Hauora Tairāwhiti Annual Plan 2016/17

Transcription

1 Hauora Tairāwhiti Annual Plan 2016/17 E91 Incorporates the 2016/19 Statement of Intent and 2016/17 Statement of Performance Expectations Annual Plan Hauora Tairāwhiti 1

2 Ta Matou Matakite - Our Vision Whaia te Hauora I roto I te Kotahitanga A Healthier Tairāwhiti by Working Together WhakaraNgātira Kia Whakara Ngātira i te oranga o to tatou hapori A Matou Uara - Our Values We take responsibility to enrich the health of our community. Enrich = increasing the quality of Quality Focus) Awhi Kia Awhi i te turoro We give caring support to our Patients. Patient Care Kotahitanga Ma te Kotahitanga o a tatou mahi ka momoho ai Through our collective effort we succeed. Employee Synergy Aroha Kia tuku Aroha ki te Whānau We give compassion to our families. Hearts and minds This document presents our Annual Plan 2016/17 (referred to as the Plan) and incorporates the 2015/18 Statement of Intent and the 2016/17 Statement of Performance Expectations. Central to understanding this Plan, is our performance story which sets out our key outcomes (what we are trying to achieve), our impacts (our shorter term contribution to an outcome), our outputs (goods and services supplied), and our inputs (resources). This plan should be read in conjunction with the Hauora Tairāwhiti Māori Health Plan and the Midland DHB Regional Services Plan. Annual Plan (2016/17), Statement of Intent ( ) and Statement of Performance Expectations (2016/17) Gisborne: Tairāwhiti District Health Board trading as Hauora Tairāwhiti Published in June 2016 by Hauora Tairāwhiti Private Bag 7001, Gisborne, 4010 This document is available on the Hauora Tairāwhiti website: Annual Plan Hauora Tairāwhiti 2

3 Contents E91 Ministers Letter of Approval for Annual Plan 2016/ Karere i to tatou Poari / Message from Our Board Module 1 - Introduction and Strategic Intentions CONTEXT The Treaty of Waitangi National Operating Environment Health Sector Challenges and Pressures Regional Operating Environment Local Operating Environment Nature and Scope of Functions Our Geography and Population Health Profile Koronga rautaki / Strategic Intentions Performance Story Tatou kite / Our vision Strategic Outcomes In National, Regional And Local Context Regional Context Strategic Outcome 1: Improve the health of the Midland populations Strategic Outcome 2: Eliminate health inequalities Local Context Key Risks and Opportunities Health Inequities Living Within Our Means Health System Workforce Shortages System Integration Regional Integration KEY MEASURES OF PERFORMANCE Fewer People Smoke Reduction in vaccine preventable diseases Improving health behaviour Children and adolescents have better oral health Long-Term Conditions Are Detected Early And Managed Well Fewer people are admitted to hospital for avoidable conditions People maintain functional independence Annual Plan Hauora Tairāwhiti 3

4 Module 2 People receive prompt and appropriate acute care People have appropriate access to elective services Improved access to mental health services More people with end-stage conditions are appropriately supported The New Zealand Health Strategy and Delivering on Priorities and Targets IMPLEMENTATION OF THE NEW ZEALAND HEALTH STRATEGY THEMES FROM THE HEALTH STRATEGY People Powered Care Closer to Home High Value and Performance One Team Smart System DELIVERING ON PRIORITIES AND TARGETS Implementing Government Priorities Child and Youth Health REDUCING UNINTENDED TEENAGE PREGNANCY INCREASED IMMUNISATION SUPPORTING VULNERABLE CHILDREN SOCIAL SECTOR TRIALS RHEUMATIC FEVER PRIME MINISTER S YOUTH MENTAL HEALTH PROJECT Long Term Conditions Prevention Identification and Management HEALTHY FAMILIES NEW ZEALAND (HE ORANGA WHĀNAU) OBESITY Living well with Diabetes CARDIOVASCULAR DISEASE Tobacco Smokefree RISING TO THE CHALLENGE System Integration Service Configuration System Level outcome measures System Level Measures CANCER STROKE SERVICES CARDIAC SERVICES PALLIATIVE CARE Annual Plan Hauora Tairāwhiti 4

5 HEALTH OF OLDER PEOPLE Shorter Stays in Emergency Departments Whānau Ora Improved Access to Elective Surgery Improved Access to Diagnostics Living within our Means LIVING WITHIN OUR MEANS NATIONAL ENTITY PRIORITY INTITATIVES NZ HEALTH PARTNERSHIPS Other Improving Quality Spinal Cord Impairment Action Plan Actions to Support Delivery of Regional Priorities Module 3 Statement of Performance Expectations OUTPUT CLASSES GUIDE TO READING THE STATEMENT OF SERVICE PERFORMANCE PEOPLE ARE SUPPORTED TO TAKE GREATER RESPONSIBILITY FOR THEIR HEALTH Fewer People Smoke Reduction In Vaccine Preventable Diseases Improving Health Behaviours People Stay Well in Their Homes and Communities An improvement in childhood oral health Long-Term Conditions are Detected Early and Managed Well Fewer People are admitted to Hospital for Avoidable Conditions More People Maintain their Functional Independence People Receive Timely and Appropriate Specialist Care People Receive Prompt and Appropriate Acute and Arranged Care People Have Appropriate Access to Elective Services Improved Health Status for those with Severe Mental Illness and/or addictions More People with End Stage Conditions are Supported Appropriately Support Services Module 4 - Financial Performance FINANCIAL PERFORMANCE Module 5 Kōwae Tuarima/ Stewardship TE WHAKAHAERE I TO TATOU PAKIHI / MANAGING OUR BUSINESS Annual Plan Hauora Tairāwhiti 5

6 To tatou iwi / Our people Organisational Performance Management Non-financial performance reporting Financial performance reporting Pūtea me te Whakahaere Pūtea / Funding and Financial Management National Rängai Hauora tari / National Health Sector Agencies Risk Management Performance and Management of Assets Te Kaha Building / Building Capability Information Communications Technology Clinical Technology Quality Assurance and Improvement HEALTH EXCELLENCE QUALITY AND SAFETY MARKERS (QSMS) QUALITY ACCOUNT PATIENT EXPERIENCE Capital and Infrastructure Development Improvement and Sustainability Initiatives Cooperative Developments Integrated Contracting Kaimahi / Workforce Managing Our Workforce within Fiscal Restraints Capacity DEVELOPING A FIT WORKFORCE - CARE CAPACITY DEMAND MANAGEMENT AND RELEASING TIME TO CARE 182 WORKFORCE DEPLOYMENT AND VARIANCE RESPONSE MANAGEMENT (VRM) Growing Our Own Careers and Health Promotions Grow Our Own Nurses Growing Our Own Nurse Specialists GENERAL PRACTITIONER TRAINING RESIDENT MEDICAL OFFICER CAREER PLANNING SUPPORT ALLIED AND TECHNICAL GROWING VULNERABLE WORKFORCES GROWING THE MĀORI WORKFORCE THE AGING WORKFORCE Capability Annual Plan Hauora Tairāwhiti 6

7 Growing the Kaiāwhina Workforce GROWING ON OUR OWN DEVELOPMENT OF THE ALLIED AND TECHNICAL WORKFORCE BETTER UTILISATION OF CLINICAL LEADERSHIP Safe and Competent Workforce CULTURE CHILDREN S WORKER SAFETY CHECKING WHAKAHAERE HAUORA / ORGANISATIONAL HEALTH Kāwanatanga / Governance Management Assessing Performance Module 6 Whirihoranga Ratonga/ Service Configuration RATONGA ROHE / SERVICE COVERAGE HURI RATONGA / SERVICE CHANGE TAKE RATONGA / SERVICE ISSUES Module /17 Performance Measures Module 8 Appendices Glossary of Terms Output Class Definitions Prevention Early Detection and Management Intensive Assessment and Treatment Services Rehabilitation and Support Output Class Revenue and Expenditure Output Measure Rationale Organisational Structure Services funded but not provided by the DHB He Urupare Rangapu Hauora Māori / Māori Health Plan Tairāwhiti Māori Health Plan Health Indicators Annual Plan Hauora Tairāwhiti 7

8 Ministers Letter of Approval for Annual Plan 2016/ Annual Plan Hauora Tairāwhiti 8

9 Annual Plan Hauora Tairāwhiti 9

10 Annual Plan Hauora Tairāwhiti 10

11 Karere i to tatou Poari / Message from Our Board E91 This document expresses our continued commitment to our local strategic action of Whāia te Hauora I roto I te Kotahitanga/ A Healthier Tairāwhiti by Working Together. It also articulates our commitment to meeting the Minister s expectations, including the Health Targets, and how we will achieve this, as well as how we will work with our Midland DHB, Primary Health Organisation, local provider and iwi partners to deliver on continual improvement services for our local people. Hauora Tairāwhiti s key focus areas can be summarised across five core areas: Care Closer to Home Increased patient Quality and Safety Health of Older People Regional and National Cooperation Living within our means. Hauora Tairāwhiti is also guided by the following 4 key strategic outcomes to achieve its vision. Prevent ill health Reduce health inequalities between population groups Support people to stay well in the community Ensure people receive timely and appropriate complex care These areas are reflected in Hauora Tairāwhiti s work-plans for improved older persons services, child and youth services, mental health services, improved performance from the primary and secondary care sector (including addressing the Minister s core Health Targets and expectations), reduced health inequalities across Māori and non-māori, and further improving the quality and safety of the health system for the people of Tairāwhiti. The 2016/17 financial year represents another challenge to the DHB. The current economic and fiscal environment in the country remains a significant planning consideration, with continuing pressure on Vote Health for the foreseeable future. Hauora Tairāwhiti has some key cost pressures in 2016/17. These include: Increased investment in regional and national service solutions; Growth in demand for some services at a higher rate than the funding increase e.g. aged residential care, cancer treatment; Significant cost increases in air transport services through clinically driven changes in practice; Expectations around waiting times targets that will increase costs as we meet higher demand expectations. The Minister of Health (the Minister ) set out his expectations in his letter of 22 December This year, the Minister has identified the following priorities: Refreshed New Zealand Health Strategy Living within our means Working across government National Health Targets Tackling obesity Annual Plan Hauora Tairāwhiti 11

12 Shifting and integrating services Health IT programme To be able to afford new investments and government expectations, Hauora Tairāwhiti will deliver additional efficiencies in its operations, as well as in its funding arrangements, on top of the significant efficiencies we have driven over the last 3 years. Meeting the 2016/17 budget against year on year savings initiatives will not be an easy task, and we have assumed that a number of national savings will be delivered on (including HBL developed business cases and the national Community Pharmacy Agreement) for us to reach our break-even budget. 2015/16 has been a successful year for Hauora Tairāwhiti. Already we have seen improvements in Hauora Tairāwhiti s performance against the Health Targets, and this will remain a continued focus for 2016/17. We are working in partnership across the Midland region to achieve performance in the faster cancer treatment, and will continue to partner with Pinnacle Midlands Health Network, Ngāti Porou Hauora and the National Hauora Coalition to achieve the immunisation target. We will also maintain and accelerate our focus on productivity and quality, which will support Hauora Tairāwhiti s dual objectives of improving health outcomes for our population, and a breakeven budget. Implementation of our patient quality and safety projects within the Provider Arm is being led through the dissemination of our patient quality and safety culture to create better outcomes with better utilisation of resources by elimination of waste. There is a transformational set of activities accelerating system integration both within health but also across agencies involved in social care. We are fully committed to this Government s Social Investment through the Manaaki Tairāwhiti initiative, which brings together local social sector leaders into a single governance group to better co-ordinate services for at-risk families. We will also continue to seek opportunities to support the development of a collective impact approach within Tairāwhiti through initiatives such as RUIA Project, which is starting to transform how services and gang whanau interact. Health care integration remains a top priority for the district and with the success of E Tipu E Rea and the single point of entry for Mental Health and Addiction Services; we are increasing the appetite within the district for change. A number of changes in 2016/17 will see primary care increasingly placed at the centre of a patients care, these changes will increase the strength of partnership between health professionals involved in the care of our people. Hauora Tairāwhiti is committed to regionalisation with the Midland region where this will deliver benefits to the Tairāwhiti population in terms of service effectiveness and sustainability. This is evidenced in our active participation in, and funding of the implementation of the Midland Regional Services Plan. Information systems are key to supporting improved clinical outcomes, and these priorities are acknowledged within regional planning, with Hauora Tairāwhiti setting aside the necessary capital investment for these to be addressed regionally. Clinical leadership development in our DHB and across the sector in Tairāwhiti is delivering results in improving outcomes for patients and raising quality of service provision. The clinical leadership structure now revised and linked to clinicians working in the community setting, partnered with management, is driving change to ensure service demand is managed, indicators of quality are improved and new service developments come to fruition. In summary, first and foremost our focus is on improving outcomes for people in Tairāwhiti through increased quality and safety of services. We will achieve this by further strengthening clinical Annual Plan Hauora Tairāwhiti 12

13 leadership and integration across the whole care spectrum. We will do this while prudently using the resources we have available, eliminating waste and living within our means. The commitment of all our partners and the staff of Hauora Tairāwhiti to these causes mean achievement against our challenging work programme is assured. Hon Jonathan Coleman Minister of Health Annual Plan Hauora Tairāwhiti 13

14 Module 1 - Introduction and Strategic Intentions As we enter the 2016/17 planning round, we see a New Zealand public health system that continues to face challenges. With challenges, however, come opportunities, and this plan details many of the opportunities and interventions we believe will have positive impacts on the health status of our population. The challenges that affect us all are both global and local. The burden of disease is unfairly distributed in our society; long term conditions and risk factors such as smoking, obesity and diabetes contribute to serious health disparity. The health of Māori remains an area in which we must do better, and more detail is to be found in Te Tairāwhiti - He Urupare Rangapu Hauora Māori, Hauora Tairāwhiti s Māori Health Plan. The physical health of people with serious mental health problems is another area for concern, with a life expectancy in this group around 5 years less than for other New Zealanders. Already we are seeing the impacts of an aging population in 2015 there were 3.64 people in the workforce for every person 65 years and over by 2031 there will be just half that number with two people in the workforce for every over-65 year old. Whilst increasing numbers of people are electing to work past the age of 65, increasing numbers of people are reaching the previous category of elderly people (85 plus often with a high degree of frailty and complex health need). The funding environment remains constrained as health consumes an ever increasing portion of total government expenditure. Rapid advances in technology continue to fuel tertiary creep or the more expensive end of health services and the public has high expectations of its health system. Resistance to common antibiotics and new infections are ever-threatening. DHBs are continually looking for ways to increase allocative efficiency by investing in preventative care. Targeting of vulnerable populations is essential if we are to realise more equitable health outcomes. There is a general acceptance that if we are to prepare well for the healthy health and disability sector we must focus on four areas: 1. Better integration of services within health and across the social sector: Strengthening integration within health and across government to support the most vulnerable, reduce inequities, and address issues outside the health and disability system that impact on health. 2. Improving the way services are purchased and provided: Ensuring funding models support change, building and supporting the key enablers and drivers of change: workforce, health information and capital. 3. Continuing to lift quality and performance: Driving performance through measuring outcomes and rewarding the right things to improve quality. 4. Supporting leadership and capability for change: Supporting strong governance, clinical and executive leadership, and capability across the health sector. As emphasised in the refreshed New Zealand Health Strategy, planning involves using a range of information, (demographic, long-term demand projections and epidemiological information) to create a smarter system which will help us respond to the needs of our population over the next 10 years and beyond, and to inform the planning and development of the services that will best meet those needs Annual Plan Hauora Tairāwhiti 14

15 A driving priority for Hauora Tairāwhiti remains the health of Māori. There is general acceptance that if we continue to do what we have always done, then we will get the results we have always got: for Māori this ultimately means a shorter life expectancy here in Tairāwhiti than in any other District Health Board (DHB) in New Zealand. This has fuelled growing momentum across health and social sectors to create a uniquely Tairāwhiti model to achieve better health outcomes more quickly, especially for Māori. A critical component of this work is the implementation of a cross-sectorial collective impact approach within any service planning or design to ensure that the people of Tairāwhiti receive high value health and social care closer to home. The refreshed New Zealand Health Strategy comes in two parts, Future Direction, and Roadmap of Actions. The Future Direction outlines a high-level direction for New Zealand s health and disability system over the next 10 years. The Roadmap of Actions identifies 20 work areas for the next five years that are pivotal in putting the refreshed Strategy in place. Detailed information is to be found throughout this plan. This document expresses our continued commitment to our local strategic action of a healthier Tairāwhiti by working together. It also articulates our commitment to implementing the refreshed New Zealand Health Strategy, meeting the Minister s expectations, including the Health Targets, how we will achieve this, as well as how we will work with our Midland DHB partners to deliver on Better, Sooner, More Convenient services for our local people. Whaia te Hauora i Roto i te Kotahitanga (A healthier Tairāwhiti by working together) Annual Plan Hauora Tairāwhiti 15

16 1.1. CONTEXT Healthcare in Tairāwhiti is heading in a new direction. That new direction involves working closer with iwi, community health and social sector partners to look at how we move health care services closer to people s homes and closer to a model that meets people s needs and present to our community as a single health and social care team. We have new values centred on our waka heritage, and a new name for our organisation Tairāwhiti District Health Board trading as Hauora Tairāwhiti. We are still a District Health Board, however our name reflects the people we serve, and the fact that we are about the wellbeing of the people of Tairāwhiti, not just the services provided at Gisborne Hospital or general practice for example. Hauora Tairāwhiti (previously known as Tairāwhiti District Health) was established on 1 January 2001 by the New Zealand Public Health and Disability Act 2000 (NZPHD), and is one of 20 DHBs in New Zealand. DHBs were established as vehicles for the public funding and provision of personal health services, public health services and disability support services for a geographically defined population 1. Hauora Tairāwhiti is a Crown Entity and is accountable to the Minister of Health. This Plan sets out the activities we will undertake in terms of national, regional and local priorities. It describes to Parliament, and to the New Zealand public what we intend to achieve in 2016/17 to improve the health of the Tairāwhiti population, and to reduce or eliminate health inequalities. We are part of the Midland DHBs region, and have worked together to improve regional consistency across our plans. This cooperation is reflected throughout this Plan. We receive funding from Government to undertake our functions 2. The amount of funding is determined by the size of our population, as well as the population s age, gender, ethnicity and socioeconomic status characteristics. We are both a funder and provider of health services. In 2016/17 we will receive $ million 3 in funding from the 1 See for a map of our DHB 2 See for information on our functions 3 In addition to this Tairāwhiti DHB will receive a net inflow of $2.16million to provide services for other populations giving a combined budget of $ million. Government for most personal health (services to improve the health of individuals), mental health and addictions, Māori health, and health of older people services for the Tairāwhiti population. Our provider arm will receive approximately 63 per cent of the service funding with the remaining 47 per cent being utilised to fund community based services including those provided by nongovernment organisations (NGOs), primary care, pharmacy and laboratories 4. The Ministry of Health also have a role in the planning and funding of some services. Some services are funded and contracted nationally, for example public health services, breast and cervical screening, as well as the provision of disability support services for people aged less than 65 years. We are socially responsible and uphold the ethical and quality standards commonly expected of providers of services and public sector organisations. We are responsible for monitoring and evaluating service delivery, including audits of the services we fund. The costs of providing services to people living outside of our district are met by the DHB of domicile of the patient, and are referred to as interdistrict services or Inter-District Flows (IDFs). Likewise, where we do not provide the service, we have funding arrangements in place enabling our district residents to travel outside the district to receive care. We also deliver against service delivery contracts with external funders, such as ACC. We closely monitor IDFs and ACC volumes to ensure our ability to provide for our own population is not adversely affected by demand from outside the district. In order to achieve the planned outputs, impacts and outcomes as outlined in this Annual Plan, we may, pursuant to section 25 of the New Zealand Public Health and Disability Act 2000, negotiate and enter into, or vary any current agreement for the provision or procurement of any health and disability support service. These agreements (or 4 See appendix one for more detail on services funded but not provided by DHBs Annual Plan Hauora Tairāwhiti 16

17 variations) may contain any terms or conditions acceptable to the DHB. Hauora Tairāwhiti is committed to the aims of the refreshed New Zealand Health Strategy. The themes identified within the strategy and the roadmap actions will support the District to shift the health system to a wellness model. We are expecting The Treaty of Waitangi transformational change in improving how we work as one team across the system to deliver on the expectations, outcomes, goals, objectives and strategic priorities we are charged with contributing to each year. The Treaty of Waitangi (Te Tiriti o Waitangi) is New Zealand s founding constitutional document and is often referred to in overarching strategies and plans throughout all sectors. Hauora Tairāwhiti is one of many organisations that value the importance of the National Operating Environment The Minister of Health, with Cabinet and the Government, develops policy for the health and disability sector. The Minister is supported by the Ministry of Health and its business units, and is advised by the Ministry, Health Workforce New Zealand, the National Health Information Board and other ministerial advisory committees. Accident and injury services are funded by the Accident Compensation Corporation (ACC). Health and Treaty. Central to the Treaty relationship and implementation of Treaty principles is a shared understanding that health is a taonga (treasure). disability services in New Zealand are delivered by a complex network of organisations and people. Each has their role in working with others across the system to achieve better, sooner, more convenient services for all New Zealanders. The network of organisations is linked through a series of funding and accountability arrangements to ensure performance and service delivery across the health and disability system. Health Sector Challenges and Pressures Major long-term systematic pressures are shaping the way health services will be delivered in the future. These pressures not only impact on New Zealand, but on a majority of health systems across the world. These challenges and pressures include: There are substantial variations in outcomes for different populations, particularly for Māori and Pacifica peoples, and those living in more socioeconomically deprived areas; With increasing diversity in our population, the health system needs to be flexible to meet changing needs and expectations of services; Changing population health needs and patterns of health and ill-health (e.g. the growing impact of long-term conditions such as diabetes and risk factors such as high body mass index, multiple comorbidities that increase with age, population growth and ageing); An ageing and unevenly distributed workforce, which does not currently match the anticipated future demand for health and disability services; More expensive treatments and increasing costs, and changing public expectations of services and treatments; and Providing excellent health care whilst ensuring the cost of the health system is sustainable (historically health spending has grown faster than Gross Domestic Product). Hauora Tairāwhiti faces a situation of being tasked with continuing to fund and provide high quality services within the context of tight financial constraints. To achieve this we must continue to work with iwi, our contracted providers, our communities, service users, whānau, and other key stakeholders to develop new and better ways of delivering services and providing models of care Annual Plan Hauora Tairāwhiti 17

18 Regional Operating Environment Hauora Tairāwhiti is one of five DHBs 5 that make up the Midland Region. In 2016/17 all five Midland DHBs will continue to progress activities towards regional cooperation in a planned manner. Collectively the Midland DHBs have agreed a strategic response to assist the region to move forward in the same direction. This direction is articulated in the Midland DHB Regional Services Plan (RSP). The health sector challenges and pressures also have implications at the regional level. Some distinguishing features of our region include: High proportion of population identifying as Māori; Low proportion of the population identifying as Asian or Pacific peoples; Higher proportion of people living in rural areas; Higher proportion of people living in areas identified as higher deprivation quintiles 4 and 5; Lower life expectancy than the New Zealand average; Higher smoking rates than the New Zealand average. Across the midland region there is a great need and desire to improve the health outcomes of our most vulnerable populations, in particular older Māori people, and our children and youth. Logo Midland DHB Website Forecast Population 2016/17 Bay of Plenty 226,530 Lakes 105,170 Tairāwhiti 47,680 Taranaki 118,110 Waikato 400,820 5 Bay of Plenty, Lakes, Tairāwhiti, Taranaki and Waikato Annual Plan Hauora Tairāwhiti 18

19 Local Operating Environment We are responsible for the provision or funding of the majority of health services in our district. These services in our district include: 2 hospital sites 3 Primary Health Organisations (PHOs) 1 mental health inpatient facility 2 community bases 2 maternity units Nature and Scope of Functions 6 aged related residential care facilities (rest homes) 7 pharmacies 12 general practice facilities 3 Māori providers We collaborate with other health and disability organisations (such as our primary care alliance partners), key stakeholders, service users, and their family/whānau, and our community to identify what health and disability services are needed and how best to use the funding we receive from Government. Through this collaboration we aim to ensure that health and disability services are well coordinated and cover the full continuum of care, with people at the centre. We expect these collaborative partnerships to also allow the sharing of resources, reduction in duplication, variation and waste across the health system to achieve the best outcomes for our community. We aim to promote, protect and improve our population s health and wellbeing through health promotion, health protection, health education and the provision of evidence-based public health initiatives As a DHB we: Plan in partnership with key stakeholders, the strategic direction for health and disability services Plan regional and national work in collaboration with the Ministry of Health and other DHBs Fund the provision of the majority of the public health and disability services in our district, through the agreements we have with providers Provide hospital and specialist services primarily for our population and also for people referred from other DHBs Annual Plan Hauora Tairāwhiti 19

20 Our Geography and Population Our DHB serves a population of 47,680 and covers 8,351 square kilometres, roughly 3% of New Zealand s land area. Tairāwhiti is the most sparsely populated North Island area, with a population density of 5.6 people per square kilometre. The district s tallest mountain is Mt Hikurangi (1,752 metres), which is the first point on the mainland that the emerging sun shines on. Māori legend states that the mountain is the resting place of Maui s canoe after he hauled up the North Island. The principal iwi tribal groups of the Tairāwhiti district are Ngāti Porou of the East Coast, and Te Aitanga-a-Mahaki, Rongowhakāta and Ngai Tamanuhiri whose tribal boundaries are situated within the Tūranganui-a-Kiwa/Poverty Bay area. While each iwi values its own identity and independence, strong kinship links exist across all the iwi groupings within Tairāwhiti. Hauora Tairāwhiti recognises the interest of iwi in terms of their aspirations to improve the health and wellbeing of their people. A detailed breakdown of our population is presented in the following table. Table: Tairāwhiti DHB projected population by age and ethnicity for 2016/17 Age Group Ethnicity Māori Pacific Asian Other Total , ,130 17, , ,550 10, , ,480 11, , ,940 4, ,240 2,900 Total 23,930 1,200 1,210 21,340 47,680 A large proportion of our population live outside the main urban areas (approximately 27% per cent) 6. Our large rural population presents diverse challenges in service delivery and accessing health services. Significant points of interest in regard to our population include: The Tairāwhiti district has an average deprivation score of 7, where 1 indicates least deprived, and 10 most deprived. 6 MoH PHO Enrolment Demographics 2014Q4 (Oct- Dec 2014) Annual Plan Hauora Tairāwhiti 20

21 Deprivation scores in our district range from 2 (in the suburb of Wainui) to 10 in Ruatoria and Te Karaka 7. 67% of Māori and 30% of non-māori in our district are considered to live in the most deprived areas; this is living in areas with deprivation deciles 9 or % of children, 0-14 years, live in these most deprived areas. Health, Education, Agriculture, Horticulture, Forestry and Fishing are the largest employers of the workforce in our district. 40% of Māori and 50% of non-māori are employed full time. 35% of Māori in our district (30% nationally) have no education qualifications 8. For Non-Māori the rate is 27% (23% nationally). 28% of families in the Tairāwhiti district are single parent families compared to 18% nationally. 49% of non-māori women aged 15 years and over in our district have had two or three children. For Māori this rate is 33%. 14% of Māori women, 15 years and older have had five or six children. For non-māori the figure is 7% 9. 54% of households in the Gisborne district live in their own home and 38% rent. Though Māori make up over 45% of our district population they account for over 70% of those on welfare benefits boutaplace/snapshot.aspx?pdf=1&id= &type=region&parentid= MSD TLA Benefit Factsheet Dec Annual Plan Hauora Tairāwhiti 21

