment carried particular significance as it was the first Waitemata District Health Board, Meeting of the Board 29/6/16 56

57 location on the Mason Clinic site dedicated to the partnership of clinical and cultural practice. The dawn blessing of the re-built Te Miro unit, Mason Clinic Two respected members of the Waitemata health community who have both played influential roles in the delivery of care to our population were recognised in the Queen s 90 th Birthday Honours. Recently retired senior Waitemata DHB senior clinician Dr Pat Alley and community-based care leader Dianne Kidd were both made Members of the New Zealand Order of Merit (MNZM). Dr Alley was recognised for his services to health after specialising in gastro-intestinal, acute general and trauma surgery for the DHB for many years, also sharing his skills internationally as an exchange surgeon and lecturer. The award also recognised his dedication to improving palliative care by supporting education and training as well as his service as the Chair of Hospice North Shore for many years, establishing valuable links between palliative care providers. Mrs Kidd was recognised for her services to health administration for her work in the community over three decades. She was a founding Trustee of the Helensville District Health Trust in 1989 and has been its Chairman since Mrs Kidd was involved in the Trust s establishment of one of New Zealand s first birthing centres and helped raise the necessary funds for purpose-built premises for the Kaipara Medical Centre. Under her chairmanship, she established a new Board for the Helensville Women and Family Centre and oversaw the opening of satellite premises in Parakai for Iris Home Support Services and the Kaipara Medical Centre. Throughout 2012 and 2013 she oversaw the acquisition of the Medical Centre by the Trust from its corporate owners and was instrumental in the creation of an innovative partnership and ownership model for the Kaipara Medical Centre between the Health Trust, its senior doctors and Waitemata DHB. It is pleasing to see two people who have committed many years of their time to the service of others in our community recognised in this way. Congratulatory notes have been sent to both on behalf of the DHB. Waitemata District Health Board, Meeting of the Board 29/6/16 57

58 Construction of the new Waitemata Clinical Skills Centre began on 15 June, to be located on the lakefront at North Shore Hospital. This state-of-the-art, two-storey teaching facility is scheduled for completion in April 2017 and will create a new home for many of the academic activities taking place across the DHB. It will include an auditorium and clinical teaching spaces, ensuring Waitemata s reputation as a place of learning and excellence continues well into the future. The centre will also have a dedicated clinical skills laboratory occupying most of the first floor and an AUT exercise-testing laboratory. The start of construction was a milestone for our DHB but it was of particular significance for Dr John Cullen, who has championed the development of such a facility for many years. It was a pleasure to join him on-site to see his dream taking shape. We owe John a debt of gratitude for his vision, energy and persistence in developing a teaching space that will benefit future generations. L-R: Dr John Cullen and CEO Dr Dale Bramley on-site at the start of construction Waitemata District Health Board, Meeting of the Board 29/6/16 58

59 Exterior impression of the new Clinical Skills Centre from outside Lakeview Cardiology Unit The auditorium is to be the showpiece of the centre The DHB has undertaken paid newspaper advertising to give the people of the Waitemata district clear advice on how best to access the appropriate level of care for their needs. The easy-to-read design was prepared in-house and encourages people to prioritise the use of primary care options, Healthline and Healthpoint where possible while reserving our emergency departments for genuine emergencies. The adverts have been published twice in both the Western Leader and North Shore Times and the design is being made available as a poster to our primary care partners. We are also promoting the key messages of the Waitemata District Health Board, Meeting of the Board 29/6/16 59

60 campaign via social media. We will be evaluating the effectiveness of this campaign on presentations to our ED over the traditionally busy winter months. Our goal, as always, is to ensure patients get the right care at the right time in the right place and this is another tool to support this and enable us to provide rapid care to those patients who do genuinely need ED treatment. At the time of drafting this report, the DHB was awaiting final Council approval to bring into service new staff car park spaces at Waitakere Hospital. These spaces were handed over to our Traffic team on 20 June, pending final Council sign-off. There are 79 new parking spaces in total on the former Te Atarau site, including two disability spaces. This will add convenience for staff working at our Waitakere campus and should free-up public parking capacity. The inaugural Director of the Institute of Innovation and Improvement has been appointed. Dr Penny Andrew will lead our innovation and quality improvement programme with the aim of making Waitemata DHB a leader in these fields across the Asia Pacific region. Her focus will be on working jointly with our services and divisions to achieve the best possible health care outcomes for our patients/clients and their families. Over the last four years, Penny has been our Clinical Leader of Quality. She brings a wealth of experience to this new role with her deep understanding of innovation and improvement methods as well as her medical and legal background. Creating a culture of appreciation A further 44 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member whose nomination is considered worthy of acknowledgement receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting were: - Toni Scott, Clerical Team Lead, Emergency Department WTH, nominated by Kate Allan and Marja Peters - Samir Seleq, Medical Registrar, RMO Unit, nominated by Denise Smith - Raewyn Gale, Registered Nurse, NSH Gastroentology, nominated by Bonita Burton-Watt - Vickie Shakur, Recruitment Consultant, nominated by Shirley Campbell - Nicola Nell, Physiotherapist, Paediatrics WTH, nominated by Shirley Campbell - Helen Lipscombe, Registered Nurse, Ward 11 NSH, nominated by Dr Sidhesh Phaldessai - Felicity Mowbray, Registered Nurse, Ward 11 NSH, nominated by Dr Sidhesh Phaldessai - Meha Modi, Food Services Associate, Hospital Operations NSH, nominated by Elizabeth Thompson - Angelina Sanders, Admin Clerk Clinical Team - SCBU West, nominated by Debbie Daniel - Angela Beddek, E-Radiology, nominated by Christine Hayes - Kevin Blair, Project Manager - E-Radiology, nominated by Christine Hayes - Jo Inivale, Specialty Nurse - Department of Anaesthesia - NSH, nominated by Margie Mazciritis - Clair Turner, Associate Clinical Charge Midwife NSH, nominated by Sam Davenport - Marc Craddock, Desktop Technician, IT - Desktop Services, nominated by Lara Hopley - Nina Dunlop, Admin Clerk, General Medical NSH, nominated by Pat Henley - Sue Thornton, Registered Nurse, Outpatients NSH, nominated by Tess Ablanida - Bronwyn Menzies, Registered Nurse, Waitakere Day Surgery WTH Theatres, nominated by Bede Saldanha Waitemata District Health Board, Meeting of the Board 29/6/16 60

61 - Dave Holder, Charge Nurse Manager, Kahikatea Unit- Carrington Hospital Site, nominated by Alison Nathan on behalf of Kahikatea team - Leuila Stevenson, Dental Therapist, Dental South 3, nominated by Anishma Ram - Jeff Chung, Dental Therapist, Dental South 3, nominated by Anishma Ram - Tama Davis, Community Support Worker - Moko Services, nominated by Huia Cannon - Jacqui Johnston, Registered Nurse - He Puna Waiora, nominated by Jason Haitana - Caroline Larsen, Registered Nurse - He Puna Waiora, nominated by Jason Haitana - Antony Marunden, Cleaner, nominated by Penny Andrew - Anne McMahon, Health Educator, nominated by Mary Gill on behalf of the WDHB Moving and Handling Educators - Dr David Burton, SMO - Anaesthesia, nominated by Karen George and Alynne Ledesma - Jenny Whitson, Registered Nurse - Ward 5, nominated by Lee Roberts - Michael Parker, Occupational Therapist - Ward 12, nominated by Yvonne Verner - Rose Smart, Research Support - Research & Knowledge Centre, nominated by Lorraine Neave - Dr John D Arcy, Medical Officer, nominated by Tracy Silva Garay - Sharyn Gruzelier, Quality Document Coordinator, nominated by Trina Robertson - Karen Moreno, Admin Clerk - Clinical Team, nominated by Jane Hamer - Leslie Ponen, Social Worker - Allied Health, nominated by Nikola Ncube - Paula Wood, Personal Assistant - Corporate, nominated by Umit Holland - Lorraine Ridgwell, Manager - Info Tec&Bus Analyst Staff, nominated by Umit Holland - Annette Murphy, Registered Nurse - Special Care Baby Unit, nominated by Vesna Simovik - Dr Cameron Burton, Registrar - Paediatricians, nominated by William Shew - Kate Kim, Registered Nurse, nominated by Craig Wotten - Barbara Mankelow, Enrolled Nurse, Te Henga Ward, nominated by Rebecca Eade - Mike Gilbertson, Associate Clinical Charge Nurse - Radiology, nominated by Pauline Bowden - Morag Thomson, Acute USS Booking Clerk - Radiology, nominated by Pauline Bowden - Stefanie Smith, Neonatal Nurse - SCBU West, nominated by Debbie Daniel - Christine Bethell, Admin Clerk - Security Services, nominated by Sharyn Gruzelier - Bridget Wilson, General Medical Registrar, nominated by Donna Riddell 2. Upcoming events Looking toward the upcoming months, we can expect to see: Further progress on the next phase of Our Values, Your Values activity. Final stages of construction of the expanded Waitakere Hospital Emergency Department, scheduled to open in August. Commencement of the Clinical Skills Centre at North Shore. Ministerial visit to launch the new childhood obesity national health target. Visit by the Capital Investment Committee to inspect Waitemata DHB facilities. Continuation of works on the Community Health Building at North Shore Hospital. Pacific Week from July. Continuation of the 2016 CEO Lecture Series. Waitemata District Health Board, Meeting of the Board 29/6/16 61

62 3. Future Focus The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be. The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience. The intended benefits are to move these projects along at a faster pace with top-level support for the significant changes required, giving greater visibility and attention to those projects identified as being important in achieving the DHB s priorities and purpose as well as instilling the culture of improvement and innovation. In a major development for the Leapfrog programme, the evitals system is now live in the pilot ward (Anawhata) at Waitakere Hospital. The evitals application is working as planned and the nurses are appreciating being able to access their patients observations and charts in one place and not having to spend time looking for paper charts. They are also enjoying using the mini-tablet computer for both eprescribing and evitals. Kritika Lal and Donna Riddell from Anawhata ward, Waitakere Hospital, using the evitals technology The Community Allied Health Mobile project now has 83 clinicians fully mobile with the tablet computers. The roll-out of eprescribing at North Shore Hospital is proceeding extremely well under David Ryan s guidance, with more than 850 beds covered. This includes all NSH general medical wards (2, 3, 5, 6, 10 and 11), Hine Ora, Short Stay and surgical wards 4 and 8. Orthopaedic wards were the next scheduled to roll-out at the time this report was prepared. The eradiology project is now complete, with more than 98 per cent of all radiology orders since 13 May placed in the new system. The old system still has future orders that will be transferred before Waitemata District Health Board, Meeting of the Board 29/6/16 62

63 it can be decommissioned by the end of July. esign-off of all reports, facilitated by ongoing one-onone training, will allow Radiology to cease all printing by the end of August. The voice-to-text software implementation team are now working with Older Adults Services as the next service to use voice recognition for dictation. The Outpatient follow-up project is working with general surgery, orthopaedics and ORL on improving their systems with the ultimate aim of reducing the proportion of patients required to attend a hospital outpatient follow-up clinic. Procurement processes are underway for the Patient Experience Reporting System and the Mobile Enterprise Application Platform. Work on the Mobility Strategy and the implementation of a longerterm Enterprise Mobile Management platform continues at healthalliance, with a new Digital Foundations Steering Group being established for the region. 4. Outcomes discussion In late May, I was present at the WHO s World Health Assembly in Geneva, which agreed on resolutions to tackle antimicrobial resistance. Below is a summary of the significant challenge this issue poses and the decisions taken by the Assembly. Tackling antimicrobial drug resistance The lack of discoveries of new antibiotics over recent decades combined with the rapidly escalating threat of antimicrobial resistance is a massive challenge for health care internationally. England s Chief Medical Officer has described this as a catastrophic threat which could see routine operations posing much greater risk of death within 20 years due to ordinary infections which can no longer be treated with antibiotics. The relatively recent discovery of a Teixobactin is the first new antibiotic product developed since the 1980s. In the meantime, existing antibiotics have been rendered less effective due to diseases evolving more quickly than the drugs historically used to treat them. Considering that a new infectious disease has been discovered each year for the past 30 years, it is understandable that the international medical community is demanding action in the form of increased investment in innovation and development to address what has been described as a discovery void. Below is a summary of the resolution passed by the World Health Assembly aimed at increasing activity in this critical area. Delegates at the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug-resistance trend. Antimicrobial resistance is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine. The plan sets out five objectives: improve awareness and understanding of antimicrobial resistance; Waitemata District Health Board, Meeting of the Board 29/6/16 63

64 strengthen surveillance and research; reduce the incidence of infection; optimise the use of antimicrobial medicines; ensure sustainable investment in countering antimicrobial resistance. The resolution urges Member States to put the plan into action, adapting it to their national priorities and specific contexts and mobilising additional resources for its implementation. Through adoption of the global plan, governments all committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. It needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans and will report progress to the Health Assembly in Waitemata DHB will work closely with the Ministry of Health in developing and implementing a New Zealand-specific action plan to align with the global action plan. Useful links: Board performance priorities The following provides a summary of the work underway to deliver on the DHB s priorities: Relief of suffering Progress: Patient and Whānau Centred Care Patient feedback National Inpatient Survey The last national survey was carried out in February We received responses from 147 (37%) people. Overall results for four domains in February 2016: In comparison to overall results in 2015, Waitemata DHB has made small gains in Communication and Partnership domains (increase 0.1 & 0.2 respectively) and a small decrease in Coordination and Needs (decrease 0.2 in each). The national inpatient survey Waitemata District Health Board, Meeting of the Board 29/6/16 64

65 went out to a selection of discharged patients in May and responses from this survey are currently being collected and collated. Friends and Family Test During May, we received feedback from 1,252 people through the Friends and Family Test (FFT). This is a five per cent increase from the preceding month, maintaining high levels of responses since rolling out the FFT postcards from March The Net Promoter Score (NPS) for May was 70, an improvement from 62 for the preceding two months and above the DHB target of 65. Allied Health teams have been using FFT and this is the second report where their feedback is available alongside the divisional data. Patient Stories A total of 33 patient videos have been completed, including stories about dental services, mental health services, Asian health support services, thrombosis services, disability Waitemata District Health Board, Meeting of the Board 29/6/16 65

66 support, surgical services, SCBU, emergency admissions, upper GI cancer, ORL, discharge planning and end-of-life care. Three further stories are currently in production, including a delirium patient experience. The stories are used for staff training, public awareness (where consent allows) and to complement other patient experience data sources. Those that are able to be viewed publicly are available on the DHB website at: Patient Information Patient Information booklet This booklet has been finalised and is awaiting printing, following approval of a communication strategy and distribution process. Continuous Quality Improvement Six ward priority projects The Senior Management Team has agreed on six priority projects that all wards are expected to implement. o o o o o o Welcoming and Friendly Care Standards Friends and Family Test Bedside Handover Protected Mealtimes Discharge Calls Many areas have already implemented these projects. Senior managers now meet regularly to maintain momentum and ensure timely implementation. Progress is reported monthly at divisional meetings and is noted on Quality Boards. Listening Week A few In Your Shoes events were facilitated in May by the patient experience team, including a focus on Maori Mental Health Services and Pacific Health Services. The patient feedback from these sessions will be used to support service-improvement focus and enhance patient outcomes. Recruitment Director Patient Experience David Price commenced at Waitemata on 26 April. This role is the first of its kind in New Zealand and will be specifically dedicated to leading the development of our Waitemata experience programme, working with clinical teams to meet our DHB priorities of better outcomes and enhanced patient experience. Facilities development Department of Medicine Occupation of the new facility is complete following the official opening on 3 May. Ward 3 Refurbishment Ward refurbishment is complete after the last of the patient rooms were handed back to the service on 13 May. Waitemata District Health Board, Meeting of the Board 29/6/16 66

67 Sky Bridge Practical completion was achieved on 10 June, followed by the official opening by the Prime Minister on 21 June (see News and Events summary). Short Stay Ward & Diagnostic Breast Service Options for a staged redevelopment and for full closure of this area to complete all works in one stage are being evaluated and a detailed business case will be presented to the Board in August Community Building 5 Significant areas of rot have been found in structural wall and roofing elements of the building which has slowed progress and added cost. The impact is currently being assessed and the DHB is working with the contractor and the service to mitigate delays to this project and the impact on the dependent Short Stay Ward project. Surgical Pathology Office Relocation The project is progressing in accordance with the programme timeline, with detailed design completed and awaiting sign-off. WTH ED New Build This project is tracking to programme with practical completion scheduled for 27 July 2016 and Go Live scheduled 17 August WTH Additional Beds Wainamu and Muruwai Wards The project has been deferred until after winter due to the complexity of decanting requirements and unacceptable impact on patients. A scope change to include relocation of cardiology beds and a refit of the existing Assessment and Diagnostic Cardiology Unit is being considered to maximise benefit from this investment. A revised business case will be presented to the Board in September. Winter contingency beds will be available in the interim and recruitment of additional staff is progressing in time for the new schedule. Better Outcomes Progress: On track Achieving the health targets April 2016 Shorter waits in Emergency Departments 94% (target 95%) Improved Access to Elective Surgery 102% (target 100%) Increased immunisation 93% (target 95%) Better help for hospitalised smokers to quit 98% (target 95%) More heart and diabetes checks 91% (target 90%) Faster Cancer Treatment (FCT) 74% (target 85%)* * The FCT is a Ministry of Health priority and includes a cohort of patients who are referred to the DHB with a high suspicion of cancer. The target is 85 per cent of this cohort of patients will receive cancer treatment, or other management, within 62 days from their referral-received date. This target is to be met by July Waitemata District Health Board, Meeting of the Board 29/6/16 67

68 Health Quality and Safety Markers Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, MHoPS achieved an outstanding result of 99 per cent of falls risk assessments and Surgical and Ambulatory achieved 96 per cent on admission. Within eight hours of admission, MHoPS achieved 93 per cent while Surgical and Ambulatory achieved 88 per cent (against a target of 90 per cent). Hand Hygiene Waitemata DHB s Hand Hygiene Audit result for May was a compliance rate of 82 per cent, exceeding the national target of 80 per cent. Healthcare-Associated Infections The CLAB insertion bundle was used in ICU on 96 per cent of occasions in May, again exceeding the national target of 90 per cent. Elective Surgery Centre (ESC) ESC discharges for April sat at 114 per cent of planned elective targets (104 per cent YTD). Elective WIES YTD is 90 per cent of planned target. Operationally, ESC continues with its efficient and productive service for its patients and clinicians, with a total of 436 patients operated on for the month. Patient satisfaction remains remarkably high, with a total of 88 satisfaction surveys completed for the month, 78 of which included positive comments. Māori Health Abdominal Aortic Aneurysm Screening Pilot for Māori On 10 June in Wellsford, the Waitemata Abdominal Aortic Aneurysm (AAA) screening pilot was officially launched with a hui jointly organised by Te Ha Oranga and Coast to Coast (one of the three participating practices). This pilot is exploring the feasibility of AAA screening by measuring the prevalence of this disease in Māori men aged and Māori women aged It is also testing a primary care-based delivery model for the screening. The pilot aims to screen approximately 500 eligible Māori enrolled with Coast to Coast, Waitakere Union Health Centre and Te Puna Hauora practices. Given the shortage of qualified sonographers in New Zealand, the project decided to train its own AAA ultrasound technician. As part of the training process, the AAA team is inviting Māori Waitemata DHB employees in the eligible age range to be screened when our trainee ultrasound technician is supported by a highly experienced vascular sonographer from Waikato DHB. This initial screening took place on 8-10 June and saw 85 per cent of invited people make an appointment for the ultrasound. Māori men and women appear to have a higher incidence of AAA than non-māori and they develop this condition at a younger age (on average eight years earlier than non-māori). In the past, screening programmes have been designed that do not work well for Māori. The AAA screening programme aims to serve as an example for other screening programmes by achieving unprecedented participation rates among Māori through detailed and innovative system design. Waitemata District Health Board, Meeting of the Board 29/6/16 68

69 Chief Executive Officer Dr Dale Bramley shows his support for the AAA Screening Pilot Community Treatment Orders Work is underway to understand why Māori are over-represented on Community Treatment Orders (Section 29) of the Mental Health Act Under the Act, a person can be put under a Compulsory Treatment Order which requires them to have treatment for their mental disorder. This treatment can be delivered within a hospital setting or within the community. When treatment is delivered within the community, it is called a Community Treatment Order (CTO). Under such an order, the patient must attend and accept treatment at their home or at some other place specified in the Order. The DHB has been consulting with Tangata Whai I Te Ora, their support workers and their whānau. As a result of running these hui, it is hoped a better understanding will emerge of the positive and negative experiences Māori have as a result of being on this type of compulsory treatment order. The Māori Health team has also completed a data analysis which confirmed the following: Māori have a higher burden of mental health illness, including schizophrenia (x2) Māori do not have twice the antipsychotic medication use (1.5) Māori have high mental health service utilisation, more hospitalisations (x2) for schizophrenia and higher readmissions (x2) Schizophrenia drives the use of CTOs (>80%), and this is similar for Māori and non-māori for hospitalised patients (1.1) CTO use is higher for Māori (x3) These findings will inform action to better understand the main drivers behind why Māori have such high rates of Schizophrenia, given this has been shown to be the main driver of CTO use within Māori population. Waitemata District Health Board, Meeting of the Board 29/6/16 69

70 Māori Health Plan The final draft of the Waitemata DHB 16/17 Māori Health Plan has been submitted to the Ministry of Health for consideration and feedback. The Ministry have approved the activities for 11 of the 12 indicator areas, with feedback on the last indicator delayed as the Ministry are awaiting further internal information prior to completing their review and feedback. Pacific Health Pacific Health was instrumental in coordinating the recent Auckland Pasefika older people s/matua consultation Fono for the development of the Ministry of Health older people s strategy. A total of 75 Pacific peoples came from various networks supported by Vakatautua services, The Fono and Treasuring Older Adults. Participants broke off into the main Pacific ethnic groups - Samoa, Tonga, Fiji, Cook Island, Tuvalu and Niue, each facilitated in their languages. The Samoa language group in progress Pacific Week Pacific Week events will roll-out across the DHB from July, with a range of activities planned to celebrate the contribution of our Pacific workforce and community. Highlights will include a Colours of the Pacific fashion competition, lunch time cultural entertainment sessions by Tuvaluan, Samoan and Tongan groups, plus a range of clinical education events across the Waitakere and North Shore campuses. Pacific Best Practice A major initiative to roll-out the Pacific Best Practice training course in the Waitemata DHB-run Auckland Regional Dental Services (ARDS) has led to a significant improvement in uptake levels, which are now well ahead of target as the table below demonstrates. Waitemata District Health Board, Meeting of the Board 29/6/16 70

71 Waitemata District Health Board, Meeting of the Board 29/6/16 71

72 CEO SCORECARD Actual Target Trend Patient Experience Actual Target Trend Better help for smokers to quit - hospitalised 98% 95% Complaint Average Response Time 14 days <14 days q Better help for smokers to quit - primary care 90% 90% p Improved Access to Elective Surgery - WDHB 102% 100% p Shorter Waits in ED 94% 95% q Quality & Safety Trend Faster cancer treatment (62 days) 74% 85% p Older patients assessed for falling risk 98% 90% p Increased immunisation (8-month old) 93% 95% Occasions insertion bundle used 100% 95% p More Heart & Diabetes Checks 91% 90% p Good hand hygiene practice 81% 80% p Pressure injuries grade 3& q Provider Arm - Service Delivery ICU - CLAB rate per 1000 line days 0.90 <1 p b. Antibiotic in the right time 98% 100% p Waiting Times Actual Target Trend ESPI Improving outcomes ESPI 2 - % patients waiting > 4 months for FSA compliant Population coverage/access Trend ESPI 5 - % patients not treated within 4 months compliant g. Cervical Screening 76% 80% q Diagnostics g. Breast screening 65% 70% q c. % of CT scans done within 6 weeks 98% 90% p Bowel Screening Participation % of MRI scans done within 6 weeks 91% 80% p - Round 1 57% 60% - Round 2 54% 60% p Urgent diagnostic colonoscopy (14 days) 91% 75% p Diagnostic colonoscopy (42 days) 55% 65% q Treatment d. Surveillance colonoscopy (84 days) 59% 65% p HSMR (Source: Health Round Tables) 75% <99% p e. Surgical intervention rates (per 10,000 pop) Patient Flow - Angioplasty q Elective Surgical Discharges (YTD) - Angiography p Elective Discharges - Total 15,601 15,244 p - Major joints q Elective Discharges - Provider Arm 10,707 10,446 p - Cataract p f. Elective Discharges - IDF Outflow 4,894 4,798 p # NOF patients to theatre (48 hours) 88% 95% p Efficiency ST elevation MI receiving PCI (120 mins) 90% 80% p Outpatient DNA rate (FSA + FUs) 9% <10% AT&R referrals assessed (2 working days) 94% 90% p Average Length of Stay - Electives 1.39 days <1.77 days q Average Length of Stay - Acutes 2.48 days <2.76 days p a. a. Health Targets Waitemata DHB Monthly Performance Scorecard CEO Scorecard April /16 Managing our Business Best Care Staff Experience Actual Target Trend Major Capital Programmes Time Budget Quality Sick leave rate 8.5 days <7.5 days q Te Atarau car park (Sep 2015) Turnover rate 11% 8-12% Department of Medicine (Mar 2016) Lost time injury rate (avg hrs/100 FTE) 2.06 <3 q WTH Emergency Department redevelopment (Apr 2016) Mason clinic - 15 Bed medium secure unit Financial Result Trend Bridge ESC To Medical Tower (Jun 2016) Net Surplus/Deficit (YTD) 31 k -625 k Lakefront (Dec 2016) How to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large. a. 2015/16 new MoH Average length of stay definition. b. Antibiotic at the right time - As at Sep Q1 2015/16 (latest data available). c. Bowel Screening data - new overall figures as at Dec 2016, will be reported one quarter in arrears. d. HSMR reported 3 months in arrears. e. SI Rates reported one quarter in arrears -as at Dec Q2 2015/16. f. Data one month in arrears - March 2016 g. As at March Q3 2015/16 A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Waitemata District Health Board, Meeting of the Board 29/6/16 72

73 5.2 Health and Safety Performance Report June 2016 Recommendation: That the report be received. Prepared by Michael Field (Group Manager, Occupational Health and Safety) Endorsed by Fiona McCarthy (Director Human Resources) 1. Purpose of report The purpose of the Health and Safety (H&S) report is to provide quarterly reporting of health and safety, performance including compliance, indicators, issues and risks to the Waitemata District Health Board. 2. Strategic Alignment Emphasis and investment on both treatment and keeping people healthy Service integration and/or consolidation Intelligence and insight Evidence informed decision making and practice Operational and financial sustainability This report discusses the risks, actions and progress towards making Waitemata DHB a safe and healthy place for people to work, be educated, receive care and visit loved ones. The report integrates cross department commentary on health and safety so it is consolidated in one place. A health and safety scorecard reports on health and safety data and provides insight into issues and trends. The report articulates actions that where possible will be informed by evidence or expert opinion. The evidence supports the undertaking of good health, safety and wellbeing practises leads to positive patient experience and outcomes and a sustainable business. 3. Highlights of the month 3.1 First Board Site Visit The first Health and Safety Board site visit was held at North Shore Hospital to review Hazardous Substances. This visit included the laboratories, our medical waste holding area and our hazardous goods store. This review was extremely beneficial for the staff involved, as it provided us with an opportunity to outline the work to date, but also to receive specific feedback from the Board members in attendance, which was insightful. Actions from the visit are as follows: Action/Question Accountability Response Timeframe Are there opportunities for workers to provide feedback/suggestions around health and safety to ensure the continual improvement mentality? Michael Field It is a requirement of the new Act, but was in place under the previous legislation. Each area has a H&S Rep, who is responsible for H&S issues within their area. They discuss H&S at team meetings, collect and report information regarding hazards/risks and also act as a conduit for staff feedback/suggestions. N/A Waitemata District Health Board, Meeting of the Board 29/06/16 73

74 Action/Question Accountability Response Timeframe Does the DHB take a lead role in disseminating information and learning s around health and safety and hazardous substances to assist primary care? Michael Field We have recently formed relationships with CMDHB, who we have been sharing information with, and will make similar connections in other Northern Region DHBs. Mid-June Area of concern - the keys in the waste compactor Michael Field Although systems and processes were already in place, given the observation, it was decided that new systems were required. Keys to the compactor are now held in the Clinical Support Services office and any staff needing to use the compactor need to sign the key out from there and then return it after they have finished. This provides visibility that someone is using the compactor, who that person is and allows the staff stationed in this area to investigate if the key is not promptly returned. The Team Leader will follow up with any staff member who does not return the keys. Communications have been sent to all staff concerned, informing them of the new system, but also reiterating the hazard associated with not following it. Completed 4. Actions from the last Board report 4.1 Ring-fenced Capex Ring-fenced capex for Health and Safety purchases has been established under the Chief Financial Officer s delegation. While a set of criteria is developed to enable access to the funds, the funds will be released on discussion with the Director Human Resources. Release of funds will be subject to normal procurement and business case processes if over $100, Maintenance fast track process At the last Board meeting the Auckland DHB fast track processes for maintenance jobs were discussed. Waitemata DHB also has a fast track process which involves the Building and Engineering Information Management System (BEIMS) administrator escalating maintenance requests that are health and safety related for review by the relevant Facilities and Development staff member. In the near future we hope to automate this process. Each request will be sent to Occupational Health and Safety for grading (from 1 to 10, with 1 being urgent), so that Facilities are able to prioritise the requests. Waitemata District Health Board, Meeting of the Board 29/06/16 74

75 5. Performance Scorecard Glossary for Monthly Performance Scorecard and Report Lost Time Injury Rate Injury Severity Rate Lost time injury Frequency Rate Lost time incidents Serious Harm (Currently Notifiable to Worksafe NZ and will in the new legislation be called Notifiable Events and have a wider criteria of reporting to include events not just injury) Mathematical calculation that describes the number of lost time injuries per 100 fulltime employees at any given time frame. Mathematical calculation that describes the number of lost days experienced as compared to the number of incidents experienced. No of lost time Injuries per million hours worked. Any injury claim resulting in lost time. The Health and Safety in Employment Act 1992 defines serious harm as: 1. Any of the following conditions that amounts to or results in permanent loss of bodily function, or temporary severe loss of bodily function: respiratory disease, noise-induced hearing loss, neurological disease, cancer, dermatological disease, communicable disease, musculoskeletal disease, illness caused by exposure to infected material, decompression sickness, poisoning, vision impairment, chemical or hot-metal burn of eye, penetrating wound of eye, bone fracture, laceration, crushing. 2. Amputation of body part. 3. Burns requiring referral to a specialist registered medical practitioner or specialist outpatient clinic. 4. Loss of consciousness from lack of oxygen. 5. Loss of consciousness, or acute illness requiring treatment by a registered medical practitioner, from absorption, inhalation or ingestion of any substance. 6. Any harm that causes the person harmed to be hospitalised for a period of 48 hours or more commencing within seven days of the harm's occurrence. Pre- Employment Significant Hazard (Instead of a definition all hazards are risk rated to determine how serious they are in the new legislation) Psychosocial Risk Patients who are away without leave (AWOLs) PCBU Officer Health screening for new employees. A hazard with the potential to cause serious harm. Might be those aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm. Patients under the Mental Health (compulsory Assessment and Treatment) Act 1992, who leave DHB premises without prescribed or approved leave. Person conducting business or undertaking. Person occupying the position of a director of a company or includes any other person occupying a position in relation to the business or undertaking that allows the person to exercise significant influence over the management of the business or undertaking. Waitemata District Health Board, Meeting of the Board 29/06/16 75

76 Worker Notifiable Injury/illness Notifiable Incident Notifiable Event Reasonably Practicable An individual who carries out work in any capacity for the PCBU e.g. employee, contractor or sub-contractor, employee of the sub-contractor, employee of labour hire company, outworker, apprentice or trainee, person gaining work experience, volunteer. (a) Amputation of body part, serious head injury, serious eye injury, serious burn, separation of skin from underlying tissue, a spinal injury, loss of bodily function, serious lacerations. (b) any admission to hospital for immediate treatment (c) any injury /illness that requires medical treatment within 48 hours of exposure to a substance (d) any serious infection (including occupational zoonoses) to which carrying out of work is a significant factor, including any infection attributable to carrying out work with microorganisms, that involves providing treatment or care to a person, that involves contact with human blood or bodily substances, involves contact with animals, that involves handling or contact with fish or marine mammals. (e) any other injury/illness declared by regulations to be notifiable. An unplanned or uncontrolled incident in relation to a workplace that exposes a worker or any other person to a serious risk to that person s health or safety arising from an immediate or imminent exposure to an escape, spillage or leakage of a substance; an implosion explosion or fire; an escape of gas or steam; an escape of a pressurised substance; an electric shock; a fall or release from height of any plant or substance; collapse or partial collapse of a structure; interruption of the main system of ventilation in an underground excavation or tunnel; collision between two vessels or capsize; or any other incident declared by regulations to be a notifiable incident. Death of a person, notifiable injury or illness or a notifiable incident. Means that which is or was at a particular time reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters.eg the likelihood of the hazard/risk occurring and the degree of harm resulting, what the person knows about hazard/risk and how to eliminate/ minimise the risk and the cost associated with elimination of the hazard/risk. Waitemata District Health Board, Meeting of the Board 29/06/16 76

77 Legend 20% variation Green 21-50% variation Amber Over 50% variation - Red The leading and lagging indicators in the above scorecard are indicative of Health and Safety performance across the organisation. Using trends and traffic light indicators will emphasise the areas where we are on or progressing towards our targets and when we need to improve. Some of our targets are staged to show improvement over time. Indicators in Red Issue Action Hazardous substances audits The new Hazardous substances co-ordinator started on 2 May and audits are due to restart week commencing 6 June. 6. Key Health and Safety Risks The table below outlines our key health and safety risks together with commentary on the current status/issues related to that risk and any actions to address issues. We have added residual risk (the portion of risk that is left after a risk assessment has been conducted) to this table. The actions reported each month are controls in progress and the residual risks from each of these identified risk areas will vary. The DHB has attempted to note the residual risk in the context of the original risk using a traffic light after each risk below. Waitemata District Health Board, Meeting of the Board 29/06/16 77

78 Legend increase in progress no change in progress decrease in progress Risk Action Residual Risk Progress since last report Aggressionphysical and verbal The Security Review project is moving ahead and a committee has been set up called the Community Alarms project. This group will look at the type of alarms required for our workers in the community. OH&S will be represented on this group. Terms of reference are currently being finalised. Aggression remains the highest accident type. We have also arranged for a meeting to be held between OH&S, Legal and Mental Health, in order to identify the best way to escalate issues with clients who have assaulted staff. We are also arranging a similar meeting with WorkSafe NZ, so we are able to explain the residual risk that is unavoidable for staff working in Mental Health, to educate WorkSafe NZ in advance of an incident occurring. Original Risk Residual Risk Risk Actions Residual Risk Progress since last report Blood and Body Fluid Incidents (BBFA) The review is still pending the needleless system pilot. Remains medium to high. Needles are still the largest contributor. Original Risk Residual Risk Waitemata District Health Board, Meeting of the Board 29/06/16 78

79 Risk Actions Residual Risk Progress since last report Hazardous Substances(HSN O) A new hazardous substances and New Organisms (HSNO) coordinator has been recruited and started on 2 nd May. He brings a wealth of knowledge to this position and the auditing will be re-commenced along with the introduction of health monitoring on exposure to hazards. Audits are due to restart the week commencing 6 th June. A business case for a dangerous goods store for Waitakere is in progress. HSNO audits and health monitoring positions will continue to reduce our risk further. Changes have been made to some processes (i.e. handling, storage and disposal) and have reduced our risk. Training of key staff about HSNO continues and is reducing the risk. Original Risk Residual Risk Risk Actions Residual Risk Progress since last report Contractor and Procurement Management The new Health, Safety and Environmental Advisor in Occupational Health and Safety has taken over the Facilities and Contractor Portfolio to oversee systems and processes and carry out training. The asbestos management group has been set up with OH&SS representation. Terms of reference have been finalised and work is currently underway reviewing our building portfolio. Additionally, an Asbestos Manager is currently being recruited to ensure day-to-day management of this activity and swift progress, with regular reporting to the committee. Continuing to have minor incidents with contractors which indicate closer attention needs to be paid to our combined processes as PCBUs. Original Risk Residual Risk Waitemata District Health Board, Meeting of the Board 29/06/16 79

80 Risk Actions Residual Risk Progress since last report Manual and Patient Handling One of top three significant hazards DHB s all have different Moving and Handling Programmes and ACC/Worksafe are keen to adopt one model A new model of engagement has been developed between occupational health and the moving and handling team to allow for quicker response to incidents and training requirements. Facility design checklist now includes moving and handling requirements. Risk remains until we see our actions result in a reduction in incidents Original Risk Residual Risk Risk Actions Residual Risk Progress since last report Health and Wellbeing (stress, fatigue, depression The Healthy Workplaces Strategy is presently going through senior management review and is expected at the Board mid-year. Residual risk remains until we put in place healthy workplace measures and can track progress. Original Risk Residual Risk Waitemata District Health Board, Meeting of the Board 29/06/16 80

81 Risk Actions Residual Risk Progress since last report Physical environment (ventilation, lighting, equipment) Ventilation, cooling and heating issues still being worked through by priority order, with OH&SS providing to support to facilities to triage these requests by risk. A number of issues require business cases to be drafted for consideration of capex funding. Hazards and risks associated with the Helipad are being reviewed by a newly formed advisory committee. Although the DHB is working on every issue that comes up, the risk will stay moderate until issues are worked through and reducing. Original Risk Residual Risk Risk Actions Residual Risk Progress since last report Slips trips and Falls All entrances now have slippery when wet signage on doors and a review of entrance way flooring has been completed. We have also introduced umbrella bag stands at entry ways. The next steps are to develop additional signage to introduce the umbrella bag stands, encourage their use, and educate visitors on why this is important. During wet weather, entry ways will be checked regularly to ensure that any additional necessary signage is in place and that excess water is mopped up. Regular communications on slip, trip and fall risks are included in training and highlighted in the Waitemata Weekly and the Occupational Health website. Work is commencing with internal communications to develop posters to educate staff on this and raise awareness of what they can do to avoid incidents. As winter comes checks will be Remains a high risk for numbers and claim costs. Waitemata District Health Board, Meeting of the Board 29/06/16 81

