Wednesday 10 th August Note: Public Excluded Session 11.00am to 12noon Open meeting from 12.45pm

Transcription

1 BOARD MEETING Wednesday 10 th August am Note: Public Excluded Session 11.00am to 12noon Open meeting from 12.45pm AGENDA Items to be considered in public meeting VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna 1

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

3 MEETING OF THE BOARD 10 th August 2016 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Tce, Takapuna WDHB BOARD MEMBERS Lester Levy - Chair Max Abbott - WDHB Board Member Kylie Clegg WDHB Board Member Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Tony Norman - WDHB Deputy Chair Morris Pita - WDHB Board Member Christine Rankin - WDHB Board Member Allison Roe - WDHB Board Member Gwen Tepania-Palmer - WDHB Board Member Time: am WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Chief Medical Officer Simon Bowen - Director Health Outcomes Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Cath Cronin Director of Hospital Services Tamzin Brott Director of Allied Health Fiona McCarthy Director Human Resources Peta Molloy - Board Secretary APOLOGIES: Warren Flaunty REGISTER OF INTERESTS Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda? PART 1 Items to be considered in public meeting AGENDA TIME 11.00am (please note agenda item times are estimates only and that the public excluded session is from 11.00am-12 noon) 1. AGENDA ORDER AND TIMING 10.15am 2. RESOLUTION TO EXCLUDE THE PUBLIC BOARD MINUTES 12.45pm 3.1 Confirmation of Minutes of the Meeting of the Board (29/06/16)... 8 Actions arising from previous meetings pm 4. CHAIR S REPORT... (Verbal Report) 5. EXECUTIVE REPORTS 12.50pm 5.1 CEO s Report pm 5.2 Health and Safety Report pm 5.3 Communications Report DECISION PAPERS 1.15pm 6.1 Appointment of Northland DHB representative to the Board of healthalliance NZ Limited PERFORMANCE REPORT 1.20pm 7.1 Financial Performance COMMITTEE REPORTS 1.35pm 8.1 Hospital Advisory Committee Meeting (29/06/16) Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting (20/07/16) Recommendation from the Auckland DHB and Waitemata DHB Disability Support Advisory Committee Meeting (01/07/16) INFORMATION PAPERS 1.40pm 9.1 Health and Safety Marker Report

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

5 Board/Committee Member Lester Levy - Board Chairman Max Abbott Kylie Clegg REGISTER OF INTERESTS Involvements with other organisations Chair Auckland District Health Board Chairman Auckland Transport Chairman Health Research Council Independent Chairman Tonkin & Taylor Chief Executive New Zealand Leadership Institute Professor of Leadership University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework Pro Vice-Chancellor (North Shore) and Dean Faculty of Health and Environmental Sciences, Auckland University of Technology Patron Raeburn House Advisor Health Workforce New Zealand Board Member, AUT Millennium Ownership Trust Chair Social Services Online Trust Board member Rotary National Science and Technology Forum Trust Board Member Hockey New Zealand Trustee and Chairman the Hockey Foundation Trustee and Beneficiary Mickyla Trust Trustee and Beneficiary M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Trustee and Beneficiary of M&K Investments Trust (owns 99% share in MC Capital Ltd, MC Securities Ltd and MC Acquisitions Ltd) Last Updated 03/02/16 19/03/14 25/11/15 Sandra Coney Chair Waitakere Ranges Local Board, Auckland Council 12/12/13 Warren Flaunty Member Henderson - Massey and Rodney Local Boards, Auckland Council 25/11/15 Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder Green Cross Health Owner Life Pharmacy North West Director Westgate Pharmacy Ltd Chair Three Harbours Health Foundation Director - Trusts Community Foundation Ltd James Le Fevre Emergency Physician Auckland Adults Emergency Department 12/08/15 Pre-hospital Physician Auckland HEMS ARHT/Auckland DHB Co-opted Member Whanganui District Health Board Hospital Advisory Committee Trustee Three Harbours Foundation Member Association of Salaried Medical Specialists Shareholder Pacific Edge Ltd James wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine Anthony Norman Board Chair - Northland DHB 01/07/16 Deputy Board Chairman Trustee and Treasurer - Kerikeri International Piano Competition Trust Partner - Mill Bay Haven, Mangonui (accommodation provider) Morris Pita Board Member Auckland District Health Board 13/12/13 Owner/operator Shea Pita and Associates Limited Shareholder Turuki Pharmacy Limited Wife is member of the Northland District Health Board Christine Rankin Member - Upper Harbour Local Board, Auckland Council 15/07/15 Director - The Transformational Leadership Company Allison Roe Member Devonport-Takapuna Local Board, Auckland Council Chairperson Matakana Coast Trail Trust 02/07/14 Gwen Tepania- Palmer Chairperson- Ngatihine Health Trust, Bay of Islands Life Member National Council Maori Nurses Alumni Massey University MBA Director Manaia Health PHO, Whangarei Board Member Auckland District Health Board Committee Member Lottery Northland Community Committee 10/04/13 Waitemata District Health Board, Meeting of the Board 24/02/16 5

6 2 Resolution to Exclude the Public Resolution: That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Minutes of the Meeting of the Board with Public Excluded 29/06/16 2. Minutes of the Hospital Advisory Committee with Public Excluded 29/06/16 3. Minutes of the Audit and Finance Committee with Public Excluded 20/07/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] 6

7 General subject of items to be considered 4. Minutes of the ADHB and WDHB Collaboration Committee Public Excluded (06/04/16) 5. Minutes of the Three Harbours Health Foundation 6. Pharmacist Services 7. NZ Health Partnerships Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] 7

8 3.1 Confirmation of Minutes of the Board meeting held on 29 th June 2016 Recommendation: That the Minutes of the Board meeting held on 29 th June 2016 be approved. 8

9 Minutes of the meeting of the Waitemata District Health Board Wednesday 29 June 2016 held at Waitemata DHB, Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.40am PART I Items considered in public meeting BOARD MEMBERS PRESENT: Lester Levy (Board Chair) Max Abbott Kylie Clegg Sandra Coney Warren Flaunty Tony Norman (Deputy Board Chair) Morris Pita Christine Rankin Allison Roe Gwen Tepania-Palmer ALSO PRESENT: Dale Bramley (Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Andrew Brant (Chief Medical Officer) Debbie Holdsworth (Director Funding) Simon Bowen (Director Health Outcomes Cath Cronin (Director of Hospital Services) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director of Human Resources) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item) PUBLIC AND MEDIA REPRESENTATIVES: APOLOGIES: WELCOME John Tamihere (Te Whanau o Waipareira Trust) (present from to 1.08pm) Raymond Hall (Te Whanau o Waipareira Trust) (present from to 1.08pm) Ngaire Harris (Te Whanau o Waipareira Trust) (present from to 1.08pm) Lynda Williams (Auckland Womens Health Council) (present from 12.56pm) Tracy McIntyre (Waitakere Health Link) (present from pm until 2.09pm) Tanja Binzegger (Health Link North) (present from pm until 2.09pm) An apology was received and accepted from James Le Fevre. The Board Chair welcomed those present and introduced Mr Bob Henderson (appointed Board member of the Health Quality and Safety Commission) who was attending the Waitemata DHB Board meeting as a Board observer. 9

10 DISCLOSURE OF INTERESTS There were no additions or other amendments to the Interests Register. There were no declarations of interest relating to the open section of the agenda. 1 AGENDA ORDER AND TIMING Items were taken in same order as listed in the agenda, except that item 6.2 was considered before item 5.1. The public excluded session was held first, from 10.40am to 12.25pm. 2 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 6-11) Resolution (Moved Christine Rankin/Seconded Gwen Tepania-Palmer) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Minutes of the Meeting of the Board with Public Excluded 25/05/16 2. Minutes of the Hospital Advisory Committee with Public Excluded 25/05/16 3. Minutes of the Audit and Finance Committee with Public Excluded 08/06/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or 10

11 General subject of items to be considered 4. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees with Public Excluded 08/06/16 5. Minutes of the Wilson Home Trust 08/04/16 6. Minutes of the Wilson Home Trust 22/04/16 Reason for passing this resolution in relation to each item under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Ground(s) under Clause 32 for passing this resolution disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the 11

12 General subject of items to be considered Reason for passing this resolution in relation to each item Schedule 3, S.32 (a)] 7. Knee Replacement System That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Colonoscopy and Gastroscopy [NZPH&D Act 2000 Schedule 3, S.32 (a)] That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available: i) would disclose a trade secret; or ii) would be likely to unreasonably prejudice the 12

13 General subject of items to be considered Reason for passing this resolution in relation to each item 9. Storage and Dispensing That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 10. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 11. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 12. Business Case That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution commercial position of any person who supplied, or who is the subject of, such information. [Official Information Act 1982 S.9 (2) (b)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] 13

14 General subject of items to be considered 13. Primary and Community Services Plan Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 14. Capital Budget That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 15. Long Term Investor Plan That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 16. Lease That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Ground(s) under Clause 32 for passing this resolution Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. 14