22 Health Profile Understanding our health profile plays an important part in our decision making processes. This information helps us focus on where we can make the greatest gains in terms of our strategic outcomes, as well as for planning and prioritisation of programmes at an operational level. Key points of interest in terms of the health profile of the population are: Immunisation rates for Māori in Tairāwhiti are in line with the national average. Communicable disease volumes have been decreasing significantly over the last few years, especially for Campylobacteriosis. Māori rates of suicide in Tairāwhiti are above that for non-māori. Smoking rates in Tairāwhiti are higher than the national average for both Māori and non-māori, with Māori rates being higher than that for non- Māori. Daily vegetable intake in Tairāwhiti is similar to the national average; however our fruit intake for both Māori and Māori is below the national average. Rates of obesity are significant in Tairāwhiti. Māori oral health rates for 5 year olds and year 8s for caries free and decayed, missing filled teeth (dmft/dmft) are worse than that for non-māori. The largest injury type by number and cost for ACC in the Gisborne district is for work related injuries. Plunket data shows Māori breastfeeding rates (exclusive, full) are less than non-māori for the 6 week, 3 month and 6 month age groups. Teenage births at Gisborne hospital are more than 4 times more likely to be for Māori mothers than non- Māori. Tairāwhiti has 231 registered doctors per 100,000 per population compared to a national rate of 271 per 100, There are 70 FTE GPs per 100,000 people in Tairāwhiti, compared to a national rate of 75 FTE per 100,000. Analysis of the health needs of people of Tairāwhiti has indicated the following features: 11 The New Zealand Medical Workforce in , Surveys/ pdf Ambulatory sensitive hospitalisations are well above the national average. Higher rates of avoidable hospitalisation. Circulatory system diseases, including ischaemic heart disease and cerebrovascular disease, accounted for over 40% of deaths. Cancer is the second most common cause of death in Tairāwhiti, accounting for 25% of all deaths, with cancer of the digestive system and lung being the most common. There is a significant burden on Māori from deaths related to cancer than non- Māori. There is a large and disproportionate burden of disease related to diabetes (including diabetes renal failure) and its long term complications for Māori. Disease of the respiratory system, bronchitis and asthma amongst infants and young children, adults and older people. Cellulitis is a significant issue for children under 5 years. Mental illness impacts significantly on this community, with the burden of disease higher for Māori than non-māori. Most of the issues related to the mortality and morbidity of Tairāwhiti residents are related to preventable lifestyle factors in particular tobacco use and obesity rates. It should also be acknowledged that with the significant economic burden borne by this community, socioeconomic factors have a bearing on the health needs of this community Annual Plan Hauora Tairāwhiti 22

23 1.2. KORONGA RAUTAKI / STRATEGIC INTENTIONS Performance Story The diagrams presented on the following pages provide a high level summary of our performance story and demonstrate the link between our outcomes and our stewardship areas. The right hand column of the diagram indicates the relevant module of this Plan for further details. National Outcomes Health & Disability System Outcomes All New Zealanders lead longer, healthier and more independent lives New Zealand s economic growth is supported Overarching health sector goals Improve and protect the health of New Zealanders Ministry of Health s Highlevel Outcomes Overarching health sector goal New Zealanders are healthier and more independent Contribute to the Government s strategic priorities by: Delivering Better Public Services within tight financial constraints Responsibly managing the Government s finances Supporting Christchurch Building a more competitive and productive economy. High-quality health and disability services are delivered in a timely and accessible way Deliver on the Government s other priority actions through: Supporting Vulnerable Children Whānau Ora the Prime Minister s Youth Mental Health project health targets Tackling Methamphetamine: An Action Plan social sector trials the Australia New Zealand Therapeutic Products Agency (ANZTPA) Smokefree 2025 The future sustainability of the health system is assured. The Ministry has a focus on ensuring health services are delivered better, sooner and more conveniently. Implement the Minister s objectives for the sector, which are to: Maintain wellness for longer by improving prevention Improve the quality and safety of health services Make services more accessible, including more care closer to home Implement Rising to the Challenge Support the health of older people Make the best use of information technology (IT) and ensure the security of patients records Strengthen the health and disability workforce Support regional and national collaboration Module One The Midland DHB s Performance Story Midland Vision Regional Strategic Outcomes Regional Long Term Impacts All residents of Midlands DHBs lead longer, healthier and more independent lives Healthy Communities Integrated Healthcare To improve the health of the our population To increase our average life expectancy To reduce premature death rates To eliminate health inequalities To improve our amenable mortality rate Midland RSP Module One Annual Plan Hauora Tairāwhiti 23

24 Regional Strategic Objectives Improve Māori health outcomes Integrate across continuums of care Improve quality across all regional services Improve clinical information systems Build the workforce Efficiently allocate public health system resources By focusing on these objectives, we will be able to drive change that enables us to live within our means. Hauora Tairāwhiti s Performance Story Whaia te Hauora I roto I te Kotahitanga Our Vision A Healthier Tairāwhiti by Working Together Our Outcomes Our Strategic Priorities 12 To improve the health of our population Join Patient, family/ centred care Know Excellent Iwi/ Community, family/ whānau knowledge and engagement Shape working with community relationships To reduce or eliminate health inequalities Vision Building a will do culture Connect Enabling good health and well-being through technology Module one Service performance Long-term Impacts People take greater responsibility for their health People stay well in their homes and communities People receive timely and appropriate specialist care Intermediate Impacts (3-5 Year Impacts) Output Fewer people smoke Reduction in vaccine preventable diseases Improving health behaviours 95% of eight months olds will have their primary course of immunisation on time 95% of 2 year olds are fully immunised 90% of 4 year olds are fully immunised 65% of year 12 eligible girls fully immunised with three doses of HPV vaccine Children and adolescents have better oral health Early detection of treatable conditions More people are managing their long term conditions well Fewer people are admitted to hospital for avoidable conditions People maintain functional independence 90 percentage of the eligible population will have had their cardiovascular and diabetes risk assessment in the last five years Oral health targets met for the age band 0-4, 5-13 and Lower annual ED volumes and increased referrals to primary extended care support team People are seen promptly for acute care People have appropriate access to ambulatory, elective and arranged services Improved health status for people with a severe mental illness More people with end stage conditions are supported 95 percentage of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours ESPI four month target for all health specialities Completion of a 90 day HONOS to support mental health status Module three Kōwae Tuarima People Performance Management Clinical Integration/ Collaboration/ Partnerships Information Module five 12 Full details of Hauora Tairāwhiti s Strategic Priorities are included in 1.6 Koronga rautaki / Strategic Intentions Annual Plan Hauora Tairāwhiti 24

25 The outputs part of the service performance section of our performance story diagram contains examples of measures contained in the statement of performance expectations. There are more than 30 output measures in total that we will be monitoring. Tatou kite / Our vision Whaia te Hauora I roto I te Kotahitanga / A Healthier Tairāwhiti by Working Together Tatou uara / Our values WhakaraNgātira Awhi Kotahitanga Aroha Kia tuku Aroha ki te Whānau Kia WhakaraNgātira i te oranga o to tatou hapori Kia Awhi i te turoro Ma te Kotahitanga o a tatou mahi ka momoho ai We give compassion to our families. We take responsibility to enrich the health of our community. We give caring support to our Patients. Through our collective effort we succeed. Hearts and minds Enrich = increasing the quality of Quality Focus Patient Care Employee Synergy Annual Plan Hauora Tairāwhiti 25

26 Value What is means at Hauora Tairāwhiti Outcomes Behaviours that show you are demonstrating this value Behaviours that are not acceptable when you are demonstrating this value WhakaraNgātira Enrich Enriching the health of our community by doing our very best We take responsibility for our results We excel in all we do We are proud to be part of TDH We keep people safe I take pride in my work I work to the highest standard I treat everyone with respect I speak up when I see quality and safety compromised Substandard work Not admitting or hiding mistakes Having a negative attitude Demeaning people We treat people fairly and equally I celebrate and recognise success in myself and others I admit when I make mistakes and I learn from them I look for opportunities to improve Awhi Support Supporting our patients and whānau We listen to patients and whānau. We involve patients and whānau in decision making People recover faster and feel better I put patients and whānau at the centre when I make decisions I make transparent decisions I encourage personal and professional development Not greeting people Not being respectful of peoples time Not communicating effectively Not identifying or being informed of the patients requested needs Kotahitanga Togetherness We work as a team I respect others opinions Putting people down and demeaning others Together we can achieve more Together we perform and achieve at higher levels We take responsibility together Together we are resilient Through collective thought we are more innovative I communicate effectively I am willing to engage I actively participate and speak up I stick by a decision that is made I recognise we are different and am considerate of others Sabotage and being manipulative Responding negatively Not attending and using this to stop the process Personal attacks Avoiding work I support my colleagues and have their back Aroha Compassion We care for people I enjoy my work Bullying and harassment Compassion and empathy People want to be cared for by us We enjoy working for TDH and are passionate about what we do I go the extra mile I keep learning I have a can do attitude Patient abuse Consistent open displays of negativity towards other staff and the workplace Annual Plan Hauora Tairāwhiti 26

27 Hauora Tairāwhiti has adopted the vision statement Mauri Ora Pae Ora, and seeks to achieve the wellbeing of whānau through the implementation of Pae Ora principles below applied at both a whānau and a systems level. THE PRINCIPLE An inclusive approach that provides services and opportunities to all families and whānau. Whānau have the capacity to achieve the life they aspire to Supporting whānau to reinstate whakapapa, and strengthen relationships with marae, iwi and hapū. Develop strong whānau that are linked to their lands and seas instilling a strong sense of their environment Building whānau collective capacity and strengths to enable whānau to achieve their economic, social and cultural aspirations and goals. Intergenerational transfer of local tikanga, knowledge and skills to increase improved health status in whānau The Kaitiaki (navigational) role is an important component as it assists whānau to identify strengths within the whānau WHAT IT LOOKS LIKE Requires agencies to work together to meet the needs of the whole whānau rather than a single focus on individuals. Services flexible enough to support the direction whānau desire. Promote identity and support whānau to be selfsustainable and self-managing. Understand the intrinsic link between identity and whānau wellness. Utilise the strengths of whānau to influence and support the needs of individuals within the context of whānau. An educated and well informed whānau is well placed to prevent the prevalence of negative influences but instead focus on healthy lifestyles in the next generation. Listen to, assist and help facilitate whānau aspirations. Strategic Outcomes In National, Regional And Local Context The Ministry of Health have a role in the planning and funding of some services. Some services are funded and contracted nationally, for example public health services, breast and cervical screening as well as the provision of disability support services for people aged less than 65 years. Major pieces of work largely completed in 2015/16 inform our strategic direction going forward. NEW ZEALAND HEALTH STRATEGY The New Zealand Health Strategy is the key source of direction for the health sector, and the refreshed Strategy Future Directions was released in April 2016 along with a roadmap of actions for Section 2A of this plan shows the immediate planning impacts for 2016/17. MORE EFFECTIVE SOCIAL SERVICES Also of major significance is the New Zealand Productivity Commission s report, More Effective Social Services. In June 2014 the Productivity Commission was asked to look at ways to improve how government agencies commission and purchase social services. The final report was released in mid- September It makes several recommendations about how to make social services more responsive, people-focused, accountable and innovative. There is a strong drive for DHBs to work together with other public, private and non-profit entities to achieve improved outcomes. The focus must be on health and well-being, not hospitals Annual Plan Hauora Tairāwhiti 27

28 CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES The Convention on the Rights of Persons with Disabilities is the first United Nations human rights treaty of the 21st century. The Convention makes it explicit that member countries must ensure the full realisation of all human rights and fundamental freedoms for all disabled people, on an equal basis with others, and without discrimination of any kind on the basis of disability. It will also help to ensure that mainstream services are inclusive of disabled people and delivered in non-discriminatory ways. ALA MO'UI: PATHWAYS TO PACIFIC HEALTH AND WELLBEING To facilitate the delivery of high-quality health services that meet the needs of Pacific peoples, 'Ala Mo'ui has been developed. This builds on the successes of the former plan, 'Ala Mo'ui It sets out the strategic direction to address health needs of Pacifica peoples and stipulates new actions which will be delivered from 2014 to Other significant documents include: TE ARA WHAKAPIRI - PRINCIPLES AND GUIDANCE FOR THE LAST DAYS OF LIFE (2015) This document provides a recommended approach to caring for people in the last days of life across all settings in New Zealand and has been endorsed by key groups across the country. This is reflected in the Tairāwhiti palliative integration project s focus on developing a collaborative approach to palliative care practice across Tairāwhiti that is people centred, culturally appropriate and in line with national guidelines HEALTH AND INDEPENDENCE REPORT 2015 This provides an overview of the state of New Zealanders health, including how well the health and disability system is performing. The focus is on a number of high profile areas for the health and disability system, including pregnancy and early childhood, mental health and well-being, and vulnerable groups. REPORT ON THE PERFORMANCE OF GENERAL PRACTICES IN WHĀNAU ORA COLLECTIVES AS AT JUNE 2015 This report focuses on the performance of general practices in Whānau Ora collectives using results from the software package HealthStat, which collects an anonymous summary of patient health information from general practices in Whānau Ora. CHILDHOOD OBESITY PLAN This package of initiatives aims to prevent and manage obesity in children and young people up to 18 years of age. The package has three focus areas made up of 22 initiatives, which are either new or an expansion of existing initiatives: Targeted interventions for those who are obese. Increased support for those at risk of becoming obese. Broad approaches to make healthier choices easier for all New Zealanders. The focus is on food, the environment and being active at each life stage, starting during pregnancy and early childhood. The package brings together initiatives across government agencies, the private sector, communities, schools, families and whānau. A cross sector community approach will be utilised by Hauora Tairāwhiti in the development of a local obesity prevention strategy and will follow a similar planning, development and implementation process as other models such as E Tipu E Rea, Healthy Families NZ, Social Sector Trials and the Tairāwhiti Children s Team. In addition, consultation is underway on a draft Strategy to Prevent and Minimise Gambling Harm for the three-year period from 1 July 2016 to 30 June 2019: on A Guide to the Commissioning Framework for Mental Health and Addiction ; and a discussion document called Foetal Alcohol Spectrum Disorder (FASD). FASD is caused by the consumption of alcohol during pregnancy. About half of all pregnancies are exposed to alcohol, and about 1% of the New Zealand population is estimated to have FASD as a result. FASD can be characterised by a range of problems such as intellectual and behavioural deficits, as well as irreversible damage to the brain and body. At the local level the Tobacco Control Plan ; Rheumatic Fever Plan Refresh , the Well Child Tamariki Ora (WCTO) Quality Improvement Framework Plan , Health of Older Persons Service Level Team planning activity and Tairāwhiti s Suicide Prevention and Postvention Plan will drive significant actions and approaches. Maternal and child health continue to be a key focus across several work programmes as we place greater Annual Plan Hauora Tairāwhiti 28

29 priority on early identification and intervention to address health needs. Supporting hapū women and their whānau to quit smoking is crucial to improving health outcomes for 0-5 year olds. Activities within the Tobacco Control Plan and the Well Child Tamariki Ora Quality Improvement Framework (WCTO QIF) Plan have identified this as a priority; new approaches and innovations will be explored to help address our high rates of smoking in pregnancy especially within our Māori population. The impact of cold, damp and overcrowded housing on health and wellbeing has become more prominent as we look towards addressing the wider determinants of health. The Rheumatic Fever Prevention Programme has been tasked with leading the establishment of an interagency housing forum to provide strategic leadership and coordination of our housing issues in Tairāwhiti. A Social investment governance group has been set up to act as an umbrella framework for such a forum which will follow similar processes to other models such as E Tipu E Rea in operating as a community led, cross sector, inter agency leadership group. Tairāwhiti s Suicide Prevention and Postvention Plan brings together a range of agencies and NGOs working to reduce suicides for those at greatest risk, namely Māori males aged 15 to 24 years, and those living in the most deprived areas. A key action is establishment of a consistent postvention response following notification of a suspected suicide. The recommendations from the Service Level Alliance Team for older persons will develop sustainable integrated health pathways for the growing population of older people in Tairāwhiti. Supporting our most vulnerable populations remains at the forefront of our programmes and the Ruia Gang Transformation Project provides agencies with an opportunity to engage with whānau to identify how our services and programmes can best meet the needs of whānau affiliated with local gangs. The Tairāwhiti WCTO Enrolment Project looks to engage with Ruia whānau to learn how we can orientate WCTO services to ensure better health outcomes for tamariki 0-5 years. Actions to address the health needs of our youth populations require urgency, particularly in the key health areas of mental health, suicide prevention, sexual health, oral health and alcohol and other drugs (AOD). A key focus over the next year will be the development of a youth health and well-being action plan to provide strategic direction and overview of youth health needs and services in Tairāwhiti. MĀORI HEALTH PLAN The mandatory requirements for DHBs in relation to reducing health disparities and achieving health equity for Māori must be reflected in our Māori Health Plan developed jointly with the PHOs in our district. Please see He Urupare Rangapu Hauora Hauora Tairāwhiti s Māori Health Plan. REGIONAL COLLABORATION District Health Boards are expected to work together at a regional level to make the best use of available resources, strengthen clinical and financial sustainability and increase access to services. Improving regional collaboration between DHBs has been an evolving process over time. In the last few years significant progress has been made in establishing the key foundations to assist regional working and DHBs are in a good position to continue implementing their regional and sub-regional priorities. Hauora Tairāwhiti is one of five DHBs 13 that make up the Midland region. In 2016/17 all five Midland DHBs will continue to progress activities towards regional cooperation in a planned manner. Collectively the Midland DHBs have developed and agreed a Midland DHBs Regional Services Plan. Hauora Tairāwhiti is committed to being an active participant in our regional planning process. This is evidenced by both clinical and management representatives from our DHB being part of the various forums and networks that have been established to guide implementation activities from our regional services plan as well as directly funding regional work and positions. HealthShare 14 is tasked with co-ordinating the delivery of regional planning and implementation on behalf of the Midland DHBs region. For the first time in preparation for the 2016/17 DHB Annual Plans, and the Regional Service Plan, the Planning and Funding teams from all five Midland DHBs met with all the region s PHOs and HealthShare to decide Midland planning priorities. 13 Bay of Plenty, Lakes, Tairāwhiti, Taranaki and Waikato 14 See module for more detail Annual Plan Hauora Tairāwhiti 29

30 REGIONAL SERVICE PLAN The purpose of a Regional Service Plan (RSP) is to provide a mechanism for DHBs to document their regional collaboration efforts and align service and capacity planning in a deliberate way. The RSPs include national and local regional priorities, and outline how DHBs intend to plan, fund and implement these services at a regional or subregional level. The plans have a specific focus on reducing service vulnerability, reducing costs and improving the quality of care to patients no matter where they live in Midland. The 2016/17 RSP guidance includes a focus on health equity which is a cross-cutting dimension of quality. There is also a continued focus on improving alignment between the DHB Annual Plans (APs) and the RSP. Priority areas for RSPs and APs include wellness for children; cardiac services; health of older people; mental health and addictions (Rising to the Challenge); cancer, workforce and regional information technology systems, and for Regional Service Plans only, major trauma and workforce. OUTCOMES There are two identified health system outcomes for New Zealand. They are: 1. New Zealanders live longer, healthier, more independent lives; 2. The health system is cost effective and supports a productive economy. These health system outcomes support the achievement of wider Government priorities and are not expected to change significantly over the medium term. The Ministry of Health has three high-level outcomes that support the achievement of the health system outcomes above: New Zealanders are healthier and more independent; High-quality health and disability services are delivered in a timely and accessible manner; The future sustainability of the health and disability system is assured. THE MINISTER OF HEALTH S LETTER OF EXPECTATIONS The Minister of Health has outlined his expectations for the 2016/17 year. The expectations reinforce the Government s ongoing commitment to protecting and growing New Zealand s public health services. The key areas highlighted in the letter of expectations are: Refreshed New Zealand Health Strategy. Living Within our Means. Working Across Government. National Health Targets. Tackling Obesity. Shifting and Integrating Services. Health Information Technology Programme PUBLIC HEALTH Public Health Units (PHUs) provide public health advice and expertise with a general goal of protecting and improving the health of the population with a focus on reducing inequalities. The five public health core functions are: 1. Health Promotion 2. Health Protection 3. Preventative Interventions 4. Health Assessment and Surveillance 5. Public Health Capacity Development. Hauora Tairāwhiti s public health service takes these core functions and places them into a settings base approach so as to align with local initiatives such as the Ruia project and Healthy Families NZ. MIDLAND REGIONAL PUBLIC HEALTH NETWORK In addition to providing advice and expertise to individual DHBs, the Midland Regional Public Health Network (the Network) provides leadership for and strengthens the performance and sustainability of the Midland public health units. The Network provides an avenue for public health units to work together on public health issues affecting the Midland region. Leadership of the Network comprises the manager and clinical director from each of the four public health units in the Midlands region: Toi Te Ora - Public Health Service (Bay of Plenty and Lakes District Health Boards); Population Health (Waikato District Health Board); Population Health (Hauora Tairāwhiti) and Public Health Unit (Taranaki District Health Board). The Network aims to further strengthen relationships with the Midland Regional Clinical Networks to ensure a public health perspective is considered within their planning. At a national level the Network is a member of the National Public Health Clinical Network (NPHCN), whose Annual Plan Hauora Tairāwhiti 30

31 membership comprises the clinical leader and manager from each public health unit and representatives from the Ministry of Health. The goals of the Midland Regional Public Health Network are to: Enhance the consistency, coordination and quality of public health service delivery across the region; Support other Midland health networks by promoting the population health approach and providing public health advice on issues that can have a population health outcome. The Network s work to date has included collaborative annual planning, business continuity planning, supporting the development of Midland position statements on key health issues, setting up a mechanism for a regional approach to health intelligence work, standardising of communicable disease control processes, peer review, staff orientation programmes and support of sole practitioners. Work streams are in place to support a consistent approach to common areas of work: Public health capacity Health Promotion Leadership Group HealthScape Public Health Information Management system Public Health Intelligence Future work streams will be determined based on the need to increase the focus on a particular public health issue and/or what might come from the final release of the National Health Strategy. In determining its direction for 2016/17, the Network will continue to align with the Ministry of Health s five core functions of public health (Health Assessment and Surveillance, Public Health Capacity Development, Health Promotion, Health Protection, and Preventive Interventions). The Network will also continue to focus on: Better integration of services within health and across the sector Lifting of quality and performance Supportive leadership and capability for change In line with the wider health sector goal of better, sooner, more convenient health services for all New Zealanders, emphasis for the Network will continue to be on effective and efficient working and service delivery. NATIONAL HEALTH TARGETS Improving performance across the sector is fundamental to the Government's goal of Better, Sooner, More Convenient health services for all New Zealanders. One of the mechanisms used to monitor our performance is the nationwide Health Targets. The following table outlines our target levels for each of the six health targets. Table: Tairāwhiti DHB Health Targets 2016/17 Health Target Indicator and National Target Tairāwhiti DHB Target 95 per cent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours. 95% Nationally, the volume of elective surgery will be increased by an average of 4,000 discharges per year. 2, At least 85 per cent of patients referred with a high suspicion of cancer wait 62 days or less to receive their first treatment (or other management) to be achieved by July 2016, increasing to 90 per cent by June % 15 total elective surgical discharges Annual Plan Hauora Tairāwhiti 31

32 Health Target Indicator and National Target Tairāwhiti DHB Target 95 per cent of eight months olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) on time. 95% 90 per cent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months 90% Childhood Obesity 90 per cent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking. By December 2017, 95% of obese children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. 90% 95% BETTER PUBLIC SERVICES The Government has set ten challenging results for the public sector to achieve over the next five years 16. Hauora Tairāwhiti is committed to focusing our inputs and outputs as appropriate to contribute to achieving the results. The results that Health is taking a major role in are: Result 2: Increase participation in quality early childhood education. In 2016, 98 per cent of children starting school will have participated in quality early childhood education. Increase infant immunisation rates so that 95 per cent of eight-month-olds are fully immunised by December 2014, and this is maintained through to 30 June Reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June Result 4: Reduce the number of assaults on children. By 2017, halt the rise in children experiencing physical abuse, and reduce current numbers by 5 percent. SOCIAL SECTOR TRIALS There is one Social Sector Trial in our district in Gisborne City; its current focus is improving educational outcomes for rangatahi by increasing 16 For more information see participation in education training and employment while also reducing Truancy Youth offending Alcohol and drug use One area in which health has been involved has been in improving the participation of rangatahi in education through truancy and supporting those who have been suspended or stood down from school as a consequence of issues relating alcohol and/or other drugs.. Government has decided to integrate the work of the trials within wider cross sectoral activities from January In Tairāwhiti, Hauora Tairāwhiti is committed to joining with iwi and social agencies to achieve this translation and maintain momentum on the initiatives underway. WHĀNAU ORA Whānau Ora is an approach that supports whānau to identify and achieve their own aspirations. It is a key cross-government work programme jointly implemented by a number of sectors, particularly health, education and social services. Te Waiora o Nukutaimemeha, our iwi relationship board, has developed a Hauora Tairāwhiti Pae Ora Position Statement which provides context and direction for the application of Pae Ora for the DHB and its partners. POLICY DRIVERS Four important policy drivers have been identified through which the health sector may best utilise Annual Plan Hauora Tairāwhiti 32

33 resources to achieve better sooner more convenient health care. They are: Better Public Services (including Social Sector Trials): DHBs must work more effectively with other parts of the social sector. The Government s Better Public Services targets and the Social Sector Trials will help drive this integrated approach that puts the person and user at the centre of service delivery. DHBs are expected to work closely with other sectors such as education and housing specifically. Regional collaboration: This means DHBs working together more effectively, whether regionally or sub-regionally. Regional Context Midland DHBs have agreed a strategic approach to assist the region to move forward in the same direction. This includes a shared vision, two strategic outcomes and six objectives. The strategic outcomes and objectives for the region are summarised below and further detail is provided in the Midland DHBs Regional Services Plan. In response to the update of the New Zealand Health Strategy, Midland DHBs have adopted the vision, refreshed guiding principles (for the system), and investment approach. Midland DHBs have also embraced Pae Ora (healthy futures), recognising that health links with the wider environment for individuals, family, whānau, and community, and the environment. Regional Vision All New Zealanders live well, stay well, get well Regional Strategic Outcomes Strategic Outcome 1: Improve the health of the Midland populations Health and wellbeing is everyone s responsibility. Individuals and family and whānau are to actively manage their health and wellbeing: employers and local and central body regulators and policy makers are expected to provide a safe and healthy environment that communities can live within. Integrated care: This includes both clinical and system integration to bring organisations and clinical professionals together, to improve outcomes for service users and their whānau/family. Integration is a key component of placing service users and their whānau/family at the centre of the system, increasing the focus on prevention, avoidance of unplanned acute care and redesigning services closer to home. Value for Money: is the assessment of benefits (better health outcomes) relative to cost, in determining whether specific current or future investments/expenditures are the best use of available resource. Strategic Outcome 2: Eliminate health inequalities The New Zealand health service has made good progress over the past 75 years. However, an ongoing challenge is to reduce ethnic inequalities in health outcomes for populations, particularly Māori and Pacific peoples. As a key focus Midland DHBs will work to eliminate health inequalities in their populations. A core function of DHBs is to plan the strategic direction for health and disability services. This occurs in partnership with key stakeholders and our community (i.e. clinical leaders, iwi, Primary Health Organisations and non-government organisations) and in collaboration with other DHBs and the Ministry of Health. Eliminating health inequalities is the goal. Regional Objectives The region has agreed six regional objectives, which are: Regional Objective 1: Improve Māori health outcomes Regional Objective 2: Integrate across continuums of care Regional Objective 3: Improve quality across all regional services Regional Objective 4: Improve clinical information systems Regional Objective 5: Build the workforce Regional Objective 6: Efficiently allocate public health system resources Annual Plan Hauora Tairāwhiti 33