82 Original Risk made in places like entrances, wards and communal areas for hazards associated with slips, trips and falls. Residual Risk 7. Funding, Planning and Outcomes We have received Simpson Grierson s written advice following the review of our health and safety plans in late May. Simpson Grierson confirms there are a number of areas where we can rely on the national contractual mechanisms in place for aged residential care and primary care. They have endorsed our capability assessment approach, however, have also identified a number of areas where further work is required before this can be implemented and recommended specialist input to provide more detailed advice. We are in the process of arranging a meeting to progress. 8. Staff Reported Incidents Glossary CO - Corporate CWF - Child, Women and Family Services ESC - Elective Surgical Centre HO - Hospital Operations MEDHOP - Medical and Health of the Older Persons Service MH - Mental Health and Addictions Services OH&S - Occupational Health and Safety SA - Surgical and ambulatory services 8.1 Staff incidents The number of reported incidents by staff during the month of April 2016 was 119. This is a decrease from 136 in March 2016 (last report states were added after the month statistics were reported). Incident trends remain the same for this reporting period. The rate of staff incidents per discharged patients is 1.36% (based on inpatients only). The rate of staff incidents per FTE is 2.32% (134 5,760x100). Table 1: Number of reported staff incidents for April 2016 and prior 23 months Waitemata District Health Board, Meeting of the Board 29/06/16 82

83 Table 2: Staff incidents by type for April 2016 Table 3: Staff Incidents by Service Waitemata District Health Board, Meeting of the Board 29/06/16 83

84 9. Serious Harm Incidents The DHB noted no staff serious harm incidents in April Top 3 Accident types that cause harm The three main types of incidents and their management are as follows: 10.1 Aggression Aggression remains a high risk area, especially within the Mental Health Environment. As mentioned previously, collaborative work with health and safety, legal services, Police and Worksafe is now underway to gain a better understanding of aggression risk within that environment and agree controls and actions to reduce the consequence of these incident types. Mental Health Collaboration A number of meetings have been held with Mental Health Services with the aim of creating a collaborative environment for dealing with staff injuries and incidents. OH&SS are now working with Mental Health Services to identify controls and responses, specific to cases of aggression. This process seeks to identify all measures that could be put in place for consideration, including documenting these decisions. This work also focusses on how we can provide resources to ensure that any incidents of aggression are not able to escalate, seeking to avoid serious harm. This has included advice around the removal of objects from entry areas that could be used as projectiles such as small plant pots, width and placement of reception desks and the fixing of chairs to each other to ensure they cannot be thrown. Table 4: Aggression Incidents by Service April 2016 Waitemata District Health Board, Meeting of the Board 29/06/16 84

85 Table 5: Physical assaults root cause April 2016 Table 6: Physical Assault outcomes April 2016 Table 7: Mental Health & MEHOP - Physical Assault (root cause Aggression) April 2016 Waitemata District Health Board, Meeting of the Board 29/06/16 85

86 10.2 Slips, Trips and Falls Slips, trips and falls this month were caused by inattention (7), wet Floors (4) work practice (2) faulty equipment (3). Services have been sent a memo reminding people to be careful of slip, trip and fall hazards and to get any environmental hazards fixed as soon as they are identified. Table 8: Slips trips and falls by service April Manual handling Moving and Handling injuries to staff since January have been recorded as follows: January: 4 February: 7 March: 5 (6 reported 1 was no injury incurred) April 2016 Number of Incidents Medicine & Health of Older People 2 Mental Health 1 Surgical & Ambulatory 4 TOTAL 7 Table 9: Patient handling incidents April 2016 Of the seven incidents recorded in April, five of these incidents resulted in sprain/strains to necks and backs. Two incidents were categorized as near misses in Surgical and Ambulatory. Waitemata District Health Board, Meeting of the Board 29/06/16 86

87 11. Health and Safety Activities 11.1 Board, Management and Staff Health and Safety Training A Health and safety training needs analysis is currently underway, with assistance being provided by the people capability team. This training needs analysis will be based on all staffing types and all managerial levels and seeks to identify specific health and safety training requirements. The final draft will be completed in July Recruitment Three new positions are in the process of being recruited to the Occupational Health and Safety team: 1. Health and Safety Advisor - this role will assist with the significant training that needs to be done at all levels of the organisation. 2. Health and Safety Investigator/Auditor - this role is required to oversee the investigations and corrective actions required to follow up on our more significant events and near misses as well as oversee the internal auditing that is required for the safety management systems. 3. An Analyst to replace the current HR Information and Financial Systems Analyst, who will also work in health and safety to improve statistical analysis and reporting. A new Clinical Team Leader and the Hazardous Substances Co-Ordinator commenced work on the 2 nd May and this has ensured that the clinical aspects of health and safety are managed and that the hazardous substances work already started has continued Influenza Vaccinations (UPDATE) To date the Flu vaccination campaign has now been completed with staff now presenting to Occupation Health and Safety for flu vaccinations. With the onset of the cooler weather there has been a slight increase in staff now requesting the flu vaccination. To date our records show over 3864 staff or 54 % have been vaccinated up to 20 June The breakdown by profession is as follows: Allied Health 794 (49.95%) Doctors 315 (53.79%) Nurses 1,428 (52.39%) Midwives 49 (35.06%) Others 579 (48.95%) this group includes HCA, Orderlies, Pharmacy etc. In-team vaccinations have now finished though several areas have indicated that if there is a need for further clinics they are happy to perform this service. Waitemata District Health Board, Meeting of the Board 29/06/16 87

88 12. Health and Safety Prosecutions: 12.1 Builder ordered to pay over $63K after employee injured in ladder fall Thursday 26 May 2016 A sentencing in the Wellington District Court yesterday has underlined the importance of managing fall from height workplace hazards after a construction worker fell from a ladder and sustained serious brain injuries. Geordie Grieve, trading as Geordie Grieve Builders, was fined $15,000 and ordered to pay $48, in reparations to the injured employee after being found guilty of one charge under the Health and Safety in Employment Act 1992 for failing to take all practicable steps to keep a worker safe. On 10 March 2015, the worker employed by Mr Grieve was using a ladder while dismantling a balcony 2.8m from the ground. As the worker attempted to get down from the ladder, the bottom of the ladder slipped forward and the worker fell, hitting his head on the ground. As a result of the fall, the worker suffered skull fractures and complex head injuries. A WorkSafe New Zealand investigation concluded that Mr Grieve failed to ensure that a fall from height hazard, a common cause of harm in the construction industry, was properly managed. It was revealed that the ladder s rubber non-slip feet were worn out and therefore unable to keep the ladder steady posing a major risk to anyone using it. WorkSafe s Construction Programme Manager Marcus Nalter says this incident could have been avoided if Mr Grieve had taken active steps to manage the hazard by making sure that the company s ladders were fit for safe use, and any defective ladders were not used by workers until fixed or replaced. Non-slip feet for ladders cost approximately $14 per pair to replace. Working from height is a significant hazard, so appropriate steps must to be taken to ensure that any potential exposure to harm is minimised. Mr Grieve s failure to identify and fix the ladder s worn out feet heavily increased the chance of a fall from height occurring, says Mr Nalter. Every employee has the right to expect to go home healthy and safe every day. In this case, basic hazard management failures put an employee in hospital for over two months with very serious injuries Quarry operator ordered to pay over $150K after employee crushed to death Wednesday 25 May 2016 A South Canterbury-based quarry and transport operator has been ordered to pay reparations of $100,000 to the family of an employee who was crushed to death while working at its Gordon Valley limestone quarry. Transport (Waimate) Limited pleaded guilty to two charges under the Health and Safety in Employment Act 1992 for failing to take all practicable steps to ensure the safety of Scott Baldwin and failing to ensure that Mr Baldwin held a current certificate of competence as a quarry manager. Waitemata District Health Board, Meeting of the Board 29/06/16 88

89 The company was also fined $54,000 at the sentencing in Timaru District Court yesterday. On March , Mr Baldwin, the quarry manager and sole regular employee on the quarry site, began work at the Gordon Valley quarry. He started two diesel motors at the plant used for processing limestone one for the hammer mill and the other for the ancillary equipment both located in an open store shed. At approximately 7pm that evening, a person from a neighbouring property heard the motors at the site running at a high pitch and not under load. Upon investigating the noise, the neighbour entered the quarry shed and found Mr Baldwin s severely injured body lying underneath rotating machinery. A WorkSafe New Zealand investigation found that the company failed to identify and manage the clear hazard posed by the quarry machinery. There were no processes in place to stop maintenance on machinery being carried out while the machinery was running, and there were no effective controls for an operator to stop the top motor in an emergency. Also the fact the company never ensured that Mr Baldwin held an appropriate qualification to manage the quarry was a significant failure. WorkSafe Chief Inspector Keith Stewart says there were a number of steps that Transport (Waimate) could have taken to prevent such an incident occurring, including installing fixed guarding to make sure people could not reach into dangerous parts of machinery at all times, conducting regular audits for hazard identification, and making sure that Mr Baldwin was not left to work alone and unsupervised. Mr Stewart says Mr Baldwin s death is a reminder of the horrific things that can happen when adequate safety measures are not in place. Large machinery used on quarries poses an inherent danger to anyone that comes into close contact with it. Transport (Waimate) failed to protect its employee, and tragically, in this instance, Mr Baldwin has had to pay the ultimate price for the company s failings, Keith Stewart says. Waitemata District Health Board, Meeting of the Board 29/06/16 89

90 5.3 Communications Recommendation: That the report be received. Prepared by: Matthew Rogers (Director, Communications) Communications support The communications team provided advice and support to the following projects/campaigns/issues/events over the last six weeks: Preparation for official opening of North Shore Hospital Sky Bridge Communications support for start of construction of Clinical Skills Centre Launch event for new childhood obesity national health target Support to communicate new parking arrangements Preparation for opening of expanded Waitakere Hospital ED Communications support for Ministry of Social Development STEP initiatives Liaison with the office of the Minister of Health on upcoming events Assisting with Allied Health Awards presentation and content for the Speech Language Therapy Journal Ongoing communications support for Maternity Collaboration Communications advice for immunisation programme Internal communications support around Bowel Screening Pilot roll-out Development of where should I go for healthcare? multi-channel campaign Management of requests for assistance on university and school student assignments Assistance with advertising placements for services Oversight of the communications roll-out of the Our Health in Mind action plan Coordination of 2016 CEO Lecture Series event by the Prime Minister Preparation of May-June edition of Healthlines magazine Liaison with Well Foundation Marketing and Communications Liaison with Waitakere Health Link Communications advice for Abdominal Aortic Aneurysm Screening Pilot Ongoing out-of-hours media line cover and senior management communications support Proof read leaflets, booklets and brochures for various departments Ongoing management of Official Information Act requests and responses Management of requests to film on DHB sites Preparation of community update on major capital works projects Ongoing social media strategy, activity and issues management Responses to Dear Dale questions and comments from staff Event photography Fortnightly CEO recognition award communications Drafting of correspondence from the corporate office Review of copy for DHB website Management of requests from external organisations to place collateral in the hospital foyers Management of DHB general all-user screen saver content Waitemata District Health Board, Meeting of the Board 29/06/16 90

91 Publications The communications team published the following during the last six weeks: May-June Healthlines, 12 pages Fortnightly A note from the CEO message Waitemata Weekly, ed to all staff users Weekly national health targets updated and communicated Designed a number of publications including medical conference posters and patient-facing information leaflets for various services Campaign: Healthcare Where should I go? Campaign for SCBU: If you need us, call us. CADS booklet: Getting the facts Health Careers booklet for Pacific Health Private Radiology Service booklet File: nurses portfolio 2016 Sky Bridge opening invitation CEO Lecture Series invitation Sleep Hospital Advice Campaign: Te Hononga Oranga Māori Diabetes Service Understanding CPR Artwork for web WDHB online career hub Waitemata DHB, Careers and Awhina websites Google Analytics Statistics Waitemata DHB website Number of visits May 2016 Total visits to this site 43,053 New Zealand 40,682 Australia 792 United Kingdom 314 United States 218 Top areas May 2016 Home page 15,911 Waitemata DHB staff page 18,454 North Shore Hospital 7,571 Waitakere Hospital 3,182 Contact us 2,895 Traffic sources May 2016 Search traffic 73% Direct traffic 19% Referral traffic 8% Waitemata District Health Board, Meeting of the Board 29/06/16 91

92 Careers website Number of visits May 2016 Total visits to this site 16,499 New Zealand 14,337 United Kingdom 553 Australia 381 United States 292 Philippines 108 Awhina Health Campus website Number of visits May 2016 Total visits to this site 1,906 New Zealand 1,651 United Kingdom 54 United States 42 Brazil 22 Australia 13 Waitemata District Health Board, Meeting of the Board 29/06/16 92

93 Social media Waitemata DHB Facebook page likes 1,825* Waitemata DHB Facebook star rating - 4.4/5 (164 reviews)* *As at 16 June 2016 OIAs received A total of 23 new OIA requests were received between 11 May and 13 June 2016: R. Turner-Waugh (Transcriptionz) - Cost, accuracy and timeliness of medical transcription services. A. McCulloch (scoop.co.nz) - Funding and services information for postnatal depression. R. Bollard (Parliament library research) - Interpreter and translation service arrangements and spending. A. Marett (Labour) - Number of physical assaults on staff in mental health units. F. Payne (Iwi n Aus) - Number of medical operations and public health care expenditure on Australian citizens living in NZ. A. Marett (Labour) - Lymphedema care provided to women who have undergone mastectomy. A. Marett (Labour) - Details of any reviews of mental health service-delivery or funding in the last six months. A. Marett (Labour) - Number of FTEs employed by Waitemata DHB waiting for police vetting. N. Wilson - (FYI.org) - Amount paid to an external service-provider for strategy workshops and analysis. A. Vailahi (NZ First) - Internal correspondence re MECAs and graduate nurses finding full-time employment by country. A. Marett (Labour) - Neurologist numbers and services for MS patients. N. Hanlon - Information relating to when a medical certificate should be issued. S. McLennan (Hannover Medical School) - Policy for reporting and responding to health and disability service incidents. C. Sziranyi (Radio NZ) - Total referral numbers for mental health services and comparison with previous five years. A. Baird (Newshub) - Details of women declined for abortions. Waitemata District Health Board, Meeting of the Board 29/06/16 93

94 L. Hopkins (NZ First) - Acceptance criteria to access funded mental health support services. P. Wakefield (NZ First) - Child tooth extractions under general anaesthetic. K. Johnston (NZ Herald) - Copies of any Crimes of Torture Act reports S. Wallace (NZ Aged Care Assn) Details of age-related residential care entries. J. Tamihere (Te Whanau O Waipareira Trust) - Number of patients, turnaround times, income flows etc for White Cross after-hours clinic. A. Harris (FYI.org) - Number of mental health patients currently detained in seclusion units. F. Thomas (NZ Doctor) - Funding information regarding palliative care. A. Marett (Labour) - Financial impact of 2010/11 GST increase and ability to meet new Community Pharmaceutical Budget spending requirements. Positive + Neutral 0 Negative - Media Clippings - 9 May 13 June 2016 Channel Auckland Well said - May + Well said - June + Dominion Post Give priority to birthing centre 0 Red flag for bowel screening 0 Listener NZ Land of hope 0 North Harbour News New network 0 Dual-board members axed 0 Success for Waitemata DHB s bowel screening programme + North Shore Times Donations call for life saving equipment + Smoking ban sticks + Better parenting programme + Milestones + Bus network 0 Success for Waitemata DHB s bowel screen programme + Dual-board roles going 0 More funding for DHB in 2016 budget + Nor West News Brief Donations call for life saving gear + Warren Flaunty bill passes in Parliament 0 Queen s birthday presents 0 NZ Doctor Waitemata DHB defeats court bid to overthrow smoking ban + Complaints about DHB s jump more than 60 per cent in five years 0 Waitemata District Health Board, Meeting of the Board 29/06/16 94

95 Peripheral oedema 0 Doubts that Budget will stretch to fit Govt s great expectations 0 Door opens for bowel cancer screening to spread nationwide 0 NZ Herald/Herald on Sunday/NZherald.co.nz/Weekend Herald I feel like road kill not a hero 0 Pain threshold on increase as hundreds await ops - The healthcare campaigner 0 Medical hub 0 Survivor lauds screening funding 0 From vineyard valley to heart attack alley 0 We re not free for everyone - hospital + Rave Waitakere hospital + Rave Big thanks + Otago Daily Times Why not begin where it is worst? 0 Bowel-screening plan rated red 0 Pharmacy Today Pharmacists should consider standing for DHB elections 0 Cost a barrier for pseudoephedrine 0 Orion Health plugs into data-driven healthcare 0 The Press/Weekend Press Christchurch Canterbury misses out on health cash again 0 Red flag for bowel screening 0 Western Leader Volunteers urgently wanted 0 Caring neighbours call ambulance 0 Donations call for life saving equipment + Thanks to hospitals + Court in support of hospital smoke ban + What s On volunteers wanted 0 Dual-board members axed 0 More doctors + Health boost + Hospitals for an emergency only + Volunteers wanted 0 TOTAL: Positive + 20 Neutral 0 30 Negative - 1 Total items 51 Waitemata District Health Board, Meeting of the Board 29/06/16 95

96 6.1 Primary Birthing Facility Consultation Outcome Recommendation: That the Board: a) Note public consultation on potential primary birthing facilities elicited 1,162 completed survey responses and heard from over 450 people through community forums. b) Note feedback from the community demonstrated strong support for either: i. A DHB owned/managed free-standing primary maternity unit in the community, or ii. A DHB owned/managed free-standing primary maternity unit on the hospital campus c) Approve development of a detailed business case to establish a primary birthing unit in West Auckland. d) Approve public release of the consultation report in full. Prepared by: Ruth Bijl (Funding and Development Manager, Child, Youth and Women), Linda Harun (former General Manager, Child Women and Family Service), Dr Peter Van De Weijer (Head of Division Medicine, Child Women and Family Services), Emma Farmer (Head of Division, Midwifery), Carol Hayward (Community Engagement Manager) and Wendy Devereux (Clinical Project Manager, Child Women and Family Services) Endorsed by: Aroha Haggie (Maori Health Gain Manager), Lita Foliaki (Pacific Health Gain Manager), Samantha Bennett (Asian, Refugee, New Migrant Health Gain Manager), Debbie Holdsworth (Director Funding) and Cath Cronin (Director Hospital Services) Glossary DHB LMC WDHB - District Health Board - Lead Maternity Carer (midwife or obstetrician) - Waitemata DHB 1. Executive Summary This paper reports the outcome of public consultation regarding development of potential primary birthing facilities. Evidence demonstrates that for women who are at low risk of complications, giving birth in a primary birthing unit reduces the use of medical interventions without compromising the health of the mother or infant. Currently only a small percentage of Waitemata women birth in the rural based primary birthing units. In October 2015, the Board approved a Maternity Plan. The Maternity Plan identified the intention to increase the number of primary birthing beds across the Waitemata and Auckland districts to increase primary births. The Waitemata Board agreed to undertake public consultation on potential urban primary birthing facilities to complement the established secondary and rural primary units in Waitemata DHB. A robust consultation process has now been undertaken with independent analysis of results. The results demostrate strong support for development of an urban primary maternity facility in Waitemata. The preferred location is dependent on the respondent s place of residence. As a result, it is recommended that, in the absence of information to the contrary, the previous Waitemata District Health Board, Meeting of the Board 29/06/

97 recommendation to the Board to prioritise a facility in the West stands. Respondents first preference was for a DHB owned/managed free-standing primary maternity unit in the community. This was followed closely by a preference for a DHB owned/managed free-standing primary maternity unit on the hospital campus. The Board is requested to approve development of detailed business cases for all of the options to support their decision regarding progressing a development of an urban primary maternity facility in West Auckland. As previously indicated, the success of such a facility would inform further consideration of a potential unit on the North Shore. 2. Strategic Alignment Community, whanau and patient centred model of care This consultation and engagement process was designed to better understand patients and families and whanau needs and expectations in relation to potential use of urban primary maternity facilities. Information obtained from the community including patients will be used to inform Board decision making and facility design. 3. Background As previously described, evidence demonstrates that for women who are at low risk of complications, giving birth in a primary birthing unit increases the chance of having a normal birth. For appropriately selected women, it is as safe to give birth in a primary birthing unit as a hospital for both mother and baby. For Maternity Services, an increase in the normal birth rate across the DHB is expected to contribute to preventing a predicted rise in the caesarean rate, increase community access to maternity care and help manage expected demand for hospital beds due to population growth over the next decade. In November 2015 the Auckland DHB and the Waitemata DHB, through the Women s Health Collaboration, launched a plan for maternity services to Amongst the 22 detailed strategies are strategies to improve confidence in normal birth and increase primary birthing beds across the region. Currently Waitemata DHB has primary birthing units in Helensville, Warkworth and Wellsford. These rural units predominantly attract local women. Community groups, private maternity organisations and independent midwives have strongly advocated for the development of primary birthing units closer to urban centres in West Auckland and North Shore. We received a petition initiated by the Maternity Services Consumer Council signed by 827 people requesting that the Board establish a primary maternity facility in West Auckland. We have also received information from a private provider demonstrating a strong interest in developing a primary maternity facility in the North Shore (Albany). To gauge the level of support for primary birthing units, including which models would be most acceptable to the community, the Board approved undertaking community consultation. Consultation was undertaken around the following Board approved options: a. Located in a hospital, next to or very close to the maternity unit, operated by the DHB b. Located on hospital grounds in a separate building, with its own entrance, operated by the DHB c. Located in the community, operated by the DHB d. Located in the community, operated by a private or community contractor (but still free). The model of care described through consultation was one where women stay postnatally in the facility they birth. Waitemata District Health Board, Meeting of the Board 29/06/

98 4. Community consultation 4.1. Methodology Point Research was engaged to provide independent advice regarding planning and analysis of consultation feedback. Consultation with the community took place between 18 January and 7 March Participants were presented with information about primary birthing units to ensure that everyone had a similar understanding of the concept and terminology being used. Questions were designed to determine community views on the: level of support for primary birthing units potential use of a primary birthing unit preferred locations preferred delivery model of care (based on four defined options), and key features of a primary birthing unit. A mixed method was used including an online survey, community meetings and a series of small group forums focused specifically on hearing the views of Maori, Pacific, Asian and young parents. Completed responses to the online survey were received from 1,162 people. Over 450 people attended community meetings. This was a higher response than expected. Research and analysis was undertaken by an independent research and analysis firm, Point Research. Point Research has over 20 years experience in heath, local and central government research. The consultation report prepared by Point Research is attached in full in Appendix Findings Respondents were positive about being asked their opinion on primary birthing units. Many responded they felt heard, listened to and applauded the DHB for listening. The Board required that the consultation sought out the quieter voices of women and their families who are generally less likely to participate in consultation. Participation by ethnicity was positive as shown in Table 1 below. Engagement with younger women was also positive with nearly a quarter (23.8%) of respondents aged under 30 years, as shown in Table 2 below. Over three quarters (77.6%) of respondents were hoping to have a baby in the future. Table 1: Participation by ethnicity (more than one ethnicity could be chosen) Ethnicity Percentage of Participants Maori 7.5% Pacific 10.5% Asian 9.9% MELAA 1.4% Other 4.8% European 77.2% Table 2: Participation by age Age group Percentage of Participants 19 years or less 1.3% years 22.5% years 41.6% years 23.1% 55 years or more 10.9% Prefer not to say 0.7% Waitemata District Health Board, Meeting of the Board 29/06/

99 Support for primary birthing units In response to the question, Would you recommend a primary birthing unit to someone having a baby?, nearly nine out of ten respondents (87% online, 88% meeting) indicated that they would be likely to recommend a primary birthing unit, with nearly three quarters (74%) indicating they were highly likely to do so. Some people expressed a desire to use a primary birthing unit for a postnatal stay only Potential use of a primary birthing unit In response to the question, Would you choose to give birth in a primary birthing unit? there was little difference based on where people lived, as shown in Figure 1. Figure 1: Would you choose to give birth in a primary birthing unit, by area (online) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% West Auckland North Shore Hibiscus Coast Rodney 0 to 4 5 to 7 8 to 10 Of those indicating they were hoping to have a baby in the future, 84% indicated they would consider giving birth in a primary birthing unit, with nearly two thirds (64%) indicating they would have a high likelihood of doing so. Current barriers to use of a primary birthing unit relate to travel time and convenience. I didn't go to the Helensville birthing facility because it would have meant my husband had to shuttle between our twins at home and me there, a 45 minute drive each way. It's about location too. I don't want to drive to Warkworth to have a baby because depending on traffic it could take 2 hours. Waitemata District Health Board, Meeting of the Board 29/06/

100 Preferred locations Participants were asked to indicate their preferences in relation to whether it was more important for a unit to be closer to home, or closer to hospital and whether they had a preference on suburb/neighbourhood. Perhaps unsurprisingly people from the West preferred a facility in the West and those from North Shore preferred the Shore. Specifically, locations of Henderson, Ranui, New Lynn (West) or Takapuna or Northcote (North Shore) were identified. Some suggested Albany. Locations between their home and the hospital (or closer to the hospital) were preferred. I would prefer to have a more gentle birth away from hospitals but close enough if needed in an emergency. I love the idea of a more peaceful and respectful birth that is more inclusive of whanau needs. Access to transport links, shops, not far from hospital in an emergency and avoiding areas of congestion were factors mentioned by respondents in relation to location. It was essential that the location was easy to get to by car Preferred model We asked respondents to rank their preference against four options approved by the Board. Options and survey results are shown in the following graphic in the order of preference. Located in the community, operated by the DHB Preferred option to: Online: 38.2% Groups: 43.2% Located on hospital grounds in a separate building, with its own entrance, operated by the DHB Preferred option to Online: 31.4% Located in the community, operated by a private or community contractor (but still free) Preferred option to Online: 23.4% Groups: 14.9% Located in a hospital, next to or very close to the maternity unit, operated by the DHB Preferred option to Online: 12.5% Groups: 28.7% Groups: 32.5% NB: preferences were randomised on online surveys to reduce the risk of bias. Differences are significant p < 0.05 Percentages may not add up to 100% as the options are drawn from four different survey variables. Overall, the preference was for a primary birthing unit operated by the DHB either located in the community or on hospital grounds in a separate building with its own entrance. Respondents cited reasons including alignment of policy, ensuring all services remain free and profit requirements potentially affecting services, as reasons for their preference for a DHB owned/operated model. While a privately operated unit did not receive widespread support from community or professional groups, just over half (51%) of the independent midwives who responded preferred this model. Pacific people preferred a community-based facility operated by a DHB. European and Māori consumers preferred this option, along with a facility based on hospital grounds in a separate building. Asian consumers favoured a primary birthing unit on the hospital grounds with a separate entrance or in the hospital near the maternity unit. Waitemata District Health Board, Meeting of the Board 29/06/

101 Key features Participants were asked about features that were important in a birthing unit. Features considered essential varied according to the age, culture and ethnicity of those consulted though there were some common features with breastfeeding support/advice the highest ranking. Mothers today are suffering because not enough attention is paid to them during and after birthing a child. Birthing centres focus more on what individual mothers and babies need. Out of 12 people in my antenatal classes two of us spent time at Warkworth birthing centre and we are the only two who breastfed successfully due to the support of the midwives at Warkworth. Respondents wanted a warm, family-friendly environment with single rooms that can accommodate friends and family. A facility that is easy to get to by car, designed to allow support people in labour, and partners to stay overnight were identified as essential in any facility build. I feel it is so important to have partner stay. I had an awful birthing experience and not having my husband with me made me feel more isolated than I already did. Nearly all of my wahine [mainly Maori and Pacific Island] go home after the birth or the next day because of the above restrictions to whanau, thus missing out on the breastfeeding support that would benefit them A location easy to get to by car, with free car-parking were identified as essential. Providing tasty healthy food choices was a high priority for women, while group participants across ethnicities indicated the importance of the provision for families to provide and heat their own food for mothers. For the majority of Māori, Pacific and MELAA mothers, it was essential that rooms should have private ensuite bathrooms as well birthing pools. The main thing I think is necessary is a private bathroom-not shared with another patient!! For the afterbirth period, the last thing you want is to be sharing a bathroom. The significance of cultural and spiritual practices when bringing a baby into the world was important to many. A quiet or prayer space with spiritual support for mothers and their families was highlighted in particular through Maori, Pacific, Asian, refugee and migrant communities Conclusion and next steps Previously, we recommended sequencing development of any facilities in the West first. The results of community consultation have not altered this advice. Consultation suggests that there is support for an urban primary birth unit and the community has expressed a preference for either a DHB operated unit in the community or a DHB operated unit on the hospital campus separate from the secondary maternity unit. We now seek the Board s endorsement to proceed to a business case to invest in primary birthing unit. The team have come up with a preferred option and will provide an update to the Board on this option at the meeting. We would expect to complete a detailed business case in December 2016 with a view to progressing the Board s decision in the 2017/18 financial year. We also seek the Board s approval to release the consultation report publicly in July Waitemata District Health Board, Meeting of the Board 29/06/

102 APPENDIX 1 - Preferred choice for type of a primary birthing unit (by ethnicity) Respondents were asked to rank the kind of primary birthing unit preferred from four options. Broken down by ethnicity to understand the quiet voices less likely to participate in consultation, in these are: European and Pacific peoples who responded to the survey had a preference for a community-based PBU operated by a DHB. Māori respondents favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance. Asian respondents were fairly equally in favour of all three DHB operated PBUs. Figure 5: Preferred primary birthing unit choice by ethnicity (online) Percent European Māori Pasifika Asian Other DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit European Māori Pacific peoples Asian Other FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, 38.8% grounds, in a 30.5% 26.2% 8.5% privately near the 778 DHB operated (302) separate (235) (199) (64) operated maternity unit building DHB operated DHB operated DHB operated DHB operated 35.1% (26) 48.9% (45) 31.5% (29) 38.9% (21) On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated 32.9% (25) 28.1% (25) 31.2% (29) 30.8% (16) privately operated In hospital, near the maternity unit In hospital, near the maternity unit On hospital grounds, in a separate building 25.7% (19) 26.6% (25) 29.5% (28) 22.6% (12) In hospital, near the maternity unit privately operated privately operated In hospital, near the maternity unit 8.5% (6) 11.4% (10) 13.0% (12) 11.8% (6) Waitemata District Health Board, Meeting of the Board 29/06/

103 Whilst Māori respondents online favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance, participants at forums with a Māori focus had a preference for community-based, DHB operated PBUs. Participants at forums with a refugee and new migrant focus showed a preference for a PBU on hospital grounds but with a separate entrance. Figure 6: Preferred primary birthing unit choice by ethnicity (groups) Percent Mixed Māori Pasifika Asian 21 DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit Mixed groups Māori Pacific peoples Asian new migrant FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, 47.2% 22.6% 18.7% grounds, in a 11.3% privately near the 23 DHB operated (25) (12) (10) separate (6) operated maternity unit building DHB operated In hospital, near the maternity unit On hospital grounds, in a separate building 60.4% (32) 34.3% (47) 46.2% (24) On hospital grounds, in a separate building DHB operated DHB operated 17.0% (9) 31.4% (43) 25.0% (13) In community, privately operated On hospital grounds, in a separate building In hospital, near the maternity unit 13.2 (7) 27.0% (37) 21.2% (11) In hospital, near the maternity unit privately operated privately operated * S - there were fewer than 5 people. Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 9.4% (5) 7.3% (10) S* 52 Waitemata District Health Board, Meeting of the Board 29/06/

104 APPENDIX 2 - Waitemata DHB: Primary Birthing Unit Consultation: Overview of community feedback 2016 (by Point Research) Waitemata District Health Board, Meeting of the Board 29/06/

105 Waitemata DHB: Primary Birthing Unit Consultation Overview of community feedback 2016 Alex Woodley Point Research Ltd, June

106 Contents Executive Summary... 3 Background... 3 Aim... 3 Method... 3 Findings... 3 Waitemata DHB: Primary Birthing Unit Consultation... 5 Background... 5 Aim... 5 Methodology... 5 Leadership... 5 Consultation information and survey questions... 5 Consultation plan... 6 Consultation process... 6 Consultation promotion... 7 Response... 7 Findings... 8 Recommend a primary birthing unit (PBU)... 8 Would you recommend a primary birthing unit to someone having a baby? (Online)... 8 Using a primary birthing unit If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit? (Online) Preferred choice for type of a primary birthing unit Respondent type Ethnicity Consumers Organisations, LMCs and other Health Professionals Women under 30 years Age Groups Gender Features of a primary birthing unit Respondent type (online) Ethnicity (online) Feedback from community Hui and Fono and group meetings Other essential features of a PBU (Online) Proximity to home or hospital

107 Location of birthing unit Waitakere North Shore Rodney Other comments Overall Appendix 1: Tables Appendix table 1: Overall: Preferred choice for the Primary Birthing Unit Appendix table 2: Preferred option for the primary birthing unit (group participants) Appendix table 3: Features of primary birthing unit, rankings by ethnicity (online) Appendix table 4: Features of PBUs, rankings by gender (Online survey) Appendix table 5: Features of the PBU identified as essential, by age group Appendix table 6: OVERALL - Proximity to home and hospital Appendix table 7: OVERALL - Would you recommend a primary birthing unit, by respondent type (online) 31 Appendix table 8: OVERALL - Would you choose to give birth in a primary birthing unit (online) Appendix table 9 - Respondent profile Appendix 2: Consultation Timeline Appendix 3: Key partners and community networks Appendix 4: People involved in consultation Appendix 5: References Appendix 6: Consultation survey

108 Executive Summary Background In November 2015 the Auckland DHB and Waitemata DHB collaboration maternity plan was launched. The plan included a strategy to increase the number of primary birthing beds across the region. In order to understand the needs of the community and the level of support for primary birthing units (PBUs) and to further understand which delivery models would be most acceptable to the community, the Waitemata DHB Board agreed to undertake broad community consultation to canvas their views. The consultation process was a robust, multi-method approach that included a significant focus on ensuring appropriate avenues and time to achieve high participation from key stakeholders and communities of interest. There were 1162 responses to the survey and more than 450 people attending community events. This substantive engagement provides confidence that the consultation process has canvassed diverse community views to inform DHB decision making Aim Community consultation sought to provide information to: 1. Determine the current level of support for primary birthing units in the community 2. Determine preferred locations for a primary birthing unit 3. Determine the preferred delivery model of care from four different options 4. Examine preferences on key features of a primary birthing unit Consultation feedback is one part of the final information which the DHB board will use to inform their decision making regarding potential primary birthing units in West Auckland and North Shore. Method The community were provided with a range of opportunities, online and in person, to find out more and provide detailed feedback including: an online survey, community forums and meetings. The data was collated and analysed using SPSS. The results were significance tested. For the purposes of this report, the Hibiscus area of Hibiscus and Bays Local Board has been included with North Shore. Primary Birthing Units are already present in Northern and Western Rodney and are being analysed separately. Findings 1. Determine the current level of support for primary birthing units in the community 1.1. The majority of online respondents (87%) and those who attended groups (88%) indicated that they would be likely to recommend a PBU to someone having a baby. 2. Determine the usage of the birthing unit 2.1. Most (64%) respondents hoping to have a baby in the future would consider choosing a birthing unit, rating the likelihood as 8 or higher on a scale from 0 (definitely would not choose) to 10 (definitely would choose) Those in West Auckland (65%) were slightly more likely to indicate that they would be likely to use a PBU (rating it 8 or higher), than those in the North Shore and Hibiscus Coast area (63%) or Rodney (61%). 3. Determine preferred locations for a primary birthing unit 3.1. Those who live in the Waitakere area would prefer the PBU to be located in Henderson, Ranui or New Lynn. Asian groups suggested Blockhouse Bay or Titirangi as an option

109 3.2. Those from the North Shore indicated that they would like to see the PBU somewhere on the North Shore, in Takapuna, or Northcote. Asian groups suggested Albany as a good location for a unit in the community Respondents from Rodney favoured a PBU based at either the North Shore, Albany or West Auckland. Some reiterated they would like to see it located close to a hospital Those in West Auckland and the North Shore and Hibiscus Coast area preferred the PBU to be between home and hospital, or closer to hospital. 4. Determine the preferred delivery model of care from four different options 4.1. Overall online survey participants and those attending forums supported a community based facility operated by a DHB or a PBU on hospital grounds, in a separate building Health providers other than LMC midwives preferred a community- based model operated by the DHB LMC midwives preferred a community based PBU privately run. This model did not receive widespread support from other demographic or professional groups There are no clear preferences by ethnicity between the community-based, DHB operated facilities, and a PBU based on hospital grounds in a separate building, as the online survey and forums supported different options It is noted, however, when respondents first two choices of model are combined, there is widespread support for a community based, DHB operated PBU. 5. Examine preferences on key features of a primary birthing unit 5.1. Features considered essential to a PBU vary according to the age, culture and ethnicity of those consulted. Nonetheless, there are some common features across the demographic groups. Breastfeeding support/advice received the highest ranking and was seen as an essential service to have as part of a PBU. Other essential features include ensuring that the PBU is a warm familyfriendly environment with single rooms which can accommodate friends and family. It must allow partners to be able to stay overnight. Respondents need it to be easy to get to by car. Lower ranked features included a children s playground, a private garden area and access to food for visitors It is noted that many of those consulted said that they would like to continue to be involved in the ongoing development of a PBU

110 Waitemata DHB: Primary Birthing Unit Consultation Overview of primary birthing unit public consultation 2016 Background Since 2013, Auckland and Waitemata DHBs have been working together to develop a plan for maternity services required over the next decade. In November 2015 the Auckland DHB and Waitemata DHB collaboration maternity plan was launched. The plan detailed 22 strategies to strengthen services, based on the themes to improve and enhance quality of care, build confidence, support parents and practitioners, and meet future population needs; including a strategy to increase the number of primary birthing beds across the region. Evidence from both New Zealand and the UK demonstrates that, for women who are at low risk of complications, giving birth in a primary birthing unit increases the chance of having a normal birth. Feedback on the maternity plan from stakeholders showed a strong support for increasing primary birthing options in the Waitemata DHB area. Currently Waitemata DHB has primary birthing units in Helensville, Warkworth and Wellsford; these are all rural units and predominantly attract local women. The distances to these units are thought to be a barrier to uptake for women giving birth. Community groups, private maternity organisations and LMC midwives have strongly advocated for the development of primary birthing units closer to urban centres in West Auckland and North Shore. In order to understand the needs of the community and the level of support for primary birthing units and to further understand which delivery models would be most acceptable to the community, the Waitemata DHB board agreed to undertake broad community consultation to canvas their views. Aim To allow the DHB board information to inform their decisions the following aims were agreed to gain the current community views to: 1. Determine the current level of support for primary birthing units in the community 2. Determine the preferred delivery model of care from four different options 3. Determine preferred locations for a primary birthing unit 4. Examine preferences on key features of a primary birthing unit Consultation feedback is one part of the final information which the DHB board will use to inform their decision making regarding potential primary birthing units in West Auckland and North Shore. Methodology Leadership A team was brought together including representation from: Māori, Pacific, Asian and migrant health, consumer representatives, community engagement specialist, obstetrics, midwifery, Women s health, and DHB planning and funding. The team engaged Alex Woodley from Point Research to assist in planning and analysis of the consultation feedback. Consultation information and survey questions The participants were presented with some basic information about primary birthing units (see Appendix 2) to ensure that everyone had a similar understanding of the concept and terminology used in this context. The questions (see Appendix 3) were designed to gain insight into the current views on the following areas: key features of a primary birthing unit, location, proximity to local hospital, preferred model of care (adjacent, on hospital site, in the community, DHB or privately run), and support for primary birthing units