15 General subject of items to be considered Reason for passing this resolution in relation to each item Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. 17. Carparking That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 18. Service Configuration That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 19. Migrant Health Contract That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] [Official Information Act 1982 S.9 (2) (j)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater 15

16 General subject of items to be considered Reason for passing this resolution in relation to each item Ground(s) under Clause 32 for passing this resolution need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] 20. Funding Contracts That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 21. Way-finding Upgrade That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 22. General Business That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)] Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Carried 10.42am 12.25pm public excluded session pm -2.27pm open session. 16

17 PRESENTATION Mr John Tamihere (Chief Executive, Te Whanau o Waipareira Trust), Mr Raymond Hall (Chair, Te Whanau o Waipareira Trust) and Ms Ngaire Harris (Project Manager, Te Whanau o Waipareira Trust) were in attendance to present to the Board regarding After Hours Care in West Auckland. Morris Pita opened the meeting with a mihimihi followed by a waiata led by Gwen Tepania-Palmer. The Board Chair welcome Mr Tamihere, Mr Hall and Ms Harris and noted the request from Mr Tamihere to speak to the Board on behalf of Te Whanau o Waipariera Trust regarding after hours care. Mr Tamihere acknowledged the Board and the opportunity to present at its meeting. Points of concern raised by Mr Tamihere regarding after hours care included: the disparity of incomes when having to pay for after hour services, the cost for those who do not qualify for a community services card but do not earn sufficient to support family and have an expense like that of care at an after hour service and public transport issues. He also noted that some patients are subject to having to arrange a debt repayment option and that there is not privacy to do this. Mr Tamihere queried the set-up of White Cross and the extent of waiting hours within the clinics. He noted the Official Information Act (OIA) request from Te Whanau O Waipareira that was recently submitted to the Waitemata DHB which includes a request for this information about White Cross and that the response to the OIA will answer these questions. Mr Tamihere acknowledged the leadership of Waitemata DHB and the good work that had occurred, however, after hours was an ongoing area of concern for Te Whanau O Waipareira. The Board Chair thanked Mr Tamihere for his presentation and Mr Hall and Ms Harris for their attendance. He noted that the DHB is currently in a procurement process and therefore limited to its response at this time. It was acknowledged that after hour services have been considered for some period of time. 3 BOARD MINUTES 3.1 Confirmation of Minutes of the Board Meeting held on 25 th May 2016 (agenda pages 12-22) Resolution (Moved Max Abbott/Seconded Gwen Tepania-Palmer) That the minutes of the Board meeting held on 25 th May 2016 be approved. Carried Actions arising from previous meetings (agenda page 23) No issues were raised. 17

18 4 CHAIR S REPORT (agenda pages 24-54) The Chair noted the correspondence from the Ministry of Health included on the agenda advising of the Board s decision making and communication guidance during the 2016 DHB election period. He requested that Board members read the information, particularly those who intend to stand for election. He also noted that the Waitemata DHB Board has in the past been exemplary in terms of maintaining confidentiality during the election period. The Chair also noted that an elected member had noted that it would be useful if the electoral officer advised potential candidates that elected DHB Board members hold full accountability for health and safety (unlike local Council). In conjunction with the electoral officer advising potential candidates about health and safety requirements it was also suggested that the candidates be provided with the 2017 meeting schedule to ensure full awareness of confirmed meeting dates. Item 6.2 of the agenda was considered at this time. The Board Chair spoke of the very sad passing of Rob Cooper, a former Board member for both Auckland DHB and Waitemata DHB and colleague for 25 years. Rob was very wise and highly constructive in moving matters forward, he mentored a number of people and his passing will be a real loss to all. Dr Levy noted that he had spent time with Rob s family following his passing and that Gwen Tepania-Palmer and Morris Pita attended Rob s Tangi at Motatau Marae in the Bay of Islands. 5 EXECUTIVE REPORTS 5.1 Chief Executive s Report (agenda pages 55-72) Dr Dale Bramley (Chief Executive Officer) summarised the report, matters highlighted included: That the new Sky Bridge was officially opened by the Prime Minister, Rt Hon John Key and the Minister of Health, Hon Dr Jonathan Coleman on 21st June That the Prime Minister also spoke as part of the CEO lecture series and outlined the Government s policy direction for health care in New Zealand. Recognition of the recent facility milestones, including that work has now commenced on the Clinical Skills Centre and that the re-built Te Miro unit has now formally opened. Congratulations were extended to David Ryan on becoming a finalist in the New Zealand Excellence in IT Awards. Acknowledging the Leapfrog programme with eprescribing is now in place for 950 beds with eradiology now complete. The evitals system is now live in the pilot ward at Waitakere Hospital and is having a positive impact. Acknowledgement of Dr Penny Andrew s appointment as the Director of the Institute for Innovation and Improvement. The Chief Executive also noted that he recently had the opportunity to attend the WHO s World Health Assembly in Geneva, focussed on addressing antimicrobial resistance (as outlined on pages of the agenda). He noted that antimicrobial 18

19 resistance is not simple infections and would mean the ability to undertake common surgery would be a threat. In response to questions it was noted that: As New Zealand is further removed strains can take longer to arrive; countries like the United States and the like experience greater issues. Although there are controls in place, the use of antibiotics in animals is a big factor. There is an international plan on the use of antibiotics in animals to action and New Zealand will participate with the Ministry of Health on increasing efforts as well. In response to a question about the national health target faster cancer treatment being below target, the Chief Executive noted that this is a key target for Cath Cronin and the Hospital Arm. The target is a positive goal and focus is being given to reach it, however, to date no DHB nationally has reached this target. The target data recorded is complicated by the requirement to include up to 15% of patients who opt not to have treatment. Some patients also require time to consider their options and the treatment path they would like to follow. The DHB has written to the Ministry of Health about this issue. It was further noted that the immunisation target also has a 5% active decline rate; the DHB is looking at how it can address the antiimmunisation campaign via social media and inform the community on the importance of immunisation. The Board Chair spoke of the Prime Minister and Minister of Health s visit, noting a tour of the Elective Surgery Centre and the opportunity to speak with patients directly giving the opportunity to see first-hand how quickly many of the patients are able to go home following surgery. The patients spoke very positively of their time in the Elective Surgery Centre. Warren Flaunty thanked the Chief Executive for his report which gives a brilliant overview of what is happening in the organisation. The report was received. 5.2 Health and Safety Performance Report June 2016 (agenda pages 73-89) Fiona McCarthy (Director, Human Resources) and Michael Field (Group Manager, Occupational Health and Safety) were present for this item. Fiona McCarthy summarised the report and matters highlighted and responses to questions included: Section 5 of the report outlines the health and safety risks for the DHB. This is being refined and with a further update to the Board at its next meeting. Most of the actions contained in the report are effectively the work priorities for the team. That the Business Leaders Forum has provided great guidance on reporting. Michael Field noted his thanks to the Board members that attended the health and safety site visit to review hazardous substances on 18 th May. The feedback from those who attended was valuable and it was very beneficial to have people who do not work in the environment viewing the areas. A number of the actions noted from the day were instantly rectified. In response to a question from Morris Pita about a 19

20 business case for a hazardous substances area at Waitakere, Michael noted that the business case was underway with the costings currently being reviewed. Michael also noted that following the Enviromark Audit the DHB is now the only certified DHB in the country, this is a significant undertaking for Waitemata DHB. He noted that the auditors were mostly focussed on health and safety aspects with three corrective actions to be completed. The Board Chair noted the bow-tie analysis tool and the need to refine ways of understanding cause and consequence. He requested that this analysis be investigated for use and once familiar with this method it should become an additional feature of the DHB s health and safety reporting. Michael Field also noted that a northern regional health and safety meeting has not been held for some time and the meetings are now being reconvened. That the report be received. 5.3 Communications (agenda pages 90-95) The Chief Executive introduced this item, noting apologies from Matt Rogers (Director, Communications) who was absent from the meeting due to an urgent matter. The Chief Executive noted the number of hits on the DHB s website had doubled, with approximately 45,000 website visits per month. It was also noted that a formal complaint had been lodged with regards to the recent interview involving Dr Andrew Brant (Chief Medial Officer) that screened on the TVNZ Marae Programme. Gwen Tepania-Palmer acknowledged the volume of work, time and energy the Communications team provides for the DHB. The report was received. 6 DECISION PAPERS 6.1 Primary Birthing Facility Consultation Outcome (agenda pages ) Linda Harun (General Manager, Child Women and Family Services), Ruth Bilj (Funding and Development Manager, Child, Youth and Women) and Emma Farmer (Head of Division, Midwifery) were present for this item. The Board Chair acknowledged the report and noted that with regard to point c) of the resolution, the Board would like to be in a position to consider a detailed business case with range of options that are independent and with a neutral approach to each option. It was noted that a business case would be submitted to the Board in either December 2016 or early Sandra Coney acknowledged the thorough consultation that was undertaken. Resolution (Moved Sandra Coney/Seconded Allison Roe) That the Board: 20

