Lakes District Health Board

Transcription

1 Lakes District Health Board Refreshed Rheumatic Fever Prevention Plan

2 Contact Person: Pip King Portfolio Manager Lakes DHB

3 Table of Contents List of Abbreviations... 4 RHEUMATIC FEVER WORK PLAN SIGN-OFF... 6 Purpose of the plan... 7 Structure of the Plan... 7 Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan Background Which activities does the DHB believe were successful? Why? Which activities does the DHB believe were cost effective? Why? Which activities would the DHB have done differently? Why? Section 2: Governance The current structure of Rheumatic Fever activities in Lakes DHB is shown below Section 3: Stakeholder Engagement Summary of Stakeholder Engagement Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017) Where is the DHB in relation to meeting the 2017 target? What is the expected trend with or without new actions? What actions will be continued or introduced to ensure the 2017 target is met? : An outline of the DHB planned investment in interventions until 30 June Error! Bookmark not defined. 4.4 Lakes DHB sustainability beyond June Appendix TITLE: Terms of Reference for Rheumatic Fever Governance

4 List of Abbreviations ARF ASH BOP BOPDHB CoBoP CONS DNS EBET GAS GP HNZC HSL ICD codes Lakes DHB MoH MOH PHN PHO PoPAG RAPHS RHD SES Toi Te Ora THCT WHHS WINZ Acute Rheumatic Fever Ambulatory Sensitive Hospitalisation Bay of Plenty Bay of Plenty District Health Board Collaboration Bay of Plenty Children s Outreach Nurse District Nursing Service Eastern Bay Energy Trust Group A streptococcus General Practice / Practitioner Housing New Zealand Corporation HealthShare Limited International Classification of Disease codes Lakes District Health Board Ministry of Health Medical Officer of Health Public Health Nurse Primary Health Organisation Population Health Professional Advisory Group Rotorua Area Primary Health Services Rheumatic Heart Disease Smart Energy Solutions Toi Te Ora Public Health Service Tuwharetoa Health Charitable Trust Western Heights Health Service Rotorua Work and Income New Zealand 4

5 Foreword Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. While we have made progress in many areas of child health we know more work is required to eradicate rheumatic fever from our population. The focus on rheumatic fever prevention by the Ministry of Health since 2012 has provided Lakes DHB with the vision and support to prioritise the planning and implementation of a rheumatic fever prevention programme. In addition we acknowledge the priority given to this work through the Prime Minister s Better Public Health Service target to reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June We are well aware that while health might lead the rheumatic fever programme of work it is up to us to engage with a range of stakeholders across government agencies and community organisations, establishing robust cross sector working relationships to ensure a shared vision and coordinated approach to implementing interventions which can prevent rheumatic fever. Lakes DHB has several cross sector programmes involving children, families and young people which will enable us to continue using existing frameworks and relationships to ensure a coordinated implementation of rheumatic fever prevention interventions. These programmes involve social services, housing, education and parenting, aligning with our focus to work across sectors, sharing a common vision for children and young people to help them to thrive, achieve and belong. We are encouraged to have the opportunity to revitalise our DHB rheumatic fever plan to adjust our thinking and strategies as a result of our learnings so far. This plan was overseen by a range of stakeholders who represent a range of our population. My sincere thanks to all those involved and Lakes DHB looks forward to increased collaboration across stakeholders as we increase action against rheumatic fever. Ron Dunham Chief Executive Lakes District Health Board 5

6 RHEUMATIC FEVER WORK PLAN SIGN-OFF This document has been reviewed and accepted as the formal Lakes DHB Rheumatic Fever Plan for implementation in terms of content and sign off by: Name: Mary Smith Project Sponsor General Manager, Planning and Funding Lakes DHB / /2015 Signature Name: Johan Morreau Rheumatic Fever Champion Consultant Paediatrician Lakes DHB / /2015 Signature Name: Neil Poskitt Rheumatic Fever Champion General Practitioner and Clinical Leader of Child Health for RAPHS / /2015 Signature 6