111 For the online consultation questions where multiple choices were given, options were randomly mixed to reduce likelihood of any favouring of response. All questions were optional, except contact details. Demographic information was requested from participants to help understand the team s effectiveness in reaching the diverse Waitemata community and to understand any differences in perspective. Tick-box options were provided that represented key communities within Waitemata that matched both census data collection approaches and how data is recorded within maternity services. This included: Gender while it was expected that more women would respond to the consultation, it was felt to be important to ensure that the father s voice was also heard and that other family members had an opportunity to contribute. Age group options were designed to be able to identify the women who were more likely to be at an appropriate birthing age for a new primary birthing unit should it go ahead. Ethnicity it was felt that it would be useful to be able to analyse any difference in perspective between communities where possible so level 2 classification (e.g. Chinese as opposed to Asian which is level 1 classification) was used where appropriate. In addition, people were asked if they were involved with a range of different types of organisation to help understand the different perspectives of LMCs, other health professionals, community providers and consumers. Consultation plan The consultation was managed in a way that provided people with different ways of providing feedback: through an online survey or through one of a series of small group forums or meetings aimed to focus specifically on the views of Māori, Pacific, Asian and young parents. The consultation which targeted the Waitemata DHB community took place between 18th January and 29th February 2016 (and later extended to 7 March 2016). Consultation process The community were provided with a range of opportunities, online and in person, to find out more and provide detailed feedback including: 1. Online consultation survey The Reo Ora Health Voice website ( was used as a platform for online feedback. The site included a link to the consultation survey, some basic information about primary birthing units, overview of consultation process and details of forums which participants could attend. An option was also given for anyone to request a speaker for a group or network meeting. Within the online survey, the only compulsory questions were name and or postal address. These were requested to ensure that feedback was genuine and to manage instances of people providing multiple responses at events and / or online. Questions on the kind of model of Primary Birthing Units and on the features people preferred were set up within the online survey so that the order of options was randomised to reduce the risk of bias. The incentive of a prize draw of one $50 supermarket voucher was offered for all those completing the consultation survey. 2. Community forums and meetings DHB-run forums (seven in total) took place on different dates and locations (including weekends and evenings). These included targeted events for the Māori, Pacific and Asian community, as well as general community events. Language support was provided where possible, and particularly within the Asian forums by the DHB s Asian Health Team and The Asian Network Incorporated. In addition, there were a number of small group discussions that targeted key communities: 6 111

112 Youth Ohana Young Parents Unit Refugee and migrant communities - Safari playgroup, De Paul House and WISE Collective Project Pacific people - Enua Ola Health Committee, Matua Pasifika Wellness Group and Tongan Selfmanagement education group Maori - Incredible Years programme (Whānau House) Positive parenting network Ranui network meeting Feedback was gathered in a slightly different format for these events to encourage and support participation. Presenters were encouraged to keep within a structured format for presentations to reduce the risk of bias, but to provide time for discussion throughout the forum to ensure that many of the participants at meetings had the ability to be heard. This approach was felt to be more encouraging and supportive of participation for Māori, Pacific and Asian communities in particular. A project team member or community facilitator listened to the table discussion and noted key points of feedback about the preferred features of primary birthing units and its preferred location. Attendees were then asked to complete a short version of the feedback form which asked for individual responses to the type of primary birthing unit preferred and whether or not the individual would recommend or use the unit. This process was designed to encourage participation from communities who prefer to provide oral feedback or who needed language support and may have found the long version of the feedback form off-putting. Consultation promotion Consultation was promoted through the following areas: Waitemata DHB website and social media accounts (facebook and twitter), and staff intranet (online link); Reo Ora Health Voice website current members across Auckland & Waitemata DHB ( ); Auckland and Waitemata DHB Women s Health Collaboration stakeholder networks ( ), who were also encouraged to send out to their own networks; Waitemata DHB Maternity staff and Lead Maternity Carer (LMC) who have access to practice in Waitemata DHB hospitals ( ); Posters distributed through DHB maternity units, libraries, community houses and parenting groups; Media coverage locally (picked up through national media via Waitemata DHB internal team meetings and weekly news; Waitemata DHB Community Engagement Forum members and their networks; Outreach also took place to support individual responses on paper surveys to the consultation from hard to reach communities. The consultation was extended for an additional week to reach key groups who had not yet engaged and to give them time to respond and provide feedback prior to the consultation closing on 7 March Response The consultation was extensive and interest was high with around 1500 people participating in the consultation process. In total, there were 1077 valid responses to the survey. Community meetings, hui and events were attended by over 450 people at meetings filling in 348 questionnaires. To strengthen the validity of the findings, the data was checked to minimise the risk of duplicate answers. It is noted that 27 respondents were found to have answered the online questionnaire or attended a group more than once. Those who responded in different capacities, for example both as an individual and on behalf of an organisation, had both responses included in the analysis. Multiple responses from seven respondents were excluded on the basis of apparent duplication

113 Responses were analysed in further detail (where possible) by the following demographic variables to: o o o o o o o Response method (online survey, group/community forum)* Responder (provider type/organisation/consumer) Ethnicity (Māori, NZ European, Pacific peoples, Asian, MELLA, Other) Location (North Shore and Hibiscus Coast, West Auckland, Rodney) Age groups (Under 19yrs, 20-29yrs, 30-39yrs, 40-54yrs, 55+ years) Gender (Male, Female) Potential future users of primary birthing unit development (women planning to have a baby in the future, women aged 30 years or less) Note that for the purposes of this report, the Hibiscus area of Hibiscus and Bays Local Board has been included with North Shore. Primary Birthing Units are already present in Northern and Western Rodney and are being analysed separately. The results highlighted within the report were selected on the basis of prioritised categories considered by the project team to be most relevant to the development of a primary birthing unit within Waitemata DHB. The Appendices contain more detailed data tables, including a more detailed responder profile. It is noted that respondents could select more than one ethnicity, and the ethnicity data Is non-prioritised. Data was analysed using SPSS. Ninety-five percent confidence intervals have been used. The data was also significance tested using t-tests. Small samples can affect the confidentiality of the results and individuals can be identified. Data has only been presented when there are at least 5 people in the population group being analysed. *Findings are shown as both online and group (community meeting) findings to reduce potential for multiple responses and to indicate those who have attended a session which allowed for group table participation/discussion. No limitation was placed on the number of events any member of the community wished to attend. Findings Recommend a primary birthing unit (PBU) Respondents were asked how likely they would be to recommend a primary birthing unit to someone having a baby, by rating their likelihood to recommend using a scale from 0 through to 10. Would you recommend a primary birthing unit to someone having a baby? (Online) Definitely not recommend 0 10 Definitely would recommend Most of those consulted indicated that they would be likely to recommend a PBU to someone having a baby. The majority of online respondents (87%) indicated that on balance, they would recommend the primary birthing unit to someone having a baby, rating the likelihood of doing so as five or more. Three-quarters (74%) indicated that they would be likely to recommend a PBU to someone having a baby, rating their likelihood of doing so as eight or higher. Similarly, most who attended groups (88%) indicated that on balance, they would recommend a PBU to someone having a baby, rating it 5 or higher

114 Although online respondents from West Auckland (86%) and North Shore and Hibiscus Coast (88%) indicated that on balance they were likely to recommend a PBU to someone having a baby, those from Rodney were most likely to do so (98%). Whilst health professionals (93%) and LMC midwives (99%) in particular were likely to recommend a PBU the majority of consumers (86%) too indicated they would recommend the unit to someone having a baby (rating the likelihood five or higher). Those from all ethnic groups indicated that they would recommend a PBU to someone having a baby. There were no significant differences between potential birthing users such as those hoping to have a baby in the future (86%), women under 30 years (87%), and other consumers. It is noted that 2% of consumers would not recommend a PBU to someone having a baby, 12% of consumers did not know whether they would or not. Figure 1: Would you recommend a primary birthing unit, by respondent type (online) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Consumers Organisations Health Professionals LMC Midwives 0 to 4 5 to 7 8 to 10 Don t Know WOULD NOT RECOMMEND Consumers 0.4% 0.0% 0.6% 0.6% 0.4% 4.0% 1.7% 6.9% 14.9% 8.4% 50.0% Organisations 0.0% 1.3% 0.0% 0.0% 0.0% 2.5% 2.5% 6.3% 15.0% 18.8% 45.0% Health 0.7% 1.4% 1.4% 2.1% 0.0% 6.3% 0.0% 2.8% 14.8% 12.7% 56.3% Professionals LMC 0.0% 0.0% 1.2% 0.0% 0.0% 2.4% 1.2% 1.2% 1.0% 8.5% 78.1% Midwives Differences are significant p < 0.05 Don t Know 12.2% % 7 1.4% 2 0.0% 0 WOULD RECOMMEND n=

115 Using a primary birthing unit Respondents were asked if they were hoping to have a baby in the future, and if so whether they would choose to give birth in a primary birthing unit, by rating their likelihood to recommend using a scale from 0 through to 10 If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit? (Online) Definitely not choose 0 10 Definitely would choose Most (84%) of those hoping to have a baby in the future indicated, on balance, that they would consider choosing a birth unit (rating the likelihood as 5 or higher). Two-thirds (64%) rating it as 8 or higher. Those in West Auckland (65%) were slightly more likely to indicate that they would be likely to use a PBU (rating it 8 or higher), than those on the North Shore and Hibiscus Coast (63%) or Rodney (61%). It is noted most of those hoping to have a baby in the future would consider giving birth in a primary birthing unit, irrespective of ethnicity or age. Figure 2: Would you choose to give birth in a primary birthing unit, by area (online) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% West Auckland North Shore Hibiscus Coast Rodney 0 to 4 5 to 7 8 to 10 Definitely not West Auckland North Shore Hibiscus Coast Rodney 8.2% (24) 5.9% (14) 10.0 % (3) 2.1% (6) 2.5% 6) 6.7% (2) 2.1% (6) 1.3% (3) 0.0% (0) 2.1% (6) 3.8% (9) 0.0% (0) 0.7% (2) 1.3% (3) 0.0% (0) 6.2% (18) 5.9% (14) 10.0% (3) 3.1% (9) 5.1% (12) 3.3% (1) 11.0% (32) 11.0% (26) 3.3% (1) 11.7% (34) 13.1% (31) 13.3% (4) 9.6% (28) 3.4% (8) 10.0% (3) 43.3% (126) 46.6% (110) 43.3% (13) Definitely would n=

116 Percent Preferred choice for type of a primary birthing unit Respondents were asked to rank the kind of primary birthing unit preferred from four options: In a hospital, next to the maternity unit, located in a hospital, next to or very close to the maternity unit; In the community, run by the DHB, located in the community, operated by the DHB; On the hospital site in a freestanding building, located on hospital grounds in a separate building, with its own entrance; In the community run by a private provider, located in the community, operated by a private or community contractor, but still free. Overall, online survey participants preferred the PBU to be based in the community and operated by the DHB or on the hospital grounds in a separate building. Figure 3: Preferred primary birthing unit choice (online) DHB operated On hospital grounds, in a separate building privately operated In hospital, near the maternity unit Preferred option Overall online FIRST CHOICE SECOND CHOICE THIRD CHOICE FORTH CHOICE n= On hospital In hospital, near 38.2% grounds, in a 31.4% 23.4% 12.5% privately the maternity 985 DHB operated (376) separate (307) (226) (121) operated unit building Differences are significant p < 0.05 Note that the percentages may not add up to 100% as the options are drawn from four different variables. Similarly, those who attended the groups and open forums either selected a community-based facility operated by the DHB, or a PBU on hospital grounds in a separate building as their first choices

117 Percent Percent Figure 2: Preferred primary birthing unit choice overall (open forums) DHB operated 33 On hospital grounds, in a separate building 29 privately operated 15 In hospital, near the maternity unit Preferred option Overall groups FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 43.2% grounds, in a 32.5% 28.7% 14.9% the maternity privately 264 DHB operated (114) separate (76) (73) (33) unit operated building Differences are significant p < 0.05 Note that the percentages may not add up to 100% as the options are drawn from four different survey variables. Those from West Auckland and Rodney favoured a community-based, DHB operated facility. Those in the North Shore Hibiscus Coast area favoured a community-based DHB operated facility, or one on the hospital grounds in a separate building. Figure 3: Preferred primary birthing unit choice by area (online) North Shore Hibiscus Coast West Auckland Rodney DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit North Shore Hibiscus Coast West Auckland FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= DHB operated DHB operated 37.2% (132) 40.8 (172) On hospital grounds, in a separate building On hospital grounds, in a separate building 33.0% (138) 33.0% (138) privately operated privately operated 24.5% (83) 21% (86) In hospital, near the maternity unit In hospital, near the maternity unit 10.3% (35) 11.2% (46)

118 Percent Rodney DHB operated 42.0% (21) s* - there were fewer than 5 respondents privately operated 32.7% (16) On hospital grounds, in a separate building 20.4% (10) In hospital, near the maternity unit Note that the percentages may not add up to 100% as the options are drawn from four different survey variables. S* 50 Respondent type The difference between consumers first and second choices, namely a community-based PBU operated by the DHB or a PBU on hospital grounds with a separate entrance, were not significant. Health providers too favoured a community-based, DHB operated facility. LMC midwives, however, preferred a privately operated community-based facility. It is noted that when respondents first and second choices were considered together, a community-based PBU, run by the DHB was either the most popular or equally popular option across all the respondent types, including LMC midwives. Figure 4: Choice by Consumer, Health provider, LMC Midwives (Online survey) Consumer Health providers LMC midwives DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit Consumer Health providers LMC midwives FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 34.8% 34.6% 24.7% 9.0% grounds, in a privately the maternity 503 DHB operated (175) (140) (121) (45) separate building operated unit DHB operated privately operated 45.6% (57) 51.3% (40) privately operated DHB operated s* - there were fewer than 5 respondents 25.4% (33) 33.3% (26) On hospital grounds, in a separate building On hospital grounds, in a separate building 20.6% (26) 14.3% (11) In hospital, near the maternity unit In hospital, near the maternity unit 12.2% (16) 131 S* 78 Note that the percentages may not add up to 100% as the options are drawn from four different survey variables Ethnicity European and Pacific peoples who responded to the survey had a preference for a community-based PBU operated by a DHB

119 Percent Māori respondents favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance. Asian respondents were fairly equally in favour of all three DHB operated PBUs. Figure 5: Preferred primary birthing unit choice by ethnicity (online) European Māori Pasifika Asian Other DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit European Māori Pacific peoples Asian Other FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 38.8% grounds, in a 30.5% 26.2% 8.5% privately the maternity 778 DHB operated (302) separate (235) (199) (64) operated unit building DHB operated DHB operated DHB operated DHB operated 35.1% (26) 48.9% (45) 31.5% (29) 38.9% (21) On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated 32.9% (25) 28.1% (25) 31.2% (29) 30.8% (16) privately operated In hospital, near the maternity unit In hospital, near the maternity unit On hospital grounds, in a separate building 25.7% (19) 26.6% (25) 29.5% (28) 22.6% (12) In hospital, near the maternity unit privately operated privately operated In hospital, near the maternity unit 8.5% (6) 11.4% (10) 13.0% (12) 11.8% (6) Whilst Māori respondents online favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance, participants at forums with a Māori focus had a preference for communitybased, DHB operated PBUs. Participants at forums with a refugee and new migrant focus showed a preference for a PBU on hospital grounds but with a separate entrance

120 Percent Figure 6: Preferred primary birthing unit choice by ethnicity (groups) Mixed Māori Pasifika Asian 21 DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit Mixed groups Māori Pacific peoples Asian new migrant FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 47.2% 22.6% 18.7% grounds, in a 11.3% privately the maternity 23 DHB operated (25) (12) (10) separate (6) operated unit building DHB operated In hospital, near the maternity unit On hospital grounds, in a separate building * S - there were fewer than 5 people. 60.4% (32) 34.3% (47) 46.2% (24) On hospital grounds, in a separate building DHB operated DHB operated 17.0% (9) 31.4% (43) 25.0% (13) privately operated On hospital grounds, in a separate building In hospital, near the maternity unit 13.2 (7) 27.0% (37) 21.2% (11) In hospital, near the maternity unit privately operated privately operated Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 9.4% (5) 7.3% (10) S* 52 Consumers When examining the preferences of consumers separately from health providers, Pacific peoples and those from other ethnicities preferred a community-based facility operated by a DHB. European and Māori consumers too preferred this option, along with the facility based on hospital grounds in a separate building. Asian consumers also favoured a PBU in the hospital near the maternity unit, along with a PBU in hospital near the maternity unit

121 Percent Figure 7: Preferred primary birthing unit choice by ethnicity for consumers (online) European Māori Pasifika Asian Other DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit C FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near European grounds, in a 36.3% 34.9% 23.9% 8.1% privately the maternity 387 consumer separate (140) DHB operated (135) (89) (31) operated unit building Māori consumer Pacific consumer Asian consumer Other consumer On hospital grounds, in a separate building DHB operated On hospital grounds, in a separate building DHB operated 37.8% (14) 47.4% (9) 37.9% (11) 50.0% (11) s* - there were fewer than 5 respondents DHB operated On hospital grounds, in a separate building In hospital, near the maternity unit privately operated 33.3% (12) 33.3% (7) 29.6% (8) 30.0% (6) privately operated privately operated DHB operated In hospital, near the maternity unit 23.5% (8) S* 20.7% (6) S* In hospital, near the maternity unit In hospital, near the maternity unit privately operated On hospital grounds, in a separate building Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 2.0% (2) 37 S* % (5) 29 S* 22 Organisations, LMCs and other Health Professionals Health professionals and respondents from organisations tended to favour a community-based DHB operated facility as either first choice or first equal choice. Pacific peoples who were staff had a clear preference for this model. Whilst European and Māori staff preferred either this model or a community-based privately operated PBU, Asian staff preferred either a community-based, DHB operated PBU or a hospital-based facility near the maternity unit

122 Percent Figure 8: Preferred primary birthing unit choice by ethnicity for organisations and health professionals (online) European Māori Pasifika Asian Other DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit European Māori Pacific peoples Asian Other FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 42.3% 37.4% grounds, in a 16.4% 8.1% privately the maternity 168 DHB operated (71) (62) separate (27) (13) operated unit building privately operated DHB operated DHB operated privately operated 41.2% (7) 76.9% (9) 42.4% (14) 47.1% (11) * There were fewer than 5 respondents DHB operated privately operated In hospital, near the maternity unit DHB operated 33.3% (5) 31.6% (6) 32.4% (12) 29.4% (5) On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building In hospital, near the maternity unit S* S* 17.1% (6) S* In hospital, near the maternity unit In hospital, near the maternity unit privately operated On hospital grounds, in a separate building Note that the percentages may not add up to 100% as the options are drawn from four different survey variables S* 17 S* 26 S* 37 S* 17 Women under 30 years Women under 30 years ranked three different models similarly, namely a community-based PBU either DHB operated or community run, or a PBU on hospital ground in a separate building. Few, however, favoured a hospital-based PBU near the maternity unit

123 Percent Percent Figure 9: Preferred primary birthing unit choice of women under 30 years (online) DHB operated On hospital grounds, in a separate building 26 privately operated 9 In hospital, near the maternity unit Preferred option Women under 30 years FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= DHB operated 36.3% (78) On hospital grounds, in a separate building 36.1% (67) privately operated 25.5% (54) In hospital, near the maternity unit Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 9.0% (19) 215 Age Groups Whilst those aged between 20 years and 39 years ranked the community-based, DHB operated facility and a PBU on hospital grounds in a separate building similarly, those aged 40 years or over had a clear preference for a community-based DHB operated facility. Figure 10: Preferred primary birthing unit choice by age group (online) years or under years years years 55+ years DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit 19 years or less years FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 53.8% grounds, in a the maternity S* S* privately S* 13 DHB operated (7) separate unit operated building On hospital grounds, in a separate building 35.4% (79) DHB operated 33.2% (73) privately operated 25.1% (55) In hospital, near the maternity unit 9.6% (21)

124 Percent years years 55+ years DHB operated DHB operated DHB operated 37.6% (151) 40.9% (88) 45.4% (44) * There were fewer than 5 respondents. On hospital grounds, in a separate building run by private provider On hospital grounds, in a separate building 33.9% (134) 26.5% (58) 29.9% (29) privately operated On hospital grounds, in a separate building privately operated 21.3% (83) 25.0% (54) 25.8% (24) In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 12.3% (48) 10.6% (23) 13.0% (12) Gender There was no significant difference between either men s or women s first and second choices, namely a DHBrun PBU in the community or a PBU on hospital grounds with a separate entrance. However, when the first and second choices were combined, women had a clear preference for a PBU in the community, run by the DHB. Figure 11: Preferred primary birthing unit option by gender (online) Women Men DHB operated privately operated On hospital grounds, in a separate building In hospital, near the maternity unit Women Men FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n= On hospital In hospital, near 38.8% grounds, in a 30.6% 24.6% 10.7% privately the maternity 878 DHB operated (341) separate (266) (212) (92) operated unit building On hospital grounds, in a separate building 33.9% (19) DHB operated 32.8% (19) In hospital, near the maternity unit 20.7% (12) privately operated Note that the percentages may not add up to 100% as the options are drawn from four different survey variables 17.5% (10)

125 Features of a primary birthing unit Respondents were asked what would be important to them to have as part of a primary birthing unit. A list was provided as a guide, and responders were asked to provide any other features important to them by ranking as: essential, nice to have, not important or don t know. Responses are represented as: cells that are shaded blue had 75% or more respondents consider them to be an essential part of the unit. numbering represents the features ranking by order of importance. Respondent type (online) Breastfeeding support/advice received the highest ranking as the most essential service to have as part of a PBU by women planning to be pregnant, consumers, organisations, and health professionals. LMC midwives selected the provision of a birthing pool as the most important service. Lower ranked features included a children s playground, a private garden area and access to food for visitors. Table 12: Features of primary birthing unit, rankings by respondent type (online) HOPING TO HAVE A BABY IN FUTURE* WOMEN UNDER 30YRS CONSUMER ORGANISATIONS HEALTH PROFESSIONALS LMC MIDWIFE** Breastfeeding support / advice Family-friendly = 2 3= Easy to get to by car = Tasty healthy meals = Partners able to stay overnight = 6 5 Birthing pool Private ensuite bathrooms = Free car parking Clinic rooms for appointments = Lounge area for families Pregnancy and parenting classes Easy to get to by public transport = Language support All day visiting Other community health services nearby Private garden area Access to food for visitors Children's playground OVERALL n=511 n=223 n=457 n=85 n=147 n=54 *Women planning pregnancy included in all data groups ** Data shaded is where 75% or more of the group have considered the feature to be essential

126 Ethnicity (online) The top ranked features that online respondents wanted to see in the PBUs were largely consistent across the ethnic groups. Breastfeeding support and advice was ranked as the most essential service by most (75% or more) respondents across all ethnicities. A family-friendly service and a service easy to get to by car were also considered essential by three-quarters or more of respondents from each ethnic group. For those from ethnic groups other than European, having partners stay overnight and private bathrooms were important to 75% or more of online respondents. Tasty meals and a birthing pool were considered essential by Europeans, Māori and Pasfika, it was less likely to be ranked highly by Asian or MELAA respondents. Pacific peoples and Asian respondents favoured a `one stop shop ranking clinic rooms for appointments with midwives, lactation consultants and physiotherapists as an essential service. Features least likely to be considered essential were private garden areas, children s playgrounds and access to food for visitors, with respondents across each of the different ethnic groups giving these lower rankings. Feedback from community Hui and Fono and group meetings Māori For those attending hui, participants ranked partners staying overnight, a lounge area for families and free parking the most highly. The next highly ranked features included a birthing pool, breastfeeding support and advice, language support and tasty healthy meals. They also said they would like to see whānau centred care. This includes space for whānau, comfortable chairs, and allowing partners and or support people to stay overnight. They would like rooms to be private, and to be designed to enable new mothers to rest. It was suggested that a whānau room could be built alongside a birthing room. The importance of cultural support was emphasised. This included birthing facing the sun, enabling an elder to offer the baby to the four winds, and ensuring the placenta could be taken home. It was felt that some staff are unaware of the importance to Māori of these cultural practices. Spirituality was also seen as important with participants considering the provision of a prayer and meditation room, and chapel to be important features of PBUs. The participants also wanted to see the PBU provide other services, such as childbirth classes, a lactation consultant, and support for new mothers such as how to look after and care for babies. For the participants of these groups, it was noted that small things can make a difference, such as toiletries and hair dryers. Participants also noted that trust needs to be built. For example, the death of a baby at a unit after a delay in transfer reduced trust of such units. Work will need to be done to make PBUs an option as many women are not given information about options other than hospitals. It was felt there needed to be a grief team available to those who may need such support

127 Pacific peoples For those attending Pacific fono, breastfeeding advice, and a PBU which was easy to get to by car ranked most highly. This was followed by features such as a birthing pool and clinic rooms for appointments. Attendees also rated pregnancy and parenting classes, access to food for visitors, all day visiting, a private garden area, private bathroom, a children s playground and family-friendly facilities as essential. Those attending fono noted that they would like to see the birthing unit closer to hospital in case of emergency. They asked for the ambulance service to be free. Fono attendees acknowledged the importance of cultural and spiritual values at the PBU. In addition to interpreter services, participants said that faith support for families, through a chaplain service and other spiritual supports such as a chapel, would be important to many Pacific peoples. One group asked for access to a woman chaplain. Other services they would like to see are free Wi-Fi services, access to computers and printers. Several groups noted that they would like a support person, not necessarily a partner, to stay overnight. In addition, they would like to see postnatal classes linked to community services, including counselling or budgeting services. In terms of the `feel of the unit, participants said the PBU would need to have a relaxed, family-friendly feel, underpinned by cultural and faith based supports. One group pointed out that rooms needed to be large enough to accommodate large Pacific families, with a children s area where children too could be cared for and stay overnight. Asian, refugee and new migrant groups Asian groups were most likely to rate having community health facilities nearby as essential to a PBU. This was followed by ease to get to by car, access to food for visitors, a birthing pool, breastfeeding support and advice, and clinic rooms for appointments. Other features which ranked highly included ease to access by public transport, all day visiting, free car parking, family-friendly facilities and a lounge area for families. Asian mothers, including Korean mothers, look after their daughters following birth, providing breastfeeding support and new parenting support. This is considered important for the wellbeing of the new mother, both physically and emotionally. Participants said that rooms would need to be of sufficient size to accommodate them. Some said that they found men on wards to be off-putting. Participants said that they would prefer single rather than shared rooms after delivery. This was a priority due to privacy reasons. Meals need to be culturally appropriate and nutritious. Cold food is considered inappropriate culturally. Food needs to be hot with vegan and vegetarian options. Korean women, for example, like to drink seaweed soup after birth to ward off postnatal depression. Similarly, special foods are important to Chinese women. It was suggested that a microwave could be provided so that clients could heat food up. The provision of a cooker, rice cooker and fridge to store food were also suggested, Like Pacific peoples, they would like to see a crèche for children. Participants said the birthing unit would need to be kept warm enough for mothers and their babies. It was suggested that the unit have underfloor heating. This is seen as very important. Participants said there was no need to provide outside space as new mothers and their babies need to be kept warm, rest and stay inside. Transport and parking were key concerns identified by those attending Asian group meetings. They said the unit would need to be accessible by public transport. Free parking was seen as important along with proximity to motorways and good roads

128 Support for new families was seen as critically important. It was suggested that staff be given permission to use their discretion and allow some families to stay longer, particularly where there is little family support. Some said that language support was needed, others felt that all day visiting would reduce the need for interpreter services. Age Groups (online) Again, breastfeeding support and advice was the PBU feature that ranked most highly across all the age groups. Although the order varied, a family-friendly service, easy to get to by car and tasty healthy meals were selected by 75% or more of those aged 20 years or over. Three-quarters of those aged under 30 years wanted their partners to stay overnight. Teen parents A young mothers (teen) group said that they would like the PBU to provide an environment more akin to a home than a hospital. They would like to see artwork on the walls, plants, and the comforts normally associated with a home environment. They would like to see dim lighting, and comforts such as a couch or lazy boy chair. They consider the soundproofing of walls to be essential as they said it was scary hearing others giving birth, and frustrating hearing others give birth if their own labour is long. Young mothers also wanted a kitchen with fruit or snacks. They were averse to the unit smelling like a hospital. The young mothers suggested additional rooms in the PBU so that the unit could be a place where they could transfer to after birthing in hospital and be supported. They were concerned that mothers could be transferred back to the unit if they had been transferred from the unit to hospital, e.g. for pain relief. Parenting groups Parenting groups wanted the PBUs to have single rather than shared rooms as they were concerned about privacy. They wanted enough space for the father to be able to stay, and for both sets of grandparents to be able to visit. They emphasised the importance of the PBU being family-friendly, and dad friendly in particular. They would like double beds to be provided for dads to stay, and they felt it was important for PBUs to have less restrictive visiting hours. They would also like to be able to bring children in to see the new baby. They reiterated the importance of a warm and friendly environment as it can be hard for new mothers to ask for help or support. Participants in parenting groups suggested the PBU could become a hub for other services, such as antenatal services, and to provide information about home births. They would also like to see the PBU provide parenting advice and support to ensure that parents are well prepared before they go home. Other services which participants suggested included physiotherapy services, exercise classes and mental health support including information on warning signs. They would like the feel of the PBU to be homely. They are wary of private providers charging them for additional extras finding it elite and off-putting. Gender (Online) Both men and women had very similar ranked preferences. The only notable difference was the ranking of birthing pools, which was considered more important to women (ranked 5 th ) than men (ranked 13 th ). For both men and women, breastfeeding support/advice was the highest ranked service to have as part of a PBU. The top four choices, namely breastfeeding support and advice, a family-friendly service, a PBU considered easy to get to by car, and a service which provided healthy, tasty meals were listed as essential by over 75% of the women surveyed. The top three services ranked by men, were considered to be essential by over 75% of male respondents

129 Lower ranked items for both men and women included access to food for visitors, and a private garden area, a children s playground and nearby health services. Other essential features of a PBU (Online) Respondents were asked if there were other essential services or features they would like to see in a PBU. More than one in ten (13%) respondents said that they would like parenting or postnatal support or advice. One in ten (10%) said that they would like the room to be comfortable, with the ability to play music, a double bed, or the provision of arm chairs and lazy boys. Some respondents (5%) noted that the Warkworth Birthing Centre was an excellent example of a PBU, and said that they would like to see any new PBUs modelled on that. It was noted that Muslim women need their own room away from men, but large enough to hold visitors. They would prefer a kitchen to be available where they could make their own halal food. They would also like a space where they can pray. Other requirements include no shoes to be worn. They would like lactation support including an option to formula feed their babies

130 Percent Proximity to home or hospital Respondents were asked whether they would prefer the Primary Birthing Unit to be closer to home or the hospital. (See Appendix 1). Those in West Auckland and on the North Shore and Hibiscus Coast area preferred the PBU to be between home and hospital, or closer to hospital. Those in Rodney favoured a mid-point. Those on the LMC midwives and other health professionals, were more likely to prefer the PBU to be located between home and hospital. Consumers were divided in their preferences between it being located between home and hospital, or nearer a hospital. Consumers from ethnicities other than European were most likely to prefer the unit to be located closer to hospital. Those attending Asian groups suggested that it needed be close enough to the hospital to get there if there are complications so that families feel safe, however far enough away that the issues associated with hospitals, such as parking, a lack of privacy and the risk of infection, are minimised. Those aged under 30 years were slightly more likely to prefer the birthing unit sited between home and hospital. Those aged years were more likely to prefer it to be sited closer to the hospital. Whilst women preferred a PBU to be located closer to hospital than home, or somewhere in between, men were slightly more likely to prefer it to be sited closer to hospital. Figure 13: Proximity to home and hospital, by area West Auckland North Shore Hibiscus Coast Rodney 0 to 4 (closer to home) 5 to 7 8 to 10 (Closer to hospital) 26 CLOSER TO HOME West Auckland North Shore Hibiscus Coast % (5) 3.7% (14 3.2% (15) 3.5% (13) 3.0% (14) 3.2% (12) 2.8% (13) 3.2% (12) 1.7% (8) 3.5% (13) 23.4% (109) 20.9% (78) 5.7% 1.9% 5.7% 5.7% 1.9% 39.6% Rodney (3) (1) (3) (3) (1) (21) * Significant differences between highest and lowest values. 5.2% (24) 4.5% (17) 3.8% (2) 13.7% (64) 12.6% (47) 3.8% (2) 16.7% (78) 17.6% (66) 13.2% (7) 6.0% (28) 7.8% (29) 9.4% (5) 23.2% (108) 19.5% (73) 9.4% (5) CLOSER TO HOSPITAL n=

131 Location of birthing unit Waitakere Those who live in the Waitakere area preferred the PBU to be located in Henderson, Ranui or New Lynn. Asian groups suggested Blockhouse Bay or Titirangi in the trees as an option. North Shore Those from the North Shore indicated that they would like to see the PBU somewhere on the North Shore, in Takapuna, or Northcote. Asian groups suggested Albany as a good location, with staff able to cope with emergencies as it is a distance from the hospital. Rodney Online respondents from Rodney favoured a PBU based at either North Shore, Albany or West Auckland. Some reiterated they would like to see it located close to a hospital. Other comments In general respondents were supportive of a PBU, largely as they felt it was good to have birthing options. Key concerns from consumers centred on how it would be run if privately operated. There were also questions regarding the availability of land. Respondents commented that they would like on-going involvement and input into the development of a PBU. Overall Overall there is agreement that those consulted would be likely to recommend the PBU to others, and those hoping to have a baby in the future would be likely to use it. The Waitemata DHB: Primary Birthing Unit Consultation of online survey respondents and group participants has found support for a PBU to be based in the community and run by the DHB. Features considered essential to a PBU vary according to the age, culture and ethnicity of those consulted. Nonetheless, there are common features, such as breastfeeding support, a warm friendly environment with single rooms which can accommodate friends and family. It is noted that many of those consulted said that they would like to continue to be involved in the development of a PBU should these be progressed

132 Appendix 1: Tables Appendix table 1: Overall: Preferred choice for the Primary Birthing Unit Gender Overall Women Men Respondent type Consumer Organisation Health Provider LMC midwives Other / Prefer not to say Ethnicity European Māori Pacific peoples Asian MELAA Other / Prefer not to say FIRST CHOICE DHB operated DHB operated On hospital grounds, in a separate building DHB operated DHB operated DHB operated privately operated DHB operated DHB operated DHB operated DHB operated DHB operated On hospital grounds, in a separate building DHB operated % n= SECOND CHOICE 38.2% (376) 38.8% (341) 33.9% (19) 34.8% (175) 51.5% (34) 45.6% (57) 51.3% (40) 42.9%* (72) 38.8% (302) 35.1% (26) 48.9% (45) 31.5% (29) 50.0% (6) 38.9% (21) On hospital grounds, in a separate building On hospital grounds, in a separate building DHB operated On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated DHB operated On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated privately operated % n= THIRD CHOICE 31.4% (307) 30.6% (266) 32.8% (19) 34.6% (140) 25.0% (16) 25.4% (33) 33.3% (26) 30.9% (53) 30.5% (235) 32.9% (25) 28.1% (25) 31.2% (29) 27.3% (3) 30.8% (16) privately operated privately operated In hospital, near the maternity unit privately operated privately operated On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated privately operated privately operated In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit On hospital grounds, in a separate building % n= FOURTH CHOICE 23.4% (226) 24.6% (212) 20.7% (12) 24.7% (121) 21.9% (14) 20.6% (26) 14.3% (11) 19.8% (34) 26.2% (199) 25.7% (19) 26.6% (25) 29.5% (28) 16.7% (2) 22.6% (12) In hospital, near the maternity unit In hospital, near the maternity unit privately operated In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit privately operated privately operated DHB operated In hospital, near the maternity unit % n= 12.5% (121) 10.7% (92) 17.5% (10) 9.0% (45) 19.1% (13) 12.2% (16) 5.4% (4) 12.9% (18) 8.5% (64) 8.5% (6) 11.4% (10) 13.0% (12) 16.7% (2) 11.8% (6)

133 Age Region 19 years or less years years years 55+ years West Auckland North Shore Hibiscus Coast Rodney Other / Prefer not to say Potential future birthing population Hoping to have a baby in the future FIRST CHOICE DHB operated On hospital grounds, in a separate building DHB operated DHB operated DHB operated DHB operated DHB operated DHB operated DHB operated DHB operated Women under 30 years DHB operated % n= SECOND CHOICE 53.8% (7) 35.4% (79) 37.6% (151) 40.9% (88) 45.4% (44) 40.8% (172) 37.2% (132) 42.0% (172) 38.7% (106) 35.6% (235) 36.3% (78) In hospital, near the maternity unit DHB operated On hospital grounds, in a separate building run by private provider On hospital grounds, in a separate building On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated privately operated On hospital grounds, in a separate building On hospital grounds, in a separate building % n= THIRD CHOICE 23.1% (3) 33.2% (73) 33.9% (134) 26.5% (58) 29.9% (29) 33.0% (138) 33.0% (138) 21.0% (86) 28.0% (75) 29.5% (195) 36.1% (67) On hospital grounds, in a separate building privately operated privately operated On hospital grounds, in a separate building privately operated privately operated privately operated On hospital grounds, in a separate building On hospital grounds, in a separate building privately operated privately operated % n= FOURTH CHOICE 15.4% (2) 25.1% (55) 21.3% (83) 25.0% (54) 25.8% (24) 21.0% (86) 24.5% (83) 20.4% (10) 25.1% (68) 23.2% (153) 25.5% (54) Note that the percentages may not add up to 100% as the options are drawn from four different survey variables Appendix table 2: Preferred option for the primary birthing unit (group participants) Open forums FIRST CHOICE run by DHB % n= SECOND CHOICE 43.0% (113) On hospital grounds, separate entrance % n= THIRD CHOICE 32.5% (76) In hospital, near the maternity unit privately operated In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit In hospital, near the maternity unit % n= FOURTH CHOICE 28.7% (73) Note that the percentages may not add up to 100% as the options are drawn from four different survey variables privately operated % n= 8.3% (1) 9.6% (21) 12.3% (48) 10.6% (23) 13.0% (12) 11.2% (46) 10.3% (35) s 13.3% (35) 11.8% (78) 9.0% (19) % n= 14.9% (33)