21 a) Note public consultation on potential primary birthing facilities elicited 1,162 completed survey responses and heard from over 450 people through community forums. b) Note feedback from the community demonstrated strong support for either: i. A DHB owned/managed free-standing primary maternity unit in the community, or ii. A DHB owned/managed free-standing primary maternity unit on the hospital campus c) Approve development of a detailed business case to establish a primary birthing unit in West Auckland. d) Approve public release of the consultation report in full. Carried Board and Committee Meeting Schedule (agenda pages ) Item 6.2 was considered with item 4 of the agenda. The Chair introduced the item noting that the Board, Hospital Advisory Committee and Audit and Finance Committee meetings will continue on the current six-weekly meeting cycle. He noted that it is proposed that the combined Auckland DHB and Waitemata DHB Community and Public Advisory Committees meeting join the same cycle as combined Auckland DHB and Waitemata DHB Disability Support Advisory Committees and Maori Health Gain Advisory Committees meetings of four scheduled meetings per year. It was emphasised that the proposed schedule is the minimum number of meetings required and that the Chair of the committee could schedule additional meetings if required. It was further noted that in 2017 Board members will be allocated lead roles in specific areas of activity as detailed in the report. Health and safety visits would also be scheduled on a regular basis. All meetings will be scheduled (with possible urgent exceptions) on a Wednesday and as with previous years Board members are advised to keep Wednesday s free for DHB business. Sandra Coney expressed concern that it may be difficult for the combined CPHAC meetings to maintain momentum with four meetings per year; Warren Flaunty acknowledged Sandra s comments and the need to ensure deadlines on matters such as submissions are met. The Board Chair reiterated that it is minimum number of meetings and that the Committee Chair could schedule additional meetings if required. Gwen Tepania-Palmer in her role as Chair of the combined ADHB and WDHB Manawa Ora meeting noted the very positive impact of four meetings per year for Manawa Ora. Manawa Ora has experienced a shift to being both strategic and focussed on its goals and outcomes. A copy of the confirmed 2017 meeting schedule will be sent to the Electoral Officer for distribution to potential candidates. Resolution (Moved Gwen Tepania-Palmer/Seconded Christine Rankin) 21

22 a) That the Board approves the attached meeting schedule for 2017, with meetings scheduled on a six weekly meeting cycle as follows: i. The Waitemata DHB Board, Audit and Finance Committee and Hospital Advisory Committee meetings schedule follows the current basis for meetings to be on a six weekly meeting cycle. ii. iii. The combined Auckland DHB and Waitemata DHB Disability Support Advisory Committee and the Maori Health Gain Advisory Committee continue to meet four times per year on a six weekly meeting cycle. That the combined Auckland and Waitemata DHB Community and Public Health Advisory Committees will meet four times per year on a six weekly meeting cycle, bringing the Committee into alignment with the combined Auckland DHB and Waitemata DHB Disability Support Advisory Committees and the Maori Health Gain Advisory Committees meeting schedule. b) That the Board approve an amendment to the Terms of Reference for the combined Auckland and Waitemata DHB Community and Public Health Advisory Committees to meet in a combined forum four times per year, as noted in recommendation a) iii. above. Carried Sandra Coney requested that her vote be recorded against this decision. 7 PERFORMANCE REPORTS 7.1 Financial Performance (agenda pages 74-88) Dr Dale Bramley (Chief Executive) introduced and summarised the report. Robert Paine s apologies were noted. The report was received. 8 COMMITTEE REPORTS (agenda pages ) 8.1 Hospital Advisory Committee Meeting held on 25 th May 2016 Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the draft minutes of the Hospital Advisory Committee Meeting held on 25 th April 2016 be received. Carried 8.2 Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting held on 08 th June 2016 Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) 22

23 That the draft minutes of the Community and Public Health Advisory Committee meeting held on 08 th June 2016 be received. Carried 9 INFORMATION PAPERS 9.1 Health and Safety Marker Report - Update June 2016 (agenda pages ) Fiona McCarthy (Director, Human Resources) introduced the item noting that progress is being made on the actions required. There has been a delay with contract management due to resource availability. Resolution (Moved Gwen Tepania-Palmer/Seconded Warren Flaunt) That the report be received. Carried 9.2 Bowel Screening Pilot Update (agenda pages ) Dr Debbie Holdsworth (Director Funding) introduced this item noting that the request for an additional report had been raised at the recent Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees meeting. Debbie advised that following the Ministry of Health s announcement for the roll out of a national bowel screening programme the business case supporting a national rollout was not available for circulation to the Board as it had not yet gone to cabinet and therefore not available for public release. Debbie noted that she will follow up with the Ministry of Health and circulate the business case if and when it is available for release. In response to a question, Debbie Holdsworth noted that the interim evaluation reports are available on the website and that the website link would be circulated to the Board. Resolution (Moved Tony Norman/Seconded Sandra Coney) That the Board receives this report. Carried 9.3 Waitemata Healthy Food and Drink Policy (agenda pages ) Simon Bowen (Director Health Outcomes) and Rebecca McLean (Public Health Dietician) were present for this time. Simon Bowen introduced the item. Sandra Coney supported the policy and queried whether it was just for the Waitemata DHB or is there an opportunity for other organisations/groups (such as the Waitakere Ranges Local Board for Auckland Council) to sign up to the Waitemata 23

24 Health Food and Drink Policy. She also queried the use of healthy food providers at events and the DHB offering support to providers of healthy food options. In response, Simon Bowen noted that the opportunity for other groups to sign up to the policy was a possibility and that it could be developed further for wider use. It was also noted that while full support is given to the policy, the option of only having health food providers at an event can be difficult for a retail provider to sustain commercially. Allison Roe acknowledged the work being undertaken in this area and the need to maintain momentum in keeping information on food groups up to date and available. Resolution (Moved Sandra Coney/Seconded Kylie Clegg) That the Board notes that the Waitemata DHB Healthy Food and Drink Policy is being updated in line with the national policy subject to agreement with the National Resident Doctors Association and the National Bipartite Action Group for the wider health workforce. Carried 9.4 Waitemata DHB and the Auckland Regional Tissue Bank (agenda pages ) Dr Andrew Brant (Chief Medical Officer), Dr Paul Muir (Medical Administration Registrar to CMO), Dr Karen Bartholomew (Public Health Physician), Dr Reena Ramsaroop (Clinical Director WDHB Pathology), Phil Shepard (Manager, Auckland Regional Tissue Bank) and Amanda Mark (Legal Manager) were present for this time. Dr Andrew Brant introduced and summarised this item. Resolution (Moved Kylie Clegg/Seconded Christine Rankin) That the Board: a) Note the progress of the Waitemata District Health Board (DHB) Breast Cancer Tissue Bank. b) Note that a memorandum of understanding between Waitemata District Health Board and the University of Auckland or the Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank will be brought back to the Board. Carried The Chair thanked those present. The meeting concluded at 2.27 pm SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 29 JUNE

25 CHAIR 25

26 Actions Arising and Carried Forward from Previous Board Meetings as at 02 August 2016 Meeting Date Agenda Ref Topic 29/05/ Bowel Screening Project website link for the evaluation reports to be sent to the Board members. Person Responsible Debbie Holdsworth Expected Report back Comment Actioned. Waitemata District Health Board, Meeting of the Board 29/06/16 26

27 5.1 Chief Executive s Report Recommendation: That the Chief Executive s Report be received. Prepared by: Dr Dale Bramley (Chief Executive Officer) 1. News and events summary A number of events of significance took place across the DHB over the past six weeks: E te Rangatira a Rob, moe mai, moe mai, moe mai ra. On 21 June, we received the sad news that Rob Cooper, a Waitemata DHB Board member for many years and a champion of Maori health for decades, had passed away. Rob will be greatly missed and this organisation owes him much for his dedication, service and wisdom. Chief Advisor Tikanga Naida Glavish and I visited Rob in the days before his passing. He was thinking fondly of the Waitemata team and had a keen interest in the opening of the Sky Bridge the day we visited. The Board Chairman Dr Lester Levy and Naida Glavish attended Rob s tangi at his family home before he travelled to Motatau Marau in the Bay of Islands. May he rest in eternal peace. Our thoughts and prayers are with his whanau. At the time of preparing this report, we were looking forward to the official opening of the expanded Waitakere Hospital Emergency Department on 5 August. The larger ED brings a significant increase in the DHB s capacity to meet the emergency medicine needs of the fastgrowing West Auckland community. Officially opened by the Minister of Health, Hon Dr Jonathan Coleman, the expansion has seen the facility almost double in size to just over 1300 square metres to cater for growing demand for care. When the facility opened in 2005, it treated 17,000 patients in its first year. This had grown to almost 50,000 last year - the greatest increase in patient numbers for any ED in the country and now managing around the same number of presentations as the North Shore Hospital ED. The new facility provides a fit-for-purpose department able to provide high-quality, round-the-clock care. It includes a new front-of-house zone, doubling of the number of consultation cubicles to 10, separate adult and paediatric waiting rooms, defined areas for patients with mental health needs, a purpose-built whanau room, two new negative pressure isolation rooms to meet modern infection control standards, four new undercover ambulance bays and new triage, reception and resuscitation areas. The ED expansion is the DHB s latest investment in health care facilities for West Aucklanders, following refurbishment of Waitakere Hospital s maternity unit, the opening of a new on-site pharmacy, enhanced acute mental health services, redevelopment of ward family rooms and the expansion of general medical teams from six to 11. Waitemata DHB jointly hosted the Prime Minister, Rt Hon John Key, and the Minister of Health, Hon Dr Jonathan Coleman, at an event to launch the new national childhood obesity target on 30 June. The target, which came into effect on 1 July, requires 95 per cent of obese children identified in B4 School Checks to be offered a referral for clinical assessment and family-based nutrition, activity and lifestyle interventions by December The target is one of 22 initiatives in the Government s Childhood Obesity Plan unveiled in October The target was launched at the Birkenhead Plunket office, within our district. Waitemata DHB contracts Plunket to provide B4 School Checks. At the launch, the Prime Minister and Waitemata District Health Board, Meeting of the Board 10/8/16 27