7 Purpose of the plan The purpose of this document is to provide a refreshed rheumatic fever prevention plan following a review of our current plan, stakeholder engagement and a review of the learning s and outcomes achieved so far. The current Lakes DHB plan was signed off to cover , but at this half-way mark we have been given the opportunity to revitalise the programme and utilise the learning s so far and ensure the momentum is further built on. While our refreshed plan is unique to the Lakes DHB population and has been developed with our partners in the Lakes population we also remain in close contact with our regional DHB s that also have higher than acceptable Rheumatic Fever rates. This has allowed Lakes DHB to share learnings and future strategies. Structure of the Plan Section 1: Section 2: Section 3: Section 4: Section 5: Presents an overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan Governance Stakeholder Engagement Achieving the 2017 Better Public Health Service rheumatic fever target (to June 2017) Ongoing investment in rheumatic fever prevention (July 2017 onwards) 7

8 Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan 1.1 Background Lakes DHB and Bay of Plenty DHB (BoP DHB) recognised ARF as a priority issue in In 2009 a joint steering group was established to lead a range of DHB funded initiatives to address rheumatic fever which are now at various stages of implementation. Ministry of Health funded projects were introduced in The initial approach taken was based on the Heart Foundation Rheumatic Fever guidelines and tidying up our secondary prevention systems. With the introduction of the Ministry of Health funded programmes a range of evolving initiatives, both nationally driven and locally driven have been implemented in Lakes DHB. The ongoing development of the programmes has been a result of evaluation and learning. This review and refresh allows a re-focus and to further strengthen successful parts of the programmes and address some of the gaps highlighted through the stakeholder engagement and governance. Actions have been implemented in the following areas: 1. raising public awareness that sore throats matter 2. continuing professional development for health professionals 3. rapid response services 4. healthy homes service 5. improving notification of ARF cases 6. improving case management and prevention of recurrence, including a Rheumatic Fever register across Lakes DHB. 7. enhanced surveillance and audit of cases A range of positive results have been demonstrated. These include raised awareness of rheumatic fever in higher risk communities and the general public; increased awareness of the sore throat guidelines among primary health care; school based health services and youth health services, the refining of the Lakes DHB rheumatic fever register, improved notification, and more recently rapid response and healthy homes programmes that are operating to agreed protocols and have the support of local communities. At the time of refreshing our rheumatic fever plan (September 2015) Lakes DHB has so far achieved our target of 4.7 in the year. 8

9 1.2 Which activities does the DHB believe were successful? Why? Activity Input and engagement with Iwi Governance Rheumatic Fever Champions Why was this successful and what are the learnings? Lakes DHB process is to consult with our two Iwi Governance Boards Te Roopu Hauora O Te Arawa and Te Nohanga Kotahitanga O Tuwharetoa who represent Lakes iwi. Their knowledge of RF has been increased and provided the ability for them to reach out to their communities with the key messages. They were able to provide information re how to actively reach out and engage with high risk Maori communities, especially through education and appropriate clinical services. We had two RF champions, a primary care and a secondary care clinician. These clinicians: have credibility as the experts provide a single point of contact for all RF related issues raise awareness provide and distribute the key messages to other clinicians work together on providing professional development implement the sore throat guidelines and any changes across the DHB are able to answer any queries re diagnosis in a timely manner provide audit and monitoring Future direction Provide an ongoing mechanism for Iwi Governance input into RF governance Child and whanau friendly primary health care, no appointments, free, after hours, staff with integrity and expert knowledge Receptionists who are child and whanau friendly Appropriate physical spaces for children and whanau with sore throats Efficient referral pathways for housing, curtains, bedding, heating that will not cause shame Almost set a recycling system up that is the norm for household items Continue with the same RF champions Add adult physician, cardiologist as a champion. Allocate dedicated time for them to be available for governance, workforce development, clinical queries, improving follow up of RF patients with secondary cardiac disease. 9