134 Appendix table 3: Features of primary birthing unit, rankings by ethnicity (online) EUROPEAN MĀORI PACIFIC PEOPLES ASIAN MELAA OTHER / PREFER NOT TO SAY Breastfeeding support / advice Family-friendly Easy to get to by car Tasty healthy meals Birthing pool Partners able to stay overnight Private ensuite bathrooms Free car parking Lounge area for families Clinic rooms for appointments (e.g. midwife, lactation consultant, physiotherapist) Easy to get to by public transport Pregnancy and parenting classes Language support All day visiting Other community health services nearby Private garden area Access to food for visitors Children's playground NB: Shaded cells denote that 75% or more respondents considered the feature to be an essential part of the unit. Appendix table 4: Features of PBUs, rankings by gender (Online survey) FEMALE MALE Breastfeeding support / advice 1 1 Family-friendly 2 3 Easy to get to by car 3 2 Tasty healthy meals 4 4= Birthing pool 5 13 Partners able to stay overnight 6 4= Private ensuite bathrooms 7 8 Free car parking 8 4= Clinic rooms for appointments (e.g. midwife, lactation consultant, physiotherapist) 9 4= Lounge area for families 10 9 Pregnancy and parenting classes Easy to get to by public transport Language support All day visiting Other community health services nearby 15 16= Private garden area Access to food for visitors Children's playground 18 16= OVERALL n=948 n=

135 * Other includes Gender Diverse & Prefer not to say. Gender diverse numbers were too small to provide robust analysis. NB: Shaded cells denote that 75% or more respondents considered the feature to be an essential part of the unit Appendix table 5: Features of the PBU identified as essential, by age group 19 AND UNDER * PREFER NOT TO SAY Breastfeeding support / advice Family-friendly Easy to get to by car Tasty healthy meals Partners able to stay overnight Birthing pool Private ensuite bathrooms Free car parking Lounge area for families Clinic rooms for appointments (e.g. midwife, lactation consultant, physiotherapist) Pregnancy and parenting classes Easy to get to by public transport Language support All day visiting Other community health services nearby Children's playground Access to food for visitors Private garden area OVERALL n-13 n=233 n=431 n=239 n=113 n=7 NB: Shaded cells denote that 75% or more respondents considered the feature to be an essential part of the unit Appendix table 6: OVERALL - Proximity to home and hospital CLOSER TO HOME Overall Hoping to have a baby in future Women under 30 years European Māori Pacific peoples Asian MELLA % 3.0% 3.3% 3.5% 2.5% 22.4% 4.4% 13.6% 16.6% 7.2% 20.8% 2.7% 3.4% 3.8% 3.3% 2.2% 22.6% 4.7% 13.0% 17.3% 6.5% 20.6% CLOSER TO HOSPITAL n= 2.7% 1.8% 0.9% 2.3% 3.6% 25.8% 6.3% 14.5% 17.2% 5.9% 19.0% % 2.8% 3.9% 3.5% 2.7% 24.0% 5.4% 14.5% 16.6% 6.0% 17.8% % 2.6% 3.8% 1.3% 1.3% 16.7% 3.8% 15.4% 12.8% 5.1% 35.9% % 6.0% 1.2% 0.0% 0.0% 19.0% 1.2% 11.9% 14.3% 10.7% 34.5% % 2.9% 1.9% 3.9% 0.0% 10.7% 1.0% 14.6% 22.3% 9.7% 29.1% % 0.0% 0.0% 0.0% 0.0% 23.1% 0.0% 15.4% 15.4% 0.0% 38.5% 13 * *Significant difference between highest and lowest values

136 Appendix table 7: OVERALL - Would you recommend a primary birthing unit, by respondent type (online) Overall Don t Know n= 0.4% 0.6% 0.8% 0.6% 0.5% 4.2% 2.0% 6.6% 13.4% 8.8% 52.1% 10.1% 1057 Potential future birthing population Hoping to have a baby 0.5% 0.6% 0.6% 0.6% 0.6% 4.1% 2.2% 6.3% 13.3% 9.0% 51.3% 11.1% 875 in future Women under % 0.0% 0.5% 0.0% 0.5% 4.6% 2.7% 3.7% 13.2% 4.1% 58.4% 11.9% 219 years Respondent type Consumers 0.4% 0.0% 0.6% 0.6% 0.4% 4.0% 1.7% 6.9% 14.9% 8.4% 50.0% 12.2% 524 Organisation s Health professional s LMC Midwives Other / Prefer not to say European Māori Pacific peoples Asian MELLA Other 0.0% 1.3% 0.0% 0.0% 0.0% 2.5% 2.5% 6.3% 15.0% 18.8% 45.0% 8.8% % 1.4% 1.4% 2.1% 0.0% 6.3% 0.0% 2.8% 14.8% 12.7% 56.3% 1.4% % 0.0% 1.2% 0.0% 0.0% 2.4% 1.2% 1.2% 7.3% 8.5% 78.0% 0.0% % 1.5% 0.5% 0.0% 1.0% 2.5% 1.5% 10.1% 9.5% 8.5% 56.3% 8.5% 199 Ethnicity 0.4% 0.2% 0.7% 0.7% 0.6% 3.7% 1.6% 6.7% 13.9% 8.1% 53.4% 10.0% % 0.0% 3.8% 0.0% 1.3% 3.8% 1.3% 10.1% 12.7% 10.1% 49.4% 6.3% % 0.9% 1.9% 0.0% 0.0% 2.8% 2.8% 5.6% 8.4% 10.3% 60.7% 6.5% % 2.0% 0.0% 0.0% 0.0% 7.8% 3.9% 7.8% 14.7% 12.7% 38.2% 12.7% % 7.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.1% 64.3% 14.3% % 0.0% 0.0% 0.0% 0.0% 5.1% 1.7% 6.8% 20.3% 6.8% 52.5% 6.8% 59 * *Significant difference between highest and lowest values. Appendix table 8: OVERALL - Would you choose to give birth in a primary birthing unit (online) CLOSER TO HOME CLOSER TO HOSPITAL n= Overall 7.8% 3.0% 2.1% 2.2% 1.0% 6.3% 3.3% 9.7% 12.7% 7.9% 44%

137 Appendix table 9 - Respondent profile All respondents Percentages (%) n=1111 Overall Online survey % Open forums (forms) % Mixed ethnicity hui participants % Māori hui participants % Pacific fono participants % Asian, refugee, migrant forums % Potential future birthing population Hoping to have a baby in future % Women under 30 years % Gender Female % Male % Gender Diverse 3 0.3% Prefer not to say 2 0.2% Age 19 years or less % years % years % years % 55 years or more % Prefer not to say 7 0.7% Ethnicity (Multiple response) European % Māori % Pacific peoples % Asian % Middle Eastern, Latin American African % 0.6% Other % Respondent type Consumers % Organisations % Health Professionals % LMC Midwife % Other / Prefer not to say % Area North Shore and Hibiscus Coast West Auckland Rodney Auckland central Other KEY Respondent type Consumers (Consumer, maternity service user); Organisations (Māori organisation, Pacific peoples organisation, Asian organisation, Youth organisation, Women s health organisation); Health professionals (LMC Midwife*, LMC Obstetrician, DHB maternity clinical staff, Community health provider, Private health provider); Other (Government / Ministry of Health, Union, Other please specify, Prefer not to say) * LMC midwife separated for analysis, as health professional providing advice on place of birth when in a primary birthing units

138 Region Grouped by locality, based on local boards by Auckland Council: North Shore and Hibiscus (Devonport-Takapuna, Hibiscus and Bays, Kaipātiki, North Shore, Upper Harbour); West Auckland (Henderson-Massey, Waitākere Ranges, West Auckland, Whau); Rodney (Rodney, excluding Hibiscus and Bays) Auckland central (Auckland) Other (Counties Manukau, Outside Auckland Metro, Other/Unknown) Unspecified (unknown, prefer not to say)

139 Appendix 2: Consultation Timeline Date Mon, 18/Jan Meetings & activities Start of public consultation period Reo Ora Website Primary Birthing Unit consultation information and survey (live) Press Release to Auckland & Waitemata press, and Womens Health Collaboration maternity stakeholders advising of start of public consultation (with links to Reo Ora site) Tue, 19/Jan Blog linking public to online consultation on Reo Ora site on Waitemata DHB facebook site Banner linking public to online consultation on Reo Ora site on Waitemata DHB website Banner linking staff to online consultation on Reo Ora site on Waitemata DHB intranet homepage Tue, 02/Feb to Fri, 05/Feb Posters advertising online consultation and public meetings, put into community at Libraries, Community Houses, Citizens Advice Bureau, and other places that families attend from Rodney: Whangaparoa to Dairy Flat North Shore: Browns Bay to Devonport Waitakere: Whenuapai to New Lynn Thu, 11/Feb Sat, 13/Feb Wed, 17/Feb Wed, 17/Feb Thu, 18/Feb Fri, 19/Feb Sat, 20/Feb Sat, 20/Feb Mon, 22/Feb Mon, 22/Feb Tue, 23/Feb Tue, 23/Feb Tue, 23/Feb Wed, 24/Feb Wed, 24/Feb 11am: Matua Pasifika Wellness Group, Henderson (Pacific Elderly Group) 10-12: West Auckland Pacific Fono, Kelston Community Hall, (Pacific focused community meeting) 10.30am: De Paul House Café Club, Onewa Road, Northcote (Migrant and displaced families) 6-8pm: North Shore Pacific Fono, Maria Assumpta Church Hall, Beach Haven (Pacific focused community meeting) 7pm Enua Ola Health Committee, The Fono (West Auckland Pacific Health & Community providers) 9.45am: Safari Playgroup, Henderson Baptist Church (Refugee & Migrant women) 10-12: North Shore community meeting, Northcote Netball Centre (general community and healthcare provider meeting) 10-12: West Auckland Asian meeting, Kelston Community Centre (Asian focused community meeting) 11.30am - WISE women meeting, Henderson (women from diverse refugee backgrounds) 1-3: North Shore Maori community hui, Birkdale Community Hall, Birkdale (Maori focused community meeting) 10-11am: Positive Parenting network meeting, Man Alive, 11 Edmonton road, Henderson 12-1: Incredible Years education, Whanau House (Maori focussed parent education) Ranui Community Action Network meeting, Ranui Baptist Church 10-12am: TANI Network Meeting (75+ people), Western Springs 10-12: West Auckland community meeting, Ranui Baptist Church (general community and healthcare provider meeting)

140 Date Wed, 24/Feb Thu, 25/Feb Sat, 27/Feb Mon, 29/Feb Meetings & activities 12-1: Incredible Years education, Whanau House (Maori focussed parent education) 8.30am: Waipareira Staff meeting, Whanau House, Henderson (Community health workers) 10-12: North Shore Asian community meeting, St John Centre, Takapuna (Asian focused community meeting) to Auckland & Waitemata press and Women s Health Collaboration maternity stakeholders advising of additional week extension of public consultation (with links to Reo Ora site) Extension update on Blog linking public to online consultation on Reo Ora site on Waitemata DHB facebook site Extension update on Banner linking public to online consultation on Reo Ora site on Waitemata DHB website Extension update on Banner linking staff to online consultation on Reo Ora site on Waitemata DHB intranet homepage Mon, 29/Feb Fri, 04/Mar Fri, 04/Mar Mon, 07/Mar 9-10: Te Puna Hauora Staff meeting, Northcote (Maori focused healthcare provider meeting) Ohana teen parents group, West Auckland (Teen parent focussed meeting) Tongan Self-Management Education group, New Lynn (older adult) 7am Reo Ora Website Primary Birthing Unit consultation information and survey (closed) End of public consultation period

141 Appendix 3: Key partners and community networks Group Womens Health Stakeholder Network General community Outcome Promoted to participants (approx. 150) Auckland DHB & Waitemata DHB Womens Health Collaboration stakeholders, who were encouraged to share with their networks across Health and Community organisations involved in Womens Health. The two Health Links were a key partner for the two general community forums. They published information in their newsletters and actively promoted through their networks with particular encouragement to attend the events. Health links also helped to distribute posters through Plunket and childcare groups and enabled participation in networks eg in Ranui. The North Shore Community Co-ordinators also helped to spread the word through their networks and while there were opportunities to attend their community family days, the team was too stretched. Maori community Disability community Asian community Worked in partnership with Te Runanga o Ngati Whatua to help encourage involvement and participation in the Maori community forum. Discussions also took place with Te Puna and with the Waipareira Trust. Promoted through the disability networks and a sign language interpreter was offered for the two general community events but not required. The Asian Network Incorporated (TANI) were a key partner and supported the two Asian community events in Kelston and Takapuna. TANI encouraged attendance at the events from people enrolled in their Healthy Babies Healthy Futures programme, promoted the consultation through their networks and social media and provided time at their network meeting to talk about the consultation and gather feedback. The Chinese New Settlers Services Trust also promoted through their networks through Chinese social media sites and attended the North Shore Asian community event. Youth Pacific community Refugee and migrant communities Cultural performers were arranged for both Asian community events which further encouraged participation from the Chinese and Korean communities. Promoted through Youthline, the Youth Health Hub and Youth Horizons Trust. Connections with Teen Parents, the Positive Parenting network and the Ohana Young Parents Unit Worked in partnership with the Fono to support attendance at the west Pacific community forum and to enable discussion with Enua Ola and other small Pacific group meetings. North Shore Pasefika forum were a partner in delivering the North Shore Pacific community forum and they helped to spread the word through local churches and through social media. Gained support from the Auckland regional refugee migrant team to connect with key groups such as the WISE women s collective and the Safari playgroup in West Auckland. Also met with De Paul House on the North Shore

142 Appendix 4: People involved in consultation Waitemata DHB staff involved in consultation meetings and promotion: Carol Hayward* Wendy Devereux* Linda Harun* Peter van der Weijer* Emma Farmer* Ruth Bijl * Lita Foliaki* Leani Sandford* Sangeeta Shah* Wai Vercoe* Aroha Haggie* Galuafi (Galu) Lui Grace Ryu Samantha Dalwood Bruce Levi Christine Mellor Sue Fitzgerald Louise Elia - Kaumatua Frank Taipari - Kaumatua Jay O'Brien Samantha Bennett Lifeng Zhou Sione Feki Consumer and partner organisations involved in consultation meetings, support and promotion: Jesse Solomon (Waitemata DHB Consumer Liaison)* Isis McKay (Auckland DHB Consumer Liaison)* The Fono: Hira Harema, Lingi Pulesea North Shore Pasefika Forum: Gaylene Wilson, Maria Lafaele Maria Assumpta Catholic Church: Fr Ikenasio Vitaliano (Parish Priest) TANI: Samuel Cho, Vishal Rishi and Lily Xu Te Runanga o Ngati Whatua: Te Hao Apaapa-Timu, Matua Heta Tobin Youth Health Hub: Junior Tavai Waipareira: Susan Van der Plas & Audrey Tinsley Te Puna: John Marsden Waitakere Health Link Tracy McIntyre, David Lui, Farhana Buksh, Kay Lindley, Noelene Coppell, David Lui Health Link North Wiki Shepherd Sinclair, Lorelle George, Jennie Michel, Tanya Binzegger Ohana Young Parent Unit: Kerry Leonard and Sam Molesworth * Womens Health Collaboration - Primary Birthing Unit Consultation Project Team

143 Appendix 5: References Hollowell J, Puddicombe D, Rowe R, Linsell L, Hardy P, Stewart M, et al. (2011). The Birthplace national prospective cohort study : perinatal and maternal outcomes by planned place of birth. Birthplace in England research programme. Final report part 4. United Kingdom. Farry, A. (2015). A retrospective cohort study to evaluate the effect of Place Presenting in Labour and Model of Midwifery Care on maternal and neonatal outocomes for the low risk women birthing in Counties Manukau District Health Board. Auckland University of Auckland Thesis available online at May 9, 2016:

144 Appendix 6: Consultation survey 18 January to 7 March 2016 Primary Birthing Unit Consultation Introduction Waitemata District Health Board (DHB) currently has primary birthing units in Helensville, Warkworth and Wellsford and is considering opening a new primary birthing unit in West Auckland, followed by one on the North Shore. Community support is a key factor in whether a unit is well used or not, so the DHB is holding a public consultation to hear what communities, individuals and health professionals think. What is a primary birthing unit Primary birthing units are places where healthy women with no complications can give birth, then stay for a day or two afterwards. They are staffed by midwives and have a relaxed homely feel. They are family friendly and partners are often able to stay overnight. Research says that giving birth in a primary birthing unit is safe for women with no complications. Primary birthing units have all the necessary equipment for normal birth. Women transfer to a hospital if they need epidurals or caesareans. Primary birthing units are free to all women eligible for publically funded healthcare (if the unit is public or has a contract with the DHB). How to have your say This consultation is important to help the DHB understand where a primary birthing unit should be located, what facilities should be there and how the unit should be managed. It will help us understand what would encourage the community to use the unit. Consultation will begin on Monday 18 January and will close on Monday 7 March As part of the consultation, there will be community events, an online survey and information available in a wide range of places including online at Where possible, the DHB will provide a speaker on request to talk with community groups or networks. This survey can be completed by individuals, community organisations, health professionals or any interested persons. It will take 5-10 minutes to complete. You do not need to complete all questions but we do ask you to provide your name and address so that we can keep you informed of the results and outcome of this consultation. Please let others know about the consultation so they can have a say too. Everyone who provides feedback will be invited to enter into a prize draw for a $50 supermarket voucher. engagement@waitematadhb.govt.nz to register for events direct, if you have any queries or would like to request a speaker. The consultation closes on Monday 29 February

145 Your feedback Your contact details As this is a public consultation your name and or postal address are required to help us feel confident that the feedback we receive is genuine. Your name and address will not be published. We will not use your name and contact details for any purpose apart from entering you into a prize draw for a $50 supermarket voucher and providing you with feedback about this consultation. 1. Your name: 2. Your address (or postal address if you prefer): 3. What suburb/neighbourhood do you live in? This will be used to help us analyse the results of the consultation but is non-compulsory. 4. What would be important to you to have as part of a primary birthing unit? Please indicate if you think the features listed are essential, nice to have or not important. Features Essential Nice to have Not important Not sure Access to food for visitors All day visiting Birthing pool Breastfeeding support / advice Children's playground Clinic rooms for appointments (eg midwife, lactation consultant, physiotherapist) Easy to get to by car Easy to get to by public transport Family friendly Free car parking Language support Lounge area for families Other community health services nearby Partners able to stay overnight Pregnancy & parenting classes Private ensuite bathrooms Private garden area Tasty healthy meals 5. Do you have any other suggestions?

146 6. Is it more important for the primary birthing unit to be closer to home or closer to the hospital? Please indicate your preferred location using the scale of closer to home closer to hospital 7. Do you have any preference on which suburb/neighbourhood it should be located? 8. Why do you think this? Primary Birthing Units come in a range of different designs to suit community needs. If a primary birthing unit is closer a hospital it is easier for a woman to transfer to hospital if needed. If the Primary birthing unit is located in the community there is a greater chance of a woman having a normal birth. For the baby, all options are equally safe. UK Birthplace study In the question below we have described the options that the Waitemata DHB is considering. Use the pictures below to rank the kind of primary birthing unit you would prefer - you can choose as many or as few as you like. 9. Please indicate your order of preference from 1st choice being your most preferred to 4th choice being your least preferred Image Explanation 1st choice Located in a hospital, next to or very close to the maternity unit. 2nd choice 3 rd choice 4 th choice Located in the community, operated by the DHB. Located on hospital grounds in a separate building, with its own entrance Located in the community, operated by a private or community contractor, but still free

147 10. Would you recommend a primary birthing unit to someone having a baby? Please use the scale of 0-10 to identify your likelihood of recommending one. 0 definitely not definitely would Don t know 11. If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit? If you are not hoping to have a baby in the future, please go to the next question. Please use the scale to identify your likelihood of using one 0 definitely not definitely would Not relevant 12. Do you have any comments to help us understand your answers to the previous questions? 13. Do you have any other comments or feedback? About you We would be grateful if you could answer a few questions about yourself to help us to understand how well we have reached our community. These questions will not be used to identify individuals but may help us to understand if there are different perspectives from different parts of the community. 14. Gender: Female / Male / Gender diverse / Prefer not to say 15. Age group: 19 years or less years years years 55+ Prefer not to say 16. Which ethnic group do you belong to? Please select as many options that apply below. New Zealand European Chinese Other European Indian Maori Japanese Samoan Korean Cook Islands Maori Other Asian Tongan Middle Eastern Niuean Latin American Tokelauan African Fijian Other please state Other Pacific Peoples Prefer not to say Filipino

148 17. Are you submitting on behalf of an organisation or group? No / Yes please specify 18. Do you align yourself with any of the following? Please select all that apply. Consumer / maternity service user Māori organisation Pacific peoples organisation Asian organisation Youth organisation Women s health organisation LMC Midwife LMC Obstetrician DHB maternity clinical staff Community health provider Private health provider Government / Ministry of Health Union Other please specify Prefer not to say 19. If you are a Lead Maternity Carer which area or areas do you work in? Please select all that apply. West Auckland North Shore Rodney Auckland Central Other please specify Prefer not to say 19. Would you like your name to be entered into the prize draw for a $50 supermarket voucher? Yes / No 20. Are you interested in being added to the mailing list to get involved in future maternity services improvements across Auckland and Waitemata DHBs? More information about the programme of work is at the following link. Note you will be able to unsubscribe at any time. Yes / No 21. Would you be interested in being added to the new Waitemata District Health Board Reo Ora Health Voice online community panel to have your say on other health matters? You will be sent links to other online surveys or occasional invitations to participate in community forums and focus groups. Note you will be able to unsubscribe at any time. Yes / No Thank you for your feedback Thank-you for your feedback and having your say about primary birthing options for the Waitemata District Health Board. What's next Feedback closes on Monday 7th March 2016 (extended deadline). Please also encourage your friends, families and networks to participate if you feel they would be interested

149 All feedback provided through events and through this survey will be collated, analysed and provided to the Waitemata DHB Board to make a final decision on primary birthing unit options. We will provide you with an update later this year on the results of the consultation, when decisions have been made and with other opportunities to get involved

150 Board and Committee Meeting Schedule Recommendation: a) That the Board approves the attached meeting schedule for 2017, with meetings scheduled on a six weekly meeting cycle as follows: i. The Waitemata DHB Board, Audit and Finance Committee and Hospital Advisory Committee meetings schedule follows the current basis for meetings to be on a six weekly meeting cycle. ii. The combined Auckland DHB and Waitemata DHB Disability Support Advisory Committee and the Maori Health Gain Advisory Committee continue to meet four times per year on a six weekly meeting cycle. iii. That the combined Auckland and Waitemata DHB Community and Public Health Advisory Committees will meet four times per year on a six weekly meeting cycle, bringing the Committee into alignment with the combined Auckland DHB and Waitemata DHB Disability Support Advisory Committees and the Maori Health Gain Advisory Committees meeting schedule. b) That the Board approve an amendment to the Terms of Reference for the combined Auckland and Waitemata DHB Community and Public Health Advisory Committees to meet in a combined forum four times per year, as noted in recommendation a) iii. above. Prepared by: Peta Molloy (Board Secretary) Endorsed by: Dr Lester Levy (Chairman) Note: the proposed Schedule has also been referred to the Auckland DHB Board for approval. Glossary ADHB CPHAC DSAC MHGAC WDHB - Auckland District Health Board - Community and Public Health Advisory Committee - Disability Support Advisory Committee - Manawa Ora (Maori Health Gain Advisory Committee) - Waitemata District Health Board 1. Summary It is proposed that the 2017 Board, Audit and Finance Committee and Hospital Advisory Committee meetings schedule follows the current basis for meetings to be on a six weekly meeting cycle. It is proposed that there be a change to the frequency of the combined ADHB and WDHB Community and Public Health Advisory Committees (CPHAC) meeting and that it be held four times per year. This will allow the Committee to better optimise its use of time and align the schedule with the current combined ADHB and WDHB DSAC and MHGAC meetings. These Committee meetings will continue to operate on a collaborative basis with ADHB within the six weekly meeting cycle. Waitemata District Health Board, Meeting of the Board 29/06/16 150

151 The proposed six weekly meeting cycle for 2017 follows below and the attached 2017 meeting schedule (attachment 1) designates the dates for each Board and Committee meeting and is coordinated with Auckland DHB s cycle. The schedule allows for the week five meeting day to be dedicated to the Board meeting only (week five also includes the ADHB and WDHB Collaboration Committee). Regular health and safety site visits will also be held on weeks three and six following any combined Committee meetings scheduled, timing and dates of the visits will be coordinated by the Board Secretaries at both ADHB and WDHB. In addition, Board members will be allocated lead roles in specific critical areas of activity: patient safety, patient experience, finance/budgets, health and safety, IT/innovation, facilities/equipment, primary care/ngos/community care, care of elderly, mental health and risk. Board members will need to spend time on and develop particular knowledge around their lead role area. The proposed cycle for 2017 follows the pattern (all meetings on Wednesdays): Current Week 1 ADHB Audit and Finance and DiSAC or Manawa Ora Week 2 WDHB Audit and Finance and CPHAC Week 3 may be used at times for special meetings, workshops and the like Week 4 ADHB HAC and ADHB Board Week 5 WDHB HAC and WDHB Board Proposed Week 1 ADHB Audit and Finance and ADHB Hospital Advisory Committee Week 2 WDHB Audit and Finance and Hospital Advisory Committee Week 3 Manawa Ora/CPHAC and DiSAC (alternating) followed by a Health and Safety site visit * Week 4 ADHB Board Week 5 WDHB Board** Week 6 may be used at times for special meetings, workshops and the like Week 6 Health and Safety site visit (may also be used at times for special meetings, workshops and the like) *** * Time can be assigned to lead roles on these days (weeks 3 and 6. ** The ADHB and WDHB Collaboration Committee will continue to be held on the WDHB Board meeting day. The only variation to this is in December, because week 5 falls on Wednesday 20 th December, it is proposed to hold the WDHB Board meeting on Thursday 14 th December The proposed cycle for the two Boards for 2017 commences on 01 st February and concludes on 15 th December. Once both Boards have confirmed the schedule, a final schedule showing venues will be distributed to Board and Committee members, staff and interested parties and included on the DHB s website. Note: Elections 2016 Elections are due on Saturday 8 th October 2016, with newly elected members coming into office on 5 th December This means that (in addition to induction sessions) both ADHB and WDHB newly elected members will have one Board and HAC meeting day prior to the end of the calendar year. Waitemata District Health Board, Meeting of the Board 29/06/16 151

152 Proposed 2017 Waitemata DHB Meeting Schedule Attachment 1 Six weekly meeting cycle: Week 1: ADHB Audit and Finance and HAC; Week 2: WDHB Audit and Finance Committee and HAC; Week 3: MHAC or CPHAC and DiSAC*; Week 4: ADHB Board; Week 5: WDHB Board; Week 6: no regular scheduled meeting* * Health and safety site visits will be schedule on weeks 3 and/or 6 COMMITTEE TIME JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Audit and Finance Committee Hospital Advisory Committee 8.30am 1.30pm 08/02 22/03 03/05 14/06 26/07 06/09 18/10 29/11 08/02 22/03 03/05 14/06 26/07 06/09 18/10 29/11 Maori Health Gain Advisory Committee (Manawa Ora) (MHGAC) Community and Public Health Advisory Committee (CPHAC) Disability Support Advisory Committee (DSAC) Week 3: Health and Safety site visits BOARD Board Only Time Board meeting open following by confidential Board HR Sub- Committee 10.00am 10.00am 1.30pm tba 9am 9.45am tba 15/02 10/05 02/08 25/10 29/03 21/06 13/09 06/12 29/03 21/06 13/09 06/12 15/02 29/03 10/05 21/06 02/08 13/09 25/10 06/12 01/03 12/04 24/05 05/07 16/08 27/09 08/11 14/12 Week 6:Health and Safety site visits 08/03 19/04 31/05 12/07 23/08 04/10 15/11 n/a Waitemata District Health Board, Meeting of the Board 29/06/16 152

153 7.1 Performance Recommendation: That the following performance reports for the month and attachments be received: 1 Financial Overview of the 2015/16 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury Prepared by: Rosemary Chung (Deputy Chief Financial Officer) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services) Waitemata District Health Board, Meeting of the Board 29/06/16 153

154 1 Financial Overview of the 2015/16 result The planned 2015/16 financial result for Waitemata DHB is a surplus of $2.811m with $1.811m to be generated in the Funder Arm and $1m in the Provider Arm and breakeven result in the Governance Arm. For the month of April, the consolidated DHB result is a surplus of $969k against a budgeted surplus of $956k and is therefore $12k favourable to budget. The Provider arm is $3.571m unfavourable to budget, the Funder Arm is $3.580m favourable to budget. The Governance and Funding Arm is $4k favourable to budget. Year to date (YTD), the consolidated DHB result is a surplus of $31k against a budgeted deficit of $625k and is therefore $656k favourable to budget. The Provider Arm is $13.898m unfavourable to budget, the Funder arm is $14.350m favourable to budget and the Governance and Funding Admin Arm is $203k favourable to budget. The month end and the year to date result is consistent with the forecast for the year of a modest surplus. The financial result for the month of April 2016 compared to the budget is summarised in the table below. WAITEMATA DISTRICT HEALTH BOARD CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date 30 April 2016 ($000's) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Forecast Budget Variance REVENUE Crown 129, ,891 1,112 1,281,766 1,279,409 2,357 1,535,311 1,535,311 0 Other 2,348 2, ,774 22,274 (500) 28,149 28, , ,182 1,170 1,303,540 1,301,683 1,857 1,563,460 1,563,460 0 EXPENDITURE Personnel - Medical 14,617 12,976 (1,641) 139, ,394 (2,337) 163, , Nursing 19,521 18,269 (1,252) 182, ,161 (4,654) 213, , Allied Health 9,766 8,726 (1,040) 88,722 88,179 (543) 106, , Support 1,443 1,231 (212) 12,919 13, ,858 15, Management / Administration 5,888 5,195 (693) 57,236 56,935 (301) 67,467 67,467 0 Total Personnel 51,235 46,397 (4,838) 481, ,776 (7,646) 566, ,650 0 Other Outsourced Services 6,986 5,556 (1,430) 60,907 55,667 (5,240) 67,023 67,023 0 Clinical Supplies 9,257 8,512 (745) 91,680 84,957 (6,723) 101, ,429 0 Infrastructure & Non-Clinical Supplies 9,199 7,788 (1,411) 86,037 78,187 (7,850) 93,882 93,882 0 Funder Provider Payments 53,706 60,972 7, , ,722 26, , , ,148 82,828 3, , ,533 6, , ,000 0 Total Expenditure 130, ,225 (1,157) 1,303,510 1,302,309 (1,201) 1,560,649 1,560,649 0 NET RESULT (625) 656 2,811 2,811 0 Waitemata District Health Board, Meeting of the Board 29/06/16 154

155 Comment on Major Variances Revenue Revenue is $1.857m YTD favourable to budget. ACC revenue is $549k favourable due to additional volumes in non acute rehab beds. Expenditure Overall expenditure was unfavourable to budget by $1.201m year to date. The key variances are summarised below: Personnel Costs ($7,646k unfavourable year to date) Variances in Personnel Cost categories were as follows: Medical staff costs are unfavourable by $2,337k Year to date. This unfavourable variance was contributed to by Medical and Health of Older People Services of $1,916k, Surgical & Ambulatory Services $604k. Child Women and Family of $501k, largely due to leave balance expenses greater than expected, and having to cover shortfalls with higher qualified staff. This is offset in Mental Health and Corporate by $475k due to vacancies and use of contract staff and $670k in relation to unpaid day leave accrual reversals. Nursing staff costs are unfavourable by $4,654 Year to date. This unfavourable variance is contributed to by higher than expected volumes and acuity resulting in additional individual patient observations (watches) on the wards and in the Mental Health in patient units (including Forensic Mental Health), the cost of statutory holiday adjustments and MECA holiday revaluations. Allied Health staff costs were unfavourable to budget by $543k for the year to date mostly due to vacancies savings due to difficulties in recruitment. Support staff costs are favourable by $189k mainly reflecting cleaners and orderly not incurred as support personnel as budgeted, with corresponding unbudgeted costs in the outsourced services cost category. Management and Admin staff costs are unfavourable by $301k. This result is contributed to by under spends in corporate of $247k, partly offset by use of contractor costs incurred as part of outsourced services. Outsourced Services Costs ($5,240k unfavourable for the year to date) Overall, outsourced nurse bureau costs were adverse by $2,288k reflecting high external bureau for nursing cover. Agency costs for casual orderlies and cleaners are greater than budget by $1,110k. The total cost also includes savings targets. Clinical Supplies Costs ($6,723k unfavourable for the year to date) Significant overspends in clinical supplies were incurred in: Medicine and Health of Older People services unfavourable to budget by $486k. Mobility aids unfavourable at $284k continues to be the major contributor. Renal fluids are favourable to budget by $268k. Hospital Operations is unfavourable to budget by $1,798k, due to increased volumes and centrally budgeted savings. Laboratory consumables and sendaway tests are unfavourable primarily due to a 7% increase in Microbiology testing for influenza and VRE screening. Blood product (Intragram) has increased 52% on last year. Provider Management and Corporate Services is unfavourable to budget by $3,867k, due to actual depreciation greater than budget ($1,045k) and budgeted savings not being achieved on the same expense line of $2,005k. Waitemata District Health Board, Meeting of the Board 29/06/16 155

156 Infrastructure costs ($7,850k unfavourable for the year to date) The unfavourable variance relates in part to unbudgeted maintenance of $874k, fire levy price increase $159k and utility budget variances of $531k. The variance also includes $9,301k savings targets. Whilst some actual savings are included in relevant expense lines, overall savings are tracking behind budget. The Provider has a number of patient care/patient flow reviews are underway to identify opportunities for greater patient experience and efficiencies. Funder Provider Payments ($26.259m favourable for the year to date) Funder Provider payments as reported in the Consolidated Statement of Financial Performance table are inclusive of Funder NGO payments and Funder IDF payments but do not include payments made to the Waitemata Provider Arm. The $26.26M favourable variance is gross of corresponding Provider Arm payments of $13.07M additional to budget that offset. Commentary on key drivers of the favourable Funder position are summarised under the Funder Financial Performance section that follows later in the report. Personnel Costs and Outsourced Service Costs Various measures are in place to get the unfavourable Personnel and Outsourced Service Costs variances back on track. These measures include constant monitoring of overtime hours taken, follow up with staff on sick leave taken, introduction of a pilot programme to more closely manage the use of watches. New HR reporting is being introduced to enable Managers to more closely manage Personnel expenditure. Clinical Supplies and Infrastructure Costs To get Clinical Supplies and Infrastructure costs back on track, management are continually working on procurement initiatives to identify savings. Savings have included successful price negotiations completed by healthalliance, substitution of products to achieve greater value, increasing the number of products available on catalogue to take advantage negotiated prices, introduction of a Kanban stock system in some wards, which has reduced stock levels and creation of available space for alternative usage. Waitemata District Health Board, Meeting of the Board 29/06/16 156

157 2 Financial Performance - DHB Arms The financial performance for each of the DHB Arms for the month and the year is summarised in the table below, and the detailed statement of Financial Performance by DHB Arm is attached to this report (Attachment 1). WAITEMATA DISTRICT HEALTH BOARD FINANCIAL PERFORMANCE BY DHB ARM Reporting Date 30 April 2016 ($000's) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Forecast Budget Variance REVENUE Provider Arm - Clinical Services 5,092 4, ,004 44,839 4,165 53,838 53,838 0 Provider Arm - Corporate & Support Services 67,808 63,624 4, , ,637 9, , ,493 0 Governance & Funding Admin Arm 1, ,229 9, ,972 11,972 0 Funder 124, , ,236,504 1,235,339 1,166 1,482,406 1,482,406 0 Elimination (66,627) (62,411) (4,216) (637,182) (624,108) (13,074) (748,929) (748,929) 0 Consolidated 131, ,182 1,170 1,303,540 1,301,683 1,857 1,561,780 1,561,780 0 EXPENDITURE Provider Arm - Clinical Services 52,383 48,644 (3,739) 536, ,178 (14,574) 624, ,768 0 Provider Arm - Corporate & Support Services 23,283 18,612 (4,671) 173, ,433 (12,836) 190, ,563 0 Governance & Funding Administration 1, (13) 10,026 9,976 (49) 11,972 11,972 0 Funder 120, ,383 3,051 1,220,645 1,233,829 13,184 1,480,595 1,480,595 0 Elimination (66,627) (62,411) 4,216 (637,182) (624,108) 13,074 (748,929) (748,929) 0 Consolidated 130, ,225 (1,157) 1,303,510 1,302,309 (1,201) 1,558,969 1,558,969 0 NET RESULT Provider Arm - Clinical Services (47,291) (44,206) (3,084) (487,749) (477,339) (10,410) (570,930) (570,930) 0 Provider Arm - Corporate & Support Services 44,524 45,012 (487) 471, ,204 (3,488) 571, ,930 0 Governance & Funding Admin Arm 4 (0) (0) 203 (0) (0) 0 Funder 3, ,580 15,859 1,509 14,350 1,811 1,811 0 Elimination 0 (0) 0 0 (0) Consolidated (625) 656 2,811 2, Provider Clinical Services The Provider Clinical services result for the ten months ended 30 April 2016 is $10,410k unfavourable to budget. This is attributed to by an unfavourable performance in Child Women and Family services $2,177k, Medicine and Health of Older People services $6,898k, Surgical and Ambulatory Services $1,900k, Elective Surgery Centre $295k offset by a favourable performance in Mental Health services $859k. The key drivers for services financial performance are summarised below. Medicine and Health of Older People The service is $6,898k unfavourable for the ten months ended 30 April Medical and Health of Older People YTD result is driven by a significant increase in demand for constant observation (watch) shifts $985k unfavourable, as well as increased nursing demand, particularly in the two EDs. The service was also impacted by leave revaluations following the MECA uplift, this is compounded by a general problem of enabling staff to take all of their annual leave entitlement. Acute demand continues to exceed contracted levels with General Medicine WIES and ED presentations both running at 108% and 106% of YTD contract respectively, resulting in higher than anticipated demand for personnel and supply costs. Surgical & Ambulatory Services The Service is $1,900k unfavorable year to date. The financial result this month is unfavourable due to the costs of running additional sessions in order to catch up on elective orthopedic volumes while managing the sustained high level of acute volumes. The unfavorable result year to date is due to higher than planned service activity year to date, with acute volumes across SAS and ESC of 187 WIES above plan year to date April and Elective Discharges at ESC 144 above plan, against which anesthetist costs are incurred at SAS and recharged to ESC.Lower ACC revenues, unmet savings lines and unbudgeted nursing costs associated with running additional beds in the short stay ward. Cost containment initiatives have been partially successful in mitigating unbudgeted costs incurred this year, however, it is clear that a more proactive approach will be needed to secure financial sustainability in FY16/17. Operational planning is well underway to ensure a strong start to 2016/17. The new HR reporting series will afford better visibility of external agency and overtime hours, sick leave taken and the progress of active leave management plans for all staff. Cover models have been updated for all wards and theatres and coupled Waitemata District Health Board, Meeting of the Board 29/06/16 157