28 Minister had the opportunity to see a child and her mother going through some of the key elements of the B4 School Check to demonstrate how children who could benefit from referral are to be identified. Prime Minister John Key witnesses a B4 School Check at the launch of the new childhood obesity health target. CEO Dr Dale Bramley (right) with Minister Coleman and Mr Key. Waitemata District Health Board, Meeting of the Board 10/8/16 28

29 A major new national community falls prevention programme developed by the Waitemata- Auckland DHB planning and funding team was given the official Government go-ahead on 12 July. The programme is aimed at people aged over-65 and will see $30.5 million invested over the next four years in supporting better outcomes for older people at-risk of a fall or injury and is the product of close collaboration between the two DHBs. Waitemata DHB is investing $457,000 per year for three years, including $57,000 from the Well Foundation in year one. The DHB s contribution is to be matched by ACC. The risk of a fall begins to increase from the age of 65 and the impacts can be significant in terms of related injuries, loss-of-confidence and social engagement. The evidence-based model adopted by the Government will see more support available for home safety assessment and intervention, treatment of osteoporosis in people with fragility fractures, in-home strength and balance exercise programmes among other means of identifying risks and taking action before falls occur. The adoption of this model is a great example of Waitemata and Auckland DHBs using our combined knowledge and skills to take a national leadership role in a complex area of health care where, unfortunately, demand is rising. Also see Section 4 Outcomes Discussion for a more detailed overview of this project. Ministers Nikki Kaye and Maggie Barry with patient Mary Mellor at the launch at Auckland City Hospital. Waitemata District Health Board, Meeting of the Board 10/8/16 29

30 In July, I launched our newest service, the Early Discharge and Rehabilitation Service (EDARS). EDARS is designed for patients with stroke and some other conditions to be discharged earlier and receive the required rehabilitation at home. The programme is for patients whose underlying medical condition is stable and is similar to the care they would receive in the Assessment, Treatment and Rehabilitation (AT&R) wards. EDARS is a comprehensive inter-disciplinary clinical team which will grow to include 19 staff (12.8 FTE) working to rehabilitate patients to be as fully functional as possible and integrated back into their own environment. The Early Discharge and Rehabilitation Service team gathers for the launch of the new service. From July, Waitemata and Auckland DHBs hosted our annual Pasifika Week celebrations, recognising the contribution of our Pacific communities. The theme of the week was Achieving Health Equity for Pacific. We were honoured to host the Samoan Head of State, His Highness Tui Atua Tupua Tamasese Efi, who was in attendance at the opening ceremony at Waitakere Hospital, along with other officials and dignitaries. The week included a diverse range of events celebrating Pacific culture, including presentations on Pacific research, men s health, nursing, patient and family journeys and a Colours of the Pacific fashion competition. A video of highlights from across Pasifika Week have been uploaded to Youtube and can be access via the following link: For further information, see the Pacific Health section of this report. Waitemata District Health Board, Meeting of the Board 10/8/16 30

31 CEO Dr Dale Bramley with Samoan Head of State, His Highness Tui Atua Tupua Tamasese Efi. A total of 49 Waitemata DHB Health Scholarships have been awarded in 2016 to young Maori and Pacific people aiming to embark on careers in healthcare. A total of 50 places were available, so the excellent take-up rate demonstrates the high value of this programme. The 2016 scholarship intake includes 38 females and 11 males, with greatest interest in nursing, followed by medicine and physiotherapy. Each scholarship recipient is given $5,000 per year to assist them in continuing their studies, with a view to increasing the participation and development of our Maori and Pacific workforce. Since its inception in 2011, the programme has provided scholarships to a total of 235 people. See Maori Health section for more detailed information. I attended a ceremony held on 19 July to mark the graduation of 151 of Waitemata DHB s cleaners and orderlies to the Level 3 NZQA standard. This was a fantastic occasion and, for many involved, it was the first formal qualification they had ever achieved. Achieving the standard required to graduate involves learning in the workplace, with one credit accumulated for every 10 hours of study. For cleaners, the level 3 accreditation is awarded to those who have demonstrated competence in 16 topics, including core cleaning skills and in selected areas of specialisation. Accreditation requires 60 credits and usually takes 10 months to achieve. For orderlies, the qualification period spans nine months and requires 50 credits across 11 topics. The course covers responses to vulnerability and abuse, strategies for de-escalating disputes, transporting people and moving equipment to support the effective functioning of a health care facility. Demonstrated knowledge or professional and ethical behaviour and procedures for infection control are also included. Congratulations to Waitemata District Health Board, Meeting of the Board 10/8/16 31

32 all concerned on this important milestone in their employment with Waitemata DHB and in their ability to support enhanced experience for our patients, their families and whanau. Staff members (L-R) Maria Garcia, Marilou Guanlao, Barbara Schwalger (Operations Manager, Clinical Support Services), Parvina Devi, Amy Pangan and Angeline Partridge celebrate with their accreditation certificates following the graduation ceremony. Members of the wider Waitemata DHB team have been named finalists in a series of major national awards. The fact that so many of our people made it to the final selection reflects well on the calibre of the team and the work we do every day to make the lives of our patients and their families/whanau better. I want to take this opportunity to mention those who have done the DHB proud by advancing to become finalists in their respective categories. Pharmacy Operations Manager David Ryan was a finalist in the Excellence in Health Informatics category at the New Zealand Excellence in IT Awards for his role in introducing electronic prescribing (e-prescribing) across North Shore and Waitakere Hospitals. E-prescribing does away with hand-written paper medication charts, thereby reducing the rate of prescribing errors, eliminating difficult-to-read hand-writing and alerting staff to patient allergies or adverse reactions. David has led e-prescribing from the ground up, with more than 850 beds now operating the technology across our hospitals and major clinical sites. David has been responsible for rolling-out a significant innovation in patient safety and his place among the national finalists was well-deserved. Two teams from our DHB were also finalists in the Institute of Public Administration New Zealand (IPANZ) Awards in early July. We were a finalist in the Excellence in Digital Government Award for our work on publishing an integrated digital quality account and for our improved organisational website. The DHB was also a finalist in the Building Trust and Confidence in Government Award for our suite of In Your Shoes initiatives aimed at improving patient experience. Congratulations and thank you to all those staff whose work has reflected so favourably on the DHB. A full list of IPANZ award finalists can be found by following this link: Waitemata District Health Board, Meeting of the Board 10/8/16 32

33 Construction of our new Waitemata Clinical Skills Centre on the North Shore lakefront is progressing to plan, with foundation works now well underway. Fortunately, heavy rains over recent weeks have not impacted on the construction schedule. Due to the location of the construction site adjacent to the helipad, it has been necessary to consult civil aviation authorities over the placement of the crane and this is now agreed as a result. Construction on the project began on 15 June and will deliver a state-of-the-art, two-storey teaching facility scheduled for completion in April It will create a new home for many of the academic activities taking place across the DHB and include an auditorium and clinical teaching spaces, ensuring Waitemata s reputation as a place of learning and excellence continues well into the future. The centre will also have a dedicated clinical skills laboratory occupying most of the first floor and an AUT exercise-testing laboratory. The calibre of special guests Waitemata DHB continues to attract provides further evidence of the high regard in which the DHB is held. Late July saw a return visit by Professor Richard Bohmer for the next round of cohort work, plus a focus on oncology. We have also had visits by the Chief Executive Officer and Chief Medical Officer from Hutt Valley DHB to look at our innovations programme as well as hosting senior leaders from Bay of Plenty DHB. Creating a culture of appreciation A thanksgiving service was held at St Lukes Chapel, North Shore Hospital, during Pasifika Week to recognise the career contribution of Tiava asu e Seupule Levaopolo Tiava asu e (or Matua Levao as known to his colleagues) for his service and commitment to Waitemata DHB and local community. His son, daughter-in-law and grandchildren were present to witness the DHB present a gift for his contribution and continuous service to the DHB over 15 years. Members of the Pacific Health team also put together a song incorporating the DHB values, led by TJ Taotua, Vodafone Gospel musician-of-the-year. Before working for Waitemata DHB, Matua Levao was a supervisor at Vita NZ Ltd in Avondale for 20 years, only resigning to start his own company in the transport industry. Levao and his wife received an invitation to attend the launch of Isa Lei and Tupu Mental Health Services in The service then advertised the vacancy for Matua. The opportunity to work with the Pacific community as well as with clinicians to better understand the problems that faced them resonated with his spirit. He started work for the DHB in 2001, helping the executive team with policy and decision-making, plus supporting with cultural and spirituality advice in terms of mental health and addictions. A wooden sculpture of a Samoan Orator (Tulafale) was presented to Matua Levao and the following was engraved on the plaque and attached to the statue: The Orator acknowledge the Trinity (Father, Son and the Holy Spirit). He also acknowledges the people and community to come into the church to worship. He also confesses to God on behalf of the community. Waitemata District Health Board, Meeting of the Board 10/8/16 33