10 Activity RF Nurse coordinator Primordial prevention Primary Preventionsore throat management services in Western Heights Primary Preventionsore throat Why was this successful and what are the learnings? Operational view of RF activities over the Lakes DHB population Identify and fill gaps, provide glue to the system Implement workforce development Coordinate the resources Expert knowledge Healthy Homes programme. Has provided a focus on housing, has identified the barriers in referral pathways. Facilitated a cross sector approach in the community of high need. Enabled a community driven programme e.g. curtain bank, men s shed, Citizens Advice Bureau, Rotorua Energy Trust (philanthropy). Ministry meetings and workshops have been helpful. Identifying the high needs areas. Adding more resource into this service for a combination skin and sore throat clinics. Combination of school and community clinics. Morning in the schools and afternoons in the community. Available until 6 pm. Word of mouth plus sign outside FREE clinics and no appointment needed. Significant unmet need and demand. Approx 20% GAS + over the past 6 months. Lakes DHB secondary schools are fortunate to have established health services in all but two secondary Future direction Continue with this role. Increased workforce development across all clinician groups Strengthen services caring for adults with Rheumatic Fever prevention of recurrence, follow up of patients with cardiac disease. Facilitate the systems for providing community, school and primary care for Lakes DHB children. Consolidate the Healthy Homes programme. Continue service development from a community led aspect. Work with health and the other sectors on efficient and easy referral pathways e.g. paediatrics, WINZ. Will need to add in community support workers and help with home visiting, antibiotic adherence. Add in some further high needs primary schools. Ongoing advertising through facebook and a 0800 number. Require ongoing updates and workforce development. Many of the nurses are 10

11 Activity management services in Secondary school clinics Primary Preventionsore throat management services by Public Health Nurses Primary Preventionsore throat management services in after hours clinics ED and private Primary Preventionsore throat management services in Primary Health Care Primary Prevention- Why was this successful and what are the learnings? schools. This includes Kura Kaupapa, alternative education and school for young mums. Nurses working under standing orders. Ability to follow up. Mobile service able to do home visiting and lots of follow up, household contacts, antibiotic adherence. PHNs can transport children to primary care and facilitate access for children and families. PHNs provide a whole child and family assessment have good referral pathways and are increasingly able to provide care to children with infected skin. Audit of Rotorua ED highlighted the number of children attending after hours with sore throats. Audit highlighted inadequate treatments, and follow up. This highlighted the fact that private after hours services are likely to be similar and that thresholds for using intramuscular Penicillin could reasonably be lowered. Primary Health care is seeing how successful the rapid response clinics and secondary school clinics which have introduced free sore throat and treatment packages of care for all children and young people up to age 18 years in RAPHS (PHO) are. These are funded through Primary Options for Acute Care (POAC) funding. The Turangi surgery (high need, high Maori) are providing this service from their own funding. Two Lakes DHB Youth One Stop Shops provide services across the DHB youth population. Very 11 Future direction employed by education, not health, we need to provide ongoing support, supervision monitoring and quality improvement. Implement standing orders with relevant supervision in place Establish simple systems for accessing relevant pharmaceuticals needed Need ongoing workforce education for after hours services on rapid response care for a potential GAS sore throat. Strengthen follow up requirements on discharge summaries. Wider advertising and demonstration to the MHN PHO how this is something primary care can provide successfully through nurse led services. Ongoing support and workforce development and a business as usual approach.

12 Activity sore throat management services in Youth One Stop Shops Oral health RF Awareness Campaign Why was this successful and what are the learnings? experienced nurses and doctors. Funded on FTE no problems incorporating rapid response, sore throat awareness, education - happy to provide education to secondary school nurses and doctors. Lakes DHB children have some of the worst dental disease when compared nationally. Raised sore throat awareness through the oral health services. Providing free dental care in pregnancy and education of children s dental hygiene. National campaign has been very helpful. Future direction Need to prioritise children at risk of RF. Provide screening and treatment more regularly. Preschool tooth brushing campaigns in the kohanga reo and preschools in the high priority populations for RF prevention. Continue promoting the national campaign resources and distribution. 1.3 Which activities does the DHB believe were cost effective? Why? Cost effective activities Community awareness raising Rapid response clinics Why? National messages, consistent and we didn t have to develop anything ourselves. Utilising an existing primary care provider (General Practice) to deliver the RR response and HH services. Creates ease of access in terms of medical follow-up, both initial and ongoing. Same provider delivering sore throat and healthy homes services economies of scale, supports effective service coordination and integration. This has enabled a vehicle or framework for other health spin offs. These include caring for skin infections as well, demonstrating how Future Direction Further use of the national messages and resources. Re assess once the national campaign ends. Continue to develop additional community clinics. Consider adding in other child health initiatives e.g. we provide skin and sore throat care, those being cared for inevitably need more Rx holistic community rapid response child health clinics, drop in, staffed appropriately etc. 12