158 with the Bureau Booking system will afford better reporting and compliance of acuity cover and the standard hours rostered on the floor. The Procurement Management Team are seeing some good initiatives coming through and work is being done to secure better reporting for services in order to track savings realised within the new financial year. Other initiatives such as ERAS and OPIVA while not contributing direct savings will continue next year and do provide greater efficiencies through reduced lengths of stay and better patient outcomes, delaying the need for additional beds. Elective Service Centre The service is $295k unfavourable year to date due to higher than planned elective volumes, 5.3% above plan year to date. Costs associated with the number of discharges have offset savings that might otherwise have been realised through under delivery of more complex cases. The year end forecast is for an unfavourable financial result as the service is planning to over-deliver on budgeted volumes to ensure the overall surgical programme meets the Waitemata DHB Surgical health Target. Careful management of elective volumes between the SAS and ESC in the new year will limit over production (leading to budget overspends) while managing ESPI compliance. Child Women & Family Services The service is $2,177k unfavourable to budget for year to date April 16. Revenue is $400k favourable year to date, driven by new service level agreements and several unplanned funding streams culminating to provide some relief against other unfavourable income and expenditure lines. Personnel costs are tracking $985k over budget and are attributed to a combination of high Medical allowances for covering registrar shortages, sick and sabbatical leave, cover for a regional shortfall in midwives, budget pricing issues within Allied Health staffing, unexpected back pay and several retirements. Personnel costs are being partially offset by under spending in other Allied Health and Management/Admin due to vacancies. Over spending in Outsourced costs $609k is being driven by a mixture of embedded savings $302k, nursing bureau $135k for sick and roster shortages, unbudgeted Anaesthetist costs and external postnatal services. Partially offsetting these costs are under spends in community radiology charging and lab send away tests. Embedded savings initiatives $165k per month remain a significant challenge. The service is looking to further build on the savings that are currently being realised through annual leave reduction, pricing benefits on community nursing continence supplies, specific dental and maternity products by exploring other areas such as community based logistics costs, telecommunications plans, cleaning and repairs and maintenance contracts to ensure that the services are getting value for money. Other group initiatives to support cost containment include the introduction of the Kanban stock management system across all inpatient wards and the creation of clinical supplies coordinator roles across North Shore and Waitakere Hospital to support this process by reducing potential over ordering and purchasing errors. A change in the model of care for Gynaecology patients is to be introduced in July 2016 resulting in a more cost effective, efficient and less invasive patient care. Mental Health Services Mental Health s favourable YTD variance after April $859k is primarily the result of revenue from the new CADs contract for drug referrals from the Ministry of Justice $625k and also the impact of high YTD vacancies in nursing $1,277k. This is partially offset with high overtime in nursing $471k due to the combination of: a) roster/sick cover particularly in the Adult and Forensic services b) high acuity care in the Forensic inpatient units where 4 patients require dedicated 2-on-1 or 3-on-1 observations and c) additional security in the Adult MHS, where staffing has been increased in Waiatarau and He Puna Waiora units to improve supervision of the courtyard areas as a result of security concerns earlier in the year. Control of overtime remains a priority for the MHSG and introduction of better management tools has resulted in a 283 hour (23%) reduction per week in average Forensic overtime hours since July SMO Waitemata District Health Board, Meeting of the Board 29/06/16 158

159 covering gaps in the registrar roster $292k in Adult and Forensic services follows an increased number of Registrar vacancies this year and excessive targeting of this account for budget savings in previous years. The Audit and Finance Committee have approved the business case for CAMHS increased service capacity in Rodney, with this service commencing from April. 2.2 Corporate and Support Services The overall result for Provider Support is $3.488m unfavourable for the year to date. Expenditure budget is overspent by $12.836m mainly due to unbudgeted repairs and maintenance $557k, outsourced colonoscopies $524k, unbudgeted gratuity and maternity leave payments $3.308m, overspends in additional cleaning and orderlies costs and clinical supplies in Hospital Operations due to increased volumes and centrally budgeted savings. Laboratory consumables and sendaway tests are unfavourable primarily due to an 8% increase in Microbiology testing. Blood product (Intragram) has increased 58% on last year. This is offset by additional revenue received of $9.347m received being $756k for outsourced colonoscopies (offset by unbudgeted outsourced costs), deficit support of $3.272m, additional funding for acute over delivery of $4.6m, additional revenue for outpatient pharmacy $373k and orthopaedic outsourcing $346k. 2.3 Financial Performance Funder The Funder position as reported in the Financial Performance by DHB Arm table represents the totality of the Funder and is inclusive of Funder Own Provider Arm Services, Funder NGO Services and Funder IDF Services. The Funder net result is $3.58M favorable to budget for the month and $14.35M favorable to budget for the year to date. The $14.35m favorable year to date variance is a net position that includes $4.17m of a budgeted $5.0M Inpatient IDF risk assessed as not needing to be accounted for. It also includes a favourable PHARMAC GST adjustment of $1.3M relating to 2014/15 as well as a favourable interim PHARMAC GST adjustment of $0.7M for the 2015/16 year. It further includes $4.9M of post budget favourable revision by PHARMAC of Drug rebates for 2015/16. It also includes various other prior year accrual releases of $1.5M and 2015/16 budgeted immunisation risk of $0.9M and a budgeted 2015/16 PHO IDF risk of $0.7M not being accounted for. 2.4 Financial Performance - Governance and Funding Administration Arm The Governance and Funding Administration (GFA) represents the Waitemata DHB share of the Joint Planning Funding and Outcomes Arm and includes the Waitemata DHB share of the Northern Regional Alliance. The GFA Core Net Result is $203k favourable to budget for the year to date. Waitemata District Health Board, Meeting of the Board 29/06/16 159

160 3 Financial Performance Other Indicators/Trends 3.1 Net Result The actual net result performance against the budget for the DHB tracked over time is illustrated in the graph below. The overall DHB result for the ten months to 30 April 2016 is $31k favourable which is $656k ahead of budget. The current full year forecast remains on budget at $2,811k. Waitemata DHB Surplus/(Deficit) By Month 10,000,000 8,000,000 6,000,000 4,000,000 2,000, ,000,000-4,000,000-6,000,000-8,000,000-10,000,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 2014/ /16 Budget Actual 3.2 Business Transformation Savings The 2015/16 financial plan includes business transformation savings of $4.150M. The savings plan is on track as summarised in the table below: Waitemata DHB Summary of Key Actions that will impact Financial Performance $000's Full Year Year to Date May-16 KEY ACTIONS - with brief description* Plan Actual Plan Variance Commentary on / Explanation of Variance FY14/15 Service Reconfigurations Regional Dental Service Reconfiguration (468) Invoicing arrangements are still being worked through for services delivered year to date. Standardisation of Clinical Supplies - Renal Fluids Savings are on track year to date. Standardisation of Clinical Supplies - Respiratory Savings are on track year to date. Standardisation of Clinical Supplies - Clinical Supplies Management Savings are on track year to date. Standardisation of Clinical Supplies - Food service contract (2) The contract was delayed until August, savings are anticipated for the remainder of the year. Standardisation of Clinical Supplies - Gastro supplies Savings are on track year to date. Standardisation of Clinical Supplies - Gastro chemicals (28) Savings are anticipated from Q2 Standardisation of Clinical Supplies - Dental Suppplies (23) Savings are a little lower than anticipated due to some more costly items being required. Investment in Revenue Generation - Child Rehab - ACC Funding / Referrals Additional ACC revenues have been realised year to date within Child Rehab services. Review and rationalisation of facilities - Rental space in Mental Health Savings are on track year to date. Review and rationalisation of facilities - Opthalmology facilities at Waitakere to accomodate additional volumes Savings are on track year to date. Review of staffing rosters and models of care (2) Savings are on track year to date. Pharmaceuticals - Cost management 1, Savings are on track year to date. Banking and finance - Treasury management 1, Savings are on track year to date. Total 4,150 2,562 2,796 (233) Waitemata District Health Board, Meeting of the Board 29/06/16 160

161 4 Capital Expenditure Capital expenditure planned for the 2015/16 year is $85.652M. The table below summarises performance against the capital expenditure budget for the month and for the year. The detailed capital expenditure statement is attached to this report (Attachment 2). $'000s Full Year Budget Month (Apr-16) YTD (Apr-16) Actual Budget Variance Actual Budget Variance Land 5, ,850 5,000 3,850 Buildings & Plant 48,954 4,631 5,320 (689) 41,254 43,801 (2,547) Clinical Equipment 10, (593) 5,226 8,345 (3,119) Other Equipment 3, ,718 3,211 (1,493) Information Technology 12, ,240 (572) 3,133 10,331 (7,198) Motor Vehicles 1, (140) 509 1,400 (891) Purchase of softw are 3, ,330 (3,330) Total Capital Expenditure 85,652 6,070 7,959 (1,889) 60,690 75,418 (14,728) As at April 2016, capital expenditure is $14.728m below the plan. Underspend in Information Technology is due in part to resourcing issues. Progress on implementation of major facilities capital projects is reported monthly to the Audit and Finance Committee via the Facilities and Development report. There are no significant departures from the plan; the under spend solely reflects the timing of the completion of projects. 5 Financial Position The financial position as at 30 April 2016 is shown below. This indicates a strong balance sheet, with net worth of $ m including $110m in cash and deposits. The favourable equity position to budget was due to the increase in property valuation ($54m) in June 2015 following detailed valuations. The detailed Statement of Financial Position for the DHB Parent is provided as Attachment 3. Opening Apr-16 Apr-16 Apr-16 Full Year In $'000s 30 Jun-15 Actual Budget Variance Budget Crown Equity 304, , ,897 65, ,897 Represented by : Current Assets 185, , ,137 54, ,177 Current Liabilities 267, , ,108 (41,094) 252,051 Net Working Capital (81,576) (128,226) (141,971) 13,745 (147,874) Fixed Assets 667, , ,616 23, ,900 Term Liabilities 281, , ,748 28, ,129 Total Employment of Capital 304, , ,897 65, ,897 6 Cash flow Position $'000s Month YTD Actual Budget Variance Actual Budget Variance Opening cash 0 73, ,385 Operating 3,949 2,137 1,812 27,256 21,370 5,886 Investing (6,070) (7,959) 1,889 (88,690) (75,418) (13,272) Financing 2, ,121 61, ,434 Closing cash 0 67,337 5, ,337 54,048 Closing Cash Balance in HBL Sw eep account 81, ,959 0 Summary of the cash flow statement as at 30 April 2016 is shown below. The detailed Cash flow statement is provided as Attachment 4. The DHB s cash position in the HBL sweep as at 30 April 2016 is $82m (last month $84m). The DHB also monitors performance in collecting amounts owed by other organisations; the total amount owed to the DHB as at 30 April 2016 was $14.0m (last month balance owed was $13.3m). 65% of this is Waitemata District Health Board, Meeting of the Board 29/06/16 161

162 within the 60 days period (46% of this relates to Ministry of Health and 21% to other DHBs). 35% is over 60 days and the majority of this is in the area most difficult to collect, i.e. non-residents income. An Accounts Receivables report and explanation for amounts overdue for more than 60 days is provided as Attachment 5. 7 Treasury 7.1 Financing Activity Term debt drawn and average interest expense and rates are shown in the tables below. Month Term Debt ($ 000s) CHFA Interest Expense ($ 000s) Jul , Aug , Sep , Oct , Nov , Dec , Jan , Feb , Mar , Apr , May-16 Jun-15 YTD 276,706 8,930 $ m of Crown debt was fully drawn as at 30 April All loan facilities have been drawn down as at 30 April The average interest rates on the loan portfolio are provided in the table below: NZD Available Facilities $000 Drawn Debt Current Month $000 Drawn Debt Last Month $000 Interest Rate Current Month CHFA Fixed $272,996 $272,996 $272, % CHFA Floating $3,710 $3,710 $3, % Total Facilities $276,706 $276,706 $276, % Monthly Weighted Average Interest Cost (Including Hedges & Margin) % Waitemata District Health Board, Meeting of the Board 29/06/16 162

163 7.2 Treasury Policy All Waitemata DHB debt shall be borrowed on either a fixed interest rate or floating interest rate basis, subject to the requirement that the overall percentage of fixed (fixed/floating master limit) in any time bucket must be in accordance with the following limits: The fixed rate amount at month-end reporting dates must be within the following maturity bands (percentages calculated on the fixed rate amount at month end): The interest rate re-pricing risk profile for the Waitemata DHB Crown debt is shown in the graph below: 7.3 Financial Covenants Waitemata DHB s performance against financial covenants (which are currently waived) is summarised below and compliance was achieved. Financial Covenants Actual Budget Covenant Met Shareholders Funds (=> $70 million) 305 m 239 m Yes Net Total Debt / (Net Total Debt + SHF) < 65% 50% 56% Yes ANZ Interest Cover EBITDA / Net Interest (> 1.5:1) Yes CHFA Interest Cover EBITDA / Net Interest (> 2.5:1) 8 8 Yes Waitemata District Health Board, Meeting of the Board 29/06/16 163

164 ATTACHMENT 1 Attachment 1 WAITEMATA DISTRICT HEALTH BOARD 30 April 2016 STATEMENT OF FINANCIAL PERFORMANCE BY DHB SERVICE GROUP MONTH Direct Revenue Direct Expenditure Contribution Net Result FTE's Head Count ($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Provider Medical Services 1, ,494 16,934 (1,560) (17,464) (15,963) (1,501) (17,464) (15,963) (1,501) 2,018 1,874 (144) 2,374 Surgical Services 1,676 1, ,591 13,678 (913) (12,915) (12,339) (576) (12,915) (12,339) (576) 1,125 1, ,287 ESC ,415 1,795 (619) (2,322) (1,750) (572) (2,322) (1,750) (572) (4) 97 Child, Women & Family Services 1,175 1, ,993 6,551 (441) (5,818) (5,463) (355) (5,818) (5,463) (355) (7) 1,168 Mental Health 1, ,891 9,685 (206) (8,771) (8,691) (80) (8,771) (8,691) (80) 1,269 1, ,391 Sub Total - Clinical Services 5,092 4, ,383 48,644 (3,739) (47,291) (44,206) (3,084) (47,291) (44,206) (3,084) 5,423 5,340 (84) 6,317 Hospital Operations ,824 5,431 (393) (5,002) (4,809) (193) (5,002) (4,809) (193) (225) 1,020 Facilities ,710 2,310 (400) (2,149) (2,260) 111 (2,149) (2,260) (49) 83 Provider Management 65,053 61,413 3,640 5,184 1,409 (3,775) 59,869 60,004 (135) 59,869 60,004 (135) 2 2 Corporate 1,371 1,539 (168) 9,564 9,462 (102) (8,194) (7,923) (270) (8,194) (7,923) (270) Sub Total - Corporate & Support Services 67,808 63,624 4,184 23,283 18,612 (4,671) 44,524 45,012 (487) 44,524 45,012 (487) 1, (171) 1,404 Total Provider 72,900 68,061 4,839 75,666 67,255 (8,411) (2,766) 806 (3,572) (2,766) 806 (3,572) 6,453 6,198 (254) 7,721 Governance & Funding Administration 1, , (13) 4 (0) 4 4 (0) Funder Arm Funder NGOs 35,015 38,702 (3,687) 31,280 38,551 7,271 3, ,585 3, ,585 Funder Inter District Flows 22,421 22, ,426 22,421 (5) (5) 0 (5) (5) 0 (5) Total Funder Arm 57,436 61,123 (3,687) 53,706 60,972 7,267 3, ,580 3, ,580 Consolidated 131, ,182 1, , ,225 (1,157) ,536 6,290 (246) 7,813 YEAR TO DATE Direct Revenue Direct Expenditure Contribution Net Result FTE's Full Year ($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Budget Provider Medical Services 10,836 9,707 1, , ,238 (8,026) (180,428) (173,530) (6,898) (180,428) (173,530) (6,898) 1,904 1,854 (50) 78,262 Surgical Services 14,921 13,639 1, , ,639 (3,182) (132,900) (131,000) (1,900) (132,900) (131,000) (1,900) 1,069 1, (15,476) ESC ,356 18,877 (479) (18,717) (18,422) (295) (18,717) (18,422) (295) ,960 Child, Women & Family Services 11,561 11, ,078 70,502 (2,576) (61,517) (59,340) (2,176) (61,517) (59,340) (2,176) ,893 Mental Health 11,047 9,877 1, , ,923 (311) (94,187) (95,046) 859 (94,187) (95,046) 859 1,224 1, ,803 Sub Total - Clinical Services 49,004 44,839 4, , ,178 (14,574) (487,749) (477,339) (10,410) (487,749) (477,339) (10,410) 5,154 5, ,442 Hospital Operations 8,402 6,133 2,269 59,341 55,596 (3,745) (50,939) (49,462) (1,477) (50,939) (49,462) (1,477) (172) (50,929) Facilities 1, ,222 27,161 23,813 (3,347) (25,433) (23,307) (2,126) (25,433) (23,307) (2,126) (44) (27,000) Provider Management 625, ,132 10,912 (1,167) (16,052) (14,885) 626, ,184 (3,973) 626, ,184 (3,973) 2 2 (3,549) Corporate 9,812 14,866 (5,054) 87,934 97,076 9,142 (78,122) (82,209) 4,088 (78,122) (82,209) 4, (58,964) Sub Total - Corporate & Support Services 644, ,637 9, , ,433 (12,836) 471, ,204 (3,488) 471, ,204 (3,488) (94) (140,442) Total Provider 693, ,476 13, , ,611 (27,411) (16,032) (2,135) (13,897) (16,032) (2,135) (13,897) 6,108 6, Governance & Funding Administration 10,229 9, ,026 9,976 (49) 203 (0) (0) Funder Arm Funder NGOs 375, ,019 (12,010) 358, ,510 27,296 16,795 1,509 15,286 16,795 1,509 15,286 1,811 Funder Inter District Flows 224, , , ,212 (1,037) (936) 0 (936) (936) 0 (936) Total Funder Arm 599, ,231 (11,909) 583, ,722 26,259 15,859 1,509 14,350 15,859 1,509 14,350 1,811 Consolidated 1,303,540 1,301,683 1,857 1,303,510 1,302,309 (1,201) 31 (625) (625) 656 6,192 6, ,811 Waitemata District Health Board, Meeting of the Board 29/06/16 164

165 ATTACHMENT 2 WAITEMATA DISTRICT HEALTH BOARD STATEMENT OF CAPITAL EXPENDITURE Month Ended 30 April 2016 Spend by Asset Category Service Budget 2015/2016 Child, Women & Family Sum of Spent YTD Apr 2016 Balance (Budget Remaining) Clinical Equipment 1,442, ,300 1,042,608 Contingency 19,264-19,264 Information Technology 99,150 13,350 85,800 Building 20,781 18,101 2,680 Motor Vehicle 209, ,953 Other Equipment 172,501 93,050 79,451 Child, Women & Family Total 1,964, ,801 1,439,757 Corporate Clinical Equipment 263, ,723 76,149 Contingency 8,960,465-8,960,465 Information Technology 6,029,720 1,021,082 5,008,638 Building 7,131, ,950 6,364,299 Other Equipment 583, ,101 (391,743) Corporate Total 22,968,664 2,950,856 20,017,808 Decision Support Contingency 2,094,081-2,094,081 Information Technology 7,746, ,953 6,992,052 Building (19,659) 2,150 (21,809) Decision Support Total 9,820, ,103 9,064,324 ESC Clinical Equipment 258, ,418 (74,294) Contingency 33,938-33,938 Information Technology 0 1,599 (1,599) Building 4,938 9,699 (4,761) ESC Total 297, ,716 (46,716) Facilities Clinical Equipment 3,682, ,415 3,293,318 Contingency 27,088-27,088 Information Technology 94,674-94,674 Building 79,517,082 47,878,027 31,639,055 Other Equipment 3,076 2, Facilities Total 83,324,653 48,270,237 35,054,416 Hospital Operations Clinical Equipment 1,500, , ,716 Contingency 167, ,977 Information Technology 354,768 1,342,435 (987,667) Building 1,465,212 1,168, ,261 Motor Vehicle 3,173, ,324 2,715,676 Other Equipment 795, , ,107 Hospital Operations Total 7,457,761 4,100,691 3,357,070 Medical & Health of Older People Clinical Equipment 817, ,570 53,520 Contingency 43,995-43,995 Waitemata District Health Board, Meeting of the Board 29/06/16 165

166 Information Technology 109, ,965 Building 21,530 18,716 2,814 Motor Vehicle 276, ,970 Other Equipment 22,717 21,320 1,397 Medical & Health of Older People Total 1,292, , ,661 Mental Health Clinical Equipment 47,725 31,395 16,330 Contingency 29,205-29,205 Building 381, , ,192 Motor Vehicle 56,562 51,612 4,950 Other Equipment 81, ,529 (64,864) Mental Health Total 596, , ,813 Surgical & Ambulatory Clinical Equipment 4,509,154 2,465,311 2,043,842 Contingency 10,895-10,895 Other Equipment 5,493 4,123 1,371 Surgical & Ambulatory Total 4,525,542 2,469,434 2,056,108 Grand Total 132,247,503 60,689,263 71,558,240 Waitemata District Health Board, Meeting of the Board 29/06/16 166

167 ATTACHMENT 3 Attachment 3 WAITEMATA DISTRICT HEALTH BOARD Reporting Date 30 April 2016 STATEMENT OF FINANCIAL POSITION ($'000s) 30/06/ /06/2016 Actual Actual Budget Budget Crown Equity 103,015 Crown Equity 103, , , ,493 Revaluation Reserve 244, , ,246 (44,872) Retained Earnings - Prior Years (42,785) (54,364) (54,364) 2,087 Retained Earnings / , , , ,897 Represented by : Current Assets 143,393 Bank and Short Term Deposits 109,959 70,637 63,677 35,454 Debtors 48,467 34,300 34, Prepayments 1, ,370 Inventory 6,362 5,700 5,700 Assets Held for Resale 185, , , ,177 Current Liabilities Bank Overdraft 127,728 Creditors 126, , ,930 46,983 Provisions and Accruals 63,994 47,690 47,690 66,368 Staff Related Liabilities - Current 77,341 74,050 74,464 26,049 Term Debt - Current Portion 26,049 3,980 3, , , , ,051 (81,576) Net Working Capital (128,226) (141,971) (147,874) Fixed Assets 567,288 Land, Buildings and Plant (net) 586, , ,553 3,346 Leasehold Building Works (net) 3,751 3,337 3,337 43,109 Equipment (net) 39,597 44,029 45, Information Technology (net) 80 9,675 12, Intangible Software (net) 199 6,659 6,903 3,449 Vehicles (net) 2,910 5,813 6,075 19,390 Work in Progress 35,702 32,000 31, , , , ,571 30,675 LT & Investments in Associates 37,768 37,079 37,329 30,675 37,768 37,079 37,329 Term Liabilities 29,064 Staff Related Liabilities- Term 21,040 20,000 21, Trust and Special Funds 435 8,503 8, ,848 Term Debt - External 251, , , , , , , , , , ,897 Waitemata District Health Board, Meeting of the Board 29/06/16 167

168 Attachment 4 WAITEMATA DISTRICT HEALTH BOARD CASHFLOW STATEMENT ($'000s) Reporting Date 30 April 2016 Month YTD Actual Budget Variance Actual Budget Variance Cash flows from operating activities: Inflows Crown 130, ,205 4,469 1,337,776 1,262,050 75,726 Interest Received (275) 4,641 5,010 (369) Other Revenue 4,637 2,665 1,972 39,100 26,650 12,450 Outflows Staff 47,448 47,194 (254) 477, ,940 (5,104) Suppliers 21,792 16,122 (5,670) 217, ,220 (56,041) Other Providers 64,966 60,630 (4,336) 643, ,300 (37,260) Capital Charge 0 1,583 1,583 12,138 15,830 3,692 Interest Paid 3,077 1,155 (1,922) 8,867 11,550 2,683 GST (net) (5,695) 550 6,245 (4,609) 5,500 10,109 Net cash from Operations 3,949 2,137 1,812 27,256 21,370 5,886 Cash flows from investing activities: Inflows Sale of Fixed Assets Associates Outflows Capital Expenditure 6,070 7,959 1,889 60,690 75,418 14,728 Investments ,000 0 (28,000) Net cash from Investing (6,070) (7,959) 1,889 (88,690) (75,418) (13,272) Cash flows from financing activities: Inflows Equity Injections New Debt Deposits Recovered Outflows Debt Repayments Funds to Deposit (2,121) 0 2,121 (61,434) 0 61,434 Net cash from Financing 2, ,121 61, ,434 Net increase / (decrease) 0 (5,822) 0 (54,048) Opening cash 0 73, ,385 Closing cash 0 67, ,337 Closing Cash Balance in HBL Sweep account 81,959 81,959 Waitemata District Health Board, Meeting of the Board 29/06/16 168

169 ATTACHMENT 5 WAITEMATA DISTRICT HEALTH BOARD Reporting Date 30 April 2016 STATEMENT OF ACCOUNTS RECEIVABLES Ref As % Total Outstanding Current 1-30 D D D 91 Days + Prior Month 1 ACC 3.5% 486, , , , , , , Accredited Employers 0.0% , Commercial 4.6% 650, , , , , , Crown (excluding MoH) 6.3% 882, , , , , , ,022, DHBS' 22.2% 3,109, ,511, , , , ,164, ,963, MOH 37.3% 5,220, ,785, , , , , ,002, Non Residents 25.6% 3,579, , , , , ,250, ,375, Overseas Govt 0.0% Patient 0.4% 53, , , , , , , Staff 0.0% 1, , , WDHB Total 13,983,413 6,830,711 1,374, , ,655 4,378,978 13,302,451 49% 10% 6% 4% 31% Total Less Nres 10,403,856 6,828, , , ,675 2,128,809 66% 7% 4% 3% 20% Total 30+ 2,822,071 27% REF 1 ACC As the aging ATB report indicates for ACC, the current oustanding represents 93.40% of the total oustanding. 3 Commercial There has been a decrease in the balance of the 91 days+ category down to $116, Crown The balance of the 91+ category has decreased by $148, compared to the previous month. 95% is less than 60 days outstanding. 5 DHB's For 61+days overdue: CMDHB has $344K for the OPEX cost from ADHB has $874K. 6 MOH 61+ days overdue: $439K as 3 invoices on-hold awaiting contract signing; $301K as 3 invoices in still in dispute 7 Non Residents $1,688,505 is on a current payment plan. This category of debtors is the most difficult to collect from. Waitemata District Health Board, Meeting of the Board 29/06/16 169

170 8.1 Hospital Advisory Committee Meeting held on 25 th May 2016 Recommendation: That the draft minutes of the Hospital Advisory Committee meeting held on 25 th May 2016 be received. Waitemata District Health Board, Meeting of the Board 29/06/16 170

171 Minutes of the meeting of the Waitemata District Health Board Hospital Advisory Committee Wednesday 25 May 2016 held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 12.44p.m. PART I Items considered in public meeting COMMITTEE MEMBERS PRESENT James Le Fevre (Committee Chair) Lester Levy (Board Chair) Kylie Clegg Sandra Coney (Deputy Committee Chair) Tony Norman (Deputy Board Chair) Morris Pita Gwen Tepania-Palmer Susanna Galea (co-opted member) Willem Landman (co-opted member) Donna Riddell (co-opted member) David Ryan (co-opted member) ALSO PRESENT Andrew Brant (Acting Chief Executive) Robert Paine (Chief Financial Officer and Head of Corporate Services) Jocelyn Peach (Director of Nursing and Midwifery) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Debbie Eastwood (GM, Medicine and Health of Older People) Peter van de Weijer (HOD Medical, Child Women and Family Services) Emma Farmer (HOD Midwifery, Child, Women and Family Services) Stephanie Doe (Acting General Manager, Child, Women and Family) Ian MacKenzie (GM, Mental Health and Addiction Services) Jeremy Skipworth (Clinical Director, Forensic Services) Joanne Brown (Funding and Development Manager-Hospitals) (from 1.05pm) David Price (Director Patient Experience) Helen Wihongi (Acting Chief Advisor Tikanga) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.) PUBLIC AND MEDIA REPRESENTATIVES Lynda Williams (Auckland Womens Health Council) APOLOGIES Apologies were received and accepted from Max Abbott, Warren Flaunty, Christine Rankin, Allison Roe and Dale Bramley and for early departure from Morris Pita. Waitemata District Health Board, Meeting of the Board 29/06/16 171

172 WELCOME The Committee Chair welcomed those present. The Committee Chair welcomed and introduced the new Director of Patient Experience, David Price. DISCLOSURE OF INTERESTS There were no additions or amendments to the interests register. There were no declarations of interest relating to the open section of the agenda. 1. AGENDA ORDER AND TIMING Items were taken in the same order as listed in the agenda. 2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 06 th April 2016 (agenda pages 7-32) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the minutes of the meeting of the Hospital Advisory Committee held on 24 th February 2016 be approved. Carried Actions Arising (agenda page 33) No issues were raised. 3. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD There were no decision items. 4. PROVIDER ARM PERFORMANCE REPORT 4.1 Provider Arm Performance Report March 2016 (agenda pages 34-95) Cath Cronin (Director of Hospital Services) introduced the report. Matters that she highlighted or updated included: The letter of compliment (page 38 of the agenda) received was a pleasure to read and to share with the Committee. That pathways and clinical improvements are progressing well with sustained change in practices being seen. Waitemata District Health Board, Meeting of the Board 29/06/16 172

173 The Shorter Stays in Emergency Departments target was achieved for the first quarter. The target was not reached in April, reaching the target in May and for the second quarter is a key focus. That colonoscopy target performance is being closely managed with stabilising and improvement being seen, but not yet regular. The Faster Cancer Treatment target is a priority to ensure the time to treat patients with cancer improves. The target rate has improved from 72% in the first quarter to 77.8% in the month of April with a goal of 85% by 30 th June With regard to the letter of compliment received, Morris Pita acknowledged the good work being undertaken in different parts of the organisation and the reflection on the organisations values. Human Resources Fiona McCarthy (Director Human Resources) briefly commented on this section of the report, noting in particular the impact of the work being undertaken within divisions around overtime and annual leave. She noted the overtime rate had seen a slight increase and as a result the strategies for using overtime are being investigated. Medicine and Health of Older Peoples Services Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services) presented this section of the report. Matters that she highlighted or updated included: The value of the patient voice was noted in the design of the Waitemata DHB s Stroke Service new model of care development, patients are being engaged with in the co-design. David Price will also be involved in supporting the codesign. On 5th June 2016, the FAST [Face-Arms-Speech-Time] campaign rolls out nationally and encourages patients to present to ED helping to reduce the damage cause by stroke. The campaign will run for approximately ten weeks and include television, radio, digital and online adverts. There has been wide communication with staff about the campaign. There are sustained allied health vacancies across services, recruitment strategies are being implemented including working with recruitment team leaders and setting in place advertising strategies. It was noted that the cost of living in Auckland was a consideration factor for overseas applicants. Child, Women and Family Services Dr Peter van de Weijer (Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department Midwifery, Child, Women and Family Services) presented this section of the report. Dr Peter van de Weijer introduced Stephanie Doe who is Acting General Manager (Child, Women and Family Services) while Linda Harun is undertaking larger project work until October Waitemata District Health Board, Meeting of the Board 29/06/16 173

174 Matters that were highlighted included: That work around improving transfer of domiciled neonates from the Neonatal Intensive Care Unit (NICU) at Auckland DHB back to the Waitemata DHB Special Care Baby Unit (SCBU) is underway. It is recognised that there is a high level of anxiety for the parents around transferring between the two services. Charge nurses from WDHB are now visiting NICU on a regular basis and also have a list of who is domiciled to Waitemata DHB and are gaining a better sense of when a transfer may occur. In response to a question it was noted that there is no data on staff time to visit NICU, however, it is a much more timely and proactive way for WDHB to be proactive and go and meet with NICU and patient families rather than reactively responding. There are currently 11 midwifery vacancies at North Shore Hospital and that nurses have been recruited to fill midwife vacancies. It was noted that there is the opportunity to recruit new graduates annually during the month of May; of the graduate pool approximately fifty per cent opt for self-employment and the remaining take opportunities across the three metro-auckland DHBs. In response to a question it was noted that the midwife FTE at North Shore Hospital was 47 and that there is a pool of casual staff that can be called in. Emma Farmer advised that whilst there is concern at the number of vacancies, she is confident a safe service is being provided. It was requested that the Committee be further updated on this matter. In response to a question about the implementation of the Waitemata DHB induction of labour guidelines, it was noted that the guidelines are reviewed every three years. Two years ago a regional group reviewed the induction of labour guidelines and reached regional consensus and this was added to the local Waitemata DHB guidelines. Of interest, a new method of induction is the use of balloon catheters, allowing patients to go home rather than staying in hospital. In terms of reviewing the guidelines, particular steps are taken including a clinical review, review of new evidence, consultation with clinicians, LMCS and consumer representatives. The gestational diabetes guidelines are national with implementation taking place in 2015, ahead of the required June 2016 date. The new guidelines require routine screening and with lower rangers than previous, more women are being diagnosed. In response to a question on whether women should be labelled as being pre-diabetic, it was noted that the testing was a national decision. It was also noted that the outcome of undetected and uncontrolled gestational diabetes on a baby can lead to a lifelong track of complications. The testing allows greater control of a baby s birth rate leading to a better result as well as positive outcomes including lifestyle advice, such as seeing a dietician. Sandra Coney requested a copy of the national gestational diabetes guidelines. In response to a question it was noted that the caesarean rates are decreasing. A report on caesarean rates is expected by the Committee every six months. The Smokefree incentives programme for pregnant women has not been successful in a recent RFP and has now been stopped. The only referral process now available is Quitline, where historically there has been no success. It is an area of concern and the Funder has now included the matter on its risk register. It was noted that the smoking cessation programme may be an option as it is offered to outpatients and may therefore be available for pregnant women, this will be investigated. Waitemata District Health Board, Meeting of the Board 29/06/16 174

175 In response to a question from Kylie Clegg about the Gateway Assessment process and following the recent media story about a three year old boy, it was noted that the DHB is confident that all the necessary processes and systems are in place, along with working with CYF. Stephanie noted that a lot of work is being done with both CYF and the Police with regular meetings being held; the Gateway Co-ordinator will be attending the CYF operations meeting each month. Gwen Tepania-Palmer noted that 30 children waiting for over six weeks for a Gateway Assessment is a long time; in response it was noted that this wait time is of particular focus and it is anticipated the wait time will reduce. This matter will be reported back to the Committee. 1.20pm the Board Chair briefly retired from the meeting. Mental Health and Addiction Services Ian McKenzie (General Manager, Mental Health and Addictions Services), Dr Jeremy Skipworth (Clinical Director, Forensic Services) and Megan Jones (Quality and Improvement Lead, Mental Health Services Group) were present for this section of the report. Ian McKenzie noted that this was his last attendance at the Waitemata DHB Hospital Advisory Committee meeting as he has accepted a role as the General Manager of Mental Health at Northland DHB. He expressed his thanks to Waitemata DHB for is time at the DHB. The Committee Chair acknowledged and thanked Ian for his work at the DHB and with the Hospital Advisory Committee. 1.35pm the Board Chair returned to the meeting. Matters highlighted or updated on Mental Health included: The acute service models for community mental health services have been running for two years now and are nearly completed. The main objective when the review commenced was to address what were clear problems and challenges of how the service was operating across the district, Rodney, North Shore and West. In listening to users and their families, steps have been put in place to ensure a better consistency for approach and referrals are handled efficiently. Service user feedback recently received expressed appreciation at the fast referral process. The Committee Chair noted the excellent work being undertaken. Following an external review of security at the Mason Clinic, three different elements of security have been identified: physical, procedural and relational. Significant progress has been made with regard to the physical element, including better lighting and camera installation. The procedural element will see a better staff mix as historically clinical staff have been exclusively used and now there has been a shift of resource to include security staff onsite. The third important aspect was the relational element and ensuring the appropriate level of clinical and nursing staff with training support and supervision. Policy documents on all three security elements are being development, ensuring they are compliant with government security. Susanna Galea noted that the submission on the proposed new Substance Addiction Bill had been submitted. The Committee Chair thanked Susanna for her work on the submission. Ian McKenzie noted that there would be a further Waitemata District Health Board, Meeting of the Board 29/06/16 175

176 report to the Committee at its next meeting on what it is thought the implications of the Bill will have on the DHB as a lead regional provider. Surgical and Ambulatory Services Michael Rodgers (Chief of Surgery) was present for this item. He conveyed apologies from Michelle Sunderland (General Manager, Surgical and Ambulatory Services). Michael Rodgers highlighted the clinically appropriate time to theatre improvement project and the effort to establish KIPs. A weekly report is now being produced on achieving the goals and will be reported to the Committee going forward. Another key issue highlighted is the faster cancer treatment times and that there is a drive to meet the targets set by the Ministry of Health and this is being closely monitored. Elective Surgery Centre Michael Rodgers noted that following the resignation of John Cullen he will continue as Chief of Surgery and that a clinical director will be appointed for the Elective Surgery Centre. Provider Arm Support Services Cath Cronin presented this section of the report, noting an area of concern was food service with more information to be provided to the Committee at its next meeting. Cath noted that the senior management team would be tasting food samples at its next meeting. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried 5. CORPORATE REPORTS 5.1 Clinical Leaders Report (agenda pages ) Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery) and Tamzin Brott (Director of Allied Health) presented this report. Andrew Brant noted that the next Waitemata DHB Primary Care Connections Forum is scheduled in July The forum has moved towards a more educational component, connecting services and providing an opportunity to learn. In response to a question form the Committee Chair about the DHB s emergency planning system, Jocelyn Peach advised that there were a number of programmes nationally and that Civil Defence were preparing a new Psychosocial support plan. Particular exercises noted included the: Orewa Tsunami Exercise that will take place on 14th June 2016, Hobsonville s fuel fire explosion exercise and passengers taken ill on a cruise liner. The Board Chair noted the importance of good communications to ensure people have access to and know how to find information in an emergency. Jocelyn will Waitemata District Health Board, Meeting of the Board 29/06/16 176