34 CEO Dr Dale Bramley with Matua Levao and the carving provided as a gift by the DHB. A further 20 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member whose nomination is considered worthy of acknowledgement receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting were: Pearl Morse, Colposcopy Clinic - Booking Clerk NSH, nominated by Georgie McPherson Jamie Nito, Dental Therapy Assistant, Puhinui School Dental Clinic, nominated by Norrieh Fadaie Wayne Brady, Orderly - Theatre ESC, nominated by Jo Boyd Julie Holliday, District Nurse - Home Health Support West, nominated by Beverley Brown Rosalie Davis, Registered Nurse - Ward 10 (Medical Ward), nominated by Gill Rolfe Sue Dobson, Registered Nurse - Ward 10 (Medical Ward), nominated by Gill Rolfe Lesley Anderson, Physiotherapist - Inpatient North Therapies, nominated by Rupert Murch Paraic McCormack, Medical Officer - CADS Central, nominated by Carolyn Falkner & Vicki Macfarlane Stefanie Johnston, Registered Nurse - Pitman House, nominated by Astrid Smith Nicolette Hansen, Operations Co-ordinator - Awhina Education, nominated by Kathryn Scott, Stephanie Vos and Fiona McCarthy Donna Riddell, Charge Nurse Manager - Anawhata Ward, nominated by Ramanamma Kalluru Fiona Fowler, Telephonist - Hospital Reception, nominated by Robyn Kamp Barbara Nicholson, Office Administrator - Occupational Health Department, nominated by Margaret Kamphuis Waitemata District Health Board, Meeting of the Board 10/8/16 34

35 Nuala Kelly, Registered Nurse - Waiatarau Unit, nominated by Dr Joanna Szelebaum, Elly Weber and the staff at Waiatarau Dr Eleri Clissold, Education Fellow - Awhina Health Campus, nominated by Dr Ian Wallace Bronwyn Barrow, Senior NASC Practitioner, NASC, nominated by Liz Munt Anne Chote, Administration Clerk - NASC West, nominated by Liz Munt Geraldine Priestley, Health Care Assistant - Ward 14, nominated by Juliet Coburn Leighann Forrest, Clinical Resource Nurse - Ward 14, nominated by Juliet Coburn Im Soo Kim, Cultural Worker - Child Development Services, nominated by Anonymous 2. Upcoming events Looking toward the upcoming months, we can expect to see: Further progress on the next phase of Our Values, Your Values activity. Progress on construction of the Clinical Skills Centre on the North Shore campus. Continuation of works on the Community Health Building at North Shore Hospital. Continuation of the 2016 CEO Lecture Series. 3. Future Focus The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be. The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience. The intended benefits are to move these projects along at a faster pace with top-level support for the significant changes required, giving greater visibility and attention to those projects identified as being important in achieving the DHB s priorities and purpose as well as instilling the culture of improvement and innovation. eprescribing has been rolled out to our Elective Surgery Centre, with only Pre-Op, PACU and ICU remaining over the next few weeks, marking the end point of the current rollout. Any further areas will be considered once existing gains have been consolidated. The project lead, pharmacist David Ryan, was this month short-listed for the ITX NZ Excellence in IT Awards. (See News and Events summary above). The Community Allied Health Mobile project now has 113 clinicians fully mobile with tablet computers. This project is now focused on enhancing use of the devices, reviewing and trialling potential apps for use by the therapists and nurses. The evitals system is progressing well in the pilot ward (Anawhata) at Waitakere Hospital. As expected, the pilot is flushing out a small number of issues that are being addressed but that may push planned timeframes out by a few weeks. Waitemata District Health Board, Meeting of the Board 10/8/16 35

36 Voice-to-text software is being rolled-out to the entire transcription team and new clinician users are being trained. Contracting is complete for the new Patient Experience Reporting System and procurement processes are continuing for the Mobile Enterprise Application Platform (MEAP). Work on shortlisting the first potential app use cases for the MEAP is underway. Site visits are providing valuable inputs in the concept for an ideal ward layout and patient rooms for Waitemata 2025, with a plan to mock-up some spaces for broader staff and consumer input and events. 4. Outcomes discussion This month, I have asked Dr Tom Robinson from the Waitemata-Auckland DHBs Health Outcomes Team to provide a summary of the falls injury prevention model recently adopted by the Government which he has overseen development of. (See News and Events Summary) Waitemata DHB Falls Injury Prevention Model Background Falls are very common in older people and are a frequent cause of hospitalisation and injury, including fractures. In the Waitemata district, there are over 16,000 Accident Compensation Corporation (ACC) claims for falls-related injuries and 3,400 falls admissions in older people each year. Falling also leads to a loss of confidence and independence and to early aged residential care placement. There is strong evidence for a range of interventions to prevent falls and fractures in the community. Waitemata DHB has recently agreed, in collaboration with the ACC, and working with Auckland DHB, to fund community falls prevention and a large extension of our fracture liaison service. Target population Community falls prevention programmes are aimed at older people, particularly people 80 years and older who have a recent history of falls or are at-risk of falling. Fracture liaison services aim to reach all inpatients and outpatients who have a fragility fracture: typically a fracture of the wrist, upper arm, spine, pelvis or hip from minor trauma. These fractures are commonly due to osteoporosis or thin bones. These patients are over the age of 50, with older people being prioritised. Fracture liaison service The FLS will consist of two-and-a-half nurses, supported by doctors, who will work at North Shore and Waitakere Hospitals. They will seek out patients with likely fragility fractures and assess their need for osteoporosis treatment, then ensure its prescription. The agreement for this service is currently being put in place and staff will then be recruited. It is expected 1500 patients will be seen each year. Community falls prevention service People with falls risk will be referred by a wide range of primary and secondary clinicians. A range of interventions such as home assessment and review of medications and health conditions are effective but, for most people, strength and balance exercises are simple and effective. This is our main focus. Waitemata District Health Board, Meeting of the Board 10/8/16 36

37 Most people will be able to attend community-based group interventions and this is considered the best option. It is much less expensive and has other benefits, such as social contact. A number of community organisations already provide these group activities. ACC is taking leadership in this aspect of the Waitemata model and are consulting with community groups and will fund a lead provider, whose role will be facilitate the required quality of delivery and ensure sufficient and equitable access across the district. Waitemata DHB staff will be working with ACC on this approach. More frail older people will be best-served by a home strength and balance exercise programme, which is provided to them individually in their own home. The Otago Exercise Programme (OEP) is a NZ-developed programme that has an excellent evidence base and is used internationally. We aim to deliver this programme to 1365 patients-a-year via two models of care. Otago Exercise Programme delivery and trial OEP has traditionally been delivered by either physiotherapists or nurses. However, many of this frail group of patients already receive Home Care Support Services. Because of the lower staff costs - and because the staff are already visiting regularly - OEP delivered by HCSS providers would be less expensive and more sustainable (possibly at one-third of the cost). Another potential benefit is a greater long-term effect because of the support workers ongoing relationship. Although many experts believe this can be achieved, there is currently no evidence for effectiveness or safety. Waitemata and Auckland DHBs will, therefore, compare these two models in a randomised controlled trial in 2017 and An application for the research component of this trial is with the Health Research Council. Waitemata DHB will request proposals for delivery of a traditional OEP within a month and aim to have a provider delivering services by November. The service will deliver OEP to 765 people-a-year. If they consent, some of these patients will be in the trial. The DHB will also work with HCSS providers to implement modified OEP. We will train both their clinical case managers and their home support workers in OEP delivery. Clinical staff will assess patients, prescribe the exercises, undertake reassessments and supervise delivery by support workers. The providers will deliver the model to 600 patients-a-year, initially only within the trial. We hope to have this in place by the end of the year. Clinical pathway To support the new services and ensure best-use by our clinicians, a clinical pathway is being developed and will be implemented with training and wider communication. Waitemata District Health Board, Meeting of the Board 10/8/16 37