13 Cost effective activities National Guidelines, national standing orders Free under 13 s Focusing our core work on the Western Heights population for rapid response and healthy homes initiatives Why? free community clinics can work. RRRF drop in clinics amazingly effective method of capturing the target population. Service stat s support impressive utilisation at a relatively small cost (1 RN and receptionist) for a few hours per week. This challenges primary care to implement models of care (well integrated with general practice) that include easily accessible nurse led approaches (supported by general practice) to deliver care. Because all the groundwork was completed and these were very clear it has been relatively easy to get other services to pick them up and implement without added resource e.g. school clinics, PHNs. Able to piggy back on this and able to use this funding for PHC to provide rapid response from 1 July Ability to implement a new service in a defined area which enabled a focus on this population rather than spreading the service thinly. Provided a framework for Western Heights to improve primary care response to children Future Direction Continue workforce development using the guidelines and online training. Business as usual Continue the focus If resource becomes available, implement more widely 1.4 Which activities would the DHB have done differently? Why? There is very little in retrospect we would do differently. Much of the work we have been able to apply learning as we go, building on existing systems,while 13

14 maintaining flexibility, rather than needing to stick to a rigid plan. This has been helpful as services provided by doctors and nurses in the community continue to evolve. Which activities would the DHB have done differently Project Management and Stakeholder engagement Primary Health Care provision of Rapid Response - it would have been helpful to get primary care providing these services more quickly More focus on workforce development and professional education Involve the secondary/tertiary services more in the initial development of the Healthy Homes service proposal Apply resource slightly differently to the rapid response and healthy homes services Why? We recognise if we had put some dedicated resource in initially we would have had a quicker and more efficient roll out of programmes. It has also caused some disconnect and this has contributed to separate agreements for Healthy Homes and Rapid Response. Free under 13 s has helped enormously. We have delivered a lot of this but the education and support needs are ongoing especially for locums Subjects such as correct treatment, rapid response rather than waiting confirmation follow up repeat questions on carriage, follow up swabs, stopping treatment when the swab is negative, household contacts reluctance to use IM bicillin as an acceptable treatment option. Require a consistent input This might have helped with getting more buy-in with the bicillin clients and referrals from secondary care. There has been a significant administration component to processing throat swabs. Currently being completed by RNs not good use of their relatively expensive time. 14

15 Section 2: Governance Currently there is a Lakes DHB and Bay of Plenty DHB joint Rheumatic Fever Steering group. This group was formed in 2009 in response to the high rheumatic fever incidence in both DHBs. The steering group has had oversight of a range of initiatives across both DHB s. In refreshing the Lakes DHB prevention plan initial stakeholder feedback is that Lakes DHB forms a small rheumatic fever governance group specific to our population needs and the refreshed plan. It is still the intent to continue the joined up steering group for networking and sharing. Below is the list of current Lakes DHB governance members and their roles following stakeholder engagement. The members were appointed by the General Manager, Planning and Funding. The terms of reference allow for future members to be appointed. Stakeholder engagement identified the need for a small functional governance group with widespread reach, decision making mandate and able to think out side the square. The terms of reference include a commitment to the review of members annually. Name Pip King-Chair Role Portfolio Manager-Rheumatic Fever Johan Morreau Rheumatic Fever Champion, Community and General Paediatrician Neil Poskitt Peace Tamuno Mary McLean Elise Pope Kate Stewart Teresa Pou Phyllis Tangitu Sharon Rye Alan Ching Tayleva Petley Anaru Marshall Hariata Johnson Rheumatic Fever Champion Primary Health Care Child Health lead and General Practitioner Adult Physician, cardiologist. The Manager Western Heights Community, Rapid Response and Healthy Homes services Rheumatic Fever Nurse Project Manager Regional Manager Housing New Zealand Western Heights Community Association General Manager Maori Health and Iwi Governance liaison Clinical Manager Tuwharetoa Charitable Trust and link to Whanau Ora Regional Manager, Ministry of Social Development Regional Manager, Child, Youth & Family Wise Well-home insulation service Maori Women s Welfare League 15