34 Local Context To contribute to achieving the outcomes at a national and regional level, we have identified our local strategic intent for 2016/17. Our strategic intent represents a continuation from previous years, as they are not short term issues easily resolved within a 12 month period. There is strong Table: Our 2016/17 priorities alignment between the strategic intent at the regional and local levels. Many factors influence outcomes. In contributing to these outcomes we will have a real impact on the lives of our population. Many of the activities we plan to implement in 2016/17 will contribute across a number of our outcomes, priorities and impacts. Te Ao Māori Pae Ora E Tipu E Rea Strategic Priority Tairāwhiti Wellbeing Collective Impact Framework Integration Description The implementation of models of care which are guided by Te Ao Māori are being developed across Tairāwhiti, this include Atua Matua (Horouta Whānaunga) and Mahi a Atua (Mental Health and Addiction). These models of care are placing the fundamental principles of the Māori world at the centre of addressing the needs of our whānau. This is a guiding principle for healthy future of all Tairāwhiti, it ensures a whānau views and perspectives are integral in the wellness process. Pae Ora is best supported when an integrated approach to care is enabled through outcome based funding models that support holistic service provision for whānau. Hauora Tairāwhiti is committed to making the paradigm shift from delivering whānau related services to a more purposeful whānau centred approach presenting as an opportunity to employ effective intervention techniques. All providers within Tairāwhiti, including secondary care services, are actively encouraged to apply Pae Ora principles in their everyday activity. This is a targeted outcomes based approach to providing a whatever it takes wrap around service to the most vulnerable young children. It focuses on the period from conception to 5 years and pulls all sectors of the health system into a single team. It incorporates Whānau Ora principles and shares health information to improve service coordination. In 2016/17 it will move from a health centric initial phase to an iwi, cross-government agencies service model. The intent of the framework is to present a one team system to the community through the removal of duplication triggered by individual agencies/services operating in silos, district wide accountabilities applying an outcomes approach, supported by strong community based engagement. The intent is to use this as the framework for the proposed 2016/17 Social Investment initiative. People get the care they need, when they need it, in ways that are user-friendly 17. Services are joined up through a smarter system 17 World Health Organisation Technical Brief No.1, May Annual Plan Hauora Tairāwhiti 34

35 Strategic Priority Organisational and workforce development Quality improvement Addressing chronic conditions Regional cooperation Financials Description approach; this involves using shared information to improve management, planning, service delivery and clinical audit. Our workforce is our biggest asset, and by extending opportunities across the district we will increase the trust and flexibility of this asset. Constantly seeking opportunities to get better at how we function and improve effectiveness. This includes increasing the use of t health research to monitor and evaluate how the system is performing. These conditions are the leading cause of ill health and premature death in New Zealand. They disproportionately affect low income earners, Māori and Pacific people. Involving the individual, whānau and community in approaches to address chronic conditions is strengthening the trust people have in the health system. By using information to provide the community with an overview of their community health we will empower them to identify and focus on solutions which will see interventions aimed at prevention and closer to home. Improving clinical services quality and viability across the Midland region and enhancing the one team approach will increase the clarity of roles across the whole system. Ensuring delivery on agreed financial forecasts and the ability to live within our means. The local priorities have been included in our overall performance story to ensure priorities important to us that are not explicitly covered in the regional strategic intent are included within this Annual Plan KEY RISKS AND OPPORTUNITIES By its nature, the health sector is complex and challenging. We have identified the following risks Health Inequities We are committed to reducing or eliminating the effects of health disparities through, firstly, identifying them and, secondly, through funding and providing universal programmes which include a focus on reducing disparities, as well as specific programmes that target disparities and improve access to services. It should be noted that long term conditions, particularly those that are exacerbated by tobacco use, maternal smoking and socio economic factors are significant contributors to health disparities. The approach we take includes: All contracting and service provision through Hauora Tairāwhiti will seek to achieve the wellbeing of whānau through the implementation of Pae Ora principles as outlined in this Plan, and and opportunities as being particularly relevant for 2016/17. apply these at both a whānau and a systems level. Implementing Te Tairāwhiti - He Urupare Rangapu Hauora Māori 2016/17 (our Māori Health Plan). Promoting screening services to hard to reach groups to increase early detection of disease. Implementing services that target communities with identified health inequalities. Setting targets by ethnicity or by high needs. Support kaupapa Māori services and ensuring services recognise the specific needs of Pacifica people. Increasing the capability of the Māori and Pacifica workforce across our district Annual Plan Hauora Tairāwhiti 35

36 Using an equity lens as part of decision-making processes (e.g. the Health Equity Assessment Tool) Engaging with our Board advisory committees - Te Waiora o Nukutaimemeha iwi relationship committee, Aged and Disability Support, Community and Public Health, Finance, Audit and IT Advisory Committees to provide advice and inform decision making Engaging with iwi leadership, and with the Tairāwhiti Pacific Islands Community Trust to provide advice and inform decision making. A challenge for DHBs in the Midland region is to configure health service delivery in a way that takes account of the complex relationships between the key social determinants of health inequalities (e.g. housing quality and employment), while recognising that a number of public and private agencies influence health outcomes. The disparity chart below indicates the key areas of inequality between Māori and non-māori at the end of the 2014/15 year with the equivalent measure included for quarter 2 of 2015/ Annual Plan Hauora Tairāwhiti 36

37 Focus Area Measure Actual 2014/15 Tobacco Rheumatic Fever Immunisation Breast Feeding Oral Health Cancer Missed Appointments Mental Health Access to Care Obesity Reduction in the number of Māori Mothers who smoke 2 weeks after giving birth Reduce the number of Māori hospitalised by Rheumatic Fever Increase the number of 8 month old Tamariki Fully immunised Improve the percentage of Tamariki fully or exclusively breastfeed at 6 weeks Improve the percentage of Tamariki fully or exclusively breastfeed at 3 months Improve the percentage of Tamariki receiving breastmilk at 6 months Increase the number of Tamariki enrolled in Dental Services Improve the number of wahine who have had a cervical cancer screen in the past 3 years Improve the number of Wahine who have had a breast screen in the past 2 years Reduction in the proportion of missed appointments by Māori Reduce the Disparity between Māori and Non Māori subject to Compulsory Treatment Orders under Mental Health Act Reduction in the Māori Ambulatory Sensitive Hospitalisations Rate in the age group Reduction in the Māori Ambulatory Sensitive Hospitalisations Rate in the age group Reduction in the Percentage of Adults who have a BMI score of % Māori 32% Non-Māori 8.5 per 100,000 people Most Recent Q2 2015/16 55% Māori 37% Non-Māori 6.4 per 100,000 people Goal 5% 2.8 per 100,000 people 91% 94% 95% 63% 71% 75% 51% 45% 60% 62% 65% 65% 90% 90% 95% 66% 68% 80% 68% 67% 70% 15% Māori 9% Non-Māori 49 Māori 16 Non Māori 7,652 per 100,000 people 5,881 per 100,000 people 50% Māori 31% Non-Māori 16% Māori 10% Non-Māori 40 Māori 11 Non Māori 7,551 per 100,000 people 5,439 per 100,000 people 42% Māori 32% Non-Māori 10% To achieve equity To achieve equity To achieve equity To achieve equity Movement Annual Plan Hauora Tairāwhiti 37

38 Living Within Our Means The ongoing pressure of the financial environment is one of the factors driving the need for the health system to transform. This means seeking efficiency Health System Workforce Shortages gains and improvements in purchasing, productivity and the quality of our operation and service delivery. The health workforce is made up of a wide variety of occupational groups employed by a number of different organisations. Workforce shortages, particularly in rural and provincial areas, are a key threat to the health system s ability to provide a full range of accessible, high-quality health services. Work is occurring at a national, regional and local level to mitigate the impact of workforce shortages. Detail on a number of the strategies in place to mitigate the impact of this challenge is set out in module 5.3. System Integration A growing commitment to the achievement of more effective system integration in partnership with general practice and community, and other appropriate stakeholders, including iwi, people and their family/whānau using services, and other government agencies is fundamental to strengthening Tairāwhiti s health and well-being systems. As in previous years, we have engaged with our primary care partners and clinical leaders to jointly develop the primary care sections of this Annual Plan. Regional Integration Integration between regional DHBs is important for both financial and clinical reasons. Clinical networks provide a platform from which to deliver clinicallyled innovation and best practice approaches; these are supported by integration initiatives in other Evidence shows that integrating primary care with other parts of the health system is vital for better management of people with long term conditions, responding to the pressure of an ageing population and in managing acute demand. Hospital demand is growing, and as more hospital admissions occur due to preventable causes, we need to examine what could be improved in regard to how where and when we deliver our services. areas (pharmacy, home-based support services, Information Systems and so on). The over-arching driver for such developments is improved service quality, and ultimately better health outcomes Annual Plan Hauora Tairāwhiti 38

39 1.4. KEY MEASURES OF PERFORMANCE The diagram below sets out the Midland DHB regional approach to the impacts we expect to occur in response to the outputs delivered. Local actions in relation to our services are recorded, along with deliverables and timing, in Modules 2 (priorities and targets), 3 (Statement of Performance Expectations) and 5 (Stewardship) of this Plan. OUTCOME 1 PEOPLE ARE SUPPORTED TO TAKE GREATER RESPONSIBILITY FOR THEIR HEALTH EXPECTATION Population health and prevention programmes ensure people are better protected from harm, more informed of the signs and symptoms of ill health and supported to reduce risk behaviours and modify lifestyles in order to maintain good health. These programmes create health-promoting physical and social environments which support people to take more responsibility for their own health and make healthier choices. WHY IS THIS OUTCOME A PRIORITY? New Zealand is experiencing a growing prevalence of long-term conditions such as diabetes and cardiovascular disease, which are major causes of poor health, and account for a significant number of presentations in general practice, and admissions to hospital and specialist services. We are more likely to develop long-term conditions as we age; with an ageing population the burden of long-term conditions will increase. The World Health Organisation (WHO) estimates more than 70% of all health funding is spent on long-term conditions. Tobacco smoking, inactivity, poor nutrition and rising obesity rates are major and common contributors to a number of the most prevalent long-term conditions. These are avoidable risk factors, preventable through a supportive environment, improved awareness and personal responsibility for health and wellbeing. Supporting people to make healthy choices will enable our population to attain a higher quality of life and to avoid, delay or reduce the impact of long-term conditions Annual Plan Hauora Tairāwhiti 39

40 Fewer People Smoke Fewer People Smoke Actual Target Target Target Percentage of Year 10 Students who have never smoked >72 Improve WHY IS THIS IMPORTANT? Smoking is a major contributor to preventable illness and long term conditions such as cancer, respiratory disease, heart disease and strokes. Cancer is the leading cause of death in New Zealand (29.8%), and is a major cause of hospitalisation and driver of cost. Cancer also highlights continuing inequalities, with Māori experiencing a higher incidence (20%+), higher mortality and higher stage at presentation. Supporting our population to say no to tobacco smoking is our foremost opportunity to target improvements in the health of our population. Key findings from the 2014/15 NZ Health Survey show a decrease in the number of adults aged 18 years and over (17.0%) and the number of youth aged years (6%) who are current smokers. While this decline in smoking rates is promising, we want to reduce the incidence even further. Notably, in the 2009 Tobacco Use Survey 80.0% of current smokers aged years said they would not smoke if they had their life over again. HOW WILL WE KNOW WE ARE SUCCEEDING? In order to have the greatest impact, we will support people from taking up smoking in the first place (Year 10 students), working our way through the continuum from prevention, to detection (identifying adults who smoke and offering them cessation advice see Health Targets), and ultimately reducing the number of people who smoke Annual Plan Hauora Tairāwhiti 40

41 Reduction in vaccine preventable diseases E91 Reduction in vaccine preventable diseases Actual Target Target Target 12/13 to 14/15 12/13 to 14/15 13/14 to 15/16 3 Year average Crude Rate per 100,000 of vaccine preventable diseases in hospitalised 0-14 year old <40 Decrease 14/15 to 16/17 WHY IS THIS IMPORTANT? Immunisation can prevent a number of diseases and is a very cost-effective health intervention. Immunisation provides protection not only for individuals but for the whole population by reducing the incidence of diseases and preventing them from spreading to vulnerable people or population groups. Population benefits only arise with high immunisation rates (herd immunity) and New Zealand s historical rates were low by international standards and insufficient to prevent or reduce the impact of preventable diseases such as measles or pertussis (whooping cough). These diseases are entirely preventable. See Health Targets. HOW WILL WE KNOW WE ARE SUCCEEDING? We will know we have succeeded by reducing our admissions for vaccine preventable diseases, and have a rate inline with or below the New Zealand average Annual Plan Hauora Tairāwhiti 41

42 Improving health behaviour Improving health behaviours Actual Target 14/ /17 % Obese of New Zealand 5-14 years population % Obese of New Zealand 15+ years population reduce rate of increase reduce rate of increase WHY IS THIS IMPORTANT? Good nutrition is fundamental to health and to the prevention of disease and disability. Nutritionrelated risk factors (such as high cholesterol, high blood pressure and obesity) jointly contribute to two out of every five deaths in New Zealand each year. HOW WILL WE KNOW WE ARE SUCCEEDING? By seeing a reduction in obesity, a proxy measure of successful health promotion and engagement, and a change in the social and environmental factors that influence people to make healthier choices Annual Plan Hauora Tairāwhiti 42

43 OUTCOME 2 - PEOPLE STAY WELL IN THEIR HOMES AND COMMUNITIES EXPECTATION General practice and community services support people to stay well by providing earlier intervention, diagnostics and treatment, and better understanding of and management of their illness or long-term condition. These services assist people to detect health conditions and risk factors earlier, making treatment and interventions easier, and reducing the complications of injury and illness. They also support people to regain their functionality after illness, and to regain their previous level of health and independence. WHY IS THIS OUTCOME A PRIORITY? For most people, their general practice team is their first point of contact with health services. General practice can deliver services sooner, closer to home, and prevent disease through education, screening, early detection and timely provision of treatment. General practice is also vital as a point of continuity and effective coordination across the continuum of care, particularly in improving the management of care for people with long-term conditions. Supporting general practice are a range of other health professionals including midwives, community nurses, social workers, aged residential care providers, personal health providers and pharmacists. These providers have prevention and early intervention perspectives that link people with other health and social services, and support them to stay well. Studies show countries with strong general practice and community care systems have lower rates of death from heart disease, cancer and stroke, and achieve better health outcomes for lower cost than countries with systems that focus on specialist level care. With an ageing population, the Midland region will require a strong base of general practice and community support, including residential care, respite and home-based support. If long-term conditions are managed effectively, crises and deterioration can be reduced and health outcomes improved. Even where returning to full health is not possible, access to responsive, needs-based services helps people to maximise function with the least restriction and dependence. If people are well they need fewer hospital-level or long-stay interventions and, those who do, have a greater chance of returning to a state of good health or slowing the progression of disease. This is not only a better health outcome for our population, it also reduces the rate of acute and unplanned hospital admissions and frees up health resources Annual Plan Hauora Tairāwhiti 43

44 Children and adolescents have better oral health Children and adolescents have better oral health Actual Target Target Target Mean DFMT Year <1.0 reduce WHY IS THIS IMPORTANT? Good oral health demonstrates early contact with health promotion and prevention services, and reduced risk factors, such as poor diet, which has lasting benefits in terms of improved nutrition and healthier body weights. Oral health is also an integral component of lifelong health and impacts a person s comfort in eating (and ability to maintain good nutrition in old age), self-esteem and quality of life. Māori children are three times more likely to have decayed, missing or filled teeth; improved oral health is a proxy measure of equity of access, and the effectiveness of mainstream services in targeting those most in need. HOW WILL WE KNOW WE ARE SUCCEEDING? Diseased, Missing or Filled Teeth (DMFT) is a count of Diseased, Missing or Filled Teeth in permanent dentition (permanent teeth) in a person s mouth. By Year 8, children s teeth should be their permanent teeth and any damage at this stage is life long, so the lower a child s DMFT, the more likely that their teeth will last a life time. A continued decrease in the DMFT score of year 8 children will signal that we are succeeding Annual Plan Hauora Tairāwhiti 44

45 Long-Term Conditions Are Detected Early And Managed Well Cervical Cancer mortality in New Zealand Actual Target Target Target WHY IS THIS IMPORTANT? If we are to empower people to take greater responsibility for their health, to improve the health of our population, and if we are to contain costs we need to detect conditions early. Early detection will lead to either successful treatment, or delaying or reducing the need for hospital and specialist care. Our greatest opportunity to do this is to manage Cardiovascular Disease (CVD or heart disease), which is one of the largest causes of death in New Zealand, and disproportionately higher for Māori. Often by the time heart problems are detected, the underlying cause of atherosclerosis (arterial disease) is usually well advanced. Our aim is to either prevent the disease by modifying risk factors such as Aged Standardised rate for NZ 1.7 Decrease healthy eating, exercise and avoiding smoking, or early detection and management. See also Health Targets. HOW WILL WE KNOW WE ARE SUCCEEDING? Screening, i.e. catching cancers when they are small, is one of the most effective methods to reduce the incidence and impact of some cancers. Additionally by increasing the proportion of people with well managed diabetes, we will reduce avoidable complications that require hospital-level intervention such as amputation, kidney failure and blindness, and will improve people s quality of life, enabling more people to stay well in their homes and communities for longer Annual Plan Hauora Tairāwhiti 45

46 Fewer people are admitted to hospital for avoidable conditions Fewer people are admitted to hospital for avoidable conditions Tairāwhiti DHB 0-4 year olds Total Population Tairāwhiti DHB year olds Total Population Actual Target Target Target 2014/ / / /19 8,921 Decrease 3,625 Decrease WHY IS THIS IMPORTANT? There are a number of admissions to hospital for conditions which are seen as avoidable through appropriate early intervention and a reduction in risk factors. As such, these admissions provide an indication of the effectiveness of screening, early intervention and community-based care. A reduction in these admissions will reflect better management and treatment of people across the whole system, will free up hospital resources for more complex and urgent cases, and support enhanced delivery of the Government s priority of better, sooner, more convenient healthcare. The key factor in reducing avoidable hospital admissions is an improved interface between general practice and hospital services. Improving people s access to and the effectiveness of primary care will facilitate early interventions, particularly among Māori and Pacifica people who often identify cost as the main barrier to accessing primary care. HOW WILL WE KNOW WE ARE SUCCEEDING? When we reduce the ratio of actual to expected avoidable hospital admissions for our population (Total and Māori) Annual Plan Hauora Tairāwhiti 46

47 People maintain functional independence E91 Average Age of Entry to Aged Related Residential Care (age in years) Actual Target Target Target 14/15 16/17 17/18 18/19 Rest Home 83.3 Increase Dementia 83.0 Increase Hospital 81.2 Increase WHY IS THIS IMPORTANT? If we are to deliver on our twin goals of improving health outcomes and reducing or eliminating health inequalities for our older population, we need to support people to maintain functional independence. As our ageing population increases, so does demand on our constrained funding. We are looking to manage the expected growth in demand, as a consequence of an ageing population, by improved models of care that support people to remain independent and living in their own homes for as long as possible. HOW WILL WE KNOW WE ARE SUCCEEDING? Ideally we would like to promote a model of care that reduces the proportional length of time an older person requires aged related residential care facilities (ARRC). As we do not currently capture this information, our best proxy indicator is to increase the average age at which an older person enters ARC Annual Plan Hauora Tairāwhiti 47

48 OUTCOME 3 - PEOPLE RECEIVE TIMELY AND APPROPRIATE SPECIALIST CARE EXPECTATION Secondary-level hospital and specialist services meet people s complex health needs, are responsive to episodic events and support community-based care providers. By providing appropriate and timely access to high quality complex services, people s health outcomes and quality of life can be improved. WHY IS THIS OUTCOME A PRIORITY? Clinicians, in cooperation with patients and their whānau/ families, make decisions with regards to complex treatment and care. Not all decisions result in interventions to prolong life, but may focus on patient care such as pain management or palliative services to improve the quality of life. For those who do need a higher level of intervention, timely access to high quality complex care improves health outcomes by restoring functionality, slowing the progression of illness and disease, and improving the quality of life. The timeliness and availability of complex treatment and care is crucial in supporting people to recover from illness and/or maximise their quality of life. Shorter waiting lists and wait times are also indicative of a well-functioning system that matches capacity with demand by managing the flow of people through services and reducing demand by moving the point of intervention earlier in the path of illness. As providers of hospital and specialist services, DHBs are operating under increasing demand and workforce pressures. Government is concerned that patients wait too long for diagnostic tests, cancer treatment and elective surgery. The expectations around reducing waiting times, coupled with the current fiscal situation, mean DHBs need to develop innovative ways of treating more people and reducing waiting times with limited resources. This goal reflects the importance of ensuring that hospital and specialist services are sustainable and that the Midland region has the capacity to provide for the complex needs of its population now, and into the future Annual Plan Hauora Tairāwhiti 48

49 People receive prompt and appropriate acute care Percentage of patients admitted, discharged or transferred from emergency departments within 6 hours Actual Target Target Target 14/15 16/17 17/18 18/19 96% >95% >95% >95% WHY IS THIS IMPORTANT? Long stays in Emergency Departments (ED) are linked to overcrowding of ED, negative clinical outcomes and compromised standards of privacy and dignity for patients. Less time spent waiting and receiving treatment in an ED improves the health services DHBs are able to provide. The duration of stay in ED is influenced by services provided in the community to reduce inappropriate ED presentations, the effectiveness of services provided in ED, and the hospital, general practice and community services provided following exit from ED. Reduced waiting time in ED is indicative of a coordinated whole of system response to the urgent needs of the population. HOW WILL WE KNOW WE ARE SUCCEEDING? When we see an increase in the percentage of people who visit our ED who are admitted, discharged or transferred within six hours. Improved performance against this measure will not only improve outcomes for our population, but will improve the public s confidence in being able to access services when they need to Annual Plan Hauora Tairāwhiti 49

50 People have appropriate access to elective services Standardised Discharge Rates per 10,000 for Publicly funded discharges Actual Target Target Target 14/15 16/17 17/18 18/19 Cardiac Surgery major joint replacement cataract procedures percutaneous revascularization coronary angiography services WHY IS THIS IMPORTANT? Elective services are an important part of the health system as they improve a person s quality of life by reducing pain or discomfort and improving independence and wellbeing. The Government wants more New Zealanders to have access to elective surgical services (see Health Targets). Improved performance against this measure is also indicative of improved hospital productivity to ensure the most effective use of resources so that wait times can be minimised and year-on-year growth is achieved. HOW WILL WE KNOW WE ARE SUCCEEDING? To meet the appropriate level of access, we want to ensure that our Standard Intervention Rates (SIRs) meet national expectations for the following selected procedures Annual Plan Hauora Tairāwhiti 50

51 Improved access to mental health services E91 28 day acute re-admission rates Actual Target Target Target 14/15 16/17 17/18 18/19 16% 15 % Decrease WHY IS THIS IMPORTANT? It is estimated that at any one time, 20% of the New Zealand population will have a mental illness or addiction, and 3% are severely affected by mental illness. With high suicide rates in some of our communities, we are working to reduce this rate and support our communities with Whānau Ora initiatives (see Module 3). There is also a high prevalence of depression with the economic downturn and other pressures. The World Health Organisation predicts that depression will be the second leading cause of disability by We have an ageing population, which places increased demand from people over 65 for mental health services appropriate to their life stage. The prevalence of mental illness in the population increases with age, and older people have different patterns of mental illness, often accompanied by loneliness, frailty or physical illness HOW WILL WE KNOW WE ARE SUCCEEDING? Access is the key to improving health status for people with a severe mental illness. Our goal is to build on our existing and well established intersectoral cooperation between general practice / community and hospital services, by offering programmes to individuals and groups from a broad range of ages children and youth, adults, and older people. If we improve access and provide services to people at the right time and in the right place, we can expect to see a reduction in our 28 day readmission rate. This will, in turn, assist in reducing pressure on our hospital services Annual Plan Hauora Tairāwhiti 51

52 More people with end-stage conditions are appropriately supported WHY IS THIS IMPORTANT? For people in our population who have end stage conditions, it is important that they, their family and whānau are supported to cope with the situation. Our focus is on ensuring that the person is able to live comfortably, without undue pain or suffering. Early identification and recognition of end-of-life choices heavily influence the quality of life an individual experiences during the dying process. Rehabilitation and Support Services contribute to this impact. Programmes include palliative care, aged residential care, respite care and home based support services. HOW WILL WE KNOW WE ARE SUCCEEDING? Palliative care is being accessed: however we want to target those with greatest need. The Palliative Care Council has identified inequalities of access to palliative care based on diagnosis (evidence of under-utilisation by those with non-malignant conditions), with a lack of suitable service provision for children and young people. We would like to see an increase in palliative support for this group. The Palliative Care Council in its 2010 position statement identified a lack of data on the need for palliative care for New Zealand and monitoring on the implementation New Zealand Palliative Care Strategy. Over the next few months we hope to work towards identifying and reporting on an impact measure Annual Plan Hauora Tairāwhiti 52

53 Module 2 - The New Zealand Health Strategy and Delivering on Priorities and Targets 2.1. IMPLEMENTATION OF THE NEW ZEALAND HEALTH STRATEGY In accordance with section 38(2) (d) of the NZPHDA, DHBs annual plans must reflect the draft refreshed NZHS s direction and detail each DHB s commitment to delivering appropriate actions in line with the Strategy s Roadmap. The refreshed NZHS has two parts: (i) Future Direction and (ii) Roadmap of Actions. The Future Direction outlines a high-level direction for New Zealand s health and disability system over the next 10 years. The Roadmap of Actions identifies 20 work areas for the next five years to put the Strategy in place. The image below illustrates the components of the Strategy. The next image illustrates how the Strategy fits with other existing government strategies and priorities. It has been informed by the Government s four high level priorities and will support the health system s contribution to a range of cross-government strategies. The refreshed NZHS focuses on health, but is set within the wider context of the interconnections between health and other aspects of people s lives. The Government is focused on improving the lives and wellbeing of New Zealanders. Its priorities include work, across agencies, to tackle the complex and long-term problems that some New Zealand families face. Examples include providing healthier homes to reduce the risk of illnesses like rheumatic fever and respiratory conditions, putting families and whānau at the centre of service delivery through Whānau Ora, and reducing assaults on children by working closely with the police, courts, education and justice sector partners and providing mental health addiction and treatment. These health links with the wider environment are shown below. Appropriate commitments and actions are referenced in this module to ensure that implementation of the Strategy can begin in 2016/17. They are structured around the five strategic themes identified in the draft strategy as illustrated below: Annual Plan Hauora Tairāwhiti 53

54 2.2. THEMES FROM THE HEALTH STRATEGY The consultation draft Strategy s strategic themes are outlined below. There are some existing planning priorities that may be impacted as a result of the Strategy Roadmap actions, once these are confirmed so in order to reduce duplication. Where there is an obvious cross over with our DHB and/or regional activities identified under existing priority areas, we have captured these in the below table that references where the detailed actions can be found elsewhere in our plan. People Powered Developing understanding of users of health services Encouraging and empowering people to be more involved in their health Reference: Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Living Well With Diabetes Rising to the Challenge Shorter Stays in Emergency Departments Whānau Ora Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Annual Plan Hauora Tairāwhiti 54

55 Partnering with them to design services Supporting people s navigation of the health system Care Closer to Home Providing health services closer to home More integrated health services, including better connection with wider public services Palliative Care Whānau Ora Rheumatic Fever Healthy Families NZ Rising to the Challenge Service Configuration Reducing Unintended Teenage Pregnancy Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Service Configuration Reference: Reducing Unintended Teenage Pregnancy Living Well With Diabetes Cardiovascular Disease Service Configuration System Level Outcome Measures Stroke Services Palliative Care Shorter Stays in Emergency Departments Whānau Ora Improved Access to Diagnostics Reducing Unintended Teenage Pregnancy Increased Immunisation Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Service Configuration Stroke Services Palliative Care Shorter Stays in Emergency Departments Whānau Ora Improved Access to Diagnostics Annual Plan Hauora Tairāwhiti 55