38 5. Board performance priorities The following provides a summary of the work underway to deliver on the DHB s priorities: Relief of suffering Progress: Patient and Whānau Centred Care Patient feedback National Inpatient Survey The last national survey was carried out in May We received responses from 134 (34%) people. Confidence and trust in Waitemata DHB services was up 2.9% in comparison to the same quarter in The results for the four domains this quarter: In comparison to the same period last year, Waitemata DHB has made gains in all domains: Communication increased 0.4, Partnership increased 0.3, Coordination and Needs increased by 0.1. Friends and Family Test During June 2016, we received feedback from 1,083 people through the Friends and Family Test (FFT). The Net Promoter Score (NPS) for June was 69, well above the DHB target of 65. Waitemata District Health Board, Meeting of the Board 10/8/16 38

39 Division Responses NPS by Question Question Excellent Good Fair Poor Waitemata DHB Did we see you promptly? 73.7% 20.7% 3.5% 2.0% Waitemata DHB Were we welcoming and friendly? 87.5% 10.8% 1.0% 0.7% Waitemata DHB Did we listen and explain? 79.9% 16.9% 2.6% 0.6% Waitemata DHB Did we show care and respect? 86.5% 11.9% 1.3% 0.3% Waitemata DHB Did we meet your expectations? 77.3% 18.4% 2.5% 1.9% Allied Health Did we see you promptly? 68.0% 28.0% 1.3% 2.7% Allied Health Were we welcoming and friendly? 94.7% 5.3% - - Allied Health Did we listen and explain? 90.7% 9.3% - - Allied Health Did we show care and respect? 97.3% 2.7% - - Allied Health Did we meet your expectations? 84.0% 16.0% - - Child Women & Family Did we see you promptly? 78.6% 16.6% 4.1% 0.7% Child Women & Family Were we welcoming and friendly? 85.5% 12.4% 1.4% 0.7% Child Women & Family Did we listen and explain? 84.1% 13.8% 2.1% - % Child Women & Family Did we show care and respect? 86.2% 11.7% 2.1% - % Child Women & Family Did we meet your expectations? 80.7% 17.2% 1.4% 0.7% Medicine & Health of Older People Did we see you promptly? 73.3% 21.2% 3.9% 1.7% Medicine & Health of Older People Were we welcoming and friendly? 86.8% 11.4% 1.2% 0.6% Medicine & Health of Older People Did we listen and explain? 77.2% 18.9% 3.2% 0.7% Medicine & Health of Older People Did we show care and respect? 84.8% 13.5% 1.4% 0.3% Medicine & Health of Older People Did we meet your expectations? 75.3% 18.4% 2.5% 1.9% Surgical & Ambulatory Services Did we see you promptly? 74.1% 19.5% 2.3% 4.1% Surgical & Ambulatory Services Were we welcoming and friendly? 92.3% 6.1% 0.5% 1.0% Surgical & Ambulatory Services Did we listen and explain? 83.8% 13.5% 1.4% 1.4% Surgical & Ambulatory Services Did we show care and respect? 89.6% 9.0% 0.9% 0.5% Surgical & Ambulatory Services Did we meet your expectations? 79.3% 16.2% 0.9% 3.6% Waitemata District Health Board, Meeting of the Board 10/8/16 39

40 PERSy Update The contract with Salmat/MaritzCX was signed on 14 July for the new in-house survey system that will allow clinical areas to ask locally meaningful questions and brings together staff and patient experience. Results will be mapped to the organisation's values and standards in order to better-inform and prioritise continuous quality improvement activity at ward level. The new system should be operational by the end of August and then the roll-out of the system will be communicated throughout the organisation. The new in-house patient experience survey system provides an incomparable level of functionality and sophistication. Aligning our vision for staff and patient experience reporting with this system will produce a world-first in healthcare. The analytical software includes robust statistical processes which will support clinical and other research and engage staff in the system. The system will be able to produce values reports, which were the subject of our national public sector award, but will also be able to drill down into the drivers of behaviours to support the wider experience programme. Patient Stories A catalogue of patient stories is currently under development. This catalogue will enable these videos to be used across the organisation in various forums and learning programmes. Each video has different messages for staff to learn from. However, the potential of each of these videos is not widely known. We currently have 33 patient videos, including stories about dental services, mental health services, Asian health support services, thrombosis services, disability support, surgical services, SCBU, emergency admissions, upper GI cancer, ORL, discharge planning and end-of-life-care. Three further stories are currently in production, including a delirium patient experience. Those that are able to be viewed publicly are available on the DHB website at Patient Information Patient Information booklet The North Shore Hospital patient information booklet has been finalised and will be printed by the end of July. The Patient Experience Team will roll the booklets out across the organisation, with a patient evaluation to determine how useful the information is and how the information is best-distributed to our patients. Healthlink has been closely involved in the preparation of the booklet. The Waitakere Hospital information booklet has commenced development. Continuous Quality Improvement Sleep Strategy Group An overarching activity strategy is in draft and will be presented to the Senior Management Team for endorsement in August. Waitemata DHB patient feedback highlights that a lack of quality sleep in hospital is a significant problem. Patients report that ward environments are not conducive to quality rest and that sleep is disturbed by clinical processes such as observation and pharmaceutical regimes. Evidence shows the benefits of effective sleep for patients recovery, wellbeing and overall experience. Currently, Waitemata DHB has limited resources or systems in place to support patients to sleep well. Waitemata District Health Board, Meeting of the Board 10/8/16 40

41 Recruitment Associate Director of Patient Experience & Volunteer Coordinator The patient experience team is in the process of recruiting an Associate Director of Patient Experience to support the vast array of patient experience work currently progressing throughout the organisation. In addition, a Volunteer Coordinator recruitment process is at interview stage, with the incumbent to progress a new Waitemata DHB volunteer program that will ensure our volunteers are supported effectively and their roles contribute to enhancing the patient experience at Waitemata DHB. They will also be responsible for implementing in many of the areas identified by Raeburn House for improvement (see below). Volunteer Review I also initiated a review of volunteer services at the DHB as many community members perform voluntary work with us (estimated at more than 300). I have been concerned for some time that we need to better support our volunteers as well as look at how we can extend this valuable engagement we receive from our community. Raeburn House undertook the review. Key findings were the need for: - Consistent orientation, onboarding and administration processes for volunteers - Development of a better sense of belonging to the wider DHB - Better acknowledgement and reward for their support to the organisation - Better centralised support - Improved coordination of volunteers Two events were hosted by Waitemata DHB in June (one at Waitakere and one at North Shore) to thank the volunteers for participating in the review and to further explore the challenges that were highlighted in the review. A further two focus groups are planned in August with representation from the various volunteer groups that support our organisation to inform the direction of a new volunteer program that will be rolled-out with the recruitment of a new full-time volunteer coordinator. Facilities development NSH Sky Bridge The Sky Bridge is complete following the official opening by the Prime Minister on 21 June. NSH Short Stay Ward (SSW) & Diagnostic Breast Service (DBS) Options for a staged redevelopment and for full closure of this area to complete all works are in the final stages of being scoped an update will be presented to the Board in August An openmarket tender process for a main contractor will be undertaken to secure firm pricing, after which approval will be sought to proceed. ESC expansion The ESC expansion project is progressing, with development of the ministerial business case led by PWC following Better Business Case ILM process. The preferred option is the development of a single new facility providing four endoscopy procedure rooms, two theatres and a 30-bed general surgery ward. Michael Hundleby from the Government s Capital Investment Committee (CIC) has been advised of the high-level costing for the preferred option. The DHB would like to progress this as a single stage business outside of regional planning requirements. We are still awaiting confirmation from the Minister that the CIC will agree to accept a business case presented as outlined above. Waitemata District Health Board, Meeting of the Board 10/8/16 41

42 NSH Antenatal and Cardiology Clinics Relocation This project progressed to completion of preliminary design in December 2015 and was then put onhold. Awaiting direction. NSH Community Building 5 See CFO Report. NSH Surgical Pathology Offices Relocation Construction is likely to begin mid late August with go-live planned for early Oct. WTH ED New Build This project is tracking to programme with practical completion scheduled for 27 July 2016, official opening on 5 August and go -live scheduled for 17 August. The Mauri Stone was reburied early on the morning of 7 June. SCBU WTH & NSH This project is for extension of the Special Care Baby Unit (SCBU) at WTH and reconfiguration of the SCBU at NSH. The WTH works will be completed first. Seed funding of $430k was endorsed at the CAMP meeting on 30 June. These funds were previously approved to scope the NSH concept only but are now allocated for scoping design at both sites. Better Outcomes Progress: On track Achieving the health targets June 2016 Shorter waits in Emergency Departments 95% (target 95%) Improved Access to Elective Surgery 104% (target 100%) Increased immunisation 92% (target 95%) Better help for hospitalised smokers to quit 98% (target 95%) More heart and diabetes checks 91% as at Q3 2015/16 (target 90%) Faster Cancer Treatment (FCT) 79% (target 85%)* * The FCT is a Ministry of Health priority and includes a cohort of patients who are referred to the DHB with a high suspicion of cancer. The target is 85 per cent of this cohort of patients will receive cancer treatment, or other management, within 62 days from their referral-received date. This target is to be met by July Health Quality and Safety Markers Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, MHOPS completed 94 per cent of falls risk assessments and Surgical and Ambulatory Services (SAS) achieved 97 per cent on admission. Hand Hygiene Waitemata DHB s Hand Hygiene Audit result for June 2016 is a compliance rate of 84 per cent for June, exceeding the national target of 80 per cent. Waitemata District Health Board, Meeting of the Board 10/8/16 42