16 The current structure of Rheumatic Fever activities in Lakes DHB is shown below. Rheumatic Fever Programme October 2015 Chief Executive Lakes District Health Board General Manager and Planning and Funding Rheumatic Fever Governance Rapid Response WHHS Tuwharetoa SBHS YOSS P.H.C ED/LPC Healthy Homes Rheumatic Fever Nurse Workforce development Community awareness raising Bicillins DNS P.C CONS High School Nurses RF Register 16

17 Section 3: Stakeholder Engagement 3.1 Summary of Stakeholder Engagement The following table has been used to summarise and record engagement with the key stakeholders. The stakeholders input was used to inform the review and refresh of this plan. Engage with key stakeholders Lakes DHB Maori Health Team Te Nohanga Kotahitanga o Tuwharetoa Te Roopu Hauora o Te Arawa Midland Health Network Rotorua Area Primary Health Service Key points Able to provide widespread iwi engagement and support Provide information on correct processes to be used for future To provide Maori Community Awareness raising Pou Whakamarama Iwi Governance Clarify roles and responsibilities Establish training requirements Identify any issues Offer support ongoing All primary care practices offering FREE rapid response to sore throats for 4-18 year olds Establish training requirements Identify any issues Offer support 17 Actions following engagement and future actions Initial meetings with both iwi governance boards and presentations Maori health to deliver a widespread community awareness raising programme to Maori to reach Maori over the Lakes population Can provide awareness raising Will take back to their hapu Need the doctors to be more friendly and welcoming Require ongoing workforce development as a result of overseas locums, new grad nurses Development needs can be unique to each practice but include rapid response guidelines Ongoing workforce development required for doctors and practice nurses and even receptionists. Receptionists must know and be responsive about the FREE service Keep providing the sore throat resources excellent Want packs for sore throats made

18 Engage with key stakeholders Tuwharetoa Health Charitable Trust Tuwharetoa Whanau Ora Youth One Stop Shops Rotovegas Anamata Café School Based Health Services Ngati Pikiao- Pacific Island community Key points Establish training requirements Identify any issues Offer support and further planning to address the issues Establish training requirements Identify any issues Offer support Actions following engagement and future actions up with the lab forms, pamphlets for the child and family, swab and the oral meds. So the nurses can easily have with them everything that they will need for care of sore throats Need to establish more clearly what the fee is for year olds for a fee for service claim Providing rapid response services under RF funding. Streamline their reporting. Workforce development. Housing is a major issue in Turangi and every year the houses get one year older and further neglected. Out of town private landlords will not insulate. Overcrowding significant issue in Turangi. Prison population attracts families and transiency. Gang population and this is an area of health need. Providing rapid response and follow up including adherence. More willing to treat GAS with IMI Bicillin. Very experienced doctors and nurses-know their community have community support. Provide an integrated primary care, sexual and reproductive health, mental health drug and addictions so this is business as usual. Will provide awareness raising. Identify needs Require ongoing workforce development,have locums but dedicated community support workers. Provide posters and resources 18

19 Engage with key stakeholders Toi Te Ora Public Health Service Western Heights Community Association Korowai Aroha Tipu Ora Ngati Pikiao Rotorua Children s Team Operational management Group Maori Women s Welfare League Kia Puawai Maternal and Child Health Integrated service 0-5 year olds Key points What are they providing? Includes health, Citizens Advice Bureau, Curtain Bank, Housing NZ, Home insulation services, pharmacy and mens shed. Whanau ora collective Includes Pepe, Moko and Tamaiti teams nurses and community support workers. Work with all pregnant women and their whanau until children are five years of age. Sort social needs as well as health Has high needs vulnerable children, large families, CYF referrals Willing to help in any way that we require. They are highly visible at many community events. Implementing minimum standards for babies and families in Western Heights and outcomes we want for children. Ensuring all children are enrolled, receiving universal services etc Actions following engagement and future actions ongoing. High needs practice. Able to provide support with marketing and communications. Provide Medical Officer of Health. Monthly meetings. Providing support with structural overcrowding. Providing beds, linen, curtains, firewood recycled heaters, fire alarms. Will apply for ongoing funding for resources. Monthly meetings. Wide reach across primary health care, Kohanga Reo, Kura Kaupapa, and Whanau Ora. Workforce development with the Lead professionals looking after these children and families required Rheumatic Fever Governance to scope. 19