177 report back further on emergency planning systems and advise what the region has in place and the expectations of other DHBs. Jocelyn further noted both the nurses week and nurses day celebrations along with the recognition of Georgina MacPherson (Nurse Practitioner, Womens Health Colposcopy Service) who was nominated as Waitemata DHB s Nursing Review Nursing Hero and Graham Zinsli who received the Red Cross Florence Nightingale Award for International Humanitarian Service. Tamzin Brott noted that the National Allied Health, Scientific and Technical Conference was hosted in Auckland and that Waitemata DHB received the overarching host prize. Tamzin also noted that the Interdisciplinary Fun Feeding Group has been re-established, which is having a positive impact on the children who need assistance and their families. With regard to the implementation of the community Allied Health mobile device project (page 101 of the agenda) it is anticipated that 80 ipads will be operational by the end of August Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried 5.2 Human Resources (agenda pages ) Fiona McCarthy (Director Human Resources) presented this report and noted that average time to hire is steadily increasing; this is a combination of both the measure in time to recruit and the time it takes for a key professional to commence. Fiona also noted that a new candidate survey was undertaken in February 2016 to gain feedback on how the DHB can improve the candidate experience. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried 6.1 Winter Plan 2016 (agenda pages ) Cath Cronin (Director of Hospital Services) presented this report. In response to a question from the Committee Chair, Cath noted that she regularly meets with Auckland DHB and is will share the Waitemata DHB Winter Plan 2016 with Auckland DHB. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the Committee notes the content and intent of the Winter Plan. Carried Waitemata District Health Board, Meeting of the Board 29/06/16 177

178 7. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 112) Resolution (Moved Kylie Clegg /Seconded David Ryan) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Confirmation of Public Excluded Minutes Hospital Advisory Committee Meeting of 06/04/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 2. Quality Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 3. HR Update Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Waitemata District Health Board, Meeting of the Board 29/06/16 178

179 General subject of items to be considered Reason for passing this resolution in relation to each item 4. Education Programme That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Carried The open session of the meeting concluded at 2.15pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 25 May2016 COMMITTEE CHAIR Waitemata District Health Board, Meeting of the Board 29/06/16 179

180 8.2 Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Meeting 08 th June 2016 Recommendation: That the draft minutes of the Community and Public Health Advisory Committee meeting held on 08 th June 2016 be received. Waitemata District Health Board, Meeting of the Board 29/06/16 180

181 Minutes of the meeting of the Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Wednesday 08 June 2016 held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 2.00p.m. Part I - Items considered in Public Meeting COMMITTEE MEMBERS PRESENT: Gwen Tepania-Palmer (Committee Chair) (ADHB and WDHB Board member) Lester Levy (ADHB and WDHB Board Chairman (present from 2.22pm) Max Abbott (WDHB Board member) (present from 2.08pm) Jo Agnew (ADHB Board member) Peter Aitken (ADHB Board member) Judith Bassett (ADHB Board member) Chris Chambers (ADHB Board member) Sandra Coney (WDHB Board member) Warren Flaunty (Committee Deputy Chair) (WDHB Board member) Robyn Northey (ADHB Board member) (present from 2.15p.m) Christine Rankin (WDHB Board member) Allison Roe (WDHB Board member) Tim Jelleyman (Co-opted member) Elsie Ho (Co-opted member) ALSO PRESENT: Dale Bramley (WDHB Chief Executive Officer) Ailsa Claire (ADHB Chief Executive Officer) Debbie Holdsworth (ADHB and WDHB, Director Funding) Simon Bowen (ADHB and WDHB, Director Health Outcomes) Andrew Old (Chief of Strategy, Participation & Improvement) Tim Wood (ADHB and WDHB, Funding and Development Manager, Primary Care) Peta Molloy (WDHB, Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item) PUBLIC AND MEDIA REPRESENTATIVES: Lynda Williams, Auckland Womens Health Council Tracy McIntyre, Waitakere Health Link Wiki Shepherd-Sinclair, Health Link North WELCOME: KARAKIA: The Committee Chair gave a warm welcome to all those present. The Committee Chair led the meeting in the Karakia. Waitemata District Health Board, Meeting of the Board 29/06/16 181

182 APOLOGIES: That apologies be received and accepted from Lee Mathias and Rev Featunai Liuaana, together with an apology for late arrival from Lester Levy. DISCLOSURE OF INTERESTS There were no additions or amendments to the Interests Register. There were no declarations of interests relating to the agenda. 1. AGENDA ORDER AND TIMING Items were taken in the same order as listed on the agenda except for agenda item 5.2 which was discussed before item COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Auckland and Waitemata District Health Boards Community and Public Health Advisory Committees Meeting held on 27th April 2016 (agenda pages 7-16) Resolution (Moved Jo Agnew/Seconded Judith Bassett) That the Minutes of the Auckland and Waitemata District Health Boards Community and Public Health Advisory Committees Meeting held on 27 th April 2016 be approved. Carried Matters Arising The Committee Chair summarised the matters arising. It was requested that the website link with regard to Breast Cancer Screening be ed to CPHAC members. 3 DECISION ITEMS There were no decision items. 4 INFORMATION ITEMS There were no decision items. Waitemata District Health Board, Meeting of the Board 29/06/16 182

183 5. STANDARD REPORTS 5.2 Planning, Funding and Outcomes Update (agenda pages 31-47) Simon Bowen (Director, Health Outcomes) introduced the report. He noted that both the ADHB and WDHB Annual Plans along with the Maori Health Plans had been submitted to the Ministry of Health. Feedback from the Ministry of Health is expected in June. He also noted that the draft Waitemata DHB Primary and Community Services Plan was submitted to the Waitemata DHB Board in May and work continues on the plan. Simon also noted the update on Auckland Regional Public Health Services (page 9 of the agenda). Ruth Bijl (Funding and Development Manager - Child, Youth and Women s Health) and Dr Karen Bartholomew (Public Health Physician) presented the Child, Youth and Women s Health section of the report. Matters included in discussion and responses to questions included: Despite all the hard work towards meeting the immunisation health target, it unfortunately will not be met at either Auckland DHB or Waitemata DHB. There have been a number of factors in not reaching the target, including the flu season and negative publicity in general towards immunisation. There is a strategic focus on ensuring the message is received earlier (when pregnant). Work is underway with general practices to support practitioners in having discussions with couples who are finding the decision to immunise difficult to make. The work being undertaken on prioritising child health was noted and highlighted in a diagram (page 33 of the agenda) representing the DHBs universal services and additional priorities. In response to a question about the regional business case for the National Child Health Information Platform, it was noted that the business case is a few months away yet. It was also noted that a plan is in place in the Waikato/Midlands region. In response to a question from Sandra Coney about the Ministry of Health s Bowel Screening Programme roll-out and the implications on the Waitemata DHB Bowel Screening pilot programme, it was noted that: The Waitemata DHB pilot was extended to now conclude December The pilot was extended on the basis of the results meeting outcomes as anticipated. The Waitemata DHB has consistently reported results and external evaluations have been undertaken on the pilot. There is a reduction in the age range (to be from 60 to 74 years) for the Ministry of Health s programme roll out. The Waitemata DHB would seek information from the Ministry of Health on the business case to roll-out the Bowel Screening programme and the impact it may have on Waitemata DHB s pilot programme. This information will be reported back to the Waitemata DHB. In response to a question from Allison Roe about a recent news story on the HP vaccine for boys, it was noted that the Ministry of Health had recently advised of its Waitemata District Health Board, Meeting of the Board 29/06/16 183

184 decision to extend the vaccination programme to boys and that this was in line with advice around the forms of tongue, throat and lip cancer. The Immunisation Governance Group is supportive of this decision. It was also noted that there will be a shift from three doses to two doses, this results from studies demonstrating that two doses are sufficient. Further information on the HPV vaccination for boys will be provided at the next Committee meeting. Tim Jelleyman noted the update from the Auckland Regional Public Health Service (ARPHS) who advised that the BCG vaccine supply expired on 31 st May 2016 with a new supply of vaccine unlikely to be available until It was requested that ARPHS provide an update on the risk associated with this. Debbie Holdsworth introduced Trish Palmer who has commenced in her role as the Funding and Development Manager for Mental Health and Addiction Services. Trish has joined the DHBs from Northland DHB. Trish Palmer was present for the Mental Health and Addictions section of the report. Matters included in discussion and responses to questions included: The information requested from the April 2016 CPHAC meeting regarding Aged Related Residential Care and the mix of beds in each DHB was noted. With regard to the pilot of an on-line training tool QPR (question, persuade, refer) for screening, the Ministry of Health has allocated 400 licences to access the online training tool. It was noted that the ADHB and WDHB completion rate was high. The Committee requested that it receive an evaluation of this training tool in due course. Following a recent media story about seclusion within mental health facilities, Robyn Northey queried the matter of seclusion in the Auckland region. It was noted that people cannot be held under the mental health act for non-specific reasons, it is not a clinical decision, but a judicial one and care needs to be taken with what is projected in the news media and actual. It was noted that matters regarding the mental health services for both Auckland DHB and Waitemata DHB are reported to the Hospital Advisory Committee. Further information will be requested on the matter of seclusion within the Auckland DHB and Waitemata DHBs mental health facilities (including dementia patients within the hospital wards) and the Auckland region; this information will be reported back to each Hospital Advisory Committee respectively. The Committee Chair welcomed Trish Palmer to the DHBs and the CPHAC meeting. Debbie Holdsworth noted the work underway with regard to the Maori Health Plan and the Pacific Health Action Plan. She also noted the work underway with Asian students and the campaign being run to educate students about the New Zealand Health system. Elsie Ho requested a copy of the Asian International Benchmarking Report, Simon Bowen advised that the report is in the process of being drafted and when completed will be presented to the Committee. With regard to the Maori Health Gain update and the Healthy Babies Healthy Futures programme, Chris Chambers requested information on how the targets are Waitemata District Health Board, Meeting of the Board 29/06/16 184

185 set and enrolments required for a lasting impact. Aroha Haggie will provide Chris with the information directly. In response to a query from Chris Chambers about the Building Pools Amendment Act, Simon noted that the report included a summary of the DHB-ARPHS issues and recommendations and the revised bill (page 44 of the agenda). Chris then queried whether the information was shared with groups like the Child, Youth and Mental Health Review Committee, coroners, the Commissioner of Children and the like, Simon Bowen will advise on the distribution directly to Chris. The Committee Chair thanked those that presented the report for their contribution and work. Resolution (Moved Max Abbott/Seconded Peter Aitken) That the report be received. Carried 5.1 Primary Care Update (pages 17-30) Debbie Holdsworth introduced Jagpal Benipal (Senior Programme Manager, Primary Care) and Daniel Tsai (Programme Manager, Community Pharmacy) to the Committee, who were present for this item. Daniel Tsai updated the Committee on the community pharmacy influenza services. Matters highlighted and responses to questions included: That this service is being trialled at 15 community pharmacies and is a fully subsidised service for eligible people aged 65 and over. The service is funded from a portion of the quality improvement fund. The overall aim of the pilot is to improve access and uptake. To date 60 people have been immunised since March In response to a question about whether the uptake was low, it was noted that this is an initial pilot and there was no comparison of data. An evaluation will be completed at the end of the pilot. In response to a question from Warren Flaunty about funding for the community pharmacy influenza services, Daniel Tsai noted that the portion of funding for quality improvement based on a population based funding formula was approximately 10 per cent for each DHB. With 15 pharmacies in the pilot each received a small portion of approximately $500 for that pharmacy individually. Tim Jelleyman queried whether the population are aware of their local pharmacy as a place to receive immunisation (he noted the uptake for rheumatic fever was very low in pharmacies as well). In response Daniel noted that as part of the pilot they will review this and look at options for promoting this service at pharmacies. The Board chair noted the importance of strong change management processes and robust pilots in order for services like this to be successful; the community need to be aware of the service. Appropriate support needs to be given to the pharmacies to ensure this promotion occurs. Waitemata District Health Board, Meeting of the Board 29/06/16 185

186 It was noted that historically the lack of privacy in pharmacies was an issue for people; this matter has been addressed as each of the pharmacies participating all have a consultation room. The option of a consultation room was provided as part of the innovation funding, a number of the participating pharmacies utilised this option. Jagpal Benipal summarised other key points in the report, responses to questions included that: The Ministry had recently streamlined its contract around pharmacies and the quit smoking programme. Both Auckland DHB and Waitemata DHB submitted an RFP, which were unfortunately not successful. There have been some issues with the data provided when reporting diabetes checks. This matter is being investigated with healthalliance and the outcome of that will be reported back to the Committee. An explanation was given on the definition of quintile 5, noting that it is the most deprived population group (approximately 20 per cent of the population). The Committee Chair thanked Jagpal and Daniel for their attendance. Resolution: (Moved Robyn Northey/Seconded Judith Bassett) That the report be received. Carried 6. GENERAL BUSINESS No matters were raised. 7 RESOLUTION TO EXCLUDE THE PUBLIC 3.13pm - Tim Jelleyman and Elsie Ho retired from the meeting. Resolution: (Moved Jo Agnew/Seconded Peter Aitken) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following item, for the reasons and grounds set out below: General subject of items to be considered 1. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees Meeting with Public Excluded 27/04/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Waitemata District Health Board, Meeting of the Board 29/06/16 186

187 General subject of items to be considered 2. Co-opted member appointments Reason for passing this resolution in relation to each item section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Carried 3.13pm 3.14pm: public excluded session The Committee Chair thanked those present for their participation in the meeting. The meeting concluded at 3.14pm. SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 08 JUNE 2016 CHAIR Waitemata District Health Board, Meeting of the Board 29/06/16 187

188 9.1 Health and Safety Marker Report update June 2016 Recommendation: That the report be received. Prepared by: Fiona McCarthy (Director Human Resources) Purpose of report The purpose of this report is to provide an update on progress towards meeting the expectations of the Health and Safety at Work Act 2015, which came into effect on 4 April Executive Summary The new Health and Safety and Work Act 2015 came into force on 4 April The new legislation is the result of work from the health and safety taskforce established in 2012 to evaluate whether the workplace and safety system in New Zealand was fit for purpose and to recommend practical strategies for reducing the high rate of workplace fatalities and serious injuries by From taskforce recommendations made in 2013, WorkSafe NZ was established with one goal to reduce workplace deaths and injuries by 25% by The most significant changes are as follows: Move from a relationship between employers and employees to one where a Person Conducting a Business or Undertaking (PCBU) has a primary duty of care for ensuring the health and safety of a worker on or near the business or undertaking. Provides for personal liability for officers of a PCBU to exercise due diligence in relation to a PCBU s health and safety obligations. Provides that suppliers, who supply, install and/or manufacture plant, fixtures, fittings, substances do so to ensure they are fit for purpose and do not pose any risk to any person. This includes any calculation, testing, analysing or examining that is required to comply with the Act, as well as guidance on safe use, handling and storage. Move from hazard management to risk management, which enables a broader view of health and safety. A change from serious harm reporting to notifiable injuries, illnesses and incidents. We are now required to report incidents that could have caused harm but may not have. Clarification of employee participation, selection and training obligations. A separate set of regulations to govern health and safety representatives is currently in consultation. The new legislation extends powers of health and safety representatives to provide improvement and compliance notices. New obligations to set up a Health and Safety Committee if requested. Additional penalties and fines with officers being exposed to higher remedies than workers. Details on how the DHB complies with the new legislation is outlined in Appendix 1, however, you will read that some processes are in place or pending, with further health and safety assurance and compliance audits to be undertaken over 2016 and 2017 and ongoing. The DHB has a number of completed and outstanding actions to meet and exceed the requirements of the Health and Safety at Work Act 2015 as outlined in Section 2. Waitemata District Health Board, Meeting of the Board 29/06/16 188

189 2. Strategic Alignment Emphasis and investment on both treatment and keeping people healthy Service integration and/or consolidation Intelligence and insight Evidence informed decision making and practice Operational and financial sustainability This report discusses the risks, actions and progress towards making Waitemata DHB a safe and healthy place for people to work, be educated, receive care and visit loved ones. The report integrates cross department commentary on health and safety so it is consolidated in one place. A health and safety scorecard reports on health and safety data and provides insight into issues and trends. The report articulates actions that where possible will be informed by evidence or expert opinion. The evidence supports the undertaking of good health, safety and wellbeing practises leads to positive patient experience and outcomes and a sustainable business. 3. Completed and outstanding actions The following actions are complete or outstanding as at 17 June Completed or partially completed actions Action Who Completed Health and Safety Occupational Health and Safety Yes representative transition training Communication on impact Director HR Yes meetings and H&S as regular agenda items Complete audit training for Facilities and Development H&S Yes Facilities Project Managers Manager Managers to be advised that all infrastructure, maintenance and environmental contractors are to be engaged via Facilities and Development Director Hospital Services and Chief Financial Officer Yes Notifiable incident process to be developed and approved by the Board Put in place pre start safety meetings for build projects Occupational Health and Safety and Facilities and Development Facilities and Development H&S Manager and Programme Manager W2025 Group Manager, HR Yes Notifiable event process approved at 25 May Board meeting. Yes Update obligations in Position Yes Descriptions Board site visit schedule Director HR Yes Draft visit schedule endorsed at the 6 April Board meeting. Waitemata District Health Board, Meeting of the Board 29/06/16 First hospital campus visits by Chair and CEO completed on 189

190 Action Who Completed 2/3 May. First Board visit on hazardous substances completed 18 May. Complete building project sign off process for health and safety Put in place a health monitoring resource and plan across all hazard groups Facilities and Development H&S Manager, Occupational Health and Safety Manager and Programme Manager W2025 Occupational Health and Safety Yes Partially A 2 year fixed term resource has been assigned and the plan will be developed progressively from May 2016 to April Ventilation, heating and cooling issues to be resolved Complete write up of resource review recommendations District Facilities Manager Director HR Ongoing and prioritised according to risk. Partially Recommendations have been sent to SMT to review. The report will be finalised for the August Board meeting. 3.2 Outstanding actions Action Who By when Board and SMT session on due diligence obligations Director HR Simpson Grierson June A session plan has been developed and is being validated with Simpson Grierson. Training is likely to take place in July. Develop an Officer orientation programme Review of ongoing training needs and other new expectations under the new Worker Engagement, Participation and Representation Regulations 2016 Director HR and Occupational Health and Safety Group Manager, Occupational Health and Safety Mid June Special project review - April to June 2016 Waitemata District Health Board, Meeting of the Board 29/06/16 190

191 Action Who By when Review of participation partnership agreement with Unions. Agreement on worker participation arrangements from the new Regulations to form part of this agreement. Occupational Health and Safety and partner unions and Regional DHBs Review due July 2016 Complete review of all work sites to assess hazardous substances and health monitoring needs Regular meetings with onsite contractors Sustainability Development Manager General Manager Facilities and Development and Group Manager Occupational Health and Safety HSNO coordinator starts 2 May and site reviews of hazardous substances will re commence. Implement a phased approach: End May Facilities to commence regular meetings with large contractors Review healthalliance procurement systems Review healthalliance contracting systems Put in place preferred supplier process for all maintenance contractors Contractor orientation material to be reviewed Review asbestos management plan in line with new regulations and update register Review sign off process for maintenance work Do a stocktake on departmental orientation H&S practices and review how departmental orientation is recorded and provide for a recording mechanism Complete pre-employment screening implementation Review orientation processes for students and volunteers Collaborative work with ha and ADHB, CMDHB and WDHB Collaborative work with ha and ADHB, CMDHB and WDHB District Facilities Manager and Facilities and Development H&S Manager Facilities and Development H&S Manager General Manager, Facilities and Development District Facilities Manager and Facilities and Development H&S Manager Occupation Health and Safety Director HR and Group Manager, Occupational Health and Safety Occupation Health and Safety Director of Patient Experience End September regular meeting with other selected contractors Underway with first process flow draft. Underway with first process flow draft. November 2016 End September We expect to have an on line orientation system available in May/June. December 2016 Draft process in place and trialled end July and finalised end October A process to review and centrally record orientation is being scoped. Estimated completion date is late 2016 October 2016 A process to review and centrally record orientation is being scoped. Estimated completion date is late 2016 Waitemata District Health Board, Meeting of the Board 29/06/16 191

192 Action Who By when Safe Way of Working KPIs need to be devolved to Divisional meetings and GM KPIs Chair, Waitemata DHB Health, Safety and Wellbeing Committee July 2016 Complete Business case and RFP for community worker alarms Chair, community workers alarms steering group Draft Plan and Business case due November 2016 Security Training framework Complete roll out of root cause analysis and investigation model Put in place process to review on site audit findings with Occupational Health and Safety team Revise Leading Indicators Project Manager, Security Review Facilities and Development H&S Manager Facilities and Development H&S Manager and Occupational Health and Safety Manager Group Manager, Occupational Health and Safety August 2016 End September 2016 Draft process in place end May and finalised end July Each element of the safe way of working will be reviewed progressively from April 2016 to April 2017, starting with HSNO Waitemata District Health Board, Meeting of the Board 29/06/16 192

193 Glossary PCBU person conducting a building or undertaking, and has a primary duty of care to ensure the health and safety of workers. The DHB is the PCBU. Officers - Includes Board Directors and the Senior Management team who make governance decisions that significantly affect the business. Officers have a duty of due diligence to ensure their business complies with its health and safety obligations. Officers may be found guilty of an offence under the Act, in addition to the PCBU. Due Diligence taking steps to acquire and keep up to date knowledge of health and safety matters; gain an understanding of the business and hazards and risk associated with that business; ensure PCBU has available and uses appropriate resources and processes to manage risk; ensure PCBU has appropriate processes for considering incidents, hazard and risks in a timely way; ensure PCBU implements processes for complying with obligations under the Act; validates the provision and use of resources and processes to comply with obligations under the Act. Workers - Workers have a duty to take reasonable care for their own safety and that their own actions do not adversely affect the safety of others. They need to comply with reasonable health and safety instructions from the PCBU and co-operate with health and safety policies and procedure. Workers are people who work at the DHB and include employees, contractors, sub- contractors or their employees, apprentices, trainees, persons gaining work experience, employees of a labour hire company and volunteers. Other people - People who come to the workplace such as visitors or customers also have duties to comply with health and safety processes. Our patients and visitors are in this group. Notifiable injury or illness an injury or illness that requires immediate treatment (i.e. amputation, serious burn, serious head injury or burn); admission to hospital; serious infection; medical treatment within 48 hours of exposure. All notifiable injuries or illnesses are to be reported to WorkSafe NZ. A notifiable incident is an incident that is an unplanned or uncontrolled incident in a workplace and that exposes a worker or other person to a serious risk to health and safety. Notifiable incidents include events such as: a spillage or leak of a substance; explosion or fire; escape of gas or steam; falls; electric shocks; structural collapses; in rush of water, gas or mud; interruption of underground ventilation. All notifiable instances are to be reported to WorkSafe NZ. Health and Safety Representative is a person elected to represent the workers in relation to health and safety matters. The representative has specific functions and roles under Schedule 2 of the Act. Waitemata District Health Board, Meeting of the Board 29/06/16 193

194 Appendix 1 Progress towards implementing the Health and Safety at Work Act 2015 Policy All of our health, safety and wellbeing policy requires an update to ensure change of terminology and focus to the new legislation. The February Board meeting endorsed the updated Health, Safety and Wellbeing Policy and our Safe Way of Working system (SWOW) document. The April Board meeting endorsed the remaining Health, Safety and Wellbeing policies and the Board health and safety visit schedule. Worker engagement, participation, and representation What the Act says How do we comply? A PCBU must: Initiate election of health and safety representatives on request of workers. Agree the work groups that are represented by a health and safety representative. Consult about matters related to health and safety. Provide information as requested with due consideration to the Privacy Act. Allow a health and safety representative time to discharge their powers under the Act. New regulations on worker engagement, participation and representation were introduced in February 2016 and outline the functions, number, training, powers and participation expectations of health and safety representatives. We have 260 health and safety representatives throughout the business, most of whom have baseline health and safety representative training, as endorsed by WorkSafe as well as divisional health and safety committees in place to provide ways to participate in local issues. In addition, the annual update of hazards is reviewed by representatives and representatives participate in the self-assessed six-monthly departmental health and safety audit. From a recent hazard event review, new expectations on participation in health and safety matters have been introduced and include ensuring work impact meetings are held for each building project and that health and safety is a regular item on team meeting agendas. Seven health and safety representatives sit on our health, safety and wellbeing committee. Transition training for all the representatives has been completed and modules for foundation health and safety training are available on line. Waitemata District Health Board, Meeting of the Board 29/06/16 194

195 What is outstanding? Consequences Review of participation agreement with Unions. Ongoing training needs (as part of the new Worker Engagement, Participation and Representation Regulations) will be assessed as part of a special project lead by Margaret Kamphuis, Group Manager, Occupational Health and Safety. We need to review the number of health and safety representatives as part of the worker participation agreement with unions. We still need to determine the process for on-site contractors to establish health and safety representatives and discuss health and safety matters together. There are fines for not having appropriate employee participation processes in place. Notifiable events What the Act says How do we comply? What is outstanding? Consequences A PCBU must report on notifiable injury, illness and incidents as soon as possible after being made aware of them. Secure a site if a notifiable event has occurred. Keep a record of notifiable events We currently have notifiable event reporting and recording processes in place. Nil There are fines for not notifying workplace injury or illness as soon as possible after being made aware of them. Health and Safety Committee What the Act says How do we comply? What is outstanding? Consequences A PCBU must: Put in place a health and safety committee if requested by a worker. Establish a health and safety committee within two months of this request. Consult about health and safety matters with the committee. Allow time for members to attend and carry out functions as a member of the committee. Provide information to the committee Within a reasonable time, adopt recommendations made by the committee. A PCBU can also establish a Health and Safety Committee on its own initiative. The first meeting of the Health, Safety and Wellbeing Committee took place on 19 April There are no outstanding actions. There are fines for not setting up a Health and Safety Committee if requested, and if a PCBU does not: allow time for members to attend committee meetings/consider matters raised at the committee; or if a PCBU does not implement recommendations from the committee. Waitemata District Health Board, Meeting of the Board 29/06/16 195

196 Orientation What the Act says How do we comply? What is outstanding? Consequences Orientation to a workplace is an important part of complying with the duty of care to ensure the provision and maintenance of a workplace that does not give rise to health and safety risks. Pre commencement orientation and a safety first video are now in use for orientation, training and general health and safety messaging. A departmental health and safety induction checklist is sent to recruiting managers. We need to ensure all new staff complete departmental orientation in health and safety, and that this is recorded centrally for easy access. We also need to put an Officer orientation programme in place. We need to check orientation processes for students and volunteers. There are fines and criminal punishments of imprisonment for reckless conduct in respect to duty of care and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Risk Management What the Act says How do we comply? PCBUs have a duty of care to ensure the health and safety of another person is not put at risk from work carried out as part of the conduct of the business or undertaking. Risks must be eliminated or minimised so that a PCBU can, in so far is reasonably practicable: Provide a workplace without risk Provide and maintain safe systems, plant and structures Ensure the safe handling, storage and use of plants, substances and structures Provide training or supervise to protect persons from risk Maintain accommodation so a worker is not exposed to risk We have an on line hazard management system where hazards are identified and controls recorded. We have started to move from the language of hazards to risk management, but in such a way as to align with rather than clash with the health sector concept of risk management and risk registers which consider organisational wide risks. Hazards/Risks are reviewed every 12 months by the divisional lead manager and Health and Safety Representatives. W2025 impact meetings are occurring. Processes to monitor and maintain operational compliance are in place, i.e. fire management plan, training, exercises, maintaining clear egress, etc., and are part of a current process improvement review. Waitemata District Health Board, Meeting of the Board 29/06/16 196

197 What is outstanding? Consequences No outstanding actions. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Contractors (Facilities, Health Alliance and Information Technology) What the Act says How do we comply? The PCBU, as well as ensuring the health and safety of its employees (workers), is also required to ensure the health and safety of other workers, as well as ensuring that plant, fixtures and fittings are without risks to health and safety to any person. There are new asbestos regulations that require a change in how PCBU s currently manage and remove asbestos. Selection of Contractors: The DHB has moved to a process of selecting a panel of preferred contractors who can tender for DHB construction and refurbishment work as it arises. Each contactor has to first qualify to be a part of the panel by satisfactorily completing contractor health and safety questionnaire which allows the organisation to demonstrate their performance against 12 health and safety criteria. Maintenance contractors do not have a preferred supplier arrangement in place as yet but contracts are in place and current for main contractors. Supplier Contracts and RFP processes: DHB contracts provide a standardised health and safety statement for minor or individual contracts. This clause will be confirmed that it satisfies the Act. Health Alliance procurement processes: Documentation is not adequate for the new Act. Orientation: Construction contractor induction is in place and completed prior to gaining access to the relevant site. Site access: All building contractors must report to Facilities before commencing their work and all Health Alliance (ha) staff (IT) will report to security. In addition, New projects must be agreed and coordinated with Facilities prior to commencing New contractors must complete induction prior to starting work A contractor carrying out an agreed task e.g. for call out does not need to report to Facilities prior they do need to report to area supervisor prior to and post work. All contractors must have a WDHB photo ID which will only be issued after completing induction) All healthalliance staff and contractors are required to have the ha issued photo id on them at all times and visible. Usually if they are based on a particular site on a regular basis (i.e. not just visiting) then we will request a security access card with photo ID for that staff member from the site. Facilities: Once inducted contractors working for Facilities are issued with a Waitemata DHB ID card with a photo. Proof of identification (passport/ drivers licence) is require to obtain this ID. The duration of the ID card can be set to cover the estimated time of the project. Waitemata District Health Board, Meeting of the Board 29/06/16 197

198 What is outstanding? On the job: Toolbox meetings occur each day. There is active management and collaboration with architects and designers to meet design expectations and requirements. Work impact meetings to assess risk occur regularly and ensure contractor health and safety plans are implemented. All Project managers, including the 2025 team are Site Safe certified. Asbestos: Asbestos register in place but the register needs to be updated in line with new regulations. This work is now underway via the WDHB Asbestos Management Group. Incidents and Accidents: Reporting of incidents and accidents follow the DHB process. Contractors experiencing any accident or incident are required to notify the DHB, investigate and report back any findings. On site audits: Regular external audits are conducted for construction site work. Project managers also undertake audits of their projects. Maintenance work review and sign off: For IT project work related to moves and new fit-outs, the desktop team work closely with the Waitemata DHB PM who reviews and signs-off that the work is complete. Building project health and safety management and sign off: A performance review is done mid-way through each major building project. Health and Safety design sign off and pre occupation processes are complete. The building sign off process follow the relevant policy. Post Implementation Reviews (PIRs): PIRs are done for each facility build project and results provided to the contractor selection panel. Selection of contractors: The DHB is moving to the same preferred supplier process for maintenance contractors as noted above for large construction contractors. This process will be in place by November. WDHB maintenance team requires contractors to provide suitable prequalification material by a certain date. If not met the contractor will be removed from the approved contractor list. Health Alliance procurement processes: The DHB is working work with CMDHB, ADHB and Health Alliance to map processes that require additional health and safety documentation. Orientation: Induction material is being reviewed. On the job: A pre start safety meeting process is in development for all build projects, as well as ensuring work impact meetings occur regularly during the project. Safety in design guidance is in development. Asbestos: To review asbestos management plan in line with new regulations. Accidents and Incidents: Facilities intend to adopt an ICAM concept of investigation that will identify why things went wrong and what actions are required to ensure compliance and keep workers safe. All of evidence gained through incident reviews, audits and investigations is saved as confirmation of active management by the DHB in its role as the PCBU. Evidence folders and process will be discussed during audit training. Waitemata District Health Board, Meeting of the Board 29/06/16 198

199 Consequences Maintenance work review and sign off: The DHB is currently sharing learning from ADHB on a task planning and sign off process for maintenance work, ensuring competent review and management oversight. Building project health and safety management and sign off: Complete implementation of project sign off documentation. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Hazardous substances What the Act says A PCBU has a primary duty of care to provide for staff use, handling and storage of substances. The DHB is also required to comply with the Hazardous Substances and New Organisms Act 1996 which requires the DHB to prevent and manage adverse effects of hazardous substances and new organisms. How do we comply? The DHB has focused on the 33 areas with high volume use of hazardous substances, with over 315 substances identified and added to the online register of substances available on StaffNet. A new and comprehensive HSNO policy has also been developed and published on the intranet, with a strong focus on roles and responsibilities. The Intranet HSNO site now contains hot links to information covering: Policy document Full HSNO database of all hazardous substances identified, including constituents, product state, UN number, CAS number, identified hazards, exposure limits, HSNO class and PPE specific to each substance. It is worth noting that, on average, we are identifying an additional 15 new chemicals per month, which are then added to the database. Master Material Safety Data Sheets (MSDS) repository Wastewater Disposal Guidelines Training resources, including introductory PowerPoint List of all Approved Handlers and their locations Emergency response requirements Specific spill kit contents list Managers responsibilities Key contacts for staff Approved handler training has been delivered for high risk areas. What is outstanding? Work has also concluded with healthalliance, to ensure that Material Safety data Sheets are supplied for all new chemicals being procured. We have another estimated 350 areas to review and we have employed a hazardous substances co-ordinator to complete this work. Waitemata District Health Board, Meeting of the Board 29/06/16 199

200 The business case for the construction of a Hazardous Substances Store for Waitakere Hospital is almost complete. The construction of this store will greatly reduce the risk associated with the bulk storage and disposal of hazardous substances at Waitakere Hospital. Consequences There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. It is worth noting that hazardous substances are covered under three sets of national legislation, as well as local bylaws (Health and Safety at Work Act 2015, Hazardous Substances and New Organisms (HSNO) Act 1996, Resource Management Act 1991 and Auckland Council s Water Supply and Wastewater Bylaw ), under all of which fines can be payable. Health of workers What the Act says A PCBU must ensure that the health of workers and conditions of the workplace are monitored for the purpose of preventing injury or illness. The PCBU must, as far as is reasonably practicable, maintain accommodation so that the worker is not exposed to risks to health and safety. How do we comply? The DHB has pre-employment screening in place but a number of staff still commence work pending their results. Planning is underway to put a process in place to ensure that staff cannot start until the health screening process is complete, results known, vaccinations or other actions are complete and the potential employee is fit for work or an offer is withdrawn if they are not fit to work. We undertake occupational health monitoring via our Occupational Physician health clinics however we wish to extend this to monitoring exposure to noisy areas (facilities), hazardous substances, laser care, and other risk areas. Monitoring for exposure for radiation (Radiology, Cardiac Catheter Lab) occurs externally. We provide free influenza and other vaccinations. A stocktake of issues with workplace heating, ventilation and cooling was completed in May 2015 and is being implemented in priority order. We have an asbestos register, and require contractors to review this prior to starting any work. Areas with friable asbestos require additional security clearance to gain access. Containers for sharps, hazardous materials and substances are provided on each site. Waitemata District Health Board, Meeting of the Board 29/06/16 200

201 Staff are provided with personal protective equipment (PPE) to wear. PPE requirements are outlined in various policies including the hazardous substances register, use of lasers, gloves, etc. Infection control processes are in place to manage any disease outbreaks and exposure. Installation of signage close to potential slip, trip and fall hazards has occurred and cleaner are asked to regularly monitor wet areas. What is outstanding? Regular communication on hazards is issued. Complete implementation of pre-employment screening. Health monitoring programmes should be in place across all relevant risk areas. An audit on use of PPE will be planned as part of the health monitoring programme to validate the application of various policies and risk controls. Consequences A resource to regularly inspect patient communal areas, wards and entrance ways is currently in recruitment. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Equipment What the Act says How do we comply? A PCBU must provide and maintain a work environment that is without risk to health and safety. Equipment that is broken is escalated for capital replacement as relevant. A register of capital assets is in place and being added to, to ensure that equipment is budgeted for replacement according to the life span of that equipment. What is outstanding? Consequences All bio-medical equipment is maintained by the Bio-Engineering team. Alert systems for community workers are being trialled as part of the review of security. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Waitemata District Health Board, Meeting of the Board 29/06/16 201

202 Training What the Act says How do we comply? A PCBU must provide any information, training, instruction and supervision necessary to protect all persons from risks to health and safety arising from work carried out by the DHB. Orientation training is provided to staff within the first 4 weeks of their employment, however we are looking to introduce preemployment orientation education for health and safety as noted in the orientation section above. Waitemata District Health Board, Meeting of the Board 29/06/16 Health and Safety representatives are provided with two days of training (Four half day modules) by the Occupational Health and Safety Service covering an introduction to health and safety management, hazard and emergency management, accidents and occupational rehabilitation, safe working procedure, health and wellbeing and the new legislation. All staff are required to complete the annual health and safety update on line. Training is provided on departmental specific instances such as moving and handling in patient areas, crisis intervention in areas where aggressive clients may be experienced, calming and restraint in mental health services, laser care in theatre, handling sharps by infection prevention and control. As already noted, approved handler training is in place for hazardous substances. Training is provided on how to access our incident management, risk register and hazard register systems. Training for notifiable events is complete. Emergency Response Training occurs regularly Fire Response and Evacuation Training occurs for all new staff and annually on-line and face to face in key areas Fire Evacuation Training occurs across all DHB areas 6 monthly which means each week there are activities in order to cover all areas Warden Training occurs on all sites annually for all wardens and deputy wardens. This is for all areas so requires multiple sessions annually Duty Nurse Manager training occurs for all new staff and three times a year Incident Management Team training occurs quarterly Key staff are required to attend Health CIMS2 training which is available monthly and is done as a regional programme with the other DHBs. This is open to all health settings including PHO s Accident and Medical centres and Residential Aged Care key staff Key staff attend CIMS4 training quarterly The DHB runs particular Health CIMS4 training with a provide provider twice a year for key areas that have identified a need. 202

203 What is outstanding? Consequences The training framework for security is currently being reviewed and due for completion in June A DHB wide training framework is being developed to enable officers and workers to increase awareness and knowledge of health and safety systems and processes. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Audits What the Act says How do we comply? An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB. Recently we have completed a number of readiness audits to access compliance with the new health and safety legislation and to assess new or different resources needed. Going forward the Northern region has agreed to undertake 2 audits during which includes community workers and contractor management. Internal audit are currently conducting a policy assurance audit and policy assurance audits will be in place from Regular external audits of contractor sites are in place. What is outstanding? Consequences A governance audit has just been completed and is due for report back in July. There are no outstanding actions. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Reporting What the Act says How do we comply? What is outstanding? Consequences An Officer of a PCBU must ensure they acquire and keep up to date on health and safety matters. Monthly reports on health and safety matters are provided to the Board meeting and the Audit and Finance Committee meeting. In time reporting will incorporate feedback from the organisational health, safety and wellbeing committee. As a result of the resource review, the DHB will revise its leading indicators and revise the Board committee reporting formats. The DHB will update the Board reporting format later in There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Waitemata District Health Board, Meeting of the Board 29/06/16 203