56 An investment early in life A focus on the prevention and management of chronic and longterm conditions Reducing Unintended Teenage Pregnancy Increased Immunisation Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Service Configuration Whānau Ora Rheumatic Fever Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Service Configuration High Value and Performance Reference: The transparent use of information An outcome-based approach An investment early in life Strong performance measurement and a culture of improvement Increased Immunisation Supporting Vulnerable Children Social Sector Trials Prime Minister s Youth Mental Health Project Healthy Families NZ Service Configuration System Level Outcome Measures Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Healthy Families NZ Obesity Service Configuration System Level Outcome Measures Whānau Ora Reducing Unintended Teenage Pregnancy Increased Immunisation Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Service Configuration Whānau Ora Social Sector Trials Rheumatic Fever Healthy Families NZ Obesity Living Well With Diabetes Annual Plan Hauora Tairāwhiti 56

57 An integrated operating model providing clarity of roles The use of investment approaches to address complex health and social issues One Team Operating as a team in a high-trust system The best and flexible use of our health and disability workforce Cardiovascular Disease Service Configuration Improved Access to Diagnostics Improved Access to Elective Surgery Supporting Vulnerable Children Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Service Configuration Cancer Palliative Care Health of Older People Shorter Stays in Emergency Departments Improved Access to Diagnostics Improved Access to Elective Surgery Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Healthy Families NZ Living Well With Diabetes Rising to the Challenge Service Configuration Departments Whānau Ora Reference: Reducing Unintended Teenage Pregnancy Increased Immunisation Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit Rising to the Challenge Service Configuration Stroke Services Palliative Care Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Annual Plan Hauora Tairāwhiti 57

58 Leadership and management training Strengthening the role for people, families and whānau and communities to support health More collaboration with researchers Smart System The increased use of analytics and systems to improve management reporting, planning and service delivery and clinical audit The availability at the point of care of reliable and accurate information including on-line electronic health records The health system as a learning system, that continuously monitors and evaluates what it is doing, and shares it Service Configuration Health of Older People Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Service Configuration Supporting Vulnerable Children Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ Obesity Service Configuration Palliative Care Whānau Ora Reducing Unintended Teenage Pregnancy Social Sector Trials Rheumatic Fever Healthy Families NZ Obesity Service Configuration Reference: Supporting Vulnerable Children Social Sector Trials Healthy Families NZ Obesity Living Well With Diabetes Cardiovascular Disease Service Configuration Increased Immunisation Supporting Vulnerable Children Living Well With Diabetes Cardiovascular Disease Social Sector Trials Rheumatic Fever Prime Minister s Youth Mental Health Project Healthy Families NZ National Partnerships Annual Plan Hauora Tairāwhiti 58

59 2.3. DELIVERING ON PRIORITIES AND TARGETS Implementing Government Priorities This section presents the actions Hauora Tairāwhiti is planning to deliver in 2016/17. Implementation of the actions outlined in this plan is expected to enable us to positively contribute to local, regional and national outcomes as well as the goal of All New Zealanders Live Well, Stay Well, Get Well, including Better Public Services (BPS). The actions and measures presented in this section show: How we are implementing Government priorities How we are contributing to the activities in the Midland Regional Services Plan and the Māori Health Plan How we plan to improve performance in terms of our local priorities. This section has been developed in collaboration with key stakeholders, both internal and external to the health sector. POLICY DRIVERS: Better Public Services creating an environment where services are encouraged to work together to deliver health care in a coordinated and cooperative manner. The aim of this policy is to support people to be healthier within their communities through the delivery of more services, and to ensure they wait less time for services. Aligned to this policy direction is a set of health targets that provide performance measures for the health sector to improve health outcomes and service quality at local and national levels. Regional Collaboration DHBs working together more effectively regionally and locally. Integrated Care clinical and service integration to bring organisations and clinical professionals together to improve outcomes for patients and service users through the delivery of integrated care. Integration is a key component of placing people at the centre of the system, increasing the focus on prevention avoidance of unplanned acute care and redesigning services closer to home. Value for Money within the current fiscal environment there is a need for health services to work more efficiently and effectively to achieve priority goals and targets. ACTIONS TO DELIVER ON ANNUAL PLAN PRIORITIES This section is clustered into five broad categories reflecting Government planning priorities. The categories and the specific priorities are outlined below. The Hauora Tairāwhiti regional and local actions to deliver on the Regional Services Plan, and Hauora Tairāwhiti s local priorities are also included in this section. The categories and priorities are not exclusive, for example there are a number of priorities which will impact long term conditions which are not included in the long term conditions column. Child and Youth Health Reducing Unintended Teenage Pregnancy (BPS target) Increased Immunisation (Health Target and BPS target) Supporting Vulnerable Children (BPS target) Social Sector Trials Rheumatic Fever (BPS target) Prime Minister s Youth Mental Health Project Long Term Conditions Prevention, Identification and Management Healthy Families NZ Obesity (Health Target) Living Well With Diabetes Cardiovascular Disease Better Help for Smokers to Quit (Health Target) Rising to the Challenge System Integration Service Configuration System Level Outcome Measures Cancer (Health Target) Annual Plan Hauora Tairāwhiti 59

60 Stroke Services Cardiac Services Palliative Care Health of Older People Shorter Stays in Emergency Departments (Health target) Whānau ora Improved Access to Diagnostics Improved Access to Elective Surgery (Health Target) Living within Our Means Living within our Means National Entity Priority Initiatives NZ Health Partnerships Ltd Other Improving Quality Actions to support delivery of Regional Priorities Annual Plan Hauora Tairāwhiti 60

61 Child and Youth Health REDUCING UNINTENDED TEENAGE PREGNANCY Our Approach During 2016/17 we will continue our focus on increasing access to reproductive health and contraception advice for youth both during term time and holidays. The youth Service Level Alliance team (SLAT), with the advice of a youth expert advisory group, will investigate gaps in the provision of long acting contraceptives at affordable costs and how any gaps can be overcome. Linkages Better Public Health Services target Vulnerable children Action Plan Objective Actions to deliver improved performance Measure Reporting Reduction of unintended teenage pregnancies Workforce development - contraceptive counselling and provision Workforce development programme in insertion of long acting contraceptive (LAC) and youth friendly services. Delivered and available from the youth health experts and youth clinical champions Ensure coverage across the population of clinicians available to insert LAC and easy access. Secondary school health services, birthing units, Lead Maternity Carers (LMC), Termination of Pregnancy (TOP) services, maternal and child health integration sites for Māori and high needs young women Resource primary health care to provide access to affordable (low cost, no cost) contraceptive and reproductive health services for under 24 year olds. DHB youth health nurses will undertake professional development in reproductive health and contraception to enable them to provide Annual Plan Hauora Tairāwhiti 61 Number of workforce development sessions Number of face to face training of clinicians Number of sites providing free under 24 year old contraceptive and sexual health services Quarter four confirmation and exception report against the annual plan actions.

62 Objective Actions to deliver improved performance Measure Reporting School based health service (SBHS) contracts Access to contraceptives and termination of pregnancy school holiday service which will see them providing reproductive and conceptive advice The current SBHS provider is looking to update their current model of care; any changes will be in place for the start of the new educational year (Jan 2017). Whatever the model it will priorities quality and delivery of contraceptive provision including: Standing orders for education, discussion, referral and provision of contraceptives at all secondary SBHS All school nurses have ECP (emergency contraception pill) endorsement on their Annual Practising Certificate (APC) updated annually SBHS nurses have monthly workforce development when identified, and support from the DHB nursing directorate Health and education have Memorandum of Understandings on workforce and quality requirements for school nurses School health services are connected to community providers for school holiday follow up and access for students when schools are closed. Referral pathways are in place and students have information All health employed school nurses in decile 1-3, alternative education and school for young parents are paid on the primary care MECA and this is auditable Minimum annual school visits from health to provide professional liaison identify any issues, work across sector, through cross sector forums with Ministry of Education to progress working relationships, sharing of information and vulnerable young people Promote and advertise providers providing free contraception and sexual health services Encourage primary care proactive approach to young people and opportunistic engagement across the DHB populations Annual Plan Hauora Tairāwhiti 62 Progress on standing orders and availability of contraceptives in all SBHS Number of nurses with and without ECP endorsement Number of SBHS workforce development sessions

63 Objective Actions to deliver improved performance Measure Reporting Promote after hours care facilities to provide information and referral pathways and options for vulnerable young people Promote the availability of FREE ECPs at Hauora Tairāwhiti community Clinic during and after hours Ensure the TOP service continues to provide insertion of LACs and referrers provide this information on referral Provision of LAC Gisborne and Te Puia Springs Hospitals, at the maternal and child health integration sites or a free community service available postpartum INCREASED IMMUNISATION Our Approach During 2016/17 we will continue our focus on increasing immunisation in our district and reaching the immunisation targets. We will focus on a continuum of care from pregnancy test to six years of age and ensure all universal services including immunisations are delivered on time. Through registration in pregnancy our system will track children from pregnancy, birth, and up to six years of age. In a collaborative and cross sector approach that we have developed with our Alliance partners we will identify and work with high needs and vulnerable children and their families to ensure immunisation and other universal services are delivered on time. Key to supporting this will be the introduction of Pinnacle-Midland Health Network s National Child Health Information Programme (NCHIP) that will bring transparency to the delivery of Well Child services, and milestone based care. We will be working with our Alliance Partners primary health care, lead maternity carers, well child tamariki ora, Ministry of Social Development, Whānau Ora, Social Sector Trial partners to make progress against this priority. Linkages Our Performance Story Impact: People take greater responsibility for their health Better Public Services: Supporting vulnerable children Minister s letter of Expectation Health Strategy Annual Plan Hauora Tairāwhiti 63

64 Action Plan Objective Actions to deliver improved performance Measure Reporting Increase infant and childhood immunisation coverage to reach and maintain immunisation targets. Review steering group role and function by December The intent of this review is to increase cross sector integration and move from a steering to a governance group; this is to ensure that a common approach is adopted for immunisation for priority groups. This review will incorporate iwi, health, social, community and NGO providers. By June 2017, a new immunisation governance forum developed which will incorporate increased social sector presence. Monitor and evaluate immunisation coverage at 6 months, 8 months, 2 years and four years at DHB, PHO and practice level, manage identified service delivery gaps and performance through monthly DHB/PHO monitoring meetings. 95% of eight months and two year olds are fully immunised 95% of four year olds are fully immunised by age 5 years by June 2017 Primary care IPIF immunisation targets 98% of newborns enrolled with general practice at 3 months of age in alignment with the WCTO quality indicators Sin monthly through Non-financial and governance reports Ongoing review of National Child Health Information Platform (NCHiP) data to see, which children are not currently on National Immunisation Register (NIR) but have received another universal childhood check. Investigate the impact that NCHiP has had on health and social child scheduled events, by December Maintain quarterly multi-disciplinary team (MDT) meetings with primary care, National Immunisation Register (NIR), Outreach Immunisation Service (OIS), National Child Health Information Platform (NCHiP), Well Child/Tamariki Ora (WCTO), E Tipu E Rea (ETER) and immunisation facilitator. Promote the use of the smart phone well child application developed by Nelson Marlborough DHB which reminds parents of due dates for immunisation events. Continue to support the Māori Women s Welfare League ongoing Annual Plan Hauora Tairāwhiti 64

65 Objective Actions to deliver improved performance Measure Reporting promotion activities to get tamariki immunised on time. HPV Immunisation Maintain funding levels at current rates Included additional Health promotion and education to school and families of eligible children. At least 70% of all 12 year-old-girls will have completed all doses of their HPV vaccine Increased Influenza Coverage Enable pharmacists to provide subsidised influenza vaccination for eligible people across the district 75% of those aged 65 and over are immunised against influenza Annual with Statement of Performance Expectations SUPPORTING VULNERABLE CHILDREN Our Approach Supporting vulnerable children contributes to the government s overall priorities by improving services to gain better outcomes and reducing avoidable expenditure in the justice, health and welfare systems helping to deliver better public services within financial constraints and helping to build a more competitive and productive economy. The core of our plan in supporting vulnerable children is meeting the requirements of the Vulnerable Children s Act 2014 and our ongoing participation in the Tairāwhiti Children s Team. LOCAL APPROACH Hauora Tairāwhiti and our providers have a duty of care to any child/young person at risk, suspected, witnessed, reported or disclosed abuse or neglect that has presented to Gisborne hospital, community or primary health provider or who has been referred to and/ or treated by a provider within Tairāwhiti. Reporting of all abuse or neglect of children/young persons to Child, Youth and Family (CYFS) is mandatory and safety of the child is the paramount consideration. We continue to take a key role in the Tairāwhiti Children s Team and are committed to meeting the requirements of the Vulnerable Children s Act (VCA). Our commitment includes a focus on services for vulnerable pregnant women and vulnerable children, and where necessary planning and remodelling of our maternal and child health services to improve health outcomes for these children. This includes addressing access, integration, quality, addressing gaps in service delivery and capacity of providers to deliver on the Children s Action Plans. We continue to advocate and support a collaborative cross-sector approach to working with vulnerable children and their families where information, services, resources are coordinated and shared to improve outcomes Annual Plan Hauora Tairāwhiti 65

66 Linkages Our Performance Story Impact: People take greater responsibility for their health Better Public Services: Supporting vulnerable children Minister s letter of Expectations Health Strategy The Vulnerable Children s Act (VCA) 2014 PP27 Supporting vulnerable children Action Plan Objective Actions to deliver improved performance Measure Reporting Reducing the number of Quarterly FVIP governance meetings Quarterly on assaults on children progress-pp27 Reducing the number of hospitalisations for injuries arising from assault, neglect or maltreatment of children Maintain: Full DHB implementation of Family Violence Intervention Programme (FVIP) through FVIP governance and to provide governance for FVIP, National Child Protection Alerts System (NCPAS), Shaken Baby, Child Protection, Gateway, Vulnerable Unborn Babies service and Children s Team Dedicated FVIP coordinator Dedicated Child Protection Coordinator Mandatory FVIP Ministry accredited training for all DHB staff, rolled out across secondary, primary and community services, including NGOs Continue rollout and training at beginning, intermediate and advanced level Brainwave Trust across providers of maternal, child and youth services CHILD PROTECTION POLICIES Three yearly Hauora Tairāwhiti DHB child protection policy reviewed in October All contractual agreements between Planning and Funding and providers of children s services to have current and implemented child protection policies. DHB to provide support to providers to review and implement child protection policies, training, assessment, documentation and human Annual Plan Hauora Tairāwhiti 66 Achieve an audit score of 80/100 for the child and the partner abuse components of the FVIP FVIP Governance monitoring of the NCPAS and the CYPAP clinical advisory group DHB supports implementation of Rising to the Challenge (e.g. COPMIA), and Healthy Beginnings: Developing perinatal and infant mental health services in NZ Number of children with Children s Action Plans Dedicated DHB and non-dhb resource provided to the Children s team Referral pathways implemented Gateway programme enlarged to provide a health entry and exit point for referrals in and out and requests for health 6 monthly to the on the FVIP to the Ministry DHB reports exceptions and remedial actions to audit scores less than 80/100 for each of the child and partner abuse components of their VIP programme NCPAS and CYPAP reports to FVIP quarterly

67 Objective Actions to deliver improved performance Measure Reporting resource systems around mandatory vetting and screening information in and out CHILDREN S WORKER SAFETY CHECKING Implementation of the requirements of the Vulnerable Children s Act 2014 workforce requirements. Expert advice and leadership from the DHB Human Resources for all queries and communication. Information sessions to all line managers and NGO employers on the introduction of the Vulnerable Children (Requirements for Safety Checks of Children s Workers) Regulations From 1 July 2016 DHB process in place for ensuring all DHB existing staff in the core workforce has passed an updated children s worker safety check unless they have an exemption approved under section 35 of the Act. All new employees have a children s worker safety check pre offer of employment confirmed Reducing the number of assaults on children NCPAS full implementation and Child Youth Protection Advisory Panel (CYPAP) oversight and governance Quarterly monitoring of the child protection Memorandum of Understanding between CYFS, Police and DHB by the FVIP governance group Early referral pathway for identified vulnerable pregnant women into Woman child and Family (WCF) social work service from LMCs, primary care, after hours and ED, implemented and monitored by the Vulnerable Pregnant Women group. Referral pathway of children identified as at risk of assault, maltreatment and/or neglect into the weekly Paediatric MDT meetings-include social work, CYFS/DHB liaison, children s outreach Participate with the NZ Police programme for Community Partner Annual Plan Hauora Tairāwhiti 67

68 Objective Actions to deliver improved performance Measure Reporting Planning for children identified as at risk of assault, maltreatment and/or neglect Cross sector relationships, planning and communication with Victim Support. Family Violence Inter Agency Response Service (FVIARS), FVIP, and CYFS/DHB liaison Safety discharge planning from ED, Children s ward, children s outpatients, Public Health Nursing, all community maternal and child nursing Service planning and development activities work to provide an effective continuum of services across primary and referred health services to meet the needs of: Pregnant women with complex needs Vulnerable children and their families Referral into the services by primary care, community agencies, secondary care, social services, CYFS, NZ Police, MSD Provide social work and intensive home visiting support attached to the vulnerable pregnant women-to be delivered through maternal and child health integration programmes including mothercraft, day programmes and increased home visiting in conjunction with LMCs, WCTO SOCIAL SECTOR TRIALS Our Approach The Social Sector Trial has been in place in Gisborne since 2013 with a focus on early intervention and prevention. The Trial comes to an end in December 2016 and will the initiatives it started or was an integral part of will transition into the Tairāwhiti District Social Investment Governance Group. Essential to this is the reshaping of social service, health and education provision to ensure better outcomes for young people with complex health needs, abusive relationships or poor family environments. The Trial also works to improve support for young people with disabilities and young people with parents in prison. The local focus is on developing sustainable approaches that are able to be transitioned and progressed when the Trials come to an end in December The establishment of a Youth SLAT is considered a key step in Annual Plan Hauora Tairāwhiti 68

69 ensuring a cross sector approach to collaboration and coordination of youth health services in Tairāwhiti. The development of a youth health action plan is essential and will be a crucial priority for 2016/17. Social Sector Trial Action Plan Prime Minister s Youth Mental Health Project Health Strategy Linkages Better Public Services: Supporting vulnerable children Action Plan Objective Actions to deliver improved performance Measure Reporting Social Sector Trials Youth Service Level Alliance Ensure SST continues to have input into decision making and involvement in youth health service planning through membership on Youth SLAT. Work collaboratively with SST to progress transition of relevant services and programmes as part of sustainability and succession management, into the Tairāwhiti District Social Investment Governance Group. Youth SLAT tasked with developing a youth health action plan that incorporates a cross sector alliance approach to address and deliver on youth health needs across Tairāwhiti. By July 2016, a youth forum will be held for youth to identify their priorities. A second forum will engage with iwi, social agencies and other stakeholder to : o Hear youth priorities o Brief presentations re own youth focussed service delivery/outcomes/challenges/vision o Collective think tank on what needs to occur in Tairāwhiti to sustainably improve youth health and well-being o Collective think tank on who does this-and where/how/outcomes Annual Plan Hauora Tairāwhiti 69 Youth SLAT function, role and responsibilities as well as short and medium term priorities identified and underway by September Transition plan for services and programmes of as part of SST and associated timeline finalised by October Engagement and consultation plan for youth health plan developed by December 2016 Gap analysis completed for youth health plan by March 2017 Youth health plan completed for follow up consultation by June 2017 Quarterly Confirmation and exception report against the actions to deliver improved performance

70 Objective Actions to deliver improved performance Measure Reporting o Collective think tank identifying the competencies and expertise of a smaller representative project group to drive the service design/re-design with December 2016 being indicative deadline to ensure it is operational in 2017/18. o The above then summarised for social investment governance group consideration and subsequent formal oversight RHEUMATIC FEVER Our Approach The refreshed Tairāwhiti Rheumatic Fever Prevention Plan has been approved and endorsed by the Minister of Health. A strong feature of the plan is the importance of utilising a cross sector approach towards the planning, implementation, monitoring and evaluation of activities outlined in the plan. This is reflected in the governance group membership which now includes representatives from PHO s, Ministry of Social Development and Housing NZ. We will look to strengthen our alliances with The Pacific Island Community Trust, Te Puni Kokiri and the Māori Women s Welfare League with the purpose of ensuring community representation and leadership at a governance level. Whānau representation at a governance level will also be included. Additional activity to reduce the incidence of skin infections; strengthen linkages with oral health services and a greater focus on secondary prophylaxis and support for clients receiving bicillin will be undertaken also. Linkages Our Performance Story Impact: Fewer people admitted to hospital for avoidable conditions Better Public Services Rheumatic Fever target Hauora Tairāwhiti Rheumatic Fever Prevention Plan Annual Plan Hauora Tairāwhiti 70

71 Action Plan Objective Actions to deliver improved performance Measure Reporting Reduce the incidence of rheumatic fever (RF) Implement actions identified in the endorsed Tairāwhiti rheumatic fever prevention plan to drive progress on meeting the DHB BPS target by 30 June Undertake case reviews of all rheumatic fever cases and address identified systems failures Confirm funding investment for rheumatic fever prevention from July 2017 By June 2017, provide the annual audit of Rheumatic Fever secondary prophylaxis coverage for children aged 0-15 years, youth years and adults 25 plus years DHB target for 2016/17 is a two thirds (66%) reduction from baseline for hospitalisations for Acute RF The 2016/17 targets for have been set by the MoH are included as per MoH requirements. 2016/17 Target: 66% reduction from baseline level Rate Numbers Tairāwhiti Delivery and reporting of endorsed rheumatic fever prevention plan that includes actions to: Increase awareness of rheumatic fever and how to prevent it. Prevent the transmission of Group A streptococcal throat infections within households Treat Group A streptococcal infections quickly and effectively Provide an investment plan for confirmed funding investment for rheumatic fever prevention from July 2017 Provide reports on lessons learned and actions taken following the case reviews Annual Plan Hauora Tairāwhiti 71

72 Objective Actions to deliver improved performance Measure Reporting Actions facilitating the effective follow up of identified RhF cases Ensure that all cases of acute and recurrent acute rheumatic fever are notified with complete case information to the Medical Officer of Health within seven days of hospital admission. Ensure patients with a history of rheumatic fever receive monthly antibiotics not more than 5 days after their due date. Confirmation and exception reporting each quarter Business case developed and submitted to DHB and MoH for approval. Quarterly Undertake an annual audit of rheumatic fever secondary prophylaxis coverage for children aged 0-15 years, youth aged years, and adults aged 25+ years. Identify and follow-up known risk factors and system failure points in cases of recurrent rheumatic fever. Follow-up on any issues identified by the 2015/16 audit of recurrent hospitalisations of acute rheumatic fever and unexpected rheumatic heart disease. Develop business case to provide support to people receiving bicillin injections. PRIME MINISTER S YOUTH MENTAL HEALTH PROJECT Our Approach Hauora Tairāwhiti continues to work with our partners to increase access to, and quality of mental health services provided to young people across the care continuum. In January 2016 the Advisory Group of the Tairāwhiti Social Sector Trials (SST) agreed in principle to be the youth service level alliance group (Youth SLAT). It will require changes to their current terms of reference and additions to the membership, but overall is viewed as a valuable addition to their remit. The Youth SLAT will report through to the Tairāwhiti Integration Forum which is made of representatives of Hauora Tairāwhiti, Pinnacle-Midland Health Network, Ngāti Porou Hauora (NPH) and National Hauora Coalition (NHC). Pinnacle-Midland Health Network continues to provide primary mental health care to those aged 12 to 19 years of age. Recruitment last year of a clinician with a strong youth focus and expertise has strengthened service delivery Annual Plan Hauora Tairāwhiti 72

73 The Youth Health Team at Hauora Tairāwhiti has completed its case study and will use the information to inform further quality improvements to the way HEEADSSS wellness checks are provided. The Children s Team is now operating in Tairāwhiti. A number of staff from Hauora Tairāwhiti sit on the triage panel with expertise from both mental illness and addiction perspectives, as well as working as lead professional with whānau. Of note for Hauora Tairāwhiti is the addition of an infant mental health service within the Child and Adolescent Mental Health Service (CAMHS) for those babies, children and young people with serious mental illness and/or addiction. This new service began in January 2016 and clinicians are now sharing their therapeutic approach with stakeholders. Access to specialist services continues to be closely monitored to enable improved access rates. Additionally this year s plan includes a measure on the provision of follow up/transition care plans to primary health care providers on discharge from Te Whare o Te Rito (ICAMHS) to improve the level and quality of support from primary care. In addition, the move from a model of visiting consultant psychiatrists to a full time consultant psychiatrist being employed within the ICAMHS team reflects a significant shift. Furthermore, another of Hauora Tairāwhiti s consultant psychiatrists and a Whānau Ora Pakeke are collaborating to strengthen the overall capabilities and confidence of the Tairāwhiti community regarding mental health and wellbeing. Their work has been centred on Mahi a Atua: an approach which prioritises indigeneity as usual care for Māori whānau presenting to mental health services. This way of being accesses Māori creation and customary stories to better engage whaiora and their whānau in a partnership to best meet their healing needs. This approach promotes a clinical environment where the reinstatement of Māori psychology is implemented to address the impact of historical and sociocultural factors that impact Māori wellbeing. Underlying this activity is the Suicide Prevention and Postvention Plan, as one of Tairāwhiti s most vulnerable groups is Māori youth aged 15 to 24 years (included in the Service development plan). Linkages PP7 Improving mental health services using transition (discharge) planning PP8 Shorter waits for non-urgent mental health and addiction services for 0-19 year olds PP25 Prime Minister s youth mental health project PP26 Mental health services development plan Children s Team Tairāwhiti Social Sector Trials Primary Health Organisations Midlands Regional Services Plan Our Performance Story Impact: People stay well in their homes and communities Annual Plan Hauora Tairāwhiti 73

74 Action Plan Objective Actions to deliver improved performance Measure Reporting School based health services (SBHS) Improve responsiveness of primary care to youth Review and improve follow-up care for those discharged from Te Whare O Te Rito Improve access to services provided by Te Whare O Te Rito through wait time targets and integrated case management Maintain SBHS in decile one to three high schools, teen parent units and alternative education facilities Continue to implement the SBHS Continuous Quality Framework to evidence quality improvement Improve health and wellbeing of Tairāwhiti s youth population by improving responsiveness, access, service provision and integration within the Gisborne Youth Action Plan ( the work plan ) Participate in the Youth SLAT as a new member representing Hauora Tairāwhiti Continue to strengthen primary mental health focusing on youth Provide follow-up/transition care plans to general practitioners for youth aged 12 to 19 years discharged from Te Whare O Te Rito. Confirm with general practitioners that the follow up care plans are activated within three weeks of discharge Continue to decrease waiting times and meet waiting time targets Continue to support the work of Children s Team with referrals and clinical input Number of eligible Year 9 students who receive HEEADSS wellness check until June 2017 Number of interventions provided in schools each quarter Outcomes of any quality activity is included in future service planning by June 2017 Monitor activity against Youth Action Plan each quarter Percentage of youth discharged from Te Whare O Te Rito with follow up/transition care plans each quarter Percentage of follow up/transition plans activated by GPs each quarter 80% young people access services within three weeks of referral. 95% young people access services within eight weeks of referral PP25 Prime Minister s youth mental health project PP25 Prime Minister s youth mental health project Service Development Plan PP25 Prime Minister s youth mental health project Service Development Plan PP8 Shorter waits for nonurgent mental health and addiction services for 0-19 year olds Annual Plan Hauora Tairāwhiti 74