43 Healthcare-Associated Infections The CLAB insertion bundle was used in ICU on 100 per cent of occasions in June The insertion bundle compliance surpasses the national target of 90%. Elective Surgery Centre (ESC) ESC discharges for June sat at 116 per cent of planned elective targets (106% YTD). Elective WIES YTD is 92 per cent of planned target. ESC is $479k unfavourable this month, $1,183k unfavourable for the full year. The financial overspend is attributed to the over-delivery of elective volumes, costs associated to unbudgeted acute volumes ($284k) and unmet embedded savings lines ($450k). Operationally, ESC continues with its efficient and productive service for its patients and clinicians, with a total of 487 patients operated on for the month (second-highest monthly volumes ever, since ESC opened). Patient satisfaction remains remarkably high, despite the increased workload, with a total of 111 satisfaction surveys completed for the month, 96 of which included positive comments. Māori Health DNA Strategy The Auckland and Waitemata DHB joint strategy to reduce inequalities in Did Not Attends (DNAs) and roadmap of actions was presented to Manawa Ora on 13 July for endorsement. The comprehensive strategic framework, which is focused on equity, contains four high-level areas of focus (domains), with 10 specific elements under each (Figure 1). Figure 1. DNA Strategic Framework Waitemata District Health Board, Meeting of the Board 10/8/16 43

44 The recently completed stocktake and gap analysis undertaken at both DHBs has generated a set of recommendations associated with each of the 10 strategic framework elements. These have been prioritised and the DNA strategy project team have presented a set of nine recommendations as the roadmap of actions. There is one overarching policy recommendation and then the recommendations are split into four high-impact but high-resource recommendations and four quick wins or lower-resource recommendations. Overarching recommendation 1. Endorse a joint DHB explicit DNA policy addressing measurement, monitoring and management with an equity focus. High-impact, high-resource 2. Implement Patient-Focused Bookings. 3. Create a tailored DNA Navigation Service. 4. Accelerate the development of clinically appropriate alternate delivery approaches and systematically offer these to patients. This includes a requirement to determine the medical value/necessity of an appointment. 5. Improve all communication to patients: Conduct health literacy review of standard letters and service-specific letters; develop standardised transport/parking and wayfinding (map) information. Quick wins or lower-resource 6. Ensure standardised and optimised text reminder across all services. 7. Resolve the issues limiting use of as a contact modality for appointments. 8. Mandate cultural competence/cald training for booking and scheduling staff (in Patient Service Centre and services who book their own clinics). 9. Review and optimise cultural competence component and assessment of values in human resource processes for booking and scheduling positions. Manawa Ora endorsed the strategy and road map of actions subject to their feedback. At the time of writing, the report was to be presented to the Hospital Advisory Committees in July for endorsement. Gap in Māori Life-Expectancy Report A report analysing the gap in Māori life-expectancy for Waitemata and Auckland DHBs is currently underway. The initial analyses focused on the social determinants of health, risk factors, disease and health system drivers of the life-expectancy gap. This work is currently being reviewed and discussed with Māori academics and representatives of the broader health sector. Health Needs Assessment at Whānau House Waitemata DHB has been working with Te Whānau o Waipareira Trust and Total Healthcare Primary Health Organisation (PHO) to conduct a health needs assessment. The objective of the project is to better-understand the health needs of the local population served by Whānau House, the extent to which Whānau House is meeting those needs and to identify the successes and opportunities for improvement. The project proposal documentation, including privacy impact assessment, was approved by the Privacy and Security Governance Group and a data-sharing agreement signed. The data collection and analysis has been completed and a draft report has been produced. The draft report has been presented to stakeholders for feedback. The final report will be presented to Manawa Ora in October. Waitemata District Health Board, Meeting of the Board 10/8/16 44

45 Māori Health Plans The 2016/17 Waitemata DHB Māori Health plan has been signed-off by the Ministry of Health and is available on the Waitemata DHB and Ministry of Health websites. Progress on improvements to ethnicity data Waitemata DHB has conducted a range of work on the drivers of ethnicity data quality issues, including the large primary care Ethnicity Data Audit Toolkit project. The DHB has worked collaboratively with the Ministry of Health on a refresh of the ethnicity data protocols for the health and disability sector. The changes to the protocols address identified systems issues. The work has included the development of a standard user interface tool for both patient and administrative IT systems interfaces. Maori Workforce Development The current capacity of the Waitemata DHB Health Scholarship programme is 50 funded places at $5000 each per annum ($250,000 per annum). The resources are allocated and administered by Human Resources for the purpose of growing our own workforce from our own communities, which is aligned to the Grow Our Own regional workforce approach. Applications were open to all ethnicities at its inception in Then, in 2011 at the direction of the WDHB Board, it became targeted to support the organisation s goals to increase participation and workforce development of Maori and Pacific peoples in the Waitemata DHB workforce. A two-year employment bond was also introduced at that time. The diagram below shows the Waitemata-Auckland DHB Maori workforce development pipeline. The area in red is the part of the pipeline the scholarship investment in intended to affect. (A customised pipeline based on the original from Rauringa Raupa, Ratima et al, 2007) Waitemata District Health Board, Meeting of the Board 10/8/16 45

46 The following table shows the number of scholarships awarded by ethnicity per annum since 2011, a total of 235 scholarships over six years. In 2016, there are 38 females and 11 males. Year Maori (n) Pasifika (n) Other (n) Total (n) Total The table below shows the areas of study for recipients for 2016 and the number of scholarship recipients expected to complete study in 2016/17. Profession Number of recipients 2016 Medical Imaging 2 Medical Laboratory Science 2 Medicine 10 1 Midwifery 4 1 Nursing 20 9 Occupational Therapy 1 1 Physiotherapy 6 3 Social Work 4 Dietitian Dental Therapist Total Number of recipients expected to complete study in Abdominal Aortic Aneurysm Screening Pilot for Māori Since its launch on 10 June, the Waitemata Abdominal Aortic Aneurysm (AAA) screening pilot has proven to be very popular, with requests for screening from people who are unenrolled and out of the age range. Screening began on 20 June in Wellsford at Coast to Coast, with everything going to plan and the last Coast to Coast patient screened on 14 July. The pilot aims to explore the feasibility of AAA screening by measuring the prevalence of this disease for Māori men aged and Māori women aged It is also testing a primary care-based screening delivery model. The intention is to screen around 500 eligible Māori enrolled with Coast to Coast, Waitakere Union Health Centre and Te Puna Hauora practices. Screening for eligible Maori WDHB employees took place over four days in early June, with 51 staff screened - an 85% participation rate for those invited. As well as contributing to staff wellness and providing a practical demonstration of the organisational value of everyone matters, staff screening was a training opportunity for the AAA sonographer, who was supervised throughout and is now Waitemata District Health Board, Meeting of the Board 10/8/16 46

47 accredited to scan independently. Staff screening also served as a mini-pilot for smoothing-out screening processes and testing the IT tool. Screening at Coast to Coast, in collaboration with Te Haa Oranga, went very well. Coast to Coast mastered the AAA IT tool early, referred to secondary care adequately and screened more patients per day than they had estimated was possible. Two outreach visits in their Maungatoroto and Mangawhai clinics helped increase screening access for remote patients. Quality control processes were established and 85% (213) of the 250 invited patients were screened. Of those screened, 10 (4.7%), were found to have a AAA and one person was diagnosed with an iliac artery aneurysm. Two patients had a AAA over 30mm, the youngest patient with AAA was 64 and two were females diagnosed with AAA. Waitakere Union have had a training session with the AAA team and intend to start screening in August. The team will work with Te Puna Hauora to install the IT tool, select patients and complete training by mid-august and screening will start in September. Māori men and women appear to have a higher incidence of AAA than non-māori and develop the condition at a younger age (eight years earlier than non-māori). The AAA screening programme intends to serve as an exemplar for health screening in New Zealand by achieving unprecedented Maori participation rates through detailed and innovative system design. Pacific Health Pasifika Week Pacific Week from July placed a spotlight on celebrating Pasifika and achieving health equity for our Pacific communities. The week opened with a visit to Waitakere Hospital by the Samoan Head of State, His Highness TuiAtua Tupua Tamasese, for a special address. Pasifika Week also featured Ministry of Health Pacific Health Chief Advisor Matafanua Hilda presenting at an evening staff networking event and acknowledged all the work of leaders who paved the way before her as well as speaking about the importance of being grounded in our culture. CEO of Rise up Academy Sita Seulupe - a Peter Blake leadership award recipient and the Next magazine Woman of the Year 2014 for her community entrepreneurship - opened up the talanoa (discussion) with the women s health group at North Shore. There was also a heartfelt speech by Pacific Health Science Academies coordinator Malcolm Andrews on why we should care about climate change and our extended fanau and aiga in the Pacific Islands. Waitemata District Health Board, Meeting of the Board 10/8/16 47