20 Engage with key stakeholders After Hours Health Services Housing New Zealand Key points Are seeing a growing number of children and young people in Rotorua Due to parents and young people unable to take time off work Difficulty arranging appointments with primary care Clarification RF Healthy Homes referral pathways Actions following engagement and future actions Need workforce development Resources Expertise Follow up can be an issue Continued engagement to further refine pathways between services 20

21 Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017) 4.1 Where is the DHB in relation to meeting the 2017 target? What is the expected trend with or without new actions? Lakes DHB is committed to reducing the incidence of Rheumatic Fever to levels set by the better public services targets. The specific targets and actuals for Lakes DHB are summarised in table 1 below. Table 1: Acute Rheumatic Fever initial hospitalisation target and actuals, rates per year for Lakes DHB (per 100,000 total population), 2009/10 to 2016/ / / /13 Target: 2013/14 Target: 2014/15 Target: 2015 /16 Target: 2016/17 Target: District Health Board Baseline rate (3-year average rate) Remain at baseline level 10% reduction from baseline level 40% reduction from baseline level 55% reduction from baseline level 2/3 reduction from baseline level Lakes Target rates Target numbers Actuals rates Actual numbers

22 4.2 What actions will be continued or introduced to ensure the 2017 target is met? Raising awareness of rheumatic fever and how to prevent it Preventing the transmission of Group A streptococcal throat infections in households Treating Group A streptococcal sore throat infections quickly and effectively in whatever context they arise Current Interventions Increased interventions to be introduced 1 January 2016 Rationale Measured by Timeframe Actions to raise awareness of rheumatic fever and how to prevent it among priority populations RF communications plan National campaign Radio, TV and petrol station messages Local resources widely distributed Rheumatic Fever Nurse providing community awareness raising Continue all current interventions Add Maori community awareness raising-pou Whakamarama. Introduce an appropriate person to work extensively in priority populations to ensure awareness raising reaches all parts of the community. Person with extensive Maori networks and partnered with community paediatrician. Develop an ongoing mechanism to provide iwi governance with regular updates and communications To develop a focus on priority populations All recent ARF patients in Lakes DHB have been Maori/PI A reluctance in some of our Maori and high needs population to seek health care early. ARF rates and reaching the target Number of community awareness raising sessions Iwi Governance contacts Quarter Pou Whakamarama in place Set up quarterly reporting to iwi governance Actions to preventing the transmission of Group A streptococcal throat infections in households Healthy Home Programme Western Heights Promote the Better Public Health Service targets including RF through the CoBOP (Collaboration Bay of Plenty) and Rotorua Continue current initiatives Healthy Homes Programme Western Heights Increase healthy communal living messages through Community Awareness Raising Provide the Public Health Poor housing stock in Lakes DHB and overcrowding Poor housing in Turangi with little or no upkeep Noted bedding and Healthy Homes reports-numbers of insulated homes and referrals Turangi Healthy Housing programme Quarter Key Tips programme in place pre Winter Community awareness raising commenced Standing orders in place across across PHNs and 22