75 Long Term Conditions Prevention Identification and Management HEALTHY FAMILIES NEW ZEALAND (HE ORANGA WHĀNAU) E91 Our Approach The Healthy Families East Cape initiative includes the Opotiki district as well as Tairāwhiti. The initiative is led by Te Aitanga a Hauiti Hauora as part of the Horouta Whanaunga Collective. DHB participation is led by Bay of Plenty DHB as a member of the Healthy Families East Cape governance group. Hauora Tairāwhiti will work with BOPDHB to ensure that linkages are made to existing DHB delivered or funded programmes delivered across the East Cape such as Health Promoting Schools, Hapū Hauora, smoking cessation and promotion of smokefree environments, monitoring of liquor licensing, and Green Prescription. Linkages Minister s Letter of Expectations Health Target More Heart and Diabetes Checks Māori Health plan Section developed and agreed with our primary care partners Our Performance Story Impact: People take greater responsibility for their health Action Plan Objective Actions to deliver improved performance Measure Reporting Healthy Families East Cape Initiative Governance: - BOP will continue on Healthy Families East Cape Governance Group representing both BOP DHB and Hauora Tairāwhiti through its Portfolio Manager, Planning and Funding, Population Health. This will provide linkages between DHB governance and executive functions and those of other partners such as local authorities, PHOs, Regional Sports Trusts, private businesses, and iwi runanga and hauora groups. Facilitation: - Hauora Tairāwhiti will facilitate the integration of physical activity, nutrition, tobacco control and alcohol moderation service programmes funded or delivered across Tairāwhiti. Links with inter-agency planning and networking groups in Tairāwhiti and Healthy Families East Cape initiative will also be strengthened. Number of Governance Group meetings attended. A confirmation and exception report against the examples of participation identified. Number of inter-agency linkages developed with the Healthy Families East Cape Initiative and reported in the confirmation and exception report. Annual Quarter 4 Quarter Annual Plan Hauora Tairāwhiti 75

76 Objective Actions to deliver improved performance Measure Reporting Health promotion: - Hauora Tairāwhiti will integrate its settingbased programmes such as Health Promoting Schools, Healthy Work place wellness models, Active Mokopuna, and its regulatory, healthy public policy, and community development work with Healthy Families East Cape. Support and participate in the Healthy Families East Cape Initiative Systemic changes: - Hauora Tairāwhiti will support the Healthy Families East Cape initiative in identifying opportunities to make system changes through engagement with the philanthropic sector, private businesses, the food and entertainment industries, and other sectors to address whole populations at scale. Establishment a local working party to identify how local services can be aligned and integrated under the Healthy Families East Cape Initiative framework Identify opportunities for further workforce development specifically in the principles underpinning Healthy Families East Cape and the Atua Matua approach. Ensure that relevant reviews of services, gaps, referral pathways etc. come from a strengths based approach that demonstrates Māori leadership, decision making and participation. By Quarter Two: Local working group established and meeting at least bimonthly with a clear set of actins developed and initiated. In collaboration with Healthy Families East Cape, at least 2-3 workforce development activities delivered for 16/17. Evidence of Māori leadership, participation and decision making in reviews of relevant services and referral pathways etc. undertaken during 16/17. Quarterly Annual Plan Hauora Tairāwhiti 76

77 OBESITY Our Approach As mentioned in section above, The Healthy Families East Cape initiative will be the overarching framework for childhood obesity prevention in Tairāwhiti. As part of this, the DHB will monitor and drive progress on the B4SC health target to be introduced in December Similar to other key programmes, such as rheumatic fever prevention, Social Sector Trials, Tairāwhiti Children s Team and E Tipu E Rea, the DHB will facilitate and support a cross sector, community led approach to childhood obesity prevention in Tairāwhiti. The entire referral pathway for children (and their whānau) requiring nutrition and physical activity support needs to be reviewed in-depth. This includes 4 year old children identified at their B4SC as being obese but also children younger and older than this requiring support. We also need to ensure that the services we have available to provide this support are appropriate and accessible for all whānau living in Tairāwhiti. Identifying kaupapa Māori models of service delivery in collaboration with whānau, hapū and iwi will be a key part of this process. Actions to reduce the incidence of obesity in Māori and Pacific families and those living in high deprivation are also linked and included in key programmes such as the WCTO Quality Improvement Programme (B4SC timeliness), oral health (health promotion messaging) and tobacco control (maternal smoking during pregnancy). Linkages DHB Population Health Annual Plan 16/17 Tairāwhiti Tobacco Control Plan WCTO Quality Improvement Framework DHB Oral Health Plan Action Plan Objective Actions to deliver improved performance Measure Reporting B4SC Health Target By Q2, in partnership with Healthy Families East Cape initiative Governance Group, identify process for B4SC health target progress, review and monitoring to be included in overall Healthy Families East Cape initiative. Monitor the B4SC health target By Q2, review current referral pathway and services available for overweight and obese children identifying any service and coverage gaps or duplication. By Q2, audit referral numbers by ethnicity, high deprivation and parents who declined a referral 95 percent of obese children identified in the B4 School Check programme will be referred to a health professional for clinical assessment and other interventions Review of referral pathway completed prior to health target taking effect. Findings and recommendations provided to key governance groups (Board, CPHAC, TWON, Healthy Families Quarterly Annual Plan Hauora Tairāwhiti 77

78 Objective Actions to deliver improved performance Measure Reporting By Q3, Present data at regular B4SC case reviews (to be established) adjust referral pathway and address any identified quality issues By Q3, Ensure a feedback loop to referrers on outcomes, results and ongoing support/interventions By Q3, Identify appropriate kaupapa Māori models of service delivery for children and their families through engagement with iwi governance, hauora providers, Māori NGO s, TKKM and Kohanga Reo and whānau. Support activities in key DHB accountability plans that will reduce the incidence, impact and burden of obesity on children and their whānau in Tairāwhiti. East Cape Governance) B4SC Case review group established to address quality issues by Q3. Feedback loop strengthened and regularly reviewed as part of case review work from Q3 onwards Evidence of engagement with whānau, hapū, iwi during Q1 and Q2. Preferred models of service delivery identified by Q3. LIVING WELL WITH DIABETES Our Approach Hauora Tairāwhiti continues to work in collaboration between our primary care, secondary care and community NGO teams to reduce the incidence and burden of diabetes for our population through prevention, early identification, supporting effective self-management, and quality integrated services. Diabetes is a significant factor in the inequity of health outcomes for our Māori population and the reduction of these inequities is the primary aim of all long term conditions services in Tairāwhiti. With the guidance of the Ministry of Health s Living Well with Diabetes A plan for people at high risk or living with diabetes document, Hauora Tairāwhiti will continue to focus on enhancing and developing services which most effectively support our people and their whānau to prevent the development of diabetes and better manage the disease. Linkages MoH Living Well with Diabetes MoH Quality Standards for Diabetes Care Tool Kit 2014 MoH Screening, Diagnosis and Management of Gestational Diabetes in New Zealand A clinical practice guideline 2014 MoH Target More Heart and Diabetes Heath Target MoH Diabetes Care Improvement Packages guidelines and Work programme 2016/17 Annual Plan Hauora Tairāwhiti 78

79 NZ Atlas of Health Care Variation: HQ & SC Midland Regional Services Plan 2016/17 The Networks Plan Pinnacle-Midland Health Network Alliance Tairāwhiti Integration Forum (TIF) work programme Healthy Families East Cape programme. Action Plan Objective Actions to deliver improved performance Measure Reporting Prevent high-risk people from developing type 2 diabetes Continue to support activities driven by the Healthy Families East Cape initiative. Continue to maintain the level of green prescriptions at 22% above the MoH funded levels. Prevent high-risk people from developing type 2 diabetes Hauora Tairāwhiti will support Ngāti Porou Hauora s re-development of their Ngāti and Healthy programme. Tairāwhiti Māori NGO providers will continue to empower community and whānau through whānau ora services. Enable effective selfmanagement Improve Quality of Services / Provide Integrated Care Tairāwhiti Māori NGO providers will continue to empower community and whānau through Whānau Ora services. We will link effectively with Hauora Tairāwhiti Healthy Populations Team to ensure effective health promotion messaging is consistent across Tairāwhiti and reaching at-risk patients and whānau. Implement the pilot mental health support for people with diabetes programme to ensure patients are supported effectively regarding their mental health, which will empower patients to manage their condition(s) well. Implement the recommended actions identified by the review of current services against the Quality Standards for Diabetes Care 2014, review due to be completed in Q4 of 2015/16. Continued support to primary care through the provision of: Diabetes education provision for clinical teams (allied, medical, Reduction in proportion of patients with Hba1c above 64, 80 and 100 mmol/mol Reduction in Ambulatory Sensitive Admissions to Hospital (ASH) rates for 45 to 64 year olds Quarterly nonfinancial reporting. 2016/17 Annual Plan Hauora Tairāwhiti 79

80 Objective Actions to deliver improved performance Measure Reporting nursing) DHB Clinical Nurse Specialist and primary care nurse joint clinics for complex patients with diabetes e.g. insulin start support Recommencement of diabetes link nurse group. Detect diabetes early and reduce the risk of complications Meet the needs of children and adults with type 1 diabetes Development of the Advanced Primary Options programme, including increased funding for provision of free primary care nurseled services targeted at high risk patients with diabetes. Maintain the support for our mums with gestational diabetes through the multidisciplinary team intervention and engagement. We will explore the opportunity to increase the integration of podiatry service provision in Tairāwhiti in Q1. Maintain and improve the current rate of CVD risk assessments. Support primary care provision of regular assessments including the proactive recall for retinal screening, foot checks and renal function tests. Provide community and mobile (East Coast) retinal screening services Continue to fund community podiatry services which reduce the progression of diabetic foot complications to amputations. Implement the pilot mental health support for people with diabetes programme. Maintain the current Tui Te Ora (secondary care) team support for primary care teams and directly with patients with type 1 diabetes including collaboratively working with the paediatricians for children. IPIF More Heart and Diabetes Checks performance is maintained and improved across our three PHOs. Reduced inequity in the above measure between Māori and Pacific and Non-Māori IPIF Quarterly Reporting 2016/17 Annual Plan Hauora Tairāwhiti 80

81 CARDIOVASCULAR DISEASE Our Approach Cardiovascular disease is a significant burden for many of our Tairāwhiti population, particularly for Māori who endure significantly worse outcomes than non-māori. Our approach is to continue to work in collaboration as one team between our primary care, secondary care, tertiary care (Waikato DHB) and community NGO partners to reduce the incidence and burden of cardiovascular disease for our population through prevention, early identification, supporting effective self-management, and quality integrated services. Linkages Integrated Performance and Incentive Framework (IPIF) New Zealand Primary Care Handbook (Update 2013) Cardiovascular and Diabetes Risk Assessment The Networks Plan Pinnacle-Midland Health Network Alliance Māori Health Plan Tairāwhiti Integration Forum (TIF) work programme Healthy Families East Cape initiative. Action Plan Objective Actions to deliver improved performance Measure Reporting More heart and diabetes checks Our PHOs will continue to deliver more heart and diabetes checks based on comprehensive cardiovascular risk assessments (CVDRAs) and diabetes checks, targeting the delivery towards high risk populations. Budget 2013 funding will be prioritised towards reducing the gap in CVDRA coverage between our Māori population and non-māori population. More Heart and Diabetes Checks Health Target / IPIF Target of 90% continue to be met and exceeded. Meet 90% Health Target / IPIF Target for our Māori population PP20: IPIF measure CVDRA rates for all, Māori, non-māori. PP20: Māori men aged years CVDRA rate We will work with our PHOs to develop reporting against the new measure: percentage of eligible Māori men in the PHO aged years who have had a CVD risk recorded within the past five years Supporting management better of Our PHOs will risk stratify people with cardiovascular disease consistently and support each person s management of the disease Improved rates of appropriate cardiac prescribing for Māori people (statins, To be included in PP20 reporting 2016/17 Annual Plan Hauora Tairāwhiti 81

82 Objective Actions to deliver improved performance Measure Reporting cardiovascular disease accordingly. We will continue to maintain the level of green prescriptions at 22% above the MoH funded levels. We will progress the development of the Advanced Primary Options programme, including increased funding for provision of free primary care nurse-led services targeted at people with high risk long term conditions. anti-coagulants etc.) TOBACCO SMOKEFREE 2025 Our Approach We will implement the actions described in our refreshed Tobacco Control Plan focussing on the Young Māori women, Whānau and Smokefree environments. This will be a focussed approach putting resource into the population with the highest rates of smoking including their geographical domicile, ethnicity and age group. Increased integration into all other aspects of health is critical to achieving Smokefree Aotearoa Supporting smokers to quit needs to be integrated into all primary, secondary and maternity health services and DHBs have a leading role. We will require our providers to prioritise smoking and ensure all staff, patients and families are provided with help to quit smoking. The Smokefree Health Targets will remain a priority and we will continue to engage regularly with our primary care partners and share information about the Health Target as well as monitoring actual performance against planned performance. We will have a renewed focus and priority on reducing smoking in pregnancy. Activities to reduce smoking in pregnancy are part of our Maternity Quality and Safety (MQSP) programme, Well Child Tamariki Ora Quality Improvement Framework and Maternal and Child Health Integration Programme. Linkages Minister s Letter of Expectations Health Target s Better Help for Smokers to Quit, primary and maternity care Tobacco Control Plan Well Child Tamariki Ora Quality Improvement Framework Maternity and Child Integration Programme 2016/17 Annual Plan Hauora Tairāwhiti 82

83 Action Plan Objective Actions to deliver improved performance Measure Reporting Better Help for Smokers to quit Maternity Implement the updated and refreshed Tobacco Control Plan DHB will work towards the goals of Smokefree Aotearoa 2025 and Smokefree Midland 2025 by ensuring that: All patients (who smoke and are seen by a health practitioner in primary, secondary and maternity care settings) are asked about their smoking status, given brief advice to stop smoking, and are offered/given effective smoking cessation support (i.e. ABC), as part of their routine clinical care; Each patient s ABC information is documented accurately within their patient record, accuracy of records will be maintained through regular practice level audits by PHO teams of smoking status and followed up with session with practice staff to reinforce correct documentation process. Primary, secondary and maternity services undertaking ABC processes with patients who smoke and refer to national and district providers of cessation services Primary care will continue to provide ongoing audit and training services to the practices within Tairāwhiti. Continue to resource and support primary care coordination of the primary care smoking target at 0.4 FTE (Pinnacle-Midland Health Network). Provide further resource 0.4 FTE from the DHB and primary care smoking cessation service to work in partnership to implement sustainable systems and processes into National Hauora Coalition (NHC) and Ngāti Porou Hauora (NPH) practices. Continue to support Lead Maternity Carers (LMCs) and primary care practices to provide pregnant women who smoke with 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 12 months 90 percent of pregnant women who identify as smokers upon registration with a DHB employed midwife or LMC are offered advice to quit and support to quit smoking By 2025, less than 5 percent of the DHB s population will be a current smoker By 2025 Tairāwhiti is smokefree. Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 83

84 Objective Actions to deliver improved performance Measure Reporting Smokefree Clauses active support to quit as early as possible in pregnancy Continue to support dedicated Smokefree midwife to liaise with LMCs and providers of services to pregnant women to implement smokefree ABC in early pregnancy, including training, referral pathways, monitoring and support Continue to attend monthly LMC meetings, college meetings to have smokefree as a routine agenda item Smokefree midwife to continue to facilitate access for all midwives (DHB and LMCs) to pregnancy smokefree training Continue to collect the information of Smokefree ABC status on the DHB booking in form, follow up incomplete documentation Continue to work with LMCs and cessation providers to implement consistent best practice referral pathways and treatment plans. Plans will be developed and implemented and monitored through the smokefree coalition. Review the integration of current specialist smokefree services for pregnant women into the maternal, child and youth health community Review providers on their focus, to identify the target group, evidence based interventions, issues, barriers etc. Continue communications to LMCs on the target and the WCTO QIF results for smokefree Continue to support sonographers providing prenatal ultrascans at Gisborne hospital radiology to provide brief advice with a view of having smoking cessation support available to provide immediate support. Continue to contractually require and support all DHB and non DHB providers to implement smokefree policies including help for all smokers over 15 years within their services (staff, volunteers and clients) and referral pathways Hospital sonographers are applying brief advice to pregnant women who smoke and referring them onto smoking cessation services Better Help for Smokers to Quit 2016/17 Annual Plan Hauora Tairāwhiti 84

85 Objective Actions to deliver improved performance Measure Reporting Smokefree Whānau Work alongside Te Ara Ha Ora the National Māori Smokefree Coalition group to promote Auahi Kore/ Tupeka Kore Marae, Kura, Koahangareo, hakinakina and areas where large groups of Māori are most likely to frequent Work alongside Te Ara Ha Ora to promote Hapūtanga wahine Increased awareness of Auahi Kore / Tupeka kore Marae etc Increased awareness of Māori traditional hapūtanga and the importance of Auahi Kore/ Smokefree RISING TO THE CHALLENGE Our Approach Hauora Tairāwhiti continues to work towards providing a more integrated continuum of care as articulated in Rising to the Challenge. In the past year this has included greater engagement with our regional and tertiary partners with further activity anticipated in 2016/2017 to consolidate our efforts to date. Access to some free GP care for people with serious mental illness and addiction commenced in July 2015; an informal evaluation was undertaken in May 2016 and resulted in some changes to the services which continue to be implemented. The single point of entry into adult mental health and addiction services was implemented in 2015 and is now being extended to include primary mental health and the infant, child and adolescent mental health services (Te Whare O Te Rito). This will require greater integration and collaboration between the primary health organisations, particularly Pinnacle-Midland Health Network and Hauora Tairāwhiti, as they will effectively be working as one team. A consultant psychiatrist is also now spending one day a week within general practice working with people presenting with early indications of mental illness and providing consult liaison to primary health care clinicians. Little progress has been made on how to best support people with high and complex needs related to serious mental illness and/or addiction in Tairāwhiti. A working group has been established to foster improved links with the tertiary provider of Tairāwhiti s regional rehabilitation and forensic services. Activity against Tairāwhiti s suicide prevention and postvention plan has been slower than anticipated for a variety of reasons. At the end of the 2015/2016 year, projects to evaluate current suicide prevention activity and to establish the postvention response team were finally underway. These activities are likely to flow into 2016/2017. With the addition of an infant mental health service into the child and adolescent service, the local perinatal clinical network is re-establishing itself with a broader focus, as well as linking to the regional network. A review of alcohol and other drug services in Tairāwhiti got underway at the end of the 2015/2016 financial year. Any recommendations will continue to be implemented this year as well as preparing for impacts of the new Substance Addiction Compulsory Assessment and Treatment Act. Work also began in 2015 to develop respite for children and young people with serious mental illness and/or addiction. 2016/17 Annual Plan Hauora Tairāwhiti 85

86 In addition, Hauora Tairāwhiti has undertaken to end the use of seclusion on the inpatient unit by A sector-wide approach is being planned as alternatives to seclusion are explored and implemented. The following action plan is based around the four objectives of Rising to the Challenge Use current resources more effectively Improve integration between primary and specialist services Cement and build on gains in resilience and recovery Deliver increased access for all age groups Funding decisions will reflect the terms and conditions of the ring fence for mental health services. Linkages Minister s Letter of Expectations PP25 Prime Minister s youth mental health project PP26 Mental health services development plan Midlands regional services plan Our Performance Story Impact: People receive timely and appropriate specialist care Our Performance Story Impact: People stay well in their homes and communities Action Plan Objective Actions to deliver improved performance Measure Reporting Improve effectiveness service Improve specialist service performance using national performance indicators and service user feedback Maximise the percentage of staff time spent in direct service delivery Support the shift to an outcomes-focussed approach Continue to actively participate in the national KPI forums (Adult, and Child and Youth) Fully implement single point of entry into mental health and addiction services including primary mental health services and Te Whare O Te Rito Reduce the number of missed appointments Discuss with providers with a view to including in agreements for /17 Annual Plan Hauora Tairāwhiti 86 Service Plan Development Improvement against KPIs each year Service Development Plan Single point of entry in place by June 2017 Access rates to mental health services Barriers are identified by August 2016 Changes are piloted by December 2016 Service Plan Development Support fit-for-purpose Implement any changes from the evaluation of the Primary Options Changes implemented by December Service Development

87 Objective Actions to deliver improved performance Measure Reporting service configuration for Mental Health Service (some free GP care for people with serious mental illness and/or addiction) 2016 Plan Support service users in the role as parents Implement at least half of essential elements of the Supporting Parents, Healthy Children guidelines All organisations have a designated champion by September 2016 Service Plan Development Data is routinely collected and recorded by December 2016 Directory of community services is available by April 2017 Resources are available for parents and children by June 2017 Relevant training is provided to staff by June 2017 Work to prevent suicide among people known to mental health and addiction services Continue to action the cross-sector Tairāwhiti Suicide Prevention and Postvention Plan Work to implement any outstanding recommendations from Preventing Suicide: Guidance for emergency departments at Gisborne Hospital. Postvention response team is in place by September 2016 Recommendations from the evaluation are assessed and implemented by June 2017 Recommendations in place in Emergency Department by June 2017 Service Plan Development Work collectively to improve coordination Improve crisis response to tangata whaiora referred by Police Continue to provide regional Eating Disorders intervention service in Tairāwhiti Implement recommendations from the service review of the Regional Eating Disorders Service once agreed by Midlands, Revised memorandum of understanding agreed with Police and Ngāti Porou Hauora by April 2017 Progress monitored via interface meetings with Police Service Plan Development 2016/17 Annual Plan Hauora Tairāwhiti 87

88 Objective Actions to deliver improved performance Measure Reporting Northern Regional Alliance and the Auckland DHBs To be determined once recommendations agreed Employment specialist With NGO partners and other key stakeholders, agree an approach to support people with serious mental illness with seeking employment Draft approach agreed by December 2016 More tangata whaiora in paid employment by June 2017 Service Plan Development Acute alternatives impatient Complete plan with consumers, whānau and stakeholders to implement a local response to supporting people with high and complex needs as a result of serious mental illness and/or addiction with approval from the Board Plan approved by the Board by June 2017 Service Plan Development Kaupapa Māori Services Continue to grow the Mahi a Atua approach within the mental health sector in Tairāwhiti Service user feedback via Feedback Informed Treatment Service Plan Development Support a coordinated multi-agency response for youth with complex interagency needs Establish community-based respite for children and young people with serious mental illness and/or addiction by December 2016 Provision of community-based respite for children and young people with serious mental illness and/or addiction by December 2016 Service Development Plan Board paper Specialist mental health services for high-needs whānau with infants Strengthen the local clinical network for perinatal and infant mental health Continue to contribute to regional work in order to provide and support integrated responses to acute care Terms of reference agreed by December 2016 Tairāwhiti representation at three regional meetings until June 2017 Service Plan Development Enhance the responsiveness of specialist addiction services to justice services Complete stocktake of alcohol and other drug services in Tairāwhiti to identify areas of need or oversupply Implement any resulting changes Stocktake completed by December 2016 Any resulting changes implemented by June 2017 Service Development Plan Board report Reduce and eliminate the use of seclusion and Work towards eliminating the use of seclusion at Te Whare Awhiora by 2020 Working group established by September 2016 Service Plan Development 2016/17 Annual Plan Hauora Tairāwhiti 88

89 Objective Actions to deliver improved performance Measure Reporting restraint for Māori System Integration Project scope signed off by the Board by December 2016 Board report SERVICE CONFIGURATION Our Approach System integration encompasses key components of system change and improvement to ensure people receive more effective and coordinated services closer to home. This priority area encompasses requirements for the Integrated Performance and Incentive Framework and integrating services into the community. Focus areas include: ensuring all children get the best start (E Tipu E Rea), supporting people with long term conditions receiving appropriate services closer to home; implementation of national criteria for community referred diagnostics; managing long term Mental Health whaiora personal health needs in primary care; continued adoption and release of clinical pathways that support integrated care for primary care direct and easy access to specialist nurse/doctor advice. Localised clinical pathway information will also support extended care in the community setting by primary care. Other key system approaches identified to significantly contribute to system integration are: long term conditions management; diabetes care improvement packages; more heart and diabetes; primary mental health which are referenced in further sections of this plan. The local Alliance team, which draws together in an Alliance Agreement Ngāti Porou Hauora, Pinnacle-Midland Health Network, National Hauora Coalition and Hauora Tairāwhiti, has taken the lead for the identification and progression of wider system oriented improvements to service integration in regard to the above focus areas and linking to existing broader Alliance work programmes in the Midland region. Pharmacist services in the community are a critical part of primary health services. Community pharmacists are the experts in medicines management, and we will be working with the national Community Pharmacy Services programme as well as our local partners to ensure services are better integrated with the wider health system and targeted towards priority areas. Information sharing is collectively appreciated as critical to support the integrated approach and information system capacity within systems and will be a key enabler for the Alliance partners to achieve objectives between primary, secondary and social sectors. As such work has begun to develop a dashboard across the Midland region which provides partners with a view of how their activity contributes to outcomes for the whole district and as a region. New models of care and approaches to delivering services in a sustainable manner are going to be critical to support the population of the district moving forward. The Alliance s work plans reflects the priorities for the district which currently are to o Ensure all children in Tairāwhiti have the best start in life 2016/17 Annual Plan Hauora Tairāwhiti 89

90 o Ensure people with long term conditions are supported in the best possible way, and o Seek to achieve an improved Integrated Care system All contracting and service provision through Hauora Tairāwhiti will seek to achieve the wellbeing of whānau through the implementation of Pae Ora principles, and apply these at both a whānau and a systems level. Tairāwhiti has already made progress in many areas around service integration and continues to work at it and perhaps hasn t publicised enough some of its initiatives. A significant piece of work was begun in late 2015 with the re-launch of Tairāwhiti District Health Board as Hauora Tairāwhiti with the accompanying WAKA values and kaupapa. Behind this new approach came recognition that continuing to do the same thing will not improve population health outcomes quickly enough, especially for Māori. Initially Hauora Tairāwhiti shared its fresh approach with iwi, consumers and Primary Health Organisations in order to test the readiness for transformational change and this grew in early 2016 to include governance groups and the social sector. There was clearly an appetite for making meaningful transformational change within the health sector and across the broader social determinants of health. An indicative plan of activity is described below. Linkages P22 Improving system integration Action Plan Objective Actions to deliver improved performance Measure Reporting Continue to develop Our Model using co-design Co-ordinated services restrict acute demand Iwi-led Social Investment Group to be project sponsor Working group established with agreed terms of reference Undertake first round of consultation with the community Develop and draft Our Model Undertake consultation of draft Model with partners and community Finalise Our Model Develop implementation plan using co-design Management of acute demand strategies planned include joint DHB- PHO ASH analysis, continued utilisation of the current Primary Options programmes. Currently two senior medical physicians are Terms of reference agreed by July 2016 First round of consultation completed by September 2016 Draft Model completed by November 2016 Final Model completed by January 2017 Implementation plan completed by February 2017 September 2016 Review the improved clinical pathways between secondary and primary care service for Mental Ongoing reporting to Iwi-led Social Investment group Six monthly reporting to the Board On-going reporting on progress to TIF 2016/17 Annual Plan Hauora Tairāwhiti 90