204 Resources What the Act says How do we comply? What is outstanding? Consequences An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB. A resource review was completed last year. The report is having portions amended and added and a set of recommendations and actions will be presented to SMT in June and to the Board in August. On review of the report we have already implemented the following new resource: 0.4 training FTE to an existing H&S adviser role Hazardous substances co-coordinator (1 FTE) Health monitoring nurse specialist (1FTE fixed term for 2 years) And the following are in recruitment H&S advisor (1FTE) so we can spread training across the advisory team and allow advisors to have service portfolios for in service outreach, advice, training and assistance Investigator / auditor (1FTE) Analyst and reporting specialist (1FTE) Complete recommendations from the resource review. There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness. Waitemata District Health Board, Meeting of the Board 29/06/16 204

205 9.2 Bowel Screening Pilot Update Recommendation: That the Board receives this report. Prepared by: Dr Debbie Holdsworth (Director Funding) Endorsed by: Dr Dale Bramley (Chief Executive) Glossary BSP - Bowel Screening Pilot, the pilot ifobt - Immuno-Faecal Occult Blood Test GP - General Practitioner PHO - Primary Health Organisation MOH - Ministry of Health, the Ministry 1. Introduction As announced in Budget 2016, $39.3 million over four years has been provided to begin a progressive rollout of a national bowel screening programme from mid-2017 (see Appendix One). This paper provides an update on the announcement and what it means for Waitemata DHB and the Bowel Screening Pilot (BSP). 2. Background International evidence supports the introduction of a national bowel screening programme by saving lives through early diagnosis and intervention. People who are diagnosed with bowel cancer and receive it at an early stage have a greater than 90% chance of surviving five years. After five years they have the same survival rate as someone who has never had bowel cancer. Most countries in Europe have implemented an organised bowel screening programme. As at 2015, Australia, the United Kingdom, Finland, France and Slovenia had completed the roll-out of organised screening programmes. Roll-out was underway in Belgium, the Netherlands, Denmark, Ireland, Italy, Poland, Malta and Spain. Pilot screening programmes were underway in Norway, Portugal and Sweden. Waitemata was selected as the pilot site to determine whether organised bowel screening could be introduced in New Zealand in a way that is: effective, safe and acceptable for participants, equitable and economically efficient. The pilot objectives are summarised in Appendix Two. 3. Pilot Progress On 31 December 2015, the original two screening rounds of the pilot were completed. Budget 2015 provided funded for the pilot to run for a third two year cycle while the results of the original pilot were evaluated to inform a decision regarding a national roll out. We have requested a copy of the Waitemata District Health Board, Meeting of the Board 29/06/16 205

206 business case supporting the national rollout for the Board s information, however, as this is yet to go to cabinet it is not yet able to be released publically. The Ministry have advised the Budget 2016 provides funding for the design, planning and set-up phases. Additional funding has been set aside for work on the national IT system and infrastructure needed for a national programme. Ongoing funding will be subject to Budget 2017 decisions. It would cover the ongoing operational costs of the programme, including screening colonoscopies. Surveillance colonoscopies that follow from screening would also be funded. 3.1 Results to date A substantive update on the Bowel Screening Pilot (BSP) was provided to the Board in April 2016 which included results up to September There have been no further results reported publically and the key aspects of this previous paper are summarised below. The previous paper can be viewed in the Diligent Boardbooks resource centre. The Ministry has released the final results for the first round (January 2012 to December 2013) and for the first twenty-one months of the second round (January 2014 September 2015). The key challenges for the Pilot at the end of round one were to increase coverage, increase equity of participation and develop the register so that it is fit for purpose in the event of either the Waitemata DHB programme continuing or a national roll-out occur. 3.2 Participation For round one, a total of 121,798 people were invited to take part and 69,176 people returned a kit which could be tested by the laboratory. Participation for the total population was 56.8%. This result falls short of the 60% target but is higher than the internationally accepted minimum participation rate of 45% for first rounds. The experience of other countries is that participation in the second round will not reach the level of participation achieved in the first round. Our pilot is proving no exception. Overall participation for the first 21 months of the second round is 53.4%. The Ministry reports round two participation overall and also broken down into three subgroups: Participants for whom this was their first invitation to participate i.e. they had aged in or moved into the area Participants who had been invited in round one but who did not respond or successfully complete a kit which could be tested Participants who were successfully screened in round one and who participated again in round two. Round one compared with round two broken down into these three subgroups is shown on the following table. Waitemata District Health Board, Meeting of the Board 29/06/16 206

207 Table 4: Participation in the BSP by ethnicity showing those invited from 1/01/12 to 30/09/15 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Rd1 Rd 2 overall average of the three Rd 2 sub-groups Rd 2 was first screen (ageing or moving in) Rd 2 was first screen (spoilt or did not respond to Rd 1 invite) Total Population Maori Pacific Asian European or Other Rd 2 was second screen (successful in Rd 1 and invited again) An 83% overall response rate for those invited for a second round is considered to be extremely good when compared with other overseas programmes and provides a measure of patient satisfaction of their experience. Bowel Screening programmes in other countries have consistently reported a lower participation rate achieved during the second round and this has been the case for the Waitemata DHB pilot to date. For the BSP the difference in the overall participation rate between rounds is not as large as anticipated. Given that participation increases for several months after the end of the reporting period, there is a chance that the second round participation will continue to rise and the difference between the two rounds will decrease. 3.2 Fair access Round one participation rates for Maori (46%) and Pacific (30.4%) were of concern. Round two has seen a strong focus on strategies designed to increase equity. Despite a reduction in overall participation between rounds (from 56.8% to 53.4%) it is pleasing to report that Maori (48%) and Pacific (38%) participation has increased during the first 21 months of round two that is, the equity gap has reduced. In comparing both Maori and Pacific against European/Other, the equity gap for Maori has reduced from 13.7% in round one to 5% in round two and for Pacific, from 29.3% to 15.3% which is a great achievement in a short space of time. When looking at the participation rates for round two in those that participated in round one, the gap between Maori and Pacific compared with European/Other is 1.2% and 4.3% respectively. It is extremely encouraging the equity gap is almost eliminated for those who participated in the first round and who participated again in the second round. A number of strategies to increase equity in participation were implemented during the second round and the equity gaps have reduced. The extension of the pilot has provided the opportunity to also trial a pay for performance model as a further strategy to increase equity. Waitemata District Health Board, Meeting of the Board 29/06/16 207

208 3.3 Screening effectiveness A total of 269 cancers were identified in the first two rounds of the pilot. Fewer cancers were identified in the second screening round than in round one. The cancer detection rate has also reduced from 2.8 per 1,000 in round one to 1.4 per 1,000 in round two (to 30 September 2015) as would be expected in a second screening round. Higher cancer detection rates for Maori have occurred in the second round. Table 2: Colorectal cancers detected during round one and round two* Ethnicity Round 1 # Round 1 % Ethnicity Round 2 # Round 2% European European Chinese 11 7 Chinese 6 6 Asian 7 4 Maori 6 4 Pacific 4 2 Asian 4 3 Maori 2 1 Pacific 3 6 Other 1 1 Other 3 3 *BSP data A significant percentage of the cancers (68.5% in round one and 65% in round two) are identified at stage 1 and 2 when treatment is more effective. This compares favourably with approximately 40% identified (anecdotally) at stage 1 and 2 in symptomatic services. Table 3: Colorectal cancer stage at diagnosis (including polyp cancers)* *BSP data Stage Round 1% Round 2% Cost effectiveness The BSP provided detailed costing data to inform the interim evaluation report which was published in late The final evaluation report is due for publication in mid-2016 and the BSP has provided updated information to the evaluation team. 4. Implications of National Rollout for Waitemata DHB The programme will be progressively rolled out across the country beginning in mid-2017, with all DHBs expected to have started screening by the end of Hutt Valley and Wairarapa DHBs begin screening the eligible 60 to 74 year age group from mid-2017, with all other DHBs following in stages. The MOH have advised a number of factors contributed to the decision to start with these two DHBs, including their history of working together and their willingness to build a closer working relationship. The DHBs are able to begin screening in 2017 and their small size will enable them to adapt more easily to the complex requirements of an evolving programme. This will also mean they can trial new systems and processes for the wider roll-out. The DHBs also have a unique population mix that includes a rural component. The order in which other DHBs will join the roll-out will be finalised after DHBs confirm their readiness. Waitemata District Health Board, Meeting of the Board 29/06/16 208

209 Bowel screening will continue to be offered at Waitemata DHB, which will transition from the Pilot to the national bowel screening model over the course of the roll-out. The current contract is for the pilot to undertake a third two year cycle of screening which concludes December There are a number of implications: 4.1 Pilot Coordination Centre During the first stage of the roll-out in 2017, the Waitemata Bowel Screening Pilot (BSP) Coordination Centre will manage and send screening invitations, coordinate the processing, analysis and management of completed tests and results for the Pilot and also for bowel screening at Hutt Valley and Wairarapa DHBs. It is expected that a National Coordination Centre (NCC) will be established by 2018 to take over this role and the selection of the NCC will be subject to a competitive process. The role of the NCC is different to what the current pilot coordination centre undertakes as the functions are split between the NCC and four Bowel Screening Regional Centres (BSRCs). The NCC would send letters to participants following a negative result and notify GPs electronically of all results. It would also advise the four Bowel Screening Regional Centres of all results. The BSRCs would then be responsible for ensuring a colonoscopy or other appropriate bowel investigation is offered to people with a positive result. The BSRCs would also receive funding for awareness-raising activities at a regional and local level that drive equitable participation. One consideration for Waitemata DHB is whether it wishes to bid to be the National Coordination Centre. If Waitemata DHB chooses not to undertake this function or is not successful in a bid to be the NCC, then following the implementation support of the Hutt Valley and Wairarapa DHBs, the Pilot coordination centre will transition to the new NCC provider in early The selection of the four BSRCs is not expected to be a formal procurement process. The Ministry intends to engage with DHBs, Alliance Groups, Regional Cancer Networks and private providers in each region before calling for Expressions of Interest for delivery of each regional centre. It is envisaged that all DHBs in a region would endorse a joint solution. 4.2 Age Range The current pilot age range is 50 to 74, however, the national programme rollout will start with a narrower eligible age range, 60 to 74. The MOH have advised the reason for the change in eligible age is that more than 80 percent of cancers detected through the Waitemata DHB pilot have been in people aged 60 to 74 years. This also aligns with the approach used in other countries when establishing a national bowel screening programme. For Waitemata DHB the age range change will mean that eligible people aged 50 years and over, who are living in the Waitemata DHB area, will continue to be invited for screening until the Pilot ends in December People in the 50 to 74 year age group who have received an invitation through the Pilot will continue to be invited to complete a bowel screening test every two years. People living in the Waitemata DHB area who have not turned 50 years by the end of the Pilot and have not been invited to participate in the Pilot will now have to wait to be screened until they turn 60 and become eligible for screening as part of the National Bowel Screening Programme. The impact of this change will mean more cancers detected with fewer colonoscopies and will release physical colonoscopy capacity from early 2018 which could be made available for symptomatic cases. Waitemata District Health Board, Meeting of the Board 29/06/16 209

210 4.3 Screening Test Sensitivity Another potential change could be the positivity threshold for the ifobt test. The MOH have advised, in line with other international bowel screening programmes, the amount of blood needed to trigger a positive result (positivity threshold) will be set at a level where there is a greater likelihood of a cancer being found in participants undergoing colonoscopy. The chosen positivity threshold will also minimise the number of participants who undergo a colonoscopy where serious problems are not found. If there is to be a change to this threshold, then this change would be implemented for the rollout of the first two DHBs and would be a change for the Waitemata pilot at the same time which would be early to mid The impact of this would be a further reduction in colonoscopy capacity required from mid-2017 onwards and as above would be available to be commissioned for the symptomatic service. Waitemata District Health Board, Meeting of the Board 29/06/16 210

211 Hon Dr Jonathan Coleman Minister of Health 26 May 2016 Bowel screening programme roll-out The roll-out of a national bowel screening programme is on track to begin in 2017, Health Minister Dr Jonathan Coleman says. Budget 2016 invests $39.3 million over four years for national bowel screening starting with Hutt Valley and Wairarapa DHBs. This will be followed by a progressive roll-out across the country. Additional funding has also been set aside in contingency to enable the IT support needed for a national screening programme. Once fully implemented, the programme is expected to screen over 700,000 people every two years. We know that bowel screening saves lives by detecting cancers at an early stage when they can more easily be treated. Around 3,000 New Zealanders are diagnosed with bowel cancer each year. The Government is committed to better access to early detection and treatment. We have been working towards a national screening programme for some time. This investment builds on the successful Waitemata DHB bowel screening pilot, which has been running since The Government has also invested $15 million since 2013 to deliver more colonoscopies and reduce colonoscopy waiting times across the country. This has also helped to build capacity within the system, Dr Coleman says. A business case for the bowel screening roll-out will go to Cabinet shortly. Once in place, DHBs will offer people aged 60 to 74 a bowel screening test every two years. More than 80 per cent of cancers found through the pilot were in those aged 60 to 74. Screening in this range will maximise the number of cancers found while minimising the cases where problems are not found. In line with international best practice for adoption of screening programmes, a staged approach is planned. Information from the pilot and discussions with the sector have confirmed there will be a sufficient clinical workforce to deliver the additional colonoscopies required for a staged roll-out of a national programme. Contact: Kirsty Taylor-Doig Waitemata District Health Board, Meeting of the Board 29/06/16 211

212 Appendix 2 - Pilot objectives The overall goal for the BSP is to determine whether organised bowel screening could be introduced in New Zealand in a way that is effective, safe and acceptable for participants, equitable and economically efficient. The Pilot addresses four key aims: 1. Effectiveness: Is a national bowel screening programme likely to achieve the mortality reduction from bowel cancer for all population groups seen in international randomised controlled trials? 2. Safety and acceptability: Can a national bowel screening programme be delivered in a manner that is safe and acceptable? 3. Equity: Can a national bowel screening programme be delivered in a manner that eliminates (or does not increase) current inequalities between population groups? 4. Economic efficiency: Can a national bowel screening programme be delivered in an economically efficient manner? Ten objectives have been determined, to address the four aims: 1. Programme design - to pilot the use of a population register, closely linked with primary health care services to invite the target population, along with a coordination centre and associated information system to manage the screening pathway 2. Screening effectiveness - to assess the early indicators of the effectiveness of bowel screening, including the number and stage of cancers detected, the number and size of adenomas detected, and colonoscopy completion rates 3. FOBT experience - to assess the performance and acceptability of the chosen FOBT in the New Zealand context including the positivity rates in New Zealand, positive predictive values for adenomas and cancers, technical repeat rates and false positive rates 4. Participation and coverage - to determine the level of participation and coverage for the eligible and invited populations, including sub-populations (defined by sex, age, ethnicity, socioeconomic status and rural representation) 5. Quality - to pilot the agreed quality standards and monitoring requirements along the Screening Pathway and assess the implications for a national programme; in particular to pilot the acceptability and safety of the standards and screening to providers and for different population groups 6. Service delivery and workforce capacity - to monitor the effect, including resource implications of screening activities, on primary care, community health services, laboratory, and secondary and tertiary services and the implications of this for a national programme 7. Fair access for all New Zealanders - to determine whether a bowel screening programme can be delivered in a way that provides fair access for all New Zealanders. In particular, to evaluate the process of adopting a focus in leadership, decision making processes and implementation of the pilot to provide fair access to all eligible people 8. Cost effectiveness - to determine the costs of all services along the Screening Pathway to determine the cost effectiveness of a bowel screening programme. To compare this, where possible, with other preventative programmes in New Zealand and bowel screening trials internationally Waitemata District Health Board, Meeting of the Board 29/06/16 212

213 9. Acceptability to the target population - to pilot provision of information and support to the target population to facilitate informed participation and evaluate the knowledge, attitudes and satisfaction of groups of participants (defined by sex, age, ethnicity, socioeconomic status and geographical residence) in the screening pilot, including identifying factors associated with non-participation 10. Acceptability to providers - to evaluate the knowledge and attitudes and acceptability to health professionals and health care providers based in community, primary care and hospital settings. Waitemata District Health Board, Meeting of the Board 29/06/16 213

214 9.3 Waitemata Healthy Food and Drink Policy Recommendation That the Board notes that the Waitemata DHB Healthy Food and Drink Policy is being updated in line with the national policy subject to agreement with the National Resident Doctors Association and the National Bipartite Action Group for the wider health workforce. Prepared by: Rebecca McLean (Public Health Dietitian) and Roslyn Norrie (Food Service Manager) Endorsed by: Simon Bowen (Director Health Outcomes) Glossary DHB ELT MOH HSR - District Health Board - Executive Leadership Team - Ministry of Health - Health Star Rating 1. Executive Summary Waitemata DHB has had a Healthy Food and Drink policy in place for some time. This is being updated in line with the National Healthy Food and Drink Policy. The purpose of the policy is to ensure that healthy foods and beverages are the predominant options available on DHB premises, and provided by contracted providers. The policy is a response to initiative 21 DHB Healthy Food Policies in the Ministry of Health s (MOH) Childhood Obesity Plan. It has been developed in accordance with the New Zealand Eating and Activity Guidelines. Ensuring an environment where healthy food and drink choices are the easiest choices is a mainstay in the prevention and reduction of overweight and obesity. The National Healthy Food and Drink Policy will provide an opportunity for Waitemata DHB to: Role model environments that promote healthy food and drink choices Normalise healthy choices and smaller servings in health settings Influence other community settings to review their food and drink environments Signal desired changes to the food industry with one consistent set of food and drink criteria across all DHBs The policy applies to all DHB facilities/sites, contractors and staff. It does not apply to inpatient meal services or meals on wheels. It is intended that the policy will be implemented by all DHBs and the MOH over a two-year period. It will be reviewed in Negotiations are taking place with the National Resident Doctors Association as required by law to reach common ground. The policy is also being discussed with the National Bipartite Action Group for the wider health workforce. Waitemata DHB Meeting of the Board 29/06/16 214

215 2. Strategic Alignment Emphasis and investment on both treatment and keeping people healthy Service integration and/or consolidation Evidence informed decision making and practice Operational and financial sustainability Obesity is one of the leading modifiable risk factors in Waitemata. Implementation of a healthy food and drink policy is one of a number of measures the DHB is taking to address obesity. The benefits from healthier Waitemata DHB food environments include improvements to health and wellbeing for staff, visitors, family/whanau of patients and the general public, being a leader and role model to the community, and demonstrating alignment with the MOH and other DHBs across the country. The DHB has worked with DHBs regionally and nationally as well as the MOH to develop the policy The policy is based on best available evidence and have been developed by a network of dietitians and public health physicians Obesity is a major risk factor for many chronic diseases including cancer, diabetes and CVD which have significant costs to the DHB. Reducing obesity therefore is an important population health goal and an important strategy to support the DHBs operational and financial sustainability 3. Background An existing Healthy Food and Beverage Environments Policy is currently in operation at Waitemata DHB. On 20 August 2015 the Director-General of Health (MOH) wrote to all DHBs requiring they no longer sell sugar-sweetened beverages on their premises. This letter also required that DHB healthy food policies be made available on DHB websites originally by 30 December 2015 and then extended to 1 July District Health Boards around the country were at varying stages of policy development and implementation, working with a range of different food and drink criteria. A National DHB Food and Drink Environments Network (the Network), which included the MOH, was established in August 2015 to agree a nationally consistent Healthy Food and Drink Policy for use across all DHBs and potentially other settings. The Network received support and advice from the Heart Foundation, Agencies for Nutrition Action, Ministry for Primary Industries, NZ Beverage Guidance Panel, and the University of Auckland in the development of the policy. In principle support was also provided from national agencies, including the NZ Medical Association, NZ Nurses Organisation, Allied Health Aotearoa NZ, Dietitians NZ, and the Royal Australasian College of Physicians. Healthy Food and Drink Environments are those where all indoor and outdoor areas a person sees, enters, is near to, or uses support healthy eating and drinking as a social norm and the easiest choice. One in four adults in the Waitemata district are obese, with disproportionately high rates for Māori (43%) and Pacific (65%) populations. Addressing obesity requires a multipronged approach and includes remodelling environments to become supportive of healthy lifestyles. The benefits from healthier Waitemata DHB food environments include improvements to health and wellbeing for staff, visitors, family/whanau of patients and the general public, being a leader and role model to the community, and demonstrating alignment with the MOH and other DHBs across the country. Waitemata DHB Meeting of the Board 29/06/16 215

216 4. Changes to Existing Policy The Auckland DHB Healthy Food and Beverage Environments Policy (Aug 2015), which is very similar to the Waitemata DHB Healthy Food and Beverage Environments Policy (Dec 2015), was used as a starting document for the National Healthy Food and Drink Policy. While there have been a number of changes, the purpose and scope of the policy is very similar to the Waitemata DHB policy. Key changes from the 2015 Waitemata DHB Healthy Food and Beverage Policy include: No confectionery will be sold on Waitemata DHB premises Green category foods are required to dominate, making up at least 55% and Amber category foods will make up less than 45% of food and drinks available. All pre-packaged foods (excluding drinks) will meet the recently established Health Star Rating (HSR) nutrient criteria of at least 3.5 stars. Additional criteria (such as portion sizes) may apply to some categories. Green category (cold) drinks have been restricted to water and milk only. Amber category options will include no added sugar juices ( 200mls) and artificially sweetened drinks ( 300mls). Flavoured milks, liquid breakfasts and (caffeinated) energy drinks including artificially sweetened varieties are all classified as red. 5. Costs Complying with the National Healthy Food and Drink Policy may impact on DHB revenue through commissions and leases. The DHB will continue to work collaboratively with retailers to progressively implement the Policy over a two-year period. It is possible that some of the retailers at Waitemata DHB may choose not to sign leases due to the Policy restrictions. If retailers who provide the DHB with a commission on revenue were to choose not to sign (or renew) contracts, and no other retailers took the lease, this would result in a reduction in total revenue for the DHB. The Healthy Food and Beverage Policy applies to any external party that provides catering on site at any DHB facility, and off site where the DHB organises and/or hosts a function for staff, visitors and/or the general public. The approved catering suppliers for Waitemata DHB are restricted to Archers Sushi, Subway or Medirest. Currently, in order to provide enough food within the $5 per person catering budget, staff often buy groceries from the supermarket, make up sandwiches and fruit platters, and then later submit an expense claim. 6. Consultation 6.1 Consultation already undertaken Internally, consultation has been undertaken with members of the senior management team, Auckland DHB dietitians, and Auckland DHB and Waitemata DHB food service managers. In April 2016 Waitemata DHB retailers and volunteer service providers affected by this policy were given the opportunity to comment on the draft Policy. Comments were received from the Red Cross. Nationally, the following agencies were invited to provide comment on the draft Policy: Allied Health Aotearoa NZ Association of Professional and Executive Employees (APEX) Association of Salaried Medical Specialists (ASMS) Compass Dietitians NZ Waitemata DHB Meeting of the Board 29/06/16 216

217 E Tu Food and Grocery Council Health Partnerships Limited NZ Medical Association NZ Nurses Organisation Public Services Association (PSA) Resident Doctors Association Royal Australasian College of Physicians Spotless In principle support was also provided from the NZ Medical Association, NZ Nurses Organisation, Allied Health Aotearoa NZ, Dietitians NZ and the Royal Australasian College of Physicians. Note that no comments were received from the PSA, E Tu, APEX or ASMS. Discussions are taking place with the Resident Doctors Association. Negotiations are taking place with the National Resident Doctors Association as required by law to reach common ground. The policy is also being discussed with the National Bipartite Action Group for the wider health workforce. 6.2 Clinical endorsement The guidelines have been endorsed by dieticians and public health physicians from the Network. 7. Implementation The DHB will continue to work collaboratively with retailers to explain the new policy and guidelines, and to support retailers to work towards achieving the guidelines in progressive steps over a twoyear period. A communication plan will be developed for staff, visitors and commercial and other stakeholders with key messages developed. A key theme in the agreement of this Policy is that we need to take our staff and the general public on a journey to better understand healthy food and drink choices. Issues are likely to be raised are around affordability, quality, choice and commercial viability. 8. Conclusion The National Healthy Food and Drink Policy provides a powerful opportunity to role-model environments that promote healthy food and drink choices across all New Zealand DHBs. It is a step in normalising healthy choices and smaller servings in health settings, with potential to influence other community settings. Agreement with this policy will also assist the food and drink industry by having one set of food and drink provision criteria for all DHBs. Ensuring a healthy food and beverage environment within areas of DHB influence is essential to supporting healthy food and beverage choices for staff, visitors and users of contracted provider services. Ensuring an environment where healthy food and beverage choices are the easiest choices is a mainstay in the prevention and reduction of overweight and obesity. References 1. Ministry for Primary Industries Health Star Rating. URL 2. QST Is Healthy Food Really Profitable: URL Waitemata DHB Meeting of the Board 29/06/16 217

218 National Healthy Food and Drink Policy Creating a healthier food and drink environment for staff, visitors and the general public in District Health Boards and the Ministry of Health Developed by the National District Health Board Food and Drink Environments Network May 2016 Please note: The content of this policy is final, although the document is yet to be fully prepared for publication ie grammatically edited and formatted. The fully edited and formatted version will be available in June Last updated 10 May

219 Table of Contents 1. Introduction Overview Purpose Scope Healthy Food and Drink Policy Healthy Food and Drink Environments Healthy Food and Drink Policy Principles Promotion of Healthy Options Staff Facilities Facilities for Storing Own Meals Drinking Water Breastfeeding in the Workplace Healthy Food and Drink Environments Criteria Food and Drink Categories Food and Drink Availability Additional Requirements Healthy Food and Drink Environments Nutrient Criteria Table Vegetables and Fruit Grain Foods Milk and Milk Products Legumes, Nuts, Seeds, Fish and other Seafood, Eggs, Poultry (e.g. Chicken), and Red Meat Mixed Meals / Ready to Heat & Eat Meals Fats and Oils, Spreads, Sauces, Dressings and Condiments Packaged Snack Foods Bakery Items Drinks Monitoring and Evaluation Associated Documents Appendix 1: Process Appendix 2: Network members and representatives of agencies supporting the development of the National Policy Last updated 10 May

220 1. Introduction Healthy eating is essential for good health and wellbeing. With increasing rates of obesity and the subsequent rise of associated poor health outcomes including type 2 diabetes and cardiovascular disease, it is essential that District Health Boards (DHBs) and the Ministry of Health (the Ministry) show leadership by providing healthy eating environments for their staff, visitors and the general public. The development of DHB Healthy Food Policies is an action in the Ministry of Health s Childhood Obesity Plan (Ministry of Health 2015a). The DHB Healthy Food and Drink Environments Network (the Network) was established in 2015 to develop a nationally consistent Healthy Food and Drink Policy (the Policy) for use across all DHBs and potentially other settings. The Network received support and advice from the Heart Foundation, Agencies for Nutrition Action, Ministry for Primary Industries, New Zealand Beverage Guidance Panel, and the University of Auckland in the development of the policy. For more information on the process used to develop this policy see Appendix 1. The Policy will be implemented in DHBs and the Ministry over a two-year period. It is the intention that the Network will continue to support DHBs and the Ministry during this period and undertake a review of the Policy in Overview 2.1 Purpose The purpose of this policy is to support DHBs and the Ministry to: demonstrate commitment to the health and wellbeing of staff, visitors, and the general public by providing healthy food and drink options, which support a balanced diet in accordance with the New Zealand Eating and Activity Guidelines act as a role model to the community by providing an environment that supports and promotes healthy food and drink choices assist the food and drink industry by having one set of food and drink provision criteria for all DHBs. Important considerations In providing healthy food and drink environments, DHBs take into consideration: the needs of different cultures, religious groups and those with special dietary needs, and accommodate these on request, where possible and practicable ecologically sound, sustainable, and socially responsible practices in purchasing and using food and drinks. Encourage procurement of seasonal and locally grown and manufactured (regional and national) food and drinks where possible and practical. the importance of discouraging association with products and brands inconsistent with a healthy food and drink environment as defined by this Policy. Last updated 10 May

221 2.2 Scope This policy applies to all DHB facilities/sites, contractors, and staff including: all food and drink provided or able to be purchased from any retailer, caterer, vending machine, or volunteer service on the DHB s premises for consumption by staff, visitors, and the general public 1 any gifts, rewards, and incentives offered to staff, guest speakers and/or formal visitors on behalf of the DHB if containing food and/or drinks any fundraisers organised by either internal or external groups where food and drinks are sold or intended for consumption on DHB premises. Fundraisers associated with groups outside the DHB which do not meet this policy should not be promoted on DHB premises or through DHB communications (e.g. chocolate fundraisers). Alternative healthy fundraising and catering ideas are encouraged [link to be inserted] all health service providers contracted by the DHB that have a food and drink environment clause in their contract with the DHB any external party that provides food or catering: o o on site at any DHB facility (e.g. recruitment agencies, drug companies), and off site where the DHB organises and/or hosts a function for staff, visitors and/or the general public (e.g. conferences, training). While the provision and consumption of healthy food and drink options is strongly encouraged, this policy excludes: food and drink brought to work by staff for their own consumption gifts from families / whānau of patients / clients to staff self-catered staff shared meals both on and off site (e.g. food brought for special occasions, off-site self-funded Christmas parties or similar celebrations) gifts, rewards, and incentives that are self-funded inpatient meal services and meals on wheels. Separate standards exist for inpatients and Meals on Wheels which reflect food and drink requirements in both health and illness and for various age groups. The majority of inpatients are admitted because they are unwell and therefore require food and drink that is appropriate at that time, for their clinical care and treatment food and drink provided by clients / patients and their families and visitors for their own use (families and visitors are encouraged to check with healthcare staff before bringing in food for inpatients) alcohol-related recommendations (please refer to your DHBs position on alcohol). 1 Includes foods and drink available for purchase by patients Last updated 10 May

222 3. Healthy Food and Drink Policy 3.1 Healthy Food and Drink Environments The intent of this policy is to ensure that the DHB and its contracted health service providers (with a healthy food and drink contract clause) role model an environment that consistently offers and promotes healthy food and drink options. Section five of this policy provides Healthy Food and Drink Criteria to provide greater clarity on how the policy can be implemented. Consistent with the Eating and Activity Guidelines for New Zealand Adults (Ministry of Health 2015b), messages and practices relating to food and drinks in the DHB will reflect the following principles: 3.2 Healthy Food and Drink Policy Principles A variety of foods from the four food groups need to be available Plenty of vegetables and fruit. Grain foods, mostly whole grain and those naturally high in fibre. Some milk and milk products, mostly low and reduced fat. Some legumes, nuts, seeds, fish and other seafood, eggs, poultry (e.g. chicken) and/or red meat with the fat removed. Mostly prepared with or contain minimal saturated fat, salt (sodium) and added sugar, and that are mostly whole and less processed. Some foods containing moderate amounts of saturated fat, salt and / or added sugar may be available in small portions (e.g. some baked or frozen goods). No deep fried foods. No or limited confectionery (e.g. sweets and chocolate) 2. Water and unflavoured milk will be the predominant cold drink options. Availability and portion sizes of drinks containing intense sweeteners 3, and no added sugar juices are limited. No sugar sweetened drinks 4. 2 The National District Health Board Food and Drink Environments Network have chosen to adopt a no confectionery policy within DHBs and the Ministry. Confectionery will be phased out over a two year period. 3 Intense sweeteners (also known as artificial sweeteners) are a type of food additive that provides little of no energy (kilojoules). Intense sweeteners permitted for use in New Zealand include aspartame, sucralose and stevia. 4 Any drink that contains added caloric sweetener usually sugar. The main categories of sugary drinks include soft-drinks/fizzy-drinks, sachet mixes, fruit drinks, cordials, flavoured milks, flavoured waters, iced teas/coffees, and energy/sports drinks. Last updated 10 May

223 Healthy food and drink choices, including vegetarian and some vegan items, appropriate to a wide variety of people should be available, with consideration given to cultural preferences, religious beliefs and special dietary requirements such as gluten free. Breastfeeding is supported in all DHB settings as the optimum infant and young child feeding practice. 3.3 Promotion of Healthy Options It is important that the DHB and its staff are role models for the community in obesity and disease prevention and advocate for healthy nutrition in the workplace and other settings as appropriate. The policy itself is a health promotion tool. Providing a healthy eating environment is a health and safety issue which should be supported by all levels of the organisation. The DHB will actively promote healthy food and drink options with staff, visitors, and the general public. Healthy options ( Green category foods and drinks refer Section 5) should be the most prominently displayed items by retailers, and should be readily available, in sufficient quantities, competitively priced and promoted to encourage selection of these options. The DHB will promote healthy eating behaviours to staff, visitors, and the general public through the provision of consistent evidence-based nutrition messages. Partnerships, fundraisers, associations, and promotions involving products and brands that are inconsistent with a healthy food and drink environment as defined by this policy are discouraged. 4. Staff Facilities 4.1 Facilities for Storing Own Meals Staff should be provided with reasonable access to food storage facilities, such as fridges, lockers or cupboards. Wherever possible this would also include reasonable access to a microwave oven. 4.2 Drinking Water The DHB will provide reasonable access to drinking water for all staff, visitors, and the general public on site. Wherever possible this should be tap water and/or water fountains, with staff encouraged to bring their own water bottle. Where water coolers are provided, each service must ensure that they are replenished, cleaned and serviced on a regular basis. Consider environmentally friendly and recyclable options when purchasing cups for water dispensing. 4.3 Breastfeeding in the Workplace The DHB will promote and support breastfeeding by: encouraging and supporting breastfeeding within the workplace providing suitable areas that may be used for breastfeeding and for expressing and storing breast milk providing suitable breaks for staff who wish to breastfeed during work, where it is reasonable and practicable. Last updated 10 May

224 Refer to your DHB s own specific breastfeeding policy for more detailed information. 5. Healthy Food and Drink Environments Criteria 5.1 Food and Drink Categories The purpose of the food and drink categories is to provide a practical way for food service providers to categorise foods. Foods will not be labelled with the colours or promoted using a traffic light labelling system. Foods and drinks are placed into three categories: Green: These foods and drinks are part of a healthy diet. They are consistent with the Healthy Food and Drink Policy Principles reflecting a variety of foods from the four food groups including: plenty of vegetables and fruit grain foods, mostly whole grain and those naturally high in fibre some milk and milk products, mostly low and reduced fat some legumes, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red meat with the fat removed; and are low in saturated fats, added sugar and added salt, and mostly whole and less processed. Green category products must consist only of green category foods, drinks, and ingredients. Amber: These foods and drinks are not considered part of an everyday diet, but may have some nutritive value. Foods and drinks in this category can contribute to consuming excess energy, and are often more processed. The amber category contains a wide variety of foods and drinks, some healthier than others. Where possible provide the healthier options within this category e.g. a potato top pie instead of a standard pie. Amber category products can contain a mixture of green and / or amber foods, drinks, and ingredients. Red: These foods and drinks are of poor nutritional value and high in saturated fat, added sugar, and / or added salt and energy. They can easily contribute to consuming excess energy. These are often highly processed foods and drinks. 5.2 Food and Drink Availability Healthy food and drinks should be the easy choice. Within a food service (e.g. cafeteria, catered event, shop, or vending machine), green category foods and drinks should predominate. This means that they should make up at least 55% of food and drinks available for consumption. Over time, organisations should aim to increase the proportion of green healthy foods and drinks (over and above the minimum 55%). Green category items: dominate the food and drinks available (at least 55% of choices available) are displayed prominently on shelves, benches, cabinets and vending machines Last updated 10 May

225 are always available in sufficient quantities to be the predominant option. Amber category items: make up less than 45% of choices available should be small portion sizes (as per specific criteria) are not prominently displayed at the expense of green category items. Red category items: are not permitted (refer to section 2.2 for the scope of the policy) should be phased out over time in accordance with each individual DHB s Policy implementation plan if these products are currently available within the DHB Additional Requirements In addition to complying with the criterion within the Nutrient Criteria Table (refer Section 6): all unpackaged / prepared on-site foods and drinks should be consistent with the overarching policy principles. all pre-packaged foods (excluding drinks) must meet set nutrient criteria standards (e.g. Health Star Rating (HSR) of at least 3.5 stars 5 ). Additional criteria (such as portion sizes) may apply to some categories. For packaged foods without a Health Star Rating, manufacturers 6 can calculate a rating using the tool here. it is acknowledged that specialty items such as gluten and dairy free items may not be able to comply with all criteria, however products are still required to reflect the overarching policy principles and relevant criteria where practical. 5 Technical Report: Alignment of NSW Healthy Food Provision Policy with the Health Star Rating System: 6 It is up to the packaged food provider / manufacturer to calculate and provide the HSR of their product(s) to the DHB if their product does not hold a HSR. DHB food service staff can contact the manufacturer / provider to seek this information prior to purchasing. Last updated 10 May

226 National DHB Food and Drink Environments Guidelines Feedback 10/05/16 6. Healthy Food and Drink Environments Nutrient Criteria Table 7 CATEGORY GREEN 55% of products must fit within this category AMBER < 45% of products must fit within this category RED Products within this category are not permitted 6.1 Vegetables and Fruit Vegetables All fresh, frozen, canned, and dried plain vegetables Opt for no / minimal added unsaturated fat / salt varieties Fruit All fresh, frozen, and canned fruit Opt for no / minimal added sugar varieties Dried fruit 30g serving size as an ingredient or part of a fruit and nut mix Dried fruit >30g serving size as an ingredient or part of a fruit and nut mix or dried fruit on its own 6.2 Grain Foods Breads and crackers All wholegrain, multigrain, wheatmeal, and wholemeal breads and crackers with a 3.5 Health Star Rating (HSR) All wholegrain, multigrain, wheatmeal, and wholemeal breads and crackers with a <3.5 HSR All white breads and crackers with a 3.5 HSR All white breads and crackers with a <3.5 HSR Breakfast cereals Cereal foods Wholegrain breakfast cereals with a 3.5 HSR and 15g / 100g sugar Wholegrain and high fibre varieties e.g. wholegrain rice, wholemeal pasta and couscous, quinoa, polenta, buckwheat, bulgur wheat, oats, pearl barley, spelt, rye Breakfast cereals with a 3.5 HSR All breakfast cereals that do not meet the green / amber criteria Refined grains and white varieties e.g. rice, plain pasta, unflavoured noodles, polenta (degermed), couscous 7 Criteria within packaged / unpackaged food and drink items may not necessarily align