23 Current Interventions Increased interventions to be introduced 1 January 2016 Rationale Measured by Timeframe governance for the Childrens Team, Social Service sector trial and Te Arawa Whanau Ora Develop a systems approach to identifying children and families at high risk of RF when the children and families are seen by health services. System to enable agencies to flag children and families living in overcrowded and poor housing, including poor heating and clothing combined with presentations for respiratory illness, repeat GAS infections, ASH, vulnerable pregnant women, vulnerable children 0-5 years, children referred to the Children s Team. Promote healthy communal living habits in homes and schools. Well Child/Tamariki Ora providers, Nursing teams with more Healthy Homes resources when home visiting Roll out a programme for train the trainer workshops for Key tips for a warmer, drier home toolkit Explore options for Healthy housing programmes in Turangi supported by Tuwharetoa and Whanau Ora Support Western Heights programme to source sustainable philanthropic funding streams and systems for household equipment, beds, bedding, heaters, dehumidifiers, dry firewood, mould kits Increased focus on opportunistic treatment of skin conditions in children Adopt of a whatever it takes approach to preventing RF beds are in demand DHB, whanau ora, and MSD all have workforce home visitors in priority communities for the key tips for drier warmer households Limited supply of needed HH service resources currently Casual correlation between skin infection and positive GAS identified Responsive and flexible approach to RF promotion, identification and treatment of children and their family/whanau Workshop for train the trainer sessions and number of attendees Response to philanthropic applications ARF rates ARF rates practice Nurses 23

24 Current Interventions Increased interventions to be introduced 1 January 2016 Rationale Measured by Timeframe PHNs, Hauora providers, Trust, GPs, Accident and Emergency Departments in hospitals and community. Actions to ensure treatment of Group A streptococcal throat infections quickly and effectively Implementing the rheumatic fever and sore throat guidelines and clinical pathway as a priority in primary care. Education and clinical updates for health professionals. Frontline clinicians, locums in primary health care and secondary care Provision of treatment immediately Sore Throats Matter Community Campaign Throat swabbing Throat swabbing and standing orders of amoxicillin in all Introduce a dedicated and increased RF workforce development programme to be delivered by the RF Nurse and RF Champions. Include antibiotic adherence education and evidence. Use the online training, face to face education sessions and site visits Increase the advertising and community awareness raising of where to go when you have a sore throat. Consider a local 0800 number, facebook. Strengthen Lakes specific information national 0800 number Increase FREE rapid response service capacity at Following stakeholder engagement identified knowledge gaps. Lack of confidence in Rapid Response eg clinicians wanting to wait for results, resistance to using IMI Bicillin in high risk cases. Lack of responsiveness by primary health care Vulnerable population unengaged with health Increasing afterhours seeking health behaviour in Lakes ARF numbers in lakes DHB Rapid Response Rheumatic Fever funded programmes reporting Quarter Education programme and plan developed for providers Delivery of the plan commences Quarter Communications plan in place Local advertising to raise awareness of rapid response services pre Winter 24

25 Current Interventions secondary school clinics. Public Health Nursing in primary schools to implement pathway into primary care for treatment of sore throats. Education of health professionals on importance of improving access to assessment and treatment Increase capacity of the community youth health services to provide free and easy access to young people with sore throats for assessment and treatment Standing orders prescriber to be responsible for follow up, evaluation of treatment and compliance. Increase support should it be needed through the public health nurses, child health nurses, family start. Increased interventions to be introduced 1 January 2016 the following services: Western Heights Rapid Response service Tuwharetoa Health Rotovegas YOSS Anamata Café YOSS Secondary School based health services Public Health Nurses Primary Health Care- Rotorua Primary Care Taupo Primary care Turangi Primary care Mangakino After Hours care Rotorua and Taupo ED Lakes Prime Care Work with PHOs to progress primary health care responsiveness to children and families with sore throats. Develop leadership structure and RF champions within primary care Rationale Increased RF prevention focus needed within primary sector No current options for afterhours Rapid Measured by ARF rates Number of clients accessing after hours services Timeframe 25

26 Current Interventions Increased interventions to be introduced 1 January 2016 Afterhours RF rapid response clinics in primary care Rationale Response RF clinic s across the region with the exception of Western Heights Measured by Timeframe Actions to address social determinants impacting on transmission of Group A streptococcal infections Lakes AOD service Specialist AOD resource embedded within rapid response sort throat nursing services: Screening Brief interventions Education Harm reduction Referral pathways to primary/secondary AOD services High proportion of at risk families/whanau present with AOD issues ARF rates Number of individuals engaged with AOD interventions Quarter 3 and Roll our of integration into other services. 26