91 Objective Actions to deliver improved performance Measure Reporting available to assist primary care decision making via telephone, in regard to acute patient needs. Finalise the development of the Advanced Primary Options suite of services, by September 2016, and implement from 1 October Advanced Primary Options is envisaged to be a mechanism for funding an increased range of services in primary care, of which some are existing secondary care services. Health and Specialist Diabetes initiated in 2015/16. October 2016, Clinical Leaders Forum identify areas where clinical pathways could be improved and seek feedback on progress to date. December 2016 Extend the Medicine clinical pathway beyond diabetes to include all General Medicine specialists. December 2016 Paediatric Specialist s clinical pathway established through E Tipu E Rea to provide support to General Practitioners. June 2017 Surgical Services clinician will establish a clinical pathway to support General Practitioners. Annual Map of Medicine pathways reviewed as planned; At least quarterly progression for localisation and matched to parallel release of e Referrals facilitated as complementary process for pathway implementation to improve integrated approach (primary/secondary) On-going reporting on progress to TIF Six monthly Board report on Annual plan progress Six monthly Board report on Annual plan progress Utilisation report by partners 2016/17 Annual Plan Hauora Tairāwhiti 91

92 Objective Actions to deliver improved performance Measure Reporting Pharmacy Action Plan Maternal Oral Health and increased adolescent coverage Participate in the national development and implementation of medicines adherence and optimisation of services of high quality (the Pharmacy Council of New Zealand s Medicines Management Competence Framework and the National Pharmacist Services Framework are good references in developing these services) that must include targeted volumes for each service by year end. This includes reviewing the current service provision across the country and building the framework for the rollout these services within the Community Pharmacy Services Agreement Participate in the national development and implementation of an efficient medicines supply chain. As part of the national development work plan, we will undertake, by December 2016, a stocktake of the current community pharmacy resources component of the one-team alignment across Tairāwhiti, including rural settings, and benchmark these against national figures and analysis of population need. As part of the community pharmacy service agreement development, Tairāwhiti will look to commission services to best meet the identified demand. From July 2016, providing free basic dental care to hapū wahine who meet the following criteria- High risk pregnancy Gestational diabetes Reside in a NZ deprivation area 8-10 Referrals will form part of the E Tipu E Rea hub. Free maternal dental care will link into the Smokefree referral pathway Utilisation report by partners Update report identifying progress made during the quarter against the actions to deliver improved performance. The report will include: Whether the DHB is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered in the quarter Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery Where quantitative measures are reported Reports must include baseline, target and quarterly performance progress 200 high risk women will be provided with free basic dental care. All hapū wahine who access the ice who smoke will be provided brief advice and referred to smoking cessation provider Year 1 will see adolescents coverage in Quarterly 6 monthly to Board and TIF 2016/17 Annual Plan Hauora Tairāwhiti 92

93 Objective Actions to deliver improved performance Measure Reporting Year one will see adolescent s dental care being provided within Western Rural, where traditionally these adolescents would have been required to travel to town. increase to 85% for western rural adolescents Primary Care Provide ongoing specialist clinical support to general practice teams to fit with people s care plans or Year of Care (Pinnacle-Midland Health Network) and continue to support the increased capability of primary care teams. Support Pinnacle-Midland Health Network s further development, evaluation and rollout of the Health Care Home model of care in Tairāwhiti and across the Midland Region. Including: Supporting the transition of one Tairāwhiti practice to Health Care Home. Supporting the new integrated Patient Health Information System including API (application programme interface) level access to hospital data Supporting the regional evaluation of Health Care Home Tairāwhiti Primary care teams sustain and improve on current excellent performance in National Health Targets PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke) Health Care Home model will be implemented in a Tairāwhiti Primary Care Practice by June Quarterly reporting Support Ngāti Porou Hauora s re-development and re-deployment of Ngāti and Health programme which will fit within primary care services on the East Coast and provide community support services which support better outcomes for Ngāti Porou people. Tairāwhiti Integration Forum re-shape Review the current membership and function of the Tairāwhiti Integration Forum (TIF) in Q1 to ensure the group is enabling the achievement of better outcomes for Tairāwhiti people, including appropriate clinical and Te Ao Māori leadership within the group. Utilise the experiences of the Capital & Coast integration journey to help guide this review. New membership and terms of reference implemented by end of Q2. 6 monthly update as part of PP /17 Annual Plan Hauora Tairāwhiti 93

94 SYSTEM LEVEL OUTCOME MEASURES Our Approach The Ministry of Health worked closely with the sector to co-develop new System Level Measures. They are: Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for 0 4 year olds (i.e. keeping children out of hospital) Acute hospital bed days per capita (i.e. using health resources effectively) Patient experience of care (i.e. person-centred care) Amenable mortality rates (i.e. prevention and early detection). System Level Measures are high-level goals of the health system that help show the outcomes of the system. That is, how it is performing and the value the country is receiving from it. System Level Measures are defined nationally by the Ministry of Health, working with the sector. They are the organising principles for contributory measures. Hauora Tairāwhiti Ngāti Porou Hauora, Pinnacle-Midland Health Network and National Hauora Collation drive implementation of the System Level Measures. Linkages Our Performance Story Impact: People receive timely and appropriate specialist care Midland Regional Services Plan Midlands Alliance Leadership Team Action Plan Objective Actions to deliver improved performance Measure Reporting System Level Measures Establishment of a Midland United Regional Alliance Leadership Team Hauora Tairāwhiti will work with partners to jointly developed and agree an Improvement Plan by 20 October Development of a Regional Alliance Leadership Team of all the Midland PHOs and DHBs. By July 2016 draft Terms of Reference for the alliance have been circulated and considered by the alliance partners. PP22: Improving system integration and System Level Measures (SLM) SI1: Ambulatory sensitive hospitalisations (ASH) SI7: SLM total acute hospital bed days per capita SI8: SLM patient experience of care SI9: SLM amenable mortality rate DV6: SLM youth access to and utilisation of youth appropriate health services DV7: SLM number of babies who live in a smoke-free household at six weeks post-natal Establishment of a Midland United Regional Alliance Leadership Team Quarterly To relevant boards on a quarterly basis 2016/17 Annual Plan Hauora Tairāwhiti 94

95 CANCER Our Approach Hauora Tairāwhiti DHB works in partnership with the Midland Cancer Network(Midland Cancer Strategy Plan ) with a vision of regionally working together as one. Collectively, we will lift the performance of our health systems by driving quality, improve experience of care, accountability, innovation and value. The Midland Cancer Network brings together regional stakeholders who are working across the cancer pathway including DHBs, NGOs, GPs and PHOs, cancer service providers, cancer consumers and their family/whānau, hospices and research organisation s. Midland encompasses the Bay of Plenty, Lakes, Hauora Tairāwhiti and Waikato districts, with an open invitation to Taranaki DHB. Cancer networks work across boundaries to improve outcomes for patients. Most New Zealanders will have experience of cancer, either personally or through a relative or friend. Cancer is the country s leading cause of death - 30% (Ministry of Health. 2010). While the overall risk of developing cancer in New Zealand is decreasing, the number of people developing cancer is increasing mainly because of population growth and ageing. Once people are diagnosed with cancer they are now less likely to die from it. This means that people are surviving longer, and being treated for longer periods of time, with different treatments. Hauora Tairāwhiti has a higher MāorSI7 i population, more people living in more socio-economically deprived areas both rural and remote areas and those who live in a large city. Māori have a higher cancer incidence (20% greater), higher cancer mortality (80% higher), and Māori are more likely than non-māori to have their cancer detected at a later stage of disease spread. There are wide variations in survival rates between DHBs in New Zealand. The strategic framework for action takes a total continuum of care approach for the Tairāwhiti population from prevention and early detection screening diagnosis and treatment follow-up and surveillance survivorship palliative care and last days of life. The 2016/17 plan aims to build and strengthen the alignment and linkages of the various Midland and Tairāwhiti health services related to the cancer continuum. This is demonstrated in the Line of Sight Section (refer below). Key objectives The Midland Cancer Strategy Plan strategic objectives are to: 1. Reduce the cancer incidence through effective prevention, screening and early detection initiatives 2. Reduce the impact of cancer through equitable access to best practice care 3. Reduce inequalities with respect to cancer 4. Improve the experience and outcomes for people with cancer The strategic objectives are supported by five enablers: infrastructure, information systems, workforce, supportive care, knowledge and research. Faster Cancer Treatment (FCT) The FCT programme is a key focus of the Hauora Tairāwhiti DHB, Midland and National Cancer Programme. The FCT programme is designed to improve access, timeliness, quality of cancer services, and standardise care pathways for all patients wherever they live. There are several main work streams to the FCT programme such as development and review against national tumour standards, service improvement and/or equity initiatives to ensure achievement of the Health Target and/or implementation of the national tumour standards, one-off FCT projects, improving the coverage and functionality of multidisciplinary meetings (MDMs). 2016/17 Annual Plan Hauora Tairāwhiti 95

96 Linkages Minister s Letter of Expectations New Zealand Cancer Plan Better, Faster Cancer Care (NZ Cancer Plan) New Zealand Cancer Health Information Strategy Midland Regional Services Plan Prostate Cancer Awareness and Quality Improvement Programme Midland Cancer Strategy Plan Midland Cancer Network Annual Plan 2016 /17 Midland MDM Action Plan 2016 Midland Radiation Oncology Plan and Midland Medical Oncology Services Plan Midland Psychological and Social Support Services Plan Midland Adult Specialist Palliative Care Services Development Plan Health Target Faster Cancer Treatment and other related policy priority indicators DHB Māori Health Plan & DHB Public Health Unit Plan Our Performance Story Impact: People receive timely and appropriate specialist care Action Plan Objective Actions to deliver improved performance Measure Reporting Faster Cancer Treatment (FCT) - Health Target Deliver against the Midland FCT Plan Continue to improve the quality of data and data collection Continue to implement initiatives to achieve the 15-25% of cancer registration cohort within the 62 day Health Target Participate in the Midland FCT and Tairāwhiti Work Groups and regional activities to improve patient care Initiatives that support primary care and/or private provider interface with FCT indicators are identified and implemented Identify and implement actions to improve FCT data collection systems to identify service improvements along the cancer patient pathway. Where required, identify risks and mitigation strategies. Continue to work towards integration of FCT data collection as business as usual across all clinical teams Faster Cancer Treatment (FCT) Health Target Progress against target to achieve 85 % of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016 and increasing to 90% by June 2017 Demonstrate 15% of Tairāwhiti newly diagnosed cancer patients, moving towards 25%, will be reported in the FCT Health Target Faster Cancer Treatment (FCT) Policy Priority 30 (PP30) 31 day indicator: 85 percent of patients with a diagnosis of cancer who receive their first cancer treatment (or other management) within 31 days of decisionto-treat. Reported quarterly with monthly data submission 2016/17 Annual Plan Hauora Tairāwhiti 96

97 Objective Actions to deliver improved performance Measure Reporting Faster Cancer Treatment (FCT) Improve Equity at a systems and organisation level Refer to Equity of Health Care for Māori: A Framework resource) Faster Cancer Treatment (FCT) - Regional tumour standard reviews Work in partnership with Midland Cancer Network to: Deliver one Kia Ora E Te Iwi community health literacy programme Implement the Midland Patient Information Resource Project 2016/ /18 Implement the Midland Psychological and Social Support Services Plan Consider including cancer component into whānau ora contracts Support a cough cough cough early detection lung cancer project clinicians support regional project Work in partnership with Midland Cancer Network and participate in the Midland DHBs stocktake of myeloma cancer services and gap analysis against national sarcoma tumour standards: Tairāwhiti self-assessment and data analysis completed by Review FCT data collection systems implemented actions to identify areas of improvement DHB Tairāwhiti 2015/16 baseline (July-Dec 15) 65.9% 2016/17 target 85-90% 2016/17 Annual Plan Hauora Tairāwhiti day cohort baseline* 7 cohort target* /16 baseline (July-Dec 2015) 88.4% 2016/17 target 85% volume baseline* 20 volume target* 20 Report on: Number of Hauora Tairāwhiti Māori health providers completed Kia ora - E te iwi programmes Hauora Tairāwhiti participation in Midland Hei Pa Harakeke work group Development of Psychological and Social Support Services Progress to include cancer prevention messages in contracts Report on progress DHB self-assessments completed 31 day Regional review against national tumour standards reports are completed 30 June 2017 June 2017 June 2017 Quarterly June 2017 Quarterly Quarterly

98 Objective Actions to deliver improved performance Measure Reporting October 2016 Participate in Midland Work Group to review findings and develop report and action Work in partnership with Midland Cancer Network and participate in the Midland DHBs stocktake of lung cancer services and gap analysis against national lung tumour standards: Tairāwhiti self-assessment and data analysis completed by April 2017 Participate in Midland Work Group to review findings and develop report and action plan by June 2017 Support monitoring through regional Lung Cancer KPI report six monthly Faster Cancer Treatment (FCT) - Improve Multi- Disciplinary Meetings (MDMs) Faster Cancer Treatment (FCT) Shorter Waits for Cancer Treatment Work in partnership with Midland Cancer Network to Identify key activities to address issues identified as a result of completed regional tumour standards reviews for lung (2014), colorectal (2014), gynae-oncology (2015), breast (2015), sarcoma (2015), lymphoma (2016). Deliver against the Midland MDM Action Plan (2016) that works towards Compliance with the National MDM Guidance and improve functionality and coverage of MDMs Sustain performance against the radiotherapy and chemotherapy wait time targets by more efficient use of existing resources; and investing in workforce, capital and capacity as required Report through Policy Priority 24 (PP24) for: Progress delivering improved cancer MDMs based on the actions agreed using the funding for MDMs including variance in expenditure against the allocated Tairāwhiti DHB MDM funds Report through Policy Priority 30 (PP30) for shorter waits for cancer treatment: All patients for treatment wait less than four weeks for radiotherapy or chemotherapy. Cancer centre reports cancer treatment target, Lead: Waikato Regional Cancer Centre. Tairāwhiti DHB to review received monthly reports and investigate if target not met Quarterly Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 98

99 Objective Actions to deliver improved performance Measure Reporting Faster Cancer Treatment (FCT) Improving the quality of data and data collection aligning with New Zealand Cancer Health Information Strategy (2015) Faster Cancer Treatment (FCT) Workforce Development Respond to the review and update of the: Midland Radiation Oncology Plan and Radiation Oncology National Linear Accelerator and Workforce Plan (due for publication June 2016) & Midland Medical Oncology Plan Implement Midland Oncology Imaging Pathway and Protocols (based on NCN work) in partnership with Midland Radiology Group (tbc - dependent on available resources) Source - Midland Routes to Cancer Diagnosis and Treatment Project Support the regional development of Midland Cancer Health Information and ICT work plan that links with national and regional strategies/initiatives i.e. FCT, NPF, ProVation, MDM, e- referral, PalCare, Dendrite (tbc - dependent on available resources). Participate in the national CHIS MDM project as required Identify workforce programmes of work that support the actions the region is undertaking to improve cancer service In partnership with Midland Cancer Network implement the Cancer Nurses Knowledge and Skills Framework Continue to support Midland to implement the Midland Medical Advanced Palliative Care Trainee Model of Service (2015). Continue support of the cancer nurse CNS/coordinator role including participation in the national CNCI evaluation process, attendance at national and regional training/mentoring forums Undertake Hauora Tairāwhiti Development of Cancer Nurse Care Coordination Framework Project and implement recommendations Continue support for Psychological and Social Support roles Report on regional service improvement initiatives Report on participation if project progresses Report on participation if project progresses Report on participation and activities Quarterly to be determined to be determined Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 99

100 Objective Actions to deliver improved performance Measure Reporting Treatment (FCT - Improved access to diagnostics for endoscopy/colonoscopy services Note: Links with elective services, radiology and cancer/fct sections of the annual plan to develop and work regionally Continue to support implementation of the national Endoscopy Quality Improvement (EQI) Programme Continue participation in Midland Colorectal and Midland Colonoscopy Work Groups to improve services Improve waiting times for diagnostic and surveillance colonoscopy services Work with MCN to develop operational policies to support using the Global Rating Scale (GRS) as part of the National Endoscopy Quality Improvement Programme (NEQIP) Use of the National Referral Criteria for Direct Access Outpatient Colonoscopy Continue to monitor CTC as a subset of CT Work regionally to implement and evaluate the Midland colonoscopy e-referral Standardise triage processes for surgical and medical colonoscopy referrals Implement ProVation using Waikato server Participate in Midland Bowel Screening Work Group to start regional conversations regarding pathways and implications should there be national rollout of a bowel screening service Report through Policy Priority 29 (PP29): Diagnostic colonoscopy 85 % of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days); and 100% within 30 days 70 % of people accepted for a non-urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100 % within 90 days Surveillance/Follow-up colonoscopy 70 % of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date, 100% within 120 days ESPI and wait list monthly reports reviewed by Provider Arm. Tairāwhiti DHB baseline table: as at 2015/16 December 2015 results DHB baseline % achieved 2015/16 urgent diagnostic 50% 2015/16 non-urgent 40% 2015/16 surveillance 68.8% Quarterly National Tumour Stream Work Programme - Prostate Cancer Implement priorities identified in the Prostate Cancer Quality Improvement Plan Work with stakeholders to implement national guidance on the use of active surveillance treatment for men with low Report on progress and activities Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 100

101 Objective Actions to deliver improved performance Measure Reporting Midland Lung Cancer Improvement Programme Hauora Tairāwhiti palliative care service improvement grade prostate cancer Work with primary care to identify actions to implement the national prostate cancer management and referral guidance Support the MCN Lung Cancer Working Group work programme priorities relating to prevention, early detection, health promotion, health literacy and addressing equity issues: Work in partnership with Waikato to improve timeliness of the Tairāwhiti lung cancer pathway Support Midland Early Detection of Lung Cancer Project 2016/17 Implement the Standards for Service Provision for Lung Cancer Patients in New Zealand Implement national lung cancer follow-up and surveillance guidance due to be developed by June 2017 Continue to support Tairāwhiti palliative care service integration activities. Support Midland Adult Specialist Palliative Care Service Development Plan recommendations Support the implementation of the hospice innovative Fund initiatives Hospice Tairāwhiti implement PalCare Participate in regional forums and initiatives to improve palliative care Continue consideration to implement National Specialist Palliative Care Service Specifications (2015) Consider National Adult Palliative Care Review recommendations (due September 2016) and build into local and regional work programme as able Report on progress and activities Report progress and activities Record of participation evidenced by meeting minutes Quarterly Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 101

102 STROKE SERVICES Our Approach The Midland Stroke Action Group are leading on regional actions to improve DHBs ability to improve stroke prevention, stroke event survival, and reduce subsequent stroke events and improve access to organised acute and rehabilitation stroke services Our organised stroke service has an integrated approach, which has been embraced by the Tairāwhiti sector wide steering group. It brings together nursing, allied health and medical specialist from both acute and rehabilitation services as well as services offered in the community. The focus of the service is about prevention and promotion as well as getting the best outcome for each patient who has had a stroke, bringing all the resources we have to ensure they get the best care. Linkages Midland DHBs Regional Services Plan Our Performance Story Impact: People stay well in their homes and communities Our Performance Story Impact: People receive timely and appropriate specialist care New Zealand Clinical Guidelines for Stroke Management 2010 National Clinical Stroke Network Midland DHBs Regional Services Plan 2015/16 Midland Stroke Network Action Plan Objective Actions to deliver improved performance Measure Reporting Stroke Service Management Management of people with stroke, acute transient ischaemic attack services and rehabilitation by dedicated virtual team (as recommended in the NZ Clinical Guidelines for Stroke Management) All stroke patients admitted and treated in the setting of an organised stroke unit with an interdisciplinary stroke team 6% of potential eligible stroke patients thrombolysed Improve the number of TIA patients having carotid ultrasound and carotid endarterectomy All eligible stroke patients receive appropriate rehabilitation services, supported by an interdisciplinary stroke team Participate in national and regional clinical stroke networks to 80 per cent of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway. 6 per cent of potentially eligible stroke patients thrombolysed 80 per cent of all eligible stroke patients receive appropriate rehabilitation services, supported by an interdisciplinary stroke team Attend and support the Midland Clinical Performance against the targets. Progress 2016/17 Annual Plan Hauora Tairāwhiti 102

103 Objective Actions to deliver improved performance Measure Reporting Stroke Awareness raising Sroke Education implement actions to improve outcomes for people who have had a stroke. Improved door to needle time to meet the 60 minute target Develop Initiatives to improve access to stroke and TIA services for Māori and Pacific peoples Increase awareness of TIA/stroke and its significance Work together with community of stroke prevention promotion explore option of increasing funding of Gisborne Stroke to have a presence on East coast Ongoing Stroke education training and development Identify actions that the region will take to develop and implement a regional workforce plan that supports the delivery and achievement of sustained, consistent and safe thrombolysis, and comprehensive evidence based interdisciplinary acute and rehabilitation stroke care provision support lead clinicians designated to stroke, such as physician, Stroke Network to implement actions to improve outcomes for people who have had a stroke All eligible stroke patients have equitable access to community stroke services, regardless of age, ethnicity or geographic domicile Equitable access to services Stroke prevention services linked with existing Cardio-vascular and other health promotion services. PHOs will continue with their CVD risk assessments as an important detective measure that can lead to the prevention of stroke. Increase funding of Gisborne Stroke to have a presence on East coast Work with Gisborne Stroke to promote the use of the FAST message in the Tairāwhiti community with an increased emphasis in the East Coast population Link stroke with cardiovascular risk assessments and activities through cardiac clinical nurse specialist services Regional education programme developed Monthly sessions for hospital staff Annual stroke education session a regional workforce plan Regional collaboration with thrombolysis training Performance the targets. Progress Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 103 against

104 Objective Actions to deliver improved performance Measure Reporting nurse, and allied health Quality assurances processes are ongoing Develop a regional oversight role to support improved information management Rehabilitation Review capacity to deliver community based rehab services for stroke patients by March Standardise expectations around post discharge follow up All members of the interdisciplinary stroke team participate in ongoing education, training and audit programmes according to the Stroke Guidelines Regional MDT case reviews At least one education session for rural GP s and practice nurses Quarterly individual audits of all stroke admissions, number thromoblised, door to needle time and outcomes Regional MDT case reviews Continue to Implement the 2010 Stroke Guidelines If necessary develop capacity to deliver community based rehab services for stroke patients. Provide psychological support for people who have had a stroke Follow up stroke patients post discharge as required Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 104

105 CARDIAC SERVICES Our Approach Hauora Tairāwhiti clinical services provide secondary level cardiac services as part of general medical services. We are an active participant in the regional clinical cardiology network and have good access to senior specialist advice. Interventional cardiac services are provided for the Tairāwhiti population by Waikato DHB with regular outreach clinics at Gisborne hospital. The acute coronary syndrome (ACS) project continues to be a major focus for our region and we are always striving to achieve better access to appropriate clinical interventions for our population. Linkages Our Performance Story Impact: People receive timely and appropriate specialist care Midland Regional Services Plan Acute Chest Pain Pathway Action Plan Objective Actions to deliver improved performance Measure Reporting Acute Coronary Syndrome Maintain the Cardiac ANZACS QI and Cardiac Surgical registers and continue to feedback to consultant for quality improvement. Maintain the increased Clinical Nurse Specialist FTE implemented to enable the ACS project manager to implement and monitor the following in alignment with the Midlands Cardiac Network Vision and goals Continue with the weekly monitoring system of ACS admissions, with statistics sent to MoH which allows timeframes and adherence to best standards of practice across the region Continue with the designed and implemented TIMI score sticker system. This is a risk score predictor. Hauora Tairāwhiti aim is for 90% of admissions to be TIMI scored within 4 hours. Maintain the Exercise Tolerance testing available on public holidays to assist Physicians with early risk stratification Continue the electronic referral system implemented across the region which provides early access for ACS patients to angiogram waitlist 70% of high-risk patients will receive an angiogram within 3 days of admission. ( Day of Admission being Day 0 ) Over 95% of patients presenting with ACS who undergo coronary angiography have completion of ANZACS-QI ACS and Cath/PCI registry data collection within 30 days Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 105

106 Objective Actions to deliver improved performance Measure Reporting Cardiac Services Maintain Local ACS project steering group to monitor and review targets set and look at next project to improve patient outcomes Pre-admitting more cardiac patients locally for Tertiary investigations to enable them to get to their appointment dates safely with all preliminary work up done locally assisting in reduced W\L timeframes. Continue to support the extension of the post-acute Cardiac - pulmonary rehabilitation for rural populations Hauora Tairāwhiti is committed to the Acute Chest Pain Pathway and will engage with regional partners to implement this pathway. Work with Waikato DHB to manage waiting times for cardiac services, so that no patient waits longer than four months for first specialist assessment or treatment. Initiatives we will be working on include Improve equity of access to cardiac diagnostics by achieving an increase in FSA volumes by at least 30 patients annually through visiting cardiology outpatient clinics including virtual FSA volumes to increase our standardised intervention rate per 10,000 in line with the National target rate for angiography and angioplasty, by June Early identification of Ischemic Heart Disease patients who present through ED with ischemic sounding chest pain will be accessed using the accelerated chest pain pathway, by September Early Revascularisation All ACS patients admitted to hospital (unstable angina, NSTEMI, and STEMI) will be placed on the ANZACS QI data base for every first episode of care, by September All intermediate and high risk patients requiring angiography will be cathed within 72 hours, by September Elective Services Patient Flow Indicators: all patients wait four months or less for first specialist assessment and treatment from January Audit FSA volumes quarterly. Audit angiography and angioplasty rates quarterly All low risk patients discharged from ED will be seen in the chest pain clinic within 7 working days. All intermediate and high risk ACS patients requiring angiography will be Quarterly 2016/17 Annual Plan Hauora Tairāwhiti 106

107 Objective Actions to deliver improved performance Measure Reporting All STEMI patients will be cathed within 24 hours, by September ANZACS QI data base All individual data base entries will be completed within 30 days, by September cathed within 72 hours Significant barriers from access to the tertiary provider s cath lab to be tabulated and escalated to senior management. Heart Failure Reduce the incidence of left ventricular systolic dysfunction, EF < 40% within our community Capture Heart Failure admission presentations using NEW database situated on ANZACS QI, by September When data is significant, research outcomes of treatment looking at suggestions for improvement in service across the continuum of care, by December Hauora Tairāwhiti intends to undertake a number of local initiatives to ensure population access to cardiac services are maintained above the agreed rates. These included- Cardiac Services review underway to lift the standard of cardiac services available at Hauora Tairāwhiti to potentially improve the lives of many in our community, by September Continue the early identification of patients with confirmation of new murmurs by allowing general practitioner s direct access to echo services. Audit the incidence of HF admissions and treatment standards, quarterly. Refer SI4: Standardised Intervention Rates. Cardiac surgery: 6.5 per 10,000 of population Percutaneous revascularisation: 12.5 per 10,000 of population 2016/17 Annual Plan Hauora Tairāwhiti 107

108 PALLIATIVE CARE Our Approach The cross sector Integrated Palliative Care project will continue to identify gaps in current palliative care services and solutions which fit local priorities. Stage 2 of the new Budget 2015 initiative funding proposal will commence during the 2016/17 year and start to provide services for psychosocial counselling and Advance Care Planning in aged related residential care, with planned expansion into rural and community care at a later stage. Linkages Resource and Capability Framework for Integrated Adult Palliative Care Services in New Zealand (MoH 2013) Review of Adult Palliative Care Services (MoH 2015) Midland Specialist Adult Palliative Care Service Development Plan Te Ara Whakapiri - Principles and Guidance for the Last Days of Life (2015) Action Plan Objective Actions to deliver improved performance Measure Reporting Budget 2015 New Initiative Funding Complete contractual processes for the new initiative funding project Support Hospice Tairāwhiti to plan and implement the approved initiative for the new funding as per the Business Case Evaluate and report progress against the Business Case as approved by Hospice NZ and Ministry of Health. Integrated Palliative Care project Nurse specialist palliative care educator and support Develop a strategic collaborative approach to palliative care practice across Tairāwhiti that is people centred, culturally appropriate and in line with national guidelines Support the Hospice Tairāwhiti Palliative care nurse specialist to provide training, mentoring and hands on support for staff across aged residential care, GP practices, secondary care and home-based support services. Advance Care Planning Support Advance Care Planning Day April 2017 Support education of Hauora Tairāwhiti staff in Advance Care Planning Implement a policy/guideline for Advance Care Planning by Progress reports on this project Regular reporting to DHB in line with contractual requirements Report on progress 2016/17 Annual Plan Hauora Tairāwhiti 108