227 6.3 Milk and Milk Products National DHB Food and Drink Environments Guidelines Feedback 10/05/16 Reduced or low-fat (with a 3.5 HSR): - milks and calcium enriched soy milk Full-fat (with a 3.5 HSR): - milks and calcium enriched soy milk Full-fat (with a <3.5 HSR): - yoghurt / dairy food (>150mls portion) Milk and milk products See section 6.9 Drinks - yoghurt / dairy food ( 150mls portion) - custard ( 150mls portion) - cheese ( 40g portion) Calcium enriched milk alternatives (e.g. rice/almond/oat) - yoghurt / dairy food ( 150mls portion) - custard ( 150mls portion) - cheese ( 40g portion) Reduced or low-fat varieties of the above (with a 3.5 HSR) with portion sizes greater than those stipulated in green category Lite varieties of cream, sour cream and cream cheese Frozen desserts (e.g. yoghurt, ice cream) with a 3.5 HSR and 100g portion - custard (>150mls portion) - cheese (>40g portion) Standard varieties of cream, sour cream, and cream cheese Frozen desserts with a <3.5 HSR or >100g portion All sugar sweetened milk drinks 6.4 Legumes, Nuts, Seeds, Fish and other Seafood, Eggs, Poultry (e.g. Chicken), and Red Meat Legumes Dried and canned beans and peas e.g. Baked beans, red kidney beans, soy beans, mung beans, lentils, chickpeas, split peas, bean curd & tofu Use reduced salt/sodium varieties where applicable. Nuts and seeds All unsalted nuts and seeds with no added sugar All salted nuts and seeds 50g portion (with no added sugar) All nuts and seeds with dried fruit 50g portion All salted nuts and seeds >50g / portion All sugared, candied, coated nuts and seeds Nuts and seeds with confectionery

228 National DHB Food and Drink Environments Guidelines Feedback 10/05/16 Fish and other seafood, eggs, poultry (e.g. chicken), and red meat See section 6.6. for suitable cooking oils and cooking methods. All fresh, frozen fish, seafood, skinless poultry e.g. chicken or turkey and lean meat. Eggs. Premium or prime mince ( 95% visual lean meats / 90% chemical lean) Canned and packaged fish, chicken and meat with a 3.5 HSR Meat with small amounts of visible fat only. Standard mince ( 90% visual lean meats/ 85% chemical lean) cooked and fat drained off. Chicken drumsticks Processed fish, chicken (e.g. smoked)and meat: 8-50g in sandwiches, rolls, salads - 120g as a main meal - 150g Sausages per meal Dried meat products e.g. jerky, biltong 3.5 HSR and 800kj per packet Canned or packaged fish, chicken, and meat with a <3.5 HSR All meat where fat is clearly visible Poultry with visible fat and skin remaining (other than drumsticks) Standard mince (where the fat is not drained off) All processed fish, chicken and meat products that do not meet amber serving size 6.5 Mixed Meals / Ready to Heat & Eat Meals Mixed meals (2 or more items/ ingredients from different food groups) and ready to eat / heat meals Unpackaged: 50% of meal is *vegetables and/or fruit and prepared with green category items / ingredients only Packaged: 3.5 HSR and meet the above criteria *A variety of coloured vegetables/fruit are recommended Unpackaged: Meal includes *vegetables and / or fruit and prepared with at least 50% green category items / ingredients Packaged: 3.5 HSR and meet the above criteria *A variety of coloured vegetables/fruit are recommended Unpackaged: Meal includes no vegetables or fruit and is prepared with less than 50% green category items / ingredients Packaged: <3.5 HSR Sandwiches Prepared with green category items only Prepared with 50% green category items Prepared with 50% green category items Sushi Prepared with green category items only All other sushi. Excludes sushi containing deep fried ingredients Containing deep fried items / ingredients Milk based Smoothies prepared onsite No added sugar, reduced fat milk based smoothies made with fresh/frozen and no sugar added canned fruit 300mls Prepared with concentrate, fruit juice, or added sugar 8 Examples of processed meats include: fresh sausages; cooked comminuted meat products (e.g. luncheon, bologna, cooked sausages); uncooked comminuted fermented meat products (UCFM) (e.g. salami, pepperoni); cooked cured meat products (e.g. ham, corned beef, pastrami); cooked uncured meat products (e.g. roast beef); bacon; dry-cured meat products (e.g. prosciutto); meat patties

229 National DHB Food and Drink Environments Guidelines Feedback 10/05/ Fats and Oils, Spreads, Sauces, Dressings and Condiments Fats and oils, spreads, sauces and dressings, and condiments Fats and oils, and spreads: - Low salt mono- or poly-unsaturated spreads e.g. margarine, peanut butter - Oil sprays and vegetable oils e.g. canola, olive, rice bran, sunflower, soya bean, flaxseed, peanut or sesame Sauces and dressings: - Reduced fat/sugar/salt varieties of salad dressings, mayonnaise, tomato sauce Use in small amounts/ Serve on the side. Condiments: If available, opt for reduced fat/sugar/salt varieties of: sauces (chilli, soy, fish etc.), pastes (tomato), relishes, stocks, yeast and vegetable extracts (Marmite, Vegemite) or if using standard items don t add salt. Mustards Fats and oils, and spreads - Single serve butter( 10g PCU) - make margarine the default option for single serve spreads. Sauces and dressings: - Standard salad dressings, mayonnaise, tomato sauce Use in small amounts / Serve on the side Lite varieties of: coconut milk or coconut cream, or dilute coconut cream with water Refer milk and milk products section for cream, sour cream and cream cheese Fats and oils, and spreads - Saturated fats and oils e.g. butter (excluding single serve 10g PCU butter), lard, palm oil, coconut cream, coconut oil and cream. Standard varieties of: coconut milk and coconut cream Refer milk and milk products section for cream, sour cream and cream cheese Herbs and spices If using salt, use iodised salt Deep fried foods Where applicable, use healthier cooking methods i.e. braise, bake, steam, grill, pan fry, or poach Where applicable, use healthier cooking methods i.e. braise, bake, steam, grill, pan fry, or poach No deep fried foods

230 6.7 Packaged Snack Foods National DHB Food and Drink Environments Guidelines Feedback 10/05/16 Packaged snack 9 foods Confectionery HSR and 800kj per packet >3.5 HSR and / or >800kj per packet All confectionery 6.8 Bakery Items Bakery items Unpackaged and packaged bakery items: - More than half of the selection of baked products offered must contain some wholemeal flour, wholegrains (e.g. oats, bran, seeds) and/or fruit / vegetables (e.g. fresh, frozen or dried) - No or minimal icing (e.g. water icing) - Use less fat, salt and sugar - No confectionary 10 within products - (Pies only) Follow the Better Pies Guidelines Portion sizes - Scones, cake or dessert 120g - Loaf, muffins 100g - Slices, friands 80g - Biscuits, muesli bars, pikelets 40g - Pies and quiches 180g - Small pastries 65g - Sausage rolls 100g All products that do not meet the amber criteria 9 Packaged Foods criteria applies to packaged foods not covered by other categories (e.g. bakery items). Generally single serve portions in vending machines and cafeterias. Where shops are onsite, multi-serve packaged foods that meet the HSR of greater than or equal to 3.5 and any other criteria that applies per serving are able to be sold e.g. crackers, cereal, biscuits, canned or packaged soups, plain popcorn. 10 Confectionery definition: confectionary includes a range of sugar-based products, including boiled sweets (hard glasses), fatty emulsions (toffees and caramels), soft crystalline products (fudges), fully crystalline products (fondants), gels (gums, pastilles, and jellies), and chocolate. (Heart Foundation Food and Beverage Classification System) Also includes fruit leathers, enrobed (e.g. yoghurt covered items), candied fruit/nuts, and compound chocolate

231 National DHB Food and Drink Environments Guidelines Feedback 10/05/ Drinks Cold Drinks Plain, unflavoured, water and reduced fat milk/ calcium enriched milk alternatives e.g. reduced fat soy milk, almond milk - Plain full-fat milk and calcium enriched milk alternatives e.g. soy milk, almond milk - Carbonated water - Still/carbonated drinks and milk drinks that are sweetened with intense sweeteners mls - Diluted no added sugar fruit or vegetable juices with total sugar content < 20g 12 and 300mls - 100% fruit and/or vegetable juices (or ice blocks) with no added sugar (including unflavoured coconut water) and 200mls - Drinks containing added sugars 13 - Sugar sweetened drinks - Milk based drinks with added sugar e.g. milkshakes and liquid breakfasts - Still/carbonated drinks that are sweetened with intense sweeteners > 300mls - Diluted no added sugar fruit or vegetable juices with total sugar content 20g and/or > 300mls Hot Drinks No criteria developed for hot drinks at this stage. Try to minimise added saturated fat, salt and sugar. Make reduced fat milk the default option. 11 Intense sweeteners (also known as artificial sweeteners) are a type of food additive that provides little of no energy (kilojoules). Intense sweeteners permitted for use in New Zealand include aspartame, sucralose and stevia. 12 This will be equivalent sugar content to 200mls of 100% fruit juice 13 Any drink that contains added caloric sweetener usually sugar. The main categories of sugary drinks include soft-drinks/fizzy-drinks, sachet mixes, fruit drinks, cordials, flavoured milks, flavoured waters, cold teas/coffees, and energy/sports drinks

232 7. Monitoring and Evaluation National DHB Food and Drink Environments Guidelines Feedback 10/05/16 The processes of Monitoring / Reporting the policy will be part of each DHB's Implementation Plan and will be aligned to the agreed expectations of the national DHB Food and Drink network and the Ministry of Health. 8. Associated Documents Ministry of Health. 2015a. Childhood Obesity Plan. URL: (accessed on 17 March 2016). Ministry of Health. 2015b. Eating and Activity Guidelines for New Zealand Adults. URL: (accessed on 17 March 2016). Ministry of Health Guidance on supporting breastfeeding mothers returning to work. URL: (accessed on 18 March 2016). Ministry of Health. 2015c. National District Health Board and Ministry of Health Healthy Food and Drink Environments Policy Principles. URL: (accessed on 17 March 2016). Heart Foundation NZ Guidelines for Providing Healthier Cafeteria Food. URL: (accessed on 17 March 2016). New Zealand Beverage Guidance Panel New Zealand Drink Guidance Panel Policy Brief: Options to Reduce Sugar Sweetened Drink (SSB) Consumption in New Zealand. URL: (accessed on 17 March 2016). Dunford, E., Cobcroft, M., Thomas, M., & Wu, J.H Technical Report: Alignment of NSW Healthy Food Provision Policy with the Health Star Rating System. Sydney, NSW: NSW Ministry of Health. URL: (accessed on 17 March 2016). Ministry for Primary Industries Health Star Rating. URL: (accessed on 17 March 2016)

233 Appendix 1: Process National DHB Food and Drink Environments Guidelines Feedback 10/05/16 Following regular teleconferences, a face-to-face meeting, and review of national and international Healthy Food policies, overarching Healthy Food and Drink Policy Principles were agreed in December The Auckland region DHBs nutrient criteria were used as the initial basis for the development of more detailed nutrient criteria. A sub-group of the Network developed draft nutrient criteria for the national policy following a face-to-face workshop and regular teleconferences. This resulted in a draft policy which included both the principles and the detailed criteria which was further refined through input from the Network. Subsequently a revised draft policy was circulated more broadly for input, particularly in relation to issues to consider for implementation, before being finalised into this Policy. The Policy has been informed primarily by the following documents: Eating and Activity Guidelines for New Zealand Adults (Ministry of Health, 2015b) the Principles are based on these; recommendations for healthy eating for children and young people were also considered. Health Star Rating (HSR) for packaged goods using 3.5 stars as an indicator of a healthier food based on a New South Wales Ministry of Health study (Dunford et al, 2015) Heart Foundation NZ s Healthier Cafeteria Guidelines (Heart Foundation NZ, 2015) and checklist. World Health Organization s Guideline: Sugars intake for adults and children (2015)

234 National DHB Food and Drink Environments Guidelines Feedback 10/05/16 Appendix 2: Network members and representatives of agencies supporting the development of the National Policy District Health Board and Ministry of Health Network Members Auckland DHB Auckland Regional Public Health Service Canterbury DHB Canterbury DHB Canterbury DHB Canterbury DHB Counties Manukau Health Counties Manukau Health Hauora Tairawhiti DHB Hawkes Bay DHB Hawkes Bay DHB Hawkes Bay DHB Mid Central Health Ministry of Health Ministry of Health Ministry of Health Nelson-Marlborough DHB Northland DHB Regional Public Health Regional Public Health South Canterbury Southern DHB Taranaki DHB Toi Te Ora - Public Health Service Waikato DHB Waitemata DHB Waitemata DHB West Coast DHB West Coast DHB Whanganui DHB Julie Carter (Dietitian) Community Liaison Dietitian Jacqui Yip (Dietitian) - Public Health Dietitian Holly Hearsey - Team Leader, Communities Team Janne Pasco Community Nutrition Advisor Kerry Marshall Manager, Communities Team Nicky Moore (Dietitian) Service Manager, Food and Beverages Doone Winnard (Public Health Physician) Stella Welsh (Dietitian) Manager, Food Service Nicki Mathieson (Dietitian) Nutrition and Physical Activity Advisor Deborah Chettleburgh (Dietitian) Nutrition and Food Service Kim Williams Population Health Advisor Tracy Ashworth - Population Health Advisor Nigel Fitzpatrick Health Promotion Advisor Anna Jackson (Dietitian) Advisor, Nutrition Harriette Carr (Public Health Physician) Principal Advisor, Public Health Louise McIntyre (Dietitian) Senior Advisor, Nutrition Rob Beaglehole (Dentist) Principal Dental Officer Edith Bennett (Dietitian) Public Health Nutrition and Physical Activity Advisor r Jane Wyllie (Dietitian) Vicki Robinson (Dietitian) Public Health Dietitian Syd Horgan Healthy Lifestyle Manager Janice Burton, Professional Leader, Health Promotion Jill Nicholls (Dietitian) Health Promoter Mel Arnold (MPH, Reg. Nutritionist) - Health Improvement Advisor Wendy Dodunski (Dietitian) - Manager Nutrition and Food Services Rebecca McLean (Dietitian) Public Health Dietitian Roslyn Norrie (Dietitian) Foodservices Manager Claire Robertson - Team Leader, Community and Public Health Rosie McGrath - Health Promoter, Community and Public Health Marama Cameron Health Promotion Manager The following representatives and organisations also provided valuable support Agencies for Nutrition Action Heart Foundation Ministry for Primary Industries University of Auckland Annaleise Goble (Reg. Nutritionist) National Project Manager Andrea Bidois (Reg. Nutritionist) Manager, Food Services and Hospitality Michelle Gibbs Senior Adviser, Food Science Cliona Ni Mhurchu (PhD) - Professor

235 National DHB Food and Drink Environments Guidelines Feedback 10/05/

236 9.4 Waitemata District Health Board and the Auckland Regional Tissue Bank Recommendation: That the Board: a) Note the progress of the Waitemata District Health Board (DHB) Breast Cancer Tissue Bank. b) Note that a memorandum of understanding between Waitemata District Health Board and the University of Auckland or the Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank will be brought back to the Board. Prepared by: Dr Paul Muir (Medical Administration Registrar to CMO), Dr Karen Bartholomew (Public Health Physician), Dr Helen Wihongi (Research Advisor Māori, Auckland and Waitemata DHBs), Dr Matt Rogers (Clinical Director WDHB Laboratories), Dr Reena Ramsaroop (Clinical Director WDHB Pathology), Phill Shepherd (Manager Auckland Regional Tissue Bank), Lee-Ann Weiss (Operations Manager WDHB Laboratory) & Amanda Mark (Legal Adviser WDHB) Endorsed by: Dr Andrew Brant (Chief Medical Officer) Glossary AAHA - Auckland Academic Health Alliance a formal collaborative arrangement between the University of Auckland and Auckland DHB relating to research, clinical delivery and teaching ADHB - Auckland District Health Board ARTB - Auckland Regional Tissue Bank Biobank - A type of biorespiratory that stores biological samples for use in research. It also includes health data relating to an individual stored in a data warehouse. Further information is located in the Appendix. FMHS - Faculty of Medicine and Health Science, University of Auckland. GAB - Governance Advisory Board (of Auckland Regional Tissue Bank) HRC - Health Research Council SAB - Scientific Advisory Board (of Auckland Regional Tissue Bank) Tissue Bank - A subset of a biobank usually referring to tumour tissue. ToR - Terms of reference WDHB - Waitemata District Health Board WDHB TOG - The Waitemata DHB Tissue Banking Operations Group that provides local level governance relating to tissue collections 1. Executive Summary In December 2014 the Board approved the establishment of a Breast Cancer Tissue Bank located at North Shore Hospital with a request to return to Board on progress. The Breast Cancer Tissue Bank has now been established, blessed and received very positive feedback from consumers. Waitemata District Health Board, Meeting of the Board 29/06/16 236

237 There is a governance structure in place with the Auckland Regional Tissue Bank (ARTB) which includes a Governance Advisory Board, Scientific Advisory Board, Core Management Group and local Waitemata DHB Tissue Banking Group. The Breast Cancer Tissue Bank is now sitting as a collection under the Auckland Regional Tissue Bank (ARTB), and Waitemata District Health Board (DHB) as an operational site (in a hub and spoke model) under the ARTB. The advisory boards and management groups now meet on a regular basis and all include strong representation of Waitemata DHB and Māori. Benefits of the ARTB include better protection and integrity of tissue samples and greater transparency of approval processes for establishment of new collections. The ARTB has been recognised nationally as a best practice model by the Health and Disability Ethics Committee and through its commitment to consumers and Māori at all levels, informed by the Te Mata Ira framework and local DHB and mana whenua involvement. A memorandum of understanding between Waitemata District Health Board and the University of Auckland or Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank will be brought back to the Board. 2. Introduction/Background In 2014, two papers were presented to the Board for a proposal to establish a Biobank 1 at Waitemata DHB. The first paper presented in April 2014 provided a background to Biobanking including issues for Māori, ethical issues, financial implication and sustainability. This was followed by a workshop session with Board members for further discussion. The second paper presented in December 2014 provided further information to specifically establish a Breast Cancer Tissue Bank located at North Shore Hospital. The Breast Cancer Tissue Bank was approved by the Board at this meeting, with a request to return to the Board with progress on the move to establishment of the collection under an umbrella regional tissue bank including any changes made as a result. Specific recommendations relating to the development of the overarching regional framework from the Board paper of December 2014 are outlined below: 1. That the Waitemata DHB Breast Cancer Tissue Bank be approved (in the same way that other biobank proposals within the region have been) under the current institutional and ethical approvals, on the condition that when the overarching framework (of the Auckland Regional Tissue Bank) is finalised the Waitemata DHB Breast Cancer Tissue Bank agree to make any necessary changes (to align with the agreed regional framework) 2. That mana whenua and the Auckland Academic Health Alliance continue to develop the overarching policy framework for the Auckland Regional Tissue Bank. 3. That development of the framework includes consumer perspectives. 4. That the framework includes governance structures (with mana whenua and consumer representation), scientific advice, community involvement, data access and laboratory processes. 1 A biobank refers to a collection of sample and health information available for future research. Comparatively, a tissue bank is a subset of a biobank usually referring to tumour tissue. A flow diagram with further information is included in Appendix 1. Waitemata District Health Board, Meeting of the Board 29/06/16 237

238 5. That the framework also includes explicit decision points (clear policy statements) on a range of issues of interest to the DHB, Māori and consumers (for example return of results, incidental findings, and the ability to be recontacted). 6. That development of the framework includes consultation with consumers, clinicians, researchers, laboratory staff, DHB management and relevant people at the Ministry of Health or other government departments. 7. That the resulting agreed framework is brought to the Waitemata and Auckland DHB Boards to inform progress. Progress of the Waitemata DHB Breast Cancer Tissue Bank The regional approach was progressed, and when established the Breast Cancer Tissue Bank at Waitemata DHB became the second biobank in the Auckland region to come under the auspices of the Auckland Regional Tissue Bank (ARTB). At the time of establishment the Breast Cancer Tissue Bank retained its current institutional and ethical approvals. Following Board approval and karakia, the breast cancer tissue bank at WDHB accepted the first patient s samples on 18 June The protocol is now well-established and is proceeding. As of 17 June 2016, 130 patients with newly diagnosed invasive breast cancer have samples stored at North Shore Hospital. The samples total 1438 vials. All standard processing protocols for the tissue banking are followed. No retrieval of tissue has been approved until the memorandum of understanding between Waitemata DHB and the ARTB has been finalised. Feedback from the patients is very positive and I quote from one of the breast care nurses: We, as CNS Breast Cancer, are very pleased to play a role in gaining consent to obtain breast cancer tumour samples for Auckland Regional Tissue Bank. In fact, patients are only too pleased to do so as they feel they have contributed in one small way to finding a reason why they have this dreaded diagnosis. Progress of Auckland Regional Tissue Bank Governance Structure Since December 2014 the ARTB has consolidated and formalised its regional governance and accountability framework and conducted a range of improvements for biobanking in the Auckland region. These include the following: Establishment of a Governance Advisory Board, Scientific Advisory Board, Core Management Group and individual DHB Tissue Banking Operations groups to provide strong governance at a regional and local level (Appendix 1). The governance structure includes representation of both mana whenua and healthcare consumers. Terms of Reference for the Governance Advisory Board and Scientific Advisory Board have been formulated and are available for the Board (Appendix 2). A Vision and Goals statement which includes strategic direction for the Auckland Regional Tissue Bank. The setting of Key Performance Indicators for the Auckland Regional Tissue Bank (Appendix 3). The preparation and use of a new detailed Participant Information Sheet and Consent Form (including multi-lingual components) specifically for healthcare consumers who wish to Waitemata District Health Board, Meeting of the Board 29/06/16 238

239 donate to the Auckland Regional Tissue Bank. This will standardise consent processes across the region which is a significant step forward and as an approach this is endorsed by the Health and Disability Ethics Committee. Better protection and integrity of samples through a significantly improved electronic database administered by the ARTB for tracking and coding. This approach is supported by prominent Māori academics as critical to the necessity to accurately track and protecting Māori tissue in a hub-and-spoke model. Greater transparency of approval processes for establishment of new tissue collections. ARTB provides transparent policies and procedures that establish high quality collections for research, robust protections for consumers and Māori and strong oversight and management of data access. Work is continuing on development of standard operating procedures for some aspects of the ARTB. A website is under development that will be freely accessible to the public and provide consumer information and advice on the Auckland Regional Tissue Bank. 3. Alignment to Auckland Regional Tissue Bank Governance structures Waitemata DHB is now an Operational Site under the ARTB umbrella. The Waitemata DHB Breast Cancer Tissue Bank approved by the Board in December 2014 is now a collection under the ARTB, held at Waitemata DHB as the local Operational Site. As noted above Waitemata DHB and Māori are well represented at all structural levels of the ARTB with well-established local Operational Site governance. This provides confidence in the robustness of the biobank including future sustainability. There are several tissue bank streams currently stored at the Waitemata DHB laboratory which have locality authorisation and relevant ethical approvals. These and future tissue bank streams approved through ARTB governance will move under the ARTB governance framework. Waitemata DHB would need to enter into a memorandum of understanding setting out the foundation for our participation in the regional tissue bank. At this stage it appears likely that the memorandum of understanding would be with either the University of Auckland or with the Auckland Academic Health Alliance in which the University and Auckland DHB are partners. The memorandum of understanding will be provided to the Board for approval before it is signed. 4. Broader context The broader national and international context of biobanking has also progressed since December The former National Health Committee (now a unit in the Ministry of Health called the Strategic Technology Prioritisation and Innovation team) is leading the International Policy Working Group on genomics and related technologies, and a national consultation process (including broad general public consultation). 2 This work involves a national stocktake of biobanks with a view to standardisation and best practice, as represented by the ARTB processes. The National Health Committee, and the ARTB establishment, has been informed by the large three year project on Māori views on biobanking, Te Mata Ira. This project was led by Maui Hudson who presented to the Board with the December 2014 paper. Te Mata Ira has produced a framework for 2 Link: Waitemata District Health Board, Meeting of the Board 29/06/16 239

240 biobanking similar to the Te Ara Tika health research framework for Māori which has been very well received by clinicians, researchers and the Health and Disability Ethics Committee. The Te Mata Ira Project included an extensive series of hui across the country seeking consumer and Māori views on biobanking. The Health and Disability Ethics Committee also endorse the ARTB processes, particularly the commitment to high quality informed consent processes, strong governance and data access arrangements and recognition of Māori views. 5. Conclusion The continuing collaborative work between the Auckland Academic Health Alliance, mana whenua, local clinicians and researchers during 2015 has resulted in a robust and high quality framework of governance structures and processes for tissue banking in the metropolitan Auckland region. The approach is recognised as best practice nationally, and recognised for promoting transparency and setting high standards of involvement and protections for Māori and consumers. There are appropriate regional and local governance structures which include Māori, consumer and Waitemata DHB representation. Additional benefits from the ARTB approach include resource for improved tracking and coding of samples. The recommended approach is to further strengthen the Waitemata DHB position through a formal memorandum of understanding with the University of Auckland or Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank which will be brought back to the Board. Waitemata District Health Board, Meeting of the Board 29/06/16 240

241 Appendix Appendix 1: Auckland Regional Tissue Bank Governance Structure and Schematic Dean (FMHS) Governance Advisory Board Dean FMHS Chief Advisor Tikanga (ADHB) CMDHB Chief Medical Officer ADHB Chief Medical Officer WDHB Chief Medical Officer Tissue Banking Expert Consumer/Lay Representatives Mana Whenua Representative Ethics Expert Ex Officio Clinical Director ARTB ARTB Manager Strategic Engagement manager Group Services Manager (SMS) Core Management Group Clinical Director ARTB Strategic Engagement Manager - AAHA Group Services Manager (SMS) Chair of the SAB ARTB Manager Scientific Advisory Board Senior Clinician/scientist (Chair) FMHS Tumuaki Mana Whenua Representative Maori Ethics Expert ADHB Representative* CMDHB Representative* WDHB Representative* Research Advisor - Maori Lay Representative UOA Scientist 1 UOA Scientist 2 UOA Scientist 3 DHB Clinician/Scientist Ethics Expert WDHB Awhina representative Ex Officio Clinical Director ARTB ARTB Manager Strategic Engagement Manager CMDHB Tissue Banking Operations Group Clinical Lab Manager *Pathologist 1 Pathologist 2 Surgeon 1 Surgeon 2 Haematologist Med Lab Scientist 1 Med Lab Scientist 2 Senior Nurse 1 Senior Nurse 2 ARTB Technician Research Advisor - Maori ADHB Tissue Banking Operations Group Clinical Lab Manager *Pathologist 1 Pathologist 2 Surgeon 1 Surgeon 2 Haematologist Med Lab Scientist 1 Med Lab Scientist 2 Senior Nurse 1 Senior Nurse 2 ARTB Technician Research Advisor - Maori WDHB Tissue Banking Operations Group* Regional Tissue Bank Manager Pathology/Laboratory staff including: Clinical director laboratories Clinical Director - Pathology Operations Manager Lab Special Assays Scientist Lab Awhina Staff including: Research and Innovation Manager All lead research nurses All lead research clinicians Research Advisor Maori *(As defined by WDHB TOG ToR) Waitemata District Health Board, Meeting of the Board 29/06/16 241

242 The Auckland Regional Tissue Bank (ARTB) now has a robust governance structure comprising of a Governance Advisory Board (GAB), Scientific Advisory Board (SAB), Core Management Group (CMG) and individual Auckland DHBs Tissue Banking Operations Groups (TOG). Mana whenua and Waitemata DHB have representation on both the GAB and SAB. Governance Advisory Board (GAB) The Governance Advisory Board has overall guidance, fiscal and guardianship responsibilities. The Governance Advisory Board (GAB) membership comprises the following: Dean Faculty of Medicine and Health Sciences, University of Auckland Chief Advisor tikanga (ADHB & WDHB) CMDHB Chief Medical Officer (or representative) ADHB Chief Medical Officer (or representative) WDHB Chief Medical Officer (or representative) Tissue Banking Expert Consumer/Lay Representative Mana T Whenua Representative Ex-officio Clinical Director ARTB ARTB Manager Strategic Engagement Manager Scientific Advisory Committee (SAB) The Scientific Advisory Board (SAB) provides the Auckland Regional Tissue Bank (ARTB) with scientific leadership, strategic advice and review of applications for biospecimen use. The Scientific Advisory Board is responsible for the following: Assess whether scientifically valid, appropriate and useful research is being proposed by researchers through a standardised application process. Review all applications for tissue use within the Auckland Regional Tissue Bank. Direct the Auckland Regional Tissue Bank in the procurement of relevant tissue streams to ensure the greatest benefit to all stakeholders. Provide the GAB with recommendations on biospecimen collection scope, future expansion and collaboration with research groups and other tissue banks both nationally and internationally including horizon scanning for new technologies that may impact on the ARTB. The SAB membership comprises the following: Chair (a senior clinician or medically trained scientist) Three Maori representatives (A tikanga advisor, the FMHS Tumuaki, and an external representative with broad knowledge of tissue banking and related issues) Health research academia (4 scientists) Clinical representatives reflecting the biospecimen collection (1 from each DHB) Lay representation (suitably informed person) WDHB Awhina Representative Waitemata District Health Board, Meeting of the Board 29/06/16 242

243 Ex-officio Clinical director - ARTB ARTB Manager Strategic Engagement Manager Chief Advisor tikanga Core Management Group (CMG) The Core Management Group leads and ensures the implementation and execution of advice from both the Governance Advisory Board and Scientific Advisory Board. The Core Management Group is also responsible for the following: Ensure that both the GAB and SAB are updated at regular intervals that all components of the tissue bank are operating as directed. The Core Management group is comprised of the following: Director- ARTB Strategic Engagement Manager Group Services Manager (SMS) Chair of the SAB ARTB Manager Waitemata District Health Board, Meeting of the Board 29/06/16 243

244 Appendix 2: Terms of Reference for ARTB Governance Advisory Board (GAB) and ARTB Scientific Advisory Board (SAB) AUCKLAND REGIONAL TISSUE BANK ADVISORY BOARD Purpose Terms of Reference The Auckland Regional Tissue Bank will be led by the Core Management Group, comprising the Tissue Bank Clinical Director and other key stakeholders, who will advise the Manager of the Bank in the overall direction of the facility and its regional tissue banking activities. The Core Management Group will be supported by the Advisory Board that will provide oversight, guidance and strategic advice. Advisory Board The Board will advise and monitor the activities of the Auckland Regional Tissue Bank in accordance with the University of Auckland policy on Units, Centres and Institutes and tikanga o Mana whenua, thereby assisting the Management Group in ensuring the tissue banking activities are of the highest standard, and meet the expectations of the funders and relevant stakeholders. Given the regional focus of the Auckland Tissue Bank it will have representation from mana whenua, the contributing institutions, and the community. Terms of Reference Provide strategic and business advice to the Tissue Bank Management Group; Provide oversight of the ethical conduct of the Tissue Bank in accordance with the requirements; of the National Ethics Committee approvals, institutional practices and community expectations; Oversight of cultural practices and partnership including maintaining the partnership with Mana Whenua; Review and approve plans, reports and budgets; Assist in raising the profile and reputation of the Regional Tissue bank and its activities; Assist in developing community engagement; Ensure funding decisions follow transparent processes and align with the purpose, vision and objectives of the Tissue Bank; Resolve disputes not able to be resolved by the Management Group, as required; Report annually to the Dean and all Partner Institutions regarding the performance of the Tissue Bank, making recommendations for change as required. Board membership The Advisory Board membership will reflect the following stakeholders: Mana Whenua University of Auckland District Health Boards Charitable Funding Sponsors Community Waitemata District Health Board, Meeting of the Board 29/06/16 244

245 Other Maori, Pacific External academic Ethical/legal The Chair and Vice Chair will be appointed by the Dean of the Faculty of Medical and Health Sciences. Representation of mana whenua shall be that of a suitably informed representative, with broad knowledge of tissue banking and related issues. Operating Guidelines for the Advisory Board Quorum Business will only be conducted if the meeting is quorate. The Advisory Board will be quorate with one half of the voting members, including representation from mana whenua and the Chair or Vice Chair, being present. Attendance by Members The Chair of the Advisory Board will use his/her best endeavours to attend 100% of the meetings. If the Chair is unable to attend then he/she will nominate an acting chair for that meeting. Other committee members should attend a minimum of 50% of all meeting. Attendance by Others Others may be invited to attend as necessary to present papers, but shall have no vote. Accountability and Reporting Arrangements Members will be required to declare any interests they might have in any issues arising at the meeting that might conflict with the business of the Auckland Regional Tissue Bank. The Governance Committee will review the minutes of the Scientific Advisory and Tissue Bank Management Committees. Frequency Meetings will be held quarterly. Additional meetings may be arranged when required to support the effective functioning of the Tissue Bank. Waitemata District Health Board, Meeting of the Board 29/06/16 245

246 AUCKLAND REGIONAL TISSUE BANK SCIENTIFIC ADVISORY BOARD Terms of Reference Governance and Purpose The Scientific Advisory Board (SAB) has been established to provide the Auckland Regional Tissue Bank (ARTB) with scientific leadership, strategic advice and review of applications for biospecimen use. It will ensure incorporation tikanga Māori in acknowledgement of the Treaty of Waitangi and will ensure that the tissue banking activities are of the highest standard, and meet the expectations of the funders and relevant stakeholders. It will lead development of tissue banking practice and will have an ultimate focus on long term benefit to patients. Given the regional focus of the ARTB it will have representation from mana whenua, the contributing institutions, and the community, with strong clinical/scientific input from academia. It will report to the Governance Advisor Board (GAB) and will support the Core Management Group (CMG) and Tissue Bank Manager. Terms of Reference Application Review: The SAB will review applications for biospecimen use, making decisions about the release of specimens for research based on research project ethical approval status, governance issues, scientific and strategic value. The SAB will also advise researchers about preparation and revision of applications for biospecimen use. Ethical Conduct: (i) As part of their review of research applications for biospecimen use, the SAB will ensure that biospecimens released will not be vulnerable to unethical use and will be used in accordance with the requirements of Ethics Committee approval and ARTB policies. (ii) As part of their Strategic Leadership, the SAB will regularly review ARTB ethical approvals to ensure they remain in step with evolving ethical understanding, research and clinical activity, as well as informing and protecting patients and communities. Legal and Financial: The SAB will observe the legal processes established by the GAB to ensure appropriate custodianship of biospecimens. Members will be required to register any potential conflicts of interests related to ARTB business. The SAB will consider financial implications when approving applications and making recommendations to the GAB regarding changes to the biospecimen collection. The SAB will observe policies and procedures established by the GAB that ensure security and access to the biospecimens held by the ARTB. Operational Processes: The SAB will be responsible for the development and regular revision of processes for effective and efficient collection of scientifically relevant tissue. Resources and budget to operate the SAB will be the responsibility of the CMG. Strategic Leadership: The ARTB is expected to lead development of future tissue banking practices including incorporation of tikanga Māori, emerging ethical protocols appropriate for the changing research environment. The SAB will provide recommendations to the GAB on biospecimen collection scope, future expansion and collaboration with research groups and other tissue banks both nationally and internationally, including horizon scanning for new technologies and initiatives that may impact on the ARTB. The minutes of the SAB meeting will be formally recorded and available to the GAB. The planning of the meetings is the responsibility of the Chair who, together with the CMG, will establish a schedule of meetings each year. Waitemata District Health Board, Meeting of the Board 29/06/16 246

247 The SAB may from time to time need to obtain independent advice and/or to co-opt outsiders with relevant experience to its meetings. Any costs associated with this will be approved by the CMG. The SAB will produce an annual report to the GAB which sets out how the SAB has met its Terms of Reference during the preceding year. The SAB will review its Terms of Reference and work programme on an annual basis. Treaty of Waitangi and Partnership: In acknowledgement of the Treaty of Waitangi the Tissue Bank will incorporate tikanga Māori and seek appropriate clinical and cultural input to ensure the value and suitability of its tissue collections and the research they support, for the ultimate benefit of all New Zealanders. Board membership The SAB membership will reflect the following stakeholders: Chair (a senior clinician or medically trained scientist) Three Māori representatives (A tikanga advisor, the FMHS Tumuaki, and an external representative with broad knowledge of tissue banking and related issues) Health research academia (4 scientists) Clinical representatives reflecting the biospecimen collection (1 from each DHB) Lay representation (suitably informed person) Ex-officio: Clinical Director Tissue Bank Manager Strategic Engagement Manager Operating Guidelines Accountability and Reporting Arrangements: Members will be required to declare any interests they might have in any issues arising at the meeting that might conflict with the business of the Auckland Regional Tissue Bank. The Governance Board will review the minutes of the Scientific Advisory Board meetings. Attendance by Members: The Chair of the Advisory Board will use his/her best endeavours to attend 100% of the meetings. If the Chair is unable to attend then he/she will nominate an acting chair for that meeting. Other Board members should attend a minimum of 50% of all meetings. Frequency: Meetings will in general be held quarterly, preferably just prior to the GAB meeting. Additional meetings will be arranged when required to support the effective functioning of the Tissue Bank. Meetings may be either in person or by telephone or other electronic means of communication. Quorum: Business will only be conducted if the meeting is quorate. The Advisory Board will be quorate with one half of the members, including the Chair or nominated acting chair, being present. Waitemata District Health Board, Meeting of the Board 29/06/16 247

248 Appendix 3: Auckland Regional Tissue Bank Key Performance Indicators Auckland Regional Tissue Bank Key Performance Indicators first 12 months The Auckland Regional Tissue Bank has established governance and advisory structures and operating processes that incorporate tikanga Māori and fully comply with New Zealand s ethical and regulatory requirements. These will include a Governance Advisory Board, Operations Committee and a Scientific Advisory Committee. HDEC ethical approvals, locality approvals and agreements with institutions to provide space, staff and other resources will be in place. Four targeted tissue collection initiatives will be underway, each of which will support specific research projects within the Auckland Academic Health Alliance while being equally balanced with tikanga Māori and the principles of the Treaty of Waitangi. These projects will be high profile projects and be likely to achieve high impact research outputs. Waitemata District Health Board, Meeting of the Board 29/06/16 248

249 Appendix 4: Schematic overview of a generic biobank Figure 1. Schematic overview of a generic biobank Cancer society tissue bank in Christchurch Middlemore tissue bank Pancreatic cancer bank North Shore Hospital Colorectal cancer tissue bank Dunedin Cardiovascular sample bank Dunedin Brain bank Auckland Arthritis sample bank Dunedin Cord blood bank (private) Fertility tissue banks (private and public) Guthrie card (newborn heel prick test) long term repository (National Screening Unit, Ministry of Health) Table 1. Examples of New Zealand biobanks Research biobanks Transplant biobanks Other Glioblastoma and Wilms tumour banks Dunedin NZORD (rare diseases) bank Dunedin Melanoma tissue banks being established in several centres around New Zealand Neuroendocrine Tumour (NET) collection Auckland and national Placenta bank Dunedin Eye bank Auckland Banked samples from longitudinal studies samples (eg Christchurch and Dunedin studies, and Growing Up in New Zealand) Waitemata District Health Board, Meeting of the Board 29/06/16 249