27 4.4 Lakes DHB sustainability beyond June 2017 Included in 4.3 above is the Lakes DHB outline of the activities we are planning to invest in from 1 July Sustainable investment will come from the Ministry ongoing funding from 1 July 2017 plus Lakes DHB population based funding. Implementing the Map of Medicine clinical pathways for sore throats and treatments will be business as usual through primary care and youth health services. Public Health Nursing and Youth One Stop Shops and secondary school based health services are planned to continue with rapid response under standing orders. The increased support and intensive child and youth health services being developed in Lakes population to feed into Family Start activity and the Rotorua and Taupo Children s teams will be used to flag children at risk and needing housing, clothing, unmet physical health needs (including sore throats, oral health care, skin infections). The Rheumatic Fever Governance will continue with rheumatic fever champions either as a stand alone governance or will merge into the Lakes DHB Te Whanake (Maternal, Child and Youth Health governance). There is also the ongoing cross sector Rotorua joint governance around children and families (White Paper, Whanau Ora, Social Service Sector trial as well as iwi, community based initiatives) which will increase access to insulated housing, safer families, improved education outcomes contributing to a reduction in inequalities. 27

28 Appendix 1 Document No: This is a controlled document. The electronic version of this document is the most up to date and in the case of conflict the electronic version prevails over any printed version. This document is for internal use only and may not be accessed or relied upon by 3 rd parties for any purpose whatsoever. TITLE: Terms of Reference for Rheumatic Fever Governance 1. Purpose/Description Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. Whilst we have made progress in many areas of child health we know more work and further focus is required to eradicate Rheumatic Fever from our population. Lakes DHB is required to update and implement a refreshed Rheumatic Fever plan from 1 January As part of the refreshed plan Lakes DHB is required to put in place an appropriate Rheumatic Fever prevention governance group. This is to ensure collective decision making about the priorities and a coordinated implementation of the refreshed plan. The governance group will be charged with overseeing the development and the implementation of the refreshed plan. 2. Function/Scope of Meeting The Rheumatic Fever governance is to provide expert advice on the development and implementation of the Lakes DHB Rheumatic Fever prevention plan. This includes ensuring a balanced portfolio of interventions to reduce rheumatic fever incidence and applying flexibility to change decisions and services based on new evidence. An Advisory Group was initially consulted on development of the proposed Project Implementation Plan to the Ministry of Health prior to the contract for implementation being agreed. The Advisory Group is to be re-established to provide expert advice to the project manager, including the direction of the project, issues related to implementation, laboratory, health providers, data, partner notification and contact tracing. 3. Membership Chair: Health Pip King Portfolio Manager Maternal, Child and Youth 28

29 Minute Taker: Tiannie Hillman-Lepper Members: Johan Morreau Neil Poskitt Mary McLean Elise Pope Sharon Rye Trust Phyllis Tangitu Kate Stewart Teresa Pou Anaru Marshall Peace Tamuno Alan Ching Tayelva Petley Hariata Johnson Rheumatic Fever Champion Rheumatic Fever Champion Manager Rapid Response services Rheumatic Fever Nurse Clinical Manager Tuwharetoa Charitable General Manager Maori Health Project Manager Housing New Zealand Wise Better Homes Adult Cardiologist Regional Manager MSD Regional Manager CYF MWWL 4. Meeting Schedule First meeting to be held Friday 16 October Subsequent meetings are to be agreed by the group attendees. The Governance Terms of Reference are to be reviewed annually to ensure they are current and have appropriate membership and that sustainable change is being delivered. 5. Minutes/Documentation Minutes recording key discussion points, actions and responsibility to be recorded, distributed for feedback before finalising one week after each meeting. Distribution by . Documentation maintained in project records on project file and electronically on Rheumatic Fever share file at Lakes DHB. 6. Reporting The Portfolio Manager reports on behalf of Lakes DHB to the Ministry of Health on a quarterly basis. Authorised by: Pip King Portfolio Manager Endorsed by: Mary Smith General Manager 29