109 Objective Actions to deliver improved performance Measure Reporting Midland Specialist Adult Palliative Care Service Development Plan December Continue to implement the Plan recommendations Participating in review and development of regional Map of Medicine palliative care pathways Report on progress Participating in regional development of clinical guidelines Te Ara Whakapiri Supporting regional Advance Care Planning within available resources Education and implementation of Te Ara Whakapiri: Principles and guidance for the last days of life. Progress report on the education and implementation in aged care. HEALTH OF OLDER PEOPLE Our Approach During 2016/17 we will continue to work with our primary care partners and regional DHBs to develop and refine integrated services that will address the needs of older people - from those with basic needs to those whose needs have a greater complexity where more restorative outcomes can be expected. Our Health of Older People (HOP) Service Level Alliance Team (SLAT) project has been running for nearly two years and is making recommendations which identify and close current gaps and develop sustainable pathways for older people across primary, secondary and tertiary services. During 2016/17 we will continue our focus on establishing a regional approach to the purchase and delivery of Home and Community Support Services (HCSS). The Midland DHB region will participate in the development of the national Health of Older People Steering Group s national framework on cost implications of quality care. Where applicable we will use the framework to inform decision-making about the implementation of a Midland DHB regional approach. Linkages Health of Older People (PP23) 2016/17 Annual Plan Hauora Tairāwhiti 109

110 Action Plan Objective Actions to deliver improved performance Measure Reporting Home and Community Support Services for Older People Quarterly update interrai: Comprehensive Clinical Assessment in residential care and in home and community support settings In Between Travel support the In Between Settlement agreement outcomes. Work with regional DHBs to progress and complete the regional DHB HCSS model of care change Report on the number and percentage of older people who have received long term home and community support services in the last three months who have had an interrai Home Care or a Contact assessment and completed care plan. Report on the percentage of people in aged residential care by facility that have a subsequent interrai long term care facility (LTCF) assessment completed within 230 days of the previous assessment. Report on the percentage of LTCF clients admitted to an aged residential care facility who had been assessed using an interrai Home Care assessment tool in the six months prior to that first LTCF assessment. Ensure older people referred for an interrai assessment to access publicly funded care services will undergo the assessment and have a service allocated/declined in a timely manner. Use interrai measures provided by the national data analysis and reporting service to benchmark and compare performance with other DHBs and DHB regions to improve outcomes for older people. Report through Policy Priority 23 (PP23) for Support the In Between Settlement agreement outcomes. HCSS services move to responsive model of care by July 2017 Evidence of the number of older people who received long term support services for home and community supports and percentage who have had an interrai Home Care or a Contact assessment and completed care plan. Report the percentage of people in aged residential care by facility who have a subsequent interrai LTCF assessment completed within 230 days of the previous assessment. Report the percentage of LTCF clients admitted to an aged residential care facility who had been assessed using an interrai Home Care assessment tool in the six months prior to that first LTCF assessment. Show time taken from any referral from any source to complete (not triage) an interrai assessment (i.e., Contact, MDS- HC, LTFC assessment). Report on using interrai measures to progress and compare performance with other DHBs and DHB regions. 2016/17 Annual Plan Hauora Tairāwhiti 110

111 Objective Actions to deliver improved performance Measure Reporting Dementia Care Quarterly update Pathways Continue the development of dementia care pathways through primary care (and key secondary care teams) training on the Map of Medicine (MoM) by Dec MoM will provide a consistent local approach to early diagnosis of people with dementia. A review of the local MoM dementia pathway will be undertaken once programme is bedded in by June Hauora Tairāwhiti will participate and contribute regionally to the Midland Map of Medicine pathways dementia work stream an engage with regional dementia educator to ensure a regional approach to dementia services. MoM will assist regional consistency across Midland DHB boundaries and ensure all providers have a view of the full pathway. The regional dementia group are providing support, surveys and additional educational opportunities to ensure a high quality regional service is available to all people living with dementia and their carers living in the midland region. Progress implementation of the HOP SLAT EPOA/ Dementia workstream recommendations. Following the HOP SLAT workshop at the end of May 2016, two dementia priority recommendations will be identified from the review, implementation of these recommendations will be started during the first 6 months of 2016/17. Continue to collect data relating to current support services for people with dementia and their carer s and utilise this information to support further service development. Work regionally to: complete an analysis of the current state of educational programmes and support groups that support informal careers in operation in the region reduce variability of education and support programmes available to support family/whānau carers and people living with dementia. At least one visit from Regional Dementia Educator per quarter to MoM education sessions to primary care. Report will include the number of education sessions for health professionals held on identification and management of delirium and dementia. Utilise regional MoM dashboard to monitor the uptake of the dementia care MoM pathway within Tairāwhiti Report on progress of the HOP SLAT EPOA/ Dementia workstream recommendations and the implementation of the two dementia initiatives. Report and evaluate referral volumes for NASC, Alzheimer s Society and specialist services. Monitor and report on access to respite services. Record carer participation in Alzheimer s Society education programmes. 2016/17 Annual Plan Hauora Tairāwhiti 111

112 Objective Actions to deliver improved performance Measure Reporting Falls Prevention Work in conjunction with primary care, ACC, HQSC and the Ministry of Health to further develop and measure the progress of the integrated falls and fracture prevention services. This includes: Provide narrative on how older people are being assessed on their risk of falls. Report the number of older people Quarterly update referred from primary and secondary Identify older people at risk of falls in secondary care, aged care care into the fracture liaison service facilities and the community (specifying the proportion referred from Identify the number of older people referred from primary and each). secondary care into the fracture liaison service Report the number of older people Identify the number of older people referred to, and seen by, a referred to a strength and balance strength and balance retaining service retaining service (numerator) and seen by Establish an osteoporosis service within secondary care a strength and balance retaining service The Tairāwhiti falls prevention service is located within primary care. (denominator). Report on establishment progress System Integration for Review processes to ensure the right health information (including Reduced readmission for 75 and over Quarterly update Older People medication chart, prescriptions, discharge summary, Advanced Care Plans) are communicated between health providers (including Aged Residential Care, Home and Community Support Services, general practice, pharmacy and secondary care), and with families. From each of the HOPS SLAT workstream, recommendations two initiatives will be identified at a May 2016 workshop, these prioritised initiatives will be progressed for implementation by quarter /17. By quarter /17 Tairāwhiti will have developed and established an integrated HOPS service. Reduction in polypharmacy for 75 and over Reduced average length of stay for 75 and over Report on implementation progress of the HOP SLAT Integrated Model of Care workstream recommendations Mental Health Increase availability of support services for older persons with mental health and addiction issues in aged residential care facilities. 2 information sessions delivered to aged related residential care facilities within Tairāwhiti Increase community mental health and addiction providers involvement with clients within aged related residential care Nurse Practitioner Aged Care Support aged care staff in their knowledge and skill set around falls reduction. Number of education sessions for aged care staff and the number of attendees. Elder Abuse Support consistent policies and procedures across service Progress reports on implementing 2016/17 Annual Plan Hauora Tairāwhiti 112

113 Objective Actions to deliver improved performance Measure Reporting providers for elder abuse intervention Stocktake of support currently in place and gaps identified recommendations from the Elder Abuse and Neglect HOP SLAT workstream Advance Directives and Enduring Power of Attorney Yellow envelope system in place by December 2016 Supporting providers Support implementation of advance care planning in aged care including Yellow Envelope transition between hospital and aged care. Progress the recommendations from the EPOA/Dementia Care HOP SLAT workstream. Develop policy and training around capacity assessments and EPOA Continue to support and increase the availability to local providers with DHB organised training opportunities Progress reports on implementing recommendations from the EPOA HOP SLAT workstream SHORTER STAYS IN EMERGENCY DEPARTMENTS Our Approach Better, Sooner, More Convenient Health Services for New Zealanders in relation to emergency departments means all New Zealanders can easily access the best services, in a timely way to improve overall health outcomes. A health system that functions well for people with acute care needs is one that: Delivers and coordinates acute care services in the hospital and community. Improves the public s confidence in being able to access services when they need to. Sees less time spent waiting and receiving treatment in the ED. Moves patients efficiently between phases of care. Makes the best use of available resources. Te Whare Hauora O Tūranganui a Kiwa s (Gisborne Hospital) Emergency Department continues to see a decrease in lower level of acuity patients; this has been achieved through closer working with primary care in areas such as Tairāwhiti s Primary Options, Strengthening links between secondary hospital and primary care general practice clinicians, teams so that general practitioners have the ability to speak directly to an Emergency Department or other specialist at the hospital over concerns around a patient Telehealth linking Emergency Department clinicians with rural practices and providing advice on the treatment pathway of a patient, and Continued media publicity enforcing the message that ED is for emergencies. Te Whare Hauora O Tūranganui a Kiwa s Emergency Department is committed to quality improvement and is continuously implementing the New Zealand Emergency Department Quality framework. This commitment to continuous quality improvement is supported through the newly established Emergency Department quality committee, who are supported 2016/17 Annual Plan Hauora Tairāwhiti 113

114 through the hospital s clinical quality group, which has at its heart, improvements in the patient journey. Linkages Our Performance Story Impact: People receive timely and appropriate specialist care. New Zealand Emergency Departments Suite of Quality Measures. Midland District Health Boards Regional Services Plan 2016/17. Integrated Health Strategy System Integration expectations and measures. Integrated Performance and Incentive Framework. Action Plan Objective Actions to deliver improved performance Measure Reporting Emergency Departments Quality Framework Continued implementation and improvement of the mandatory measures to improvement Te Whare Hauora O Tūranganui a Kiwa s Emergency Department quality. Reduced rates of readmission, especially for those over 65 and 75 Whole of System Hauora Tairāwhiti, its Board, its leadership team, clinicians and staff maintain a commitment to continue the effort which will see the DHB maintain and improve on the six hour waiting time Health Target Diagnostic/analysis work to identify the main factors impacting on ED length of stay. Address the most significant bottlenecks and constraints identified in the Diagnostic/analysis work. Actions spanning the whole system pre ED, within the ED, and post-ed. Whole of organisation focus, with demonstrable support from senior managers and clinicians. Further develop Care planning and patient care plans. This will extend the capacity of Trendcare to ensure that discharge planning and community supports are considered as early as possible in the patients length of stay 95 per cent of patients will be admitted, discharged, or transferred from an Emergency Department within six hours. Reduced rates of readmission, especially for those over 65 and 75 Annual Plan 6 monthly reporting EDd Quality framework on going report Performance against the Health Target Progress on specific actions 2016/17 Annual Plan Hauora Tairāwhiti 114

115 Objective Actions to deliver improved performance Measure Reporting Primary care Work with primary care general practice to increase availability of same day appointments. Continue to support general practitioners with advice on treatment pathways for individual patients Provide telehealth across the district to support general practitioners in rural practices with advice and support on patient pathways. WHĀNAU ORA Our Approach Whānau Ora is an approach that supports whānau to identify and achieve their own aspirations. It is a key cross-government work programme jointly implemented by a number of sectors, particularly health, education and social services. Whānau Ora is an inclusive interagency approach to providing health and social services that builds the capacity of New Zealand families with high need. It empowers whānau as a whole rather than focusing separately on individual family members and the challenges they face in isolation. The Whānau Ora philosophy is distinctive because it: Recognises a collective entity (the whānau) Endorses a group capacity for self-determining Has an intergeneration capacity for self determination Is built on a Māori cultural foundation Asserts a positive role for whānau within society and Can be applied to a wide range of social and economic sectors Establishes a collaborative platform for service provision across a collective of providers In November 2015, the Whānau Ora Partnership Group agreed to a set of indicators to support Whānau Ora, including five key areas for the health sector that contribute to Whānau Ora (mental health, asthma, oral health, obesity and tobacco) to achieve accelerated progress towards health equity for Māori and Pacific, and Whānau Ora in the next four years. The Partnership group provides leadership to Whānau Ora by setting its direction and priorities and overseeing its progress and success. The indicators are mental health (reduced rate of Māori committed to compulsory treatment relative to non-māori), tobacco (better support for pregnant women to quit smoking), asthma (reduced asthma admission rates for Māori and Pacific children), oral health (Māori and Pacific 5 year old children who are caries free), and obesity (B4 School Check services). Mental Health, Tobacco and Oral Health have been included as priority areas in the Māori Health Plan. Hauora Tairāwhiti will take a partnership approach and work closely with Te Runanga o Ngāti Porou, Te Runanga o Tūranganui-a-Kiwa and the Commissioning Agency Te Pou Matakana to focus on reducing inequity in our communities. Hauora Tairāwhiti will also work with our Pasifika community 2016/17 Annual Plan Hauora Tairāwhiti 115

116 and the Pasifika Futures commissioning agency to ensure the Tairāwhiti Pasifika community is not left behind. Linkages Maori Health Plan Mental Health Asthma Oral health Obesity Tobacco Action Plan Objective Actions to deliver improved performance Measure Reporting Whānau Ora Hauora Tairāwhiti will accelerate progress towards health equity in the five priority areas implementing and monitoring the following activity. Reduced rate of Māori committed to compulsory treatment relative to non-māori. Māori Health Plan Indicator: Hauora Hinengaro /Mental Health Appropriate rates of use of Section 29 of the Mental Health Act (community treatment order). Increase the support offered to service users by the Indigenous Psychiatrist employed by Hauora Tairāwhiti during 2016/17. Continue to promote and grow the Mahi a Atua approach when dealing with Māori presenting to Mental Health services in Tairāwhiti and expand this approach into other areas of the DHB by the end of 2016/17 Provide service users with access to more cultural support staff through a realignment of roles to be completed by the December Performance is to be monitored on a quarterly basis through the Māori Health Plan. The Mental Health Target is to be set in collaboration with the Ministry of Health. All people with serious mental illness and/or addiction write and use Recovery Action Plans by the end of 2016/ /17 Annual Plan Hauora Tairāwhiti 116

117 Objective Actions to deliver improved performance Measure Reporting Increase in the number of children who are caries free at age 5 Māori Health Plan Indicator: Hauora Niho /Oral Health Improved oral health outcomes for Māori children. Maintain and work towards reducing the current arrears rate of children overdue for their scheduled examinations throughout 2016/17. Support the MOH national initiative to supply toothbrushes/toothpaste to low decile neighbourhoods. Resources will be distributed before December Oral health services are included in the E Tipu E Rea project, and through this coordinated approach at risk children will be targeted for a range of services including oral health during 2016/17. Hapu Māori women smoke-free at two weeks post-natal. Māori Health Plan Indicator: Tupeka/ Tobacco More Māori women who are smokefree at two weeks postnatal. The Tairāwhiti SUDI prevention plan will have smoking cessation as a focus area as smoking has been shown to impact on the risk of a SUDI event. The districts SUID plan is being driven by the community and will be agreed with implementation starting early Te Aka Ora a Māori health provider - will lead whānau cessation support activities targeting young hapū women to be Smokefree in 2016/17 The DHB will continue to provide Hospital sonographers with >90 per cent of Hapu women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking. >95% of tamariki are enrolled in oral health service. 95% of all pregnant Māori women smoke-free at two weeks post-natal. 2016/17 Annual Plan Hauora Tairāwhiti 117

118 Objective Actions to deliver improved performance Measure Reporting cessation training during 2016/17 allowing them to provide brief advice to pregnant women who smoke and refer them onto smoking cessation services. Reduced asthma and wheeze admission rates for Māori children (ASH 0-4 years) Māori Health Plan Indicator 2: Putanga ki te Oranga Access to Care Tairāwhiti is working together on a cross-sectorial collective impact approach to improve outcomes for the most vulnerable. One of the initiatives will be the improvement in the quality of housing. This will impact out high asthma and wheeze admission rates. The advanced Primary Options programme increases the treatment options available to primary care to stop a person s condition progressing to a stage which would require an admission. This has been successful in assisting in the reduction of admissions in areas such as cellulitis, asthma and wheeze and as a result the number of options available will be increased to include community interventions by October An ASH admission rate of <6,612 per 100,000 people is achieved for Maori tamariki (0-4 yo) by June Childhood Obesity Annual Plan : Obesity Work with district partners to ensure a pathway exists to provide support to the whanau of tamariki who are at risk of obesity. Continue to place the Atua Mata model, developed by Horouta Whanaunga Collective, at the centre of lifestyle changes for whanau across Tairāwhiti and East Cape. By 30 June 2017, >95% of obese children identified in the B4SC programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. 2016/17 Annual Plan Hauora Tairāwhiti 118

119 Objective Actions to deliver improved performance Measure Reporting Supporting our local Whānau Ora Collective Hauora Tairāwhiti will continue to support improved outcomes for Māori and their whānau. Hauora Tairāwhiti will continue to support Te Runanganui O Ngāti Porou and Te Runanga O Tūranganui-a-Kiwi and explore opportunities between them, health social agencies and Te Pou Matakana to work together. Ngāti Porou Hauora and Turanga Health, iwi health arms of the districts two Runanganui are both providing Whanau Direct investments across Tairāwhiti. Hauora Tairāwhiti will also work with our Pasifika community and the Pasifika Futures commissioning agency to ensure the Tairāwhiti Pasifika community is not left behind. Through the Tairāwhiti Social Sector Integration initiative (Manaaki Tairāwhiti), Te Pou Matakana and Pasifika Futures will be invited to at least one funders meeting per year. This will ensure that investment strategies across the Tairāwhiti Social Sector align and build on each other for the betterment of the community. The Boards of Ngāti Porou Hauora (NPH), Te Runanganui O Ngāti Porou and Hauora Tairāwhiti continue to engage in designing how future sustainable services are to be delivered to the district East Coast communities. This redesign has at its core the need for these communities to direct how services engage with them while delivering a high quality service. With the support of Te Runanganui O Ngai Porou, NPH and Hauora Tairāwhiti are in year two of a three year approach to moving NPH to an Outcomes based agreement and increasing the levels of trust around contracting which this requires. The DHB has successfully negotiated two integrated contracts with other crown partners to fund Te Aitanga-a-Hauiti Hauora (HH) and Tūranga Health (TH). Both these agreements have a strong outcomes focused basis, and we will continue implementation of integrated contracts where opportunities present themselves. In 2016/17 we will increase services included in these agreements to High quality model of care which meets the criteria identified by East Coast communities in 2013/14 consultations. This is expected to be finalised by during 2016/17 and provide a comprehensive redesign of Te Puia Springs Hospital. Improvement in the outcome measures within each providers integrated contract. 2016/17 Annual Plan Hauora Tairāwhiti 119

120 Objective Actions to deliver improved performance Measure Reporting included mental health service which have previously been excluded. A number of smaller providers who provide the majority of their services to the districts Māori community are being encouraged to further develop whanua ora approaches based on successes with TH and HH. We will work with the Ministry to support those primary care providers, who are part of Whānau Ora collectives, to use their practice management systems to report on whānau outcomes. The continuation of the E Tipu E Rea project, will improve outcomes and improve service delivery to the districts children (-9 months to 5 years). The project focuses on changes which will improve universal access, however has a targeted focus on changes that support the engagement of the most disadvantaged pepi and tamariki to access the best available health care within the district. Continued development of innovative approach to service delivery. Increased number of 2015/16 service agreements reflect an outcomes based approach IMPROVED ACCESS TO ELECTIVE SURGERY Our Approach To achieve our objective of improving people s access to planned care locally, Hauora Tairāwhiti is implementing a number of productivity initiatives as well as working closely with our primary care partners to improve access to virtual First Specialist Appointments, (FSA)s, and direct access to diagnostics, as well as the implementation of various clinical pathways, some of which are being worked regionally through the primary care work stream of the Midland Regional Services Plan. To achieve our objective of improving access to planned care regionally, we will continue to work cooperatively with our regional DHB colleagues by formalising clinical arrangements around the delivery of services (renal and cardiac in particular), as well as developing a regional electives plan that focuses on regional productivity and efficiencies. Linkages Minister s Letter of Expectation. Health Target Improved Access to Elective Services. 2016/17 Annual Plan Hauora Tairāwhiti 120

121 Midland DHBs Regional Services Plan 2016/17. Our Performance Story Impact: People receive timely and appropriate specialist care. Action Plan Objective Actions to deliver improved performance Measure Reporting Improved access to Electives funding will be allocated to support required levels of Performance against Elective Surgery elective surgery, specialist assessment, diagnostics, and alternative models of care. the Health Target Improving Quality Standardised intervention rates will be used to assess areas of need for improved equity of access. Hauora Tairāwhiti will continue to work at regional and national levels to support the implementation of the national patient flow collection Patient flow management will be improved to achieve further reductions in waiting times for electives. No patient will wait longer than a maximum of four months. Support the Health Quality and Safety Commissions Quality & Safety Makers to achieve All three parts of the surgical safety checklist are use at least 90 per cent of the time 95 per cent of hip and knee replacement patients receive cephazolin 2g as surgical prophylaxis 100 per cent of hip and knee replacement patients have appropriate skin preparation Delivery against agreed volume schedule, including a minimum of 2,574 elective surgical discharges in 2016/17 towards the Electives Health Target. Refer to SI4: Elective services standardised intervention rates. Elective Services Patient Flow Indicators expectations are met and maintenance of the waiting time which sees all patients wait four months or less for first specialist assessment. Performance updates published by HQSC and local quality report Inpatient length of Stay (OS3) target achieved Reduction in readmission after 30 days (OS8) Progress on specific actions 2016/17 Annual Plan Hauora Tairāwhiti 121

122 Objective Actions to deliver improved performance Measure Reporting Patients will be prioritised for treatment using national, or nationally recognised, tools, and treatment will be in accordance with assigned priority and time waiting. Prepare elective orthopaedic pathway from referral to discharge, this includes Referral guidelines Patient preparedness, including readiness and education Inpatient event Discharge Follow-up Continue with the principles and methods learned from The Productive Operating Theatre across all services to identify bottlenecks in capacity Continue to support surgical teams to improve on benchmarked performance for start times and patient turnaround, thereby further increasing theatre capacity IMPROVED ACCESS TO DIAGNOSTICS Our Approach Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times for diagnostics can reduce delays to a patient s episode of care and improve DHB demand and capacity management. Currently, the Tairāwhiti community has excellent access to most diagnostic services. Continued monitoring and improvements in waiting times, untangling system bottlenecks, and identification of other areas of improvement will ensure that this good access will be maintained. Linkages Our Performance Story Impact: people receive time and appropriate access to diagnostic services Midland DHBs Regional Services Plan 2015/16 Improved Access to Elective Services 2016/17 Annual Plan Hauora Tairāwhiti 122

123 National Patient Flow Collection Faster Cancer Treatment programme Action Plan Objective Actions to deliver improved performance Measure Reporting Improved Access to Agreed NPF system changes are Quarterly Diagnostics implemented. Continue to move towards 100% compliance for waiting time targets through planned and coordinated resourcing and closer PHO management of referrals. Manage the implementation of national guidelines when released. Information on diagnostics will be provided as part of Phase 3 of the National Patient Flow (NPF) project to measure the patient journey through secondary services. Work with regional and national clinical groups to contribute to development of improvement programmes. Support and participate implementation as required. Continued purchasing of higher radiology volumes in PVS 16/17 than actual delivery 14/15, improving access for our demographic need through defined referral criteria. Continue to ensure internal data collection systems are in place to facilitate accurate reporting. Patients access diagnostic services in accordance with priority. Representation, attendance and participation in national and regional clinical group activities. PP29: Improving waiting times for diagnostic services. 2016/17 Annual Plan Hauora Tairāwhiti 123

124 Objective Actions to deliver improved performance Measure Reporting Increase access to community referred bone density scan focusing on our older population especially those within residential care Colonoscopy/Endosco py Continue to work with primary care to improve effectiveness of Endoscopy programme. Continue to provide direct access to X-ray, ultra-scan, and CT to primary care. Map of Medicine utilisation within the health sector, streamlining synergies in our current models of care amongst various the service providers. Work with the Provider Arm to improve patient surveillance rates by funding more colonoscopies. Continue development and monitoring of the Global Rating Scale (GRS) to identify the key areas for quality improvement. CT and MRI 95% of accepted referrals for CT scans, and 85% of accepted referrals for MRI scans will receive their scan within six weeks (42 days). Diagnostic colonoscopy 85% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days, inclusive), 100% within 30 days Quarterly Implement the electronic referral pathway for direct access colonoscopy - this is already underway and we already use the national criteria for manual referral direct access to colonoscopy. Work with the regional network on (i) establishing direct access criteria for referral and pathway; and (ii) shared initiatives and planning capacity. 70% of people accepted for a non-urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 90 days. Surveillance colonoscopy 70% of people waiting for surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date, 100% within 120 days. 2016/17 Annual Plan Hauora Tairāwhiti 124

125 Living within our Means LIVING WITHIN OUR MEANS Our Approach We will be focusing on the following initiatives to enable us to live within our means: Funding and/or participating in all other National Entity Initiatives as required by the Minister and the Ministry. The financial impacts of the National Entity initiatives have been included in full in the Annual Plan, as expected by the Minister; Care Capacity Demand Management and Releasing Time to Care (implemented together as the Fit Approach) in wards and departments to ensure the best possible matching of patient need to staff resources which will lead to improved outcomes for patients, increased staff satisfaction and lower overall cost of service; Working to maintain Provider Arm staffing levels with a consequent net saving in Outwards IDFs; These initiatives will all have a role to play in ensuring Hauora Tairāwhiti operates in a financially sustainable manner, ensuring delivery of agreed services within available funding. This is important for the resident population and also for the health of the organisation generally and will better enable Hauora Tairāwhiti to respond to the low funding increase environment in 2016/17 and forecast into the future. Linkages Stewardship Module Midland District Health Boards Regional Services Plan 2016/17 Action Plan Objective Actions to deliver improved performance Measure Reporting Living within our means Operate within agreed financial plans Appropriate clinical and executive leadership Actions include: Increase theatre utilisation Proactive management of employment cost growth and improved use of workforce System Integration 3: Ensuring delivery of Service Coverage Ownership OS3: Inpatient Length of Stay Ownership OS8: Reducing Acute Readmissions to Hospital Output 1: Output Delivery against 2016/17 Annual Plan Hauora Tairāwhiti 125

126 Objective Actions to deliver improved performance Measure Reporting Reconfigure current service delivery models Increase in service outputs delivered within a primary care and/or community setting, relative to hospital delivery, and reduction in demand for acute hospital services Further roll-out of the Fit Approach and completion of revised staffing profiles for wards/departments. Allocated savings actions are carried through to completion by the assigned responsible leader. Plan. Savings target is met Financial targets are met NATIONAL ENTITY PRIORITY INTITATIVES Our Approach We are expected to align our planning with the planning intentions of key national agencies. Each of these national agencies has initiatives for the 2016/17 year which will impact our DHB. The national agencies and aligning activities of support are included in the below action plan. Hauora Tairāwhiti is committed to engage with the Ministry of Health on the work programme of the former National Health Committee once this programme is confirmed. Linkages Midland Regional Services Plan 2015/16 Letter of Expectations Module 2 Improving Quality Module 2 Living Within Our Means Module 4 Financial Performance Module 5 Stewardship 2016/17 Annual Plan Hauora Tairāwhiti 126

127 Action Plan Objective Actions to deliver improved performance Measure Reporting Health Promotion Agency (HPA) Campaign support for health targets The Health Promotion Agency (HPA) is often requested to undertake national health promotion activities to support the achievement of Government priority areas, including health targets. Potential areas include oral health, patient portals, food front of pack labelling, and Healthy Families NZ. For example: (1) To deliver a rheumatic fever public awareness campaign targeted at Pacific and Māori parents of at risk children and young people. The main objectives are to raise awareness about: The link between sore throats and rheumatic fever The importance of getting sore throats in at risk children checked by a health professional The importance of completing the full antibiotics course for children who have Group A streptococcal bacteria How people at-risk of rheumatic fever can keep their children safe in their own homes. (2) Immunisation is one of the most effective and cost-effective medical interventions to prevent disease. The Ministry of Health has contracted the Health Promotion Agency to promote immunisation in New Zealand, through various work streams. The Health Promotion Agency also supports the Ministry of Health by developing new resources of providing This aligns to Government health priorities, health outcome impacts, and health system enabler. The Immunisation Programme supports the meeting of the following Health Targets: - Infant immunisations (target of 95% of eight month olds will have their primary course of immunisations - 6 weeks, 3 months and 5 months; on time by Dec 2014 and maintained until The DHB will support national health promotion activities around the health targets. 2016/17 Annual Plan Hauora Tairāwhiti 127

128 Objective Actions to deliver improved performance Measure Reporting Alcohol Pregnancy and Alcohol Screening and Brief Intervention (SBI) reprints as the need is identified. The programme provides critical information for parents of infants, school aged children, teens and adults. The information provided helps parents make informed health choices for their babies and children, and alerts and prompts New Zealanders to get themselves or their families vaccinated at the appropriate times. The Alcohol and Pregnancy work programme is to contribute towards a reduction in harms related to prenatal alcohol exposure by: Reducing the number of women consuming alcohol while they are pregnant Increasing public awareness of the risk associated with alcohol consumption during pregnancy Supporting health professionals (particularly primary care providers) to provide advice in a routine, effective and consistent way to women about alcohol and pregnancy. HPA also has a programme of work to support Alcohol Screening and Brief Intervention in primary settings. This aligns with DHB work in this area. 95% of all two year olds are fully immunised). HPV Immunisation (target of 60% of young girls will receive the three doses of HPV reducing the burden of cervical cancer in New Zealand). Aligns with government and non-government initiatives and calls for action in this area, including: Government's response to the Health Select Committee's inquiry into improving child health outcomes Expectation from industry that the Government will undertake other activities to promote alcohol and pregnancy messages, to support their voluntary pregnancy warning labelling efforts Ministry of Health's work to develop a Foetal Alcohol Spectrum Disorder (FASD) action plan. Harmful alcohol use was estimated to cost New Zealand $4.9 billion in 2005/06 (Berl 2009). However, previous estimates have ranged from $735 million to $16.1 billion (Law Commission, 2009, p168) This aligns to Government health priorities, health outcome impacts, and health system enablers. There is also evidence that if delivered DHBs will support alcohol screening and brief intervention DHBs will support the provision of routine and consistent advice 2016/17 Annual Plan Hauora Tairāwhiti 128

129 Objective Actions to deliver improved performance Measure Reporting Health Quality and Safety Commission (HQSC) Surgical site infection programme (SSIP) - National Infection Surveillance Data Warehouse Surgical site infection programme (SSIP) - DHB Infections Management systems National inpatient patient experience survey and reporting system - Patient experience Continued DHB support for ongoing hosting costs of the national surveillance data warehouse with CDHB ($0.27m p.a.). DHB adoption of Infections Prevention and Control Systems investment and implementation including local integrations. Both Hospital and Community with National hosting. Costs are dependent on DHBs' decision to take up the system. Overall sector costs estimated at $1.5m capital and $2.5m ongoing operating. National in-patient survey to be used by all DHBs quarterly that can be incorporated in existing local patient experience surveys that provides a nationally consistent model of patient experience indicators across the population, SBI can reduce alcoholharm in the community. Goal - Removal / reduction in preventable patient harm resulting from surgical site infections throughout the New Zealand health and disability sector. An ability to deliver a consistent approach to the monitoring of SSIs. An ability to provide accurate outcome measures for SSI. Measurement of reduction in SSI rates. Financial benefits will vary by DHB. Additional cost of treating patients with an SSI has been conservatively estimated at $21,000 per SSI. National and local surgical site infection surveillance system to generate verifiable information that drives practice change and improvement. Financial benefits will vary by DHB. Additional cost of treating patients with an SSI has been conservatively estimated at $21,000 per SSI. Patient experience indicators help measure and report how consumers and patients actually experience the health system e.g. what happened to them and how did it make them feel? By capturing this consistently and coherently across New Zealand s health system, this information can be used to make substantial improvements to women of child bearing age about alcohol and pregnancy The DHB will commit to meeting infection control expectations in accordance with Operational Policy Framework - Section 9.8. The DHB will continue development of infection management systems at local DHB level. The DHB commits to surveying patient experience of the care they received using the national core survey, at least quarterly. 2016/17 Annual Plan Hauora Tairāwhiti 129

130 Objective Actions to deliver improved performance Measure Reporting Health Workforce NZ (HWNZ) indicators Capability Leadership and Primary Care - patient experience survey and reporting system Increasing the number of sonographers Programmes to support improvement science and increased clinical leadership. Similar proposal to the national in-patient experience survey to be used by PHOs. The sonographer workforce needs to grow by 300 full time equivalent (FTE) employees over the period to 2023, more than double the current FTE numbers, to enable more timely delivery of healthcare services, and meet the faster cancer health target, increased demand from demographic change and growth of sonography as a diagnostic tool. Hauora Tairāwhiti maintains one trainee position. to both the experience and the actual quality of care received. Efficiencies are achieved with one nationally consistent system and contract, compared to individual, and/or non compatible systems. Building sector capability and clinical leadership and a culture of quality and safety improvement. Uptake of increased sector leadership, good practice and transfer of improvements skills and expertise. Outcome measures still under development. Financial benefits will vary by DHB. No major DHB outlay other than releasing staff (and the associated operating costs of this). Commission fund and sponsor DHB placements. Help measure and report how consumers and patients actually experience the health system from a primary care perspective. Increasing the sonographer workforce will enable more timely delivery of healthcare services, meet faster cancer health targets and meet increased demand for sonography as a diagnostic tool. HWNZ is contributing $27,000 per trainee per annum to employers for their trainees over the 3 year training programme The DHB will meet expectations in accordance with Operational Policy Framework Section 9.3 & DHBs hold contract with PHOs but this initiative funded directly by MoH for 3 year period no DHB financial implications The DHB will indicate (as applicable): the number of trainee positions possible under Medical Radiation Technologists Board (MRTB) requirements given qualified staff, 2016/17 Annual Plan Hauora Tairāwhiti 130

131 Objective Actions to deliver improved performance Measure Reporting Expanding the role of Nurse practitioners, clinical nurse specialists and palliative care nurses Create new nurse specialist palliative care educator and support roles A Government policy 2014 health workforce commitment is to expand the role and number of nurse practitioners, clinical nurse specialists and palliative care nurses. A Government policy 2014 health workforce commitment is to create 60 nurse specialist palliative care educator and support roles at hospices. Nurse practitioners can, amongst other services, assess, diagnose and prescribe medicines for specific groups. Clinical nurse specialists cover a wide range of specialties including diabetes, cardiology, respite care, wound care, care of the elderly, mental health and addiction. Expansion of the nurse practitioner and clinical nurse specialist role, especially the palliative care nurse role will enable medical staff to undertake more complex procedures and improve service delivery. HWNZ is already funding the training component of these roles. Palliative care nurse specialist will provide training, mentoring and hands on support for staff across aged residential care, GP practices and home-based support services. The investment will be consistent with HWNZ's current investment in postgraduate nurse how they intend to increase the number of trainee positions available, and how they intend to work with private providers to ensure a smooth flow of training across both (distinct) environments. The DHB will indicate its plans to expand the role of nurse practitioners, clinical nurse specialists and palliative care nurses in its region The DHB will demonstrate the steps it is taking to support the regional approach to implementing nurse specialist palliative 2016/17 Annual Plan Hauora Tairāwhiti 131

132 Objective Actions to deliver improved performance Measure Reporting Expanding the role of specialist nurses to perform colonoscopies A Government policy 2014 health workforce commitment is to expand the role of nurses and train specialist nurses to perform colonoscopies. The Ministry of Health is developing and implementing an advanced nursing role in endoscopy for senior nurses with relevant postgraduate education and experience. training. Government policy commitment September 2014: $7m to create 60 nurse specialist palliative care educators and support roles at hospices. Nurse endoscopists will make a direct contribution and an indirect contribution to service delivery, including enabling release of medical staff to undertake more complex procedures. Development of the nurse endoscopist role is critical to the delivery of bowel screening in New Zealand. Government policy commitment September 2014: $8m over 4 years to increase the number of colonoscopies performed. care educator and support roles. The DHB supports the regional approach to expanding the role of specialist nurses to perform colonoscopies. Increasing number medical physicists the of Increasing the number of medical community based training There is a low retention rate of graduates from the Medical Physics programme and a low number of postgraduate positions available to graduates, despite reported staff shortages. The number of medical physicists needs to grow to address the vulnerability of a small workforce and to enable more timely delivery of health care services and meet the faster cancer health target. As part of the revised New Zealand Curriculum Framework for Prevocational Medical Training, the Medical Council will require PGY1 and PGY2 interns to undertake one clinical attachment in a community-based setting by the end of Radiation therapy is reliant on an adequate supply of medical physicists to plan an implement patient treatment programmes. Increasing the number of medical physicists will allow succession planning of a small workforce, vital to DHB workforce and service planning. HWNZ is already funding the training of medical physicists. More medical trainees are exposed to quality community-based training experiences, and will have increased experience of integrated care and choose to vocationally train in general practice. An increase in the number and availability of The DHB will demonstrate its commitment to the recruitment of Medical Physics registrars to reduce the vulnerability of a small and critical workforce. The DHB will ensure prevocational trainees have access to community-based attachments, working 2016/17 Annual Plan Hauora Tairāwhiti 132

133 Objective Actions to deliver improved performance Measure Reporting National Health Information Technology Board places and providing access to primary care/community settings for prevocational trainees National Maternity Information System Platform (MISP NZ) electronic Prescribing and Administration (epa) Regional CWS (Including MedMan) Regional CDR Regional PAS HWNZ is working with the Medical Council, the Royal New Zealand College of General Practitioners and district health boards to ensure employment and funding arrangements support these requirements. Implementation of the National Maternity Information System Platform with the MCIS module live. The platform also supports neonatal care, patient portals and Newborn Hearing Screening. Implementation of hospital based epa Using the NZULM as the medicines data source and integrated with epharmacy and emr where implemented A common platform providing DHB clinicians access to and interaction with common clinical information across patients in the region. It includes the capture all sources of hospital information, including ED & Theatres, nursing prevocational clinical attachments across DHBs will support RMO career progression. Long term financial benefits are anticipated through early intervention and better integration between primary and secondary services. A single platform to record births across the sector, will enable The care received by a pregnant woman and her baby to be safer and of higher quality, because health professionals will have timely access to information about a woman s clinical/medical and maternity history before making care decisions. Bring together relevant information collected about a woman and her baby in the community. Studies have shown that there is up to a 50% error rate in the patient's drug chart. epa reduces this rate and enhances both patient safety, the quality of clinical decision-making and the efficiency of managing the patient's drug chart. Clinical Workstation and Clinical Data Repository allow a patient centric view of clinical information from a hospital (or community) setting. It is the basis for a regional electronic health record and is the essential platform enabling support of other in conjunction with the Medical Council of New Zealand and primary and community-based practices. DHBs are to identify actions and milestones to show that MISP-NZ has been implemented, or is in the process of being implemented across all 20 DHBs. Commitment to work regionally to ensure epa has been implemented, or is in the process of being implemented across all 20 DHBs. Commitment to work regionally to ensure each region has completed the 2016/17 Annual Plan Hauora Tairāwhiti 133

134 Objective Actions to deliver improved performance Measure Reporting Health IT Programme (1) single EHR (2) digital hospital blueprint (3) preventative health IT platform (4) data for health/social investment observations and ereferrals triage. It will complement and provide data to the national Electronic Health Record (EHR). Each region has a major programme in train: Northern: Northern Electronic Health Record (NEHR) Midland: espace Central: Regional Health Informatics Programme (RHIP) South Island: Patient Information Care System (PICS) During the design phase of the Health IT Programme, regions will engage with the national programme to establish sector requirements. During the implementation phase the regions will continue to support the national programme and integrate their systems with national systems based on agreed interoperability standards. high value functionality like emr, electronic orders, results sign-off. It will also support a person's on-line access to their own health record. Hospital based patient administration systems are a fundamental enabler to support other high value functionality, like Clinical Workstation and National Patient Flow. 8 DHB's need to replace their obsolete systems. A single longitudinal EHR and other national system platforms will enable access to high-value patient information to support (a) accurate, high quality information available at the point of care, (b) better care coordination (c) clinical decision support. This initiative supports the NZ Health Strategy, in particular, allowing people to access their own information, supporting virtual teams of clinicians, and overall enabling a smarter health system to operate. implementation of the regional applications. Commitment to work regionally to ensure each region has developed a roadmap for delivery of each capability. Commitment to work regionally to ensure participation on advisory groups. 2016/17 Annual Plan Hauora Tairāwhiti 134

135 NZ HEALTH PARTNERSHIPS Our Approach Hauora Tairāwhiti will work in partnership with NZ Health Partnerships to delivery cost effective healthcare and ensure efficient use of health resources. Linkages Stewardship Module Midland District Health Boards Regional Services Plan 2016/17 Objective Action Plan NZ Health Partnerships Ltd Actions to deliver improved performance Hauora Tairāwhiti will work in partnership with NZ Health Partnerships to progress the following initiatives: National Oracle Solution (formerly Finance, Procurement and Supply Chain) The National Oracle Solution will design and build a single financial management information system ready for DHB implementation. The designing of the processes and the system of the National Oracle Solution programme will be done through a co-creation approach with the sector, using existing DHB expertise. DHBs will commit resources to the implementation of Oracle system, and will fully factor in expected budget benefit impacts. Food Services - NZ Health Partnerships has supported Hauora Tairāwhiti in implementing the Food Services business case. Linen and Laundry Services NZ Health Partnerships will continue to work with the DHBs that are open to considering a collective arrangement for outsourced Linen and Laundry Services. National Infrastructure Platform - The National Infrastructure Platform programme aims to achieve qualitative, clinical and financial benefits for DHBs through a national approach to IS infrastructure consumption. The national approach is driven by converging 40 infrastructure facilities into a single infrastructure platform delivered from two data centre facilities. It will also align the health sector s infrastructure services with the Government s overall Information Communications Technology goal of harnessing technology to deliver better, trusted public services. DHBs will commit to working collaboratively with NZ Health Partnerships to progress the National Infrastructure Platform. DHBs will commit resources to the decision reached in relation to the implementation of the programme. 2016/17 Annual Plan Hauora Tairāwhiti 135

136 Other IMPROVING QUALITY Our Approach Quality and patient safety are a top priority at Hauora Tairāwhiti with many initiatives successfully in place and others underway. But there is always more to do. Staff want to make a difference for our people and their ongoing actions are critical to patient safety. We are committed to implementing the initiatives specified by the Health Quality and Safety Commission through its Open for Better Care programme which is underpinned by the New Zealand Triple Aim. As part of this programme in 2013 Hauora Tairāwhiti published its first Quality Account which recorded the quality improvement which abound in the organisation to improve patient quality and safety. All DHB staff, clinical leaders and managers are responsible for improving quality and participating in quality improvement initiatives and projects. The key work areas are: Continuing to keep our people safe o By participating in the national patient safety campaign reducing falls resulting in harm, reducing surgical site infection, reducing peri-operative harm (including safety in theatres and venous thromboembolism (VTE)) and reducing medication errors o Improving our hand hygiene compliance o Reducing the number of people who develop a pressure injury whilst in hospital o Minimising seclusion practice in mental health Continuing to improve the quality of end of life care Continuing to work to improve our escalation process when a person s condition deteriorates Improving our customer care and responsiveness to patient needs These areas were chosen because of the common themes identified from our serious event investigations or because our people raised them as concerns. Quality of care, listening to our consumers and community and preventing harm are at the centre of Hauora Tairāwhiti s quality improvement plan. This work is both directed from a clinical governance framework and from a floor up approach. Linkages Annual Plan Quality Plan TDH Quality Account Module 2 Health of Older Person 2016/17 Annual Plan Hauora Tairāwhiti 136

137 Action Plan Objective Actions to deliver improved performance Measure Reporting Quality & Safety Marker (QSM) Falls Hand Hygiene Support the Quality & Safety Markers (QSMs) and the Commission s associated priority areas by demonstrating: As highlighted in the Health of Older Person section we will continue to support the aged related residential care pilot clinical nurse specialist falls in aged care. In the last 18 months this role has been the key to sustained improvement in the use of Vitamin B in aged related residential care facilities. Hauora Tairāwhiti is committed to meet and sustain achievement at or above the identified QSM threshold for falls risk assessment and individualised care plans by: By having individual wards reporting to senior management on the QSMs on a weekly basis Quarterly audits of performance against the markers will be completed and displayed on the knowing How we are Doing Boards as part of the Fit approach Continue with use of the April falls event as a way of promoting falls prevention with staff The Hauora Tairāwhiti falls prevention group continues to be a well-attended multi agency group and has assisted in developing an integrated approach across Tairāwhiti to falls and fracture prevention. This activity is aligned to the local Health of Older persons group who ensure its activities include a systematic approach to health of older peoples care pathways. Hauora Tairāwhiti will continue to audit and report on our compliance rate against the 5 moments three times a year. This target has been discussed at Clinical Governance and Leadership Team with a commitment of senior clinicians to ensure there is frontline ownership of the patient safety practice. 90 percent of older people in hospital are given a falls risk assessment 98 percent of older patients assessed as at risk of falling receive an individualised care plan addressing the risks identified 80 percent compliance with good hand hygiene practice Medication Safety Hauora Tairāwhiti is participating in the regional IS programme Implementation of the electronic 2016/17 Annual Plan Hauora Tairāwhiti 137

138 Objective Actions to deliver improved performance Measure Reporting Safe surgery SSI: Patient Harm and will implement medication management in line with the regional timeframes. Hauora Tairāwhiti is committed to all three aspects of Safe Surgery. commitment to ensure that the checklist is being used in paperless form, as a teamwork and communication tool rather than an audit tool Implementation of a patient safety culture to enhance team work and communication by the introduction new paper work a tick box to record the complete process meeting the paperless expectation commitment to sustain the old QSM threshold of all three parts of the World Health Organisation (WHO) surgical safety checklist (sign in, time out and sign out) being used in a minimum of 90 percent of operations commitment to working with the Commission to continue to implement briefing and debriefing for each theatre list We are continuously collecting data related to the QSMs and for the last quarter achieved 100 percent for all three QSMs. We will maintain this result with constant auditing and feedback to clinicians. The data is reviewed at the Infection Control Committee each month where any variance is investigated and actions to improve quality and safety implemented. We expect to work with any national roll out of joint work currently being planned by the MoH, ACC and HQSC in relation to medicine reconciliation platform. A new marker measuring the use of the checklist as a teamwork and communication tool will be in use from 1 July All three parts of the surgical safety checklist are used 100% of the time Compliance with the SSI Quality Safety Markers which are: 100 percent of hip and knee replacement patients receive prophylactic antibiotics 0-60 minutes before incision 100 percent of hip and knee replacement patients receive cephazolin (2g) 100 percent of hip and knee replacement patients receive alcohol based skin preparation encourage clinicians to complete ACC 45 and ACC 2152 (treatment injury 2016/17 Annual Plan Hauora Tairāwhiti 138

139 Objective Actions to deliver improved performance Measure Reporting Trigger Tools Quality Accounts preventing harm from pressure injuries. We are in the process of adopting new risk assessments to monitor skin integrity and this will form part of the new admission to discharge planner Continue to audit 10 charts per month to provide a picture of harm caused by commission and present this to Clinical Governance Committee at 6 monthly intervals Having produced three quality accounts which have improved year on year we are keen to establish an on line permanent Quality Account which is updated at quarterly intervals. This would follow the template as recommended by the HQSC guidance and would keep the account live throughout the year rather than just at the required publishing date. The recent implementation of a web based quality and risk management system will allow greater reporting of some quality measures to relevant DHB Boards and committees. claim) forms for all grades of pressure injury except grade one, to provide a more accurate picture of the incidence of pressure injuries occurring while patients are in our care report to HQSC all pressure injuries grade three and above as serious adverse events measure and report pressure injury prevalence regularly and consistently improve classification and documentation of pressure injuries by grade in the patient record and ensure they are coded implement structured risk assessment to support clinical judgement and evidence-based prevention approaches. Trend harm categories to ascertain where further work is required The Quality Account is updated quarterly on the organisation s website. 2016/17 Annual Plan Hauora Tairāwhiti 139

140 Spinal Cord Impairment Action Plan SPINAL CORD IMPAIRMENT ACTION PLAN Objectives Actions to deliver improved performance Measured by Hauora Tairāwhiti will ensure information and actions outlined in the plan are disseminated to clinicians via its clinical governance mechanism and will ensure pathways are developed that explicitly outline process and align with the action plan. Hauora Tairāwhiti intends to engage with ambulance and other providers to implement the SCI pre-hospital destination and referral pathway. Report on progress made against actions in the Spinal Cord Impairment Action Plan. ACTIONS TO SUPPORT DELIVERY OF REGIONAL PRIORITIES Hauora Tairāwhiti will continue to participate as part of the Midland DHB Region. Within the Midland Regional Services Plan, we aim to achieve health and well-being for the populations served by the Midland DHBs. The focus for 2016/17 is on collaboration and the challenge is about behaviours, particularly how we will behave in an environment where we experience significant financial challenges and expectations of even higher performance. Throughout this Annual Plan there are a number of activities we have planned to undertake which will support delivery of the regional priorities identified in the Regional Services Plan. This section includes actions from the Regional Services Plan that are not covered elsewhere in this Plan, major trauma, Hepatitis C, health workforce and information technology. Note that the extent of the Hauora Tairāwhiti s involvement in these actions has not yet been determined. Objectives Actions to deliver improved performance Measured by Major Trauma Regional actions to support trauma in Midland communities include: Trauma specialist workforce is optimal, well trained and sustainable Midland has a quality trauma specialised workforce in a supportive, progressive environment, with the workforce matched to the priority strategic elements, and MTS personnel are supported in career and professional development: Optimal FTE applied to trauma positions within each Midland DHB, with appropriate Provision of a single progress report on resources to support training and education (MRTS Business Case - stage 2 endorsement) behalf of the region agreed by all DHBs Implementation of an optimal workforce plan for MTS hub group Recommendations made within that region. for clinical and data staff in individual DHBs Maintain clinical interface All trauma staff exposed to current trauma best practice, and trauma staff contributing to trauma forums at regional and national level. Royal Australasian College of Surgeons Trauma Verification Programme and recommendations addressed. MTS to lead an annual trauma 2016/17 Annual Plan Hauora Tairāwhiti 140

141 Objectives Actions to deliver improved performance Measured by symposium, with all trauma staff attending and contributing to the symposium: DHBs support appropriate education and training to maintain clinical skills at expert level Patient and family surveys to be conducted at each DHB Clinical staff members are supplied with information to improve trauma quality, eg, clinical matrices, guidelines, TQIP reports, etc. Data management platform supports the integration and optimal use of trauma and related data Completion of the relational database by Waikato IS with a sustainable support plan in place. Trauma data backlog resolved as a priority enabling real time tracking and analysis that is informative, efficient and responsive to stakeholders. The Trauma Quality Improvement Programme (TQIP) is fully supported by an accurate and up to date relational database. Successful integration of associated databases into the relational database. The Midland Trauma Research Centre (MTRC) is fully functioning to maximise the trauma registry and associated high quality data research activity: Ensure up-to-date inputting of data at DHB of origin Develop processes to support the efficient and accurate collection and entry of data and quality checking processes at point of contact Ensure a common language based on the MTS Data Dictionary. Hauora Tairāwhiti will Submit major trauma data to the Midland Regional Trauma Registry and the National Major Trauma Registry Implement a Regional Major Trauma Destination Policy, when plans approved. hold monthly trauma committee meetings inclusive of St John and representation / input from other stakeholders on an as required basis Monthly case reviews of trauma cases across Tairāwhiti Provide clinical education to improve patient outcomes utilising the MRTS guidelines and to meet education requirements of National Trauma Group Attendance at Midland Trauma Symposium and International Trauma conference in 2016 Review of processes and feedback from National Trauma Director Investigate quality improvement /research initiatives across Tairāwhiti 2016/17 Annual Plan Hauora Tairāwhiti 141

142 Objectives Actions to deliver improved performance Measured by Provide trauma data to Hauora Tairāwhiti leadership group Development of an integrated Hepatitis C service across the Midland Region The Midland DHBs are tasked with implementing a single clinical pathway for hepatitis C care across the region in order to provide consistent services, which maximise the wellbeing of all New Zealanders living with hepatitis C. A second objective is to implement integrated hepatitis C assessment and treatment services across community, primary and secondary care services in the region. Actions to support the implementation of integrated hepatitis C assessment and treatment services include: raising community and GP awareness and education of the hepatitis C virus (HCV) and the risk factors for infection providing targeted testing of individuals at risk for HCV exposure raising patient and GP awareness of long term consequences of HCV and the benefits of Hepatitis C treatment, including lifestyle management and antiviral therapy providing community based access to HCV testing and care that will include Fibroscan services to all regions as a means for assessment of disease severity and as a triage tool for referral to secondary care and prioritisation for antiviral therapy establishing systems to report on the delivery of Fibroscans in primary and secondary care settings providing community based ongoing education and support (including referral to needle exchange services, community alcohol and drug services, GP primary care services or social service agencies) providing long term monitoring (life-long in people with cirrhosis and until cured in people without cirrhosis) providing good information sharing with relevant health professionals working collaboratively with primary and secondary care to improve access to treatment Workforce Refer section in Module 5 IT Refer section in Module 5 Quarterly narrative report on progress of the key actions. Report six monthly broken down by quarters on the following measures: Measures Data and Source Number of people Total number of people diagnosed with hepatitis C per annum (by age). with a positive HCV PCR test in the DHB region (data from five reference labs provided to regiona DHBs). Number of HCV patients who have had a Fibroscan in the last year (a) new patients (b) follow up (by age and ethnicity). Number of people receiving PHARMAC funded antiviral treatment per annum (by age and ethnicity). Total number of hepatitis C Fibroscans performed annually (data from the delivery of Fibroscans in primary and secondary care). Total number of people prescribed antivira treatment who have hepatitis C (data from PHARMAC provided to regional DHBs). 2016/17 Annual Plan Hauora Tairāwhiti 142

143 Module 3 Statement of Performance Expectations We have worked with other DHBs in the Midland region, our primary care partners as well as other key stakeholders to develop the Statement of Performance Expectations (SPE) in which we provide measures and forecast standards of our output delivery performance. The actual results against these measures and standards will be presented in our Annual Report 2016/17. The performance measures chosen are not an exhaustive list of all of our activity, but they do reflect a good representation of the full range of outputs that we fund and / or provide. They also have been chosen to show the outputs which contribute to the achievement of national, regional and local outcomes (see modules 1 and 2). Where possible, we have included with each measure past performance as baseline data. Activity not mentioned in this module will continue to be planned, funded and/or provided to a high standard. We do report quarterly to the Ministry of Health and / or our Board on our performance related to this activity OUTPUT CLASSES DHBs must provide measures and standards of output delivery performance under aggregated output classes. Outputs are goods and services that are supplied to someone outside our DHB. Output classes are an aggregation of outputs, or groups of similar outputs of a similar nature. The output classes used in our statement of forecast service performance are also reflected in our financial measures. The four output classes that have been agreed nationally are described below. They represent a continuum of care, as follows: 2016/17 Annual Plan Hauora Tairāwhiti 143