48 Pasifika Week was a colourful celebration of diversity. Staff, patients and visitors also took advice and information from various Pacific Health provider stalls at the North Shore and Waitakere campuses. There was also a Research forum organised by the Pacific Health Gains funding and planning team, with addresses by Pacific academics Dr Timote Vaioleti and Dr Peggy Fair-Dunlop. The Engaging Pasefika Online tool was also launched, intended as a pre-cursor to face-to-face workshop training for enhancing engagement with Pasefika families. Many community groups provided entertainment and there was a fashion competition for the bestdressed female, male and group. The competition was tough this year but the Workforce team prevailed. Pacific Health Operations Manager Penina Felise-Mackay led two workshops bringing together nonclinical support staff with an address by Orderly Matua Fuimaoano Pepe. A mental health patient experience fono was led by consumer advisor Papaalii Johnny Siaosi and a well-received resilience workshop was led by Takanga a fohe service manager and psychologist Epenesa Olo-Whaanga. A video capturing some of the highlights of Pasifika Week 2016 has been uploaded to Youtube and can be accessed via the following link: Waitemata District Health Board, Meeting of the Board 10/8/16 48

49 CEO Scorecard Actual Target Trend Patient Experience Actual Target Trend Better help for smokers to quit - hospitalised 98% 95% Complaint Average Response Time 13 days <14 days q g. Better help for smokers to quit - primary care 90% 90% p Improved Access to Elective Surgery - WDHB 104% 100% p Shorter Waits in ED 95% 95% q Quality & Safety Trend Faster cancer treatment (62 days) 79% 85% p Older patients assessed for falling risk 95% 90% q Increased immunisation (8-month old) 92% 95% q Occasions insertion bundle used 100% 95% p g. More Heart & Diabetes Checks 91% 90% p h. Good hand hygiene practice 82% 80% p Pressure injuries grade 3& p Provider Arm - Service Delivery ICU - CLAB rate per 1000 line days 0.88 <1 b. Antibiotic in the right time 96% 100% q Waiting Times Actual Target Trend ESPI Improving outcomes ESPI 2 - % patients waiting > 4 months for FSA compliant Population coverage/access Trend ESPI 5 - % patients not treated within 4 months compliant g. Cervical Screening 76% 80% g. Diagnostics Breast screening 65% 70% q % of CT scans done within 6 weeks 96% 90% q c. Bowel Screening Participation % of MRI scans done within 6 weeks 93% 80% - Round 2 54% 60% p - Round 3 54% 60% Urgent diagnostic colonoscopy (14 days) 90% 75% q Diagnostic colonoscopy (42 days) 72% 65% p Treatment Surveillance colonoscopy (84 days) 69% 65% p d. HSMR (Source: Health Round Tables) 75% <99% p e. Surgical intervention rates (per 10,000 pop) Patient Flow - Angioplasty p Elective Surgical Discharges (YTD) - Angiography p Elective Discharges - Total 19,115 18,421 p - Major joints p Elective Discharges - Provider Arm 13,199 12,623 p - Cataract p h. Elective Discharges - IDF Outflow 5,916 5,798 p # NOF patients to theatre (48 hours) 94% 85% p Efficiency ST elevation MI receiving PCI (120 mins) 79% 80% q Outpatient DNA rate (FSA + FUs) 10% <10% q AT&R referrals assessed (2 working days) 95% 90% a. Average Length of Stay - Electives 1.44 days <1.77 days q a. Average Length of Stay - Acutes 2.60 days <2.76 days q f. Health Targets Waitemata DHB Monthly Performance Scorecard CEO Scorecard June /16 Managing our Business Best Care Staff Experience Actual Target Trend Major Capital Programmes Time Budget Quality Sick leave rate 8.6 days <7.5 days q Te Atarau car park (Sep 2015) Turnover rate 11% 8-12% Department of Medicine (Mar 2016) Lost time injury rate (per hours worked) 3.30 <10 WTH Emergency Department redevelopment (Apr 2016) Mason clinic - 15 Bed medium secure unit Financial Result Trend Bridge ESC To Medical Tower (Jun 2016) Net Surplus/Deficit (YTD) 1,847 k 2,811 k Lakefront (Dec 2016) How to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large. a. 2015/16 new MoH Average length of stay definition. b. Antibiotic at the right time - As at Dec Q2 2015/16 (latest data available). c. Bowel Screening a quarter in arrears - Round 3 commenced (participation rate for invites Jan - March 2016). d. HSMR reported one quarter in arrears - as at March Q3 2015/16. e. SI Rates reported one quarter in arrears -as at March Q3 2015/16. f. New method of calculation and target - Rate per hours worked g. As at March Q3 2015/16 h. One month in arrears - May Revised calculation and target A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Waitemata District Health Board, Meeting of the Board 10/8/16 49

50 5.2 Health and Safety Performance Report August 2016 Recommendation: That the report be received Prepared by: Michael Field (Group Manager, Occupational Health and Safety) Endorsed by: Fiona McCarthy (Director Human Resources) 1. Purpose of report The purpose of the Health and Safety (H&S) report is to provide quarterly reporting of health, safety and wellbeing performance including compliance, indicators, issues and risks to the Waitemata District Health Board. 2. Strategic Alignment Community, whanau and patient centred model of care Emphasis and investment on both treatment and keeping people healthy Intelligence and insight Evidence informed decision making and practice Outward focus and flexible, service orientation Operational and financial sustainability This report comments on issues and risks that impact of patient care and organisational culture. This report comments on organisational health information via incidents, health monitoring, and leave information. The report provides information and insight into workplace incidents and what the DHB is doing to respond to these and other workplace risks. The leading and lagging indicator dashboard is based on current best practise indicators and targets. Health, safety and wellbeing risks and programmes are inherently focused on staff, patients, visitors, students and contractors. All strategic and operational work programmers and policy decisions are discussed with relevant services e.g. site visits, approaches to reduce risks (Section 6). As appropriate, programmes of work will outline how services will ensure operational or financial sustainability and how measures of success are set and value and return on investment is monitored. 3. Highlight of the month Board Health and Safety Site visit The second and third Health and Safety Board site visits have been held in June. (1) Board members undertook a site visit to the Mason Clinic to review the physical environment and to gain a better understanding of the nature of the work undertaken there and the inherent hazards this work poses to workers. 50

51 Mason Clinic has expressed their appreciation for the opportunity to talk to Board members about the work they do, the improvements in health and safety made over the years, as well as the challenges they face on a day-to-day basis. Issues raised were as follows: Issues Leaky Buildings - is any way to fast track remedial works? Security Aggression Comment/Actions Current remedial maintenance plan noted and any potential changes are being discussed with Facilities. Longer term plan is to upgrade the site. Recommendations on site security were made in the August 2015 security report and the initial responses to that report were discussed and noted. The service is constantly revisiting potential hazards and training of staff in deescalation techniques to mitigate risks. Meeting arranged with WorkSafe NZ so they can visit the Mason Clinic, understand the nature of the work and assist us to ensure the DHB has considered all the possible risks and mitigations. (2) Board members undertook a site visit to review campus security and the physical environment of North Shore Hospital. Members received an appreciation of the challenges to secure a large and diverse site and the impact of buildings on the physical environment and campus layout. There are no follow up actions at this stage. 4. Actions from the last Board report Nil. 5. Performance Scorecard Legend 20% variation Green 21-50% variation Amber Over 50% variation - Red 51

52 The leading and lagging indicators in the above scorecard are indicative of Health and Safety performance across the organisation. Using trends and traffic light indicators will emphasise the areas where we are on or progressing towards our targets and when we need to improve. Some of our targets are staged to show improvement over time. Indicators in Red Issue Action Attendance at Corporate Orientation There was no corporate orientation conducted in June. Glossary for Monthly Performance Scorecard and Report Lost Time Injury Rate Injury Severity Rate Lost time injury Frequency Rate Lost time incidents Serious Harm (Currently Notifiable to Worksafe NZ and will in the new legislation be called Notifiable Events and have a wider criteria of reporting to include events not just injury) Pre- Employment Significant Hazard (Instead of a definition all hazards are risk rated to determine how serious they are in the new legislation) Psychosocial Risk Mathematical calculation that describes the number of lost time injuries per 100 fulltime employees at any given time frame. Mathematical calculation that describes the number of lost days experienced as compared to the number of incidents experienced. No of lost time Injuries per million hours worked. Any injury claim resulting in lost time. The Health and Safety in Employment Act 1992 defines serious harm as: 1. Any of the following conditions that amounts to or results in permanent loss of bodily function, or temporary severe loss of bodily function: respiratory disease, noise-induced hearing loss, neurological disease, cancer, dermatological disease, communicable disease, musculoskeletal disease, illness caused by exposure to infected material, decompression sickness, poisoning, vision impairment, chemical or hot-metal burn of eye, penetrating wound of eye, bone fracture, laceration, crushing. 2. Amputation of body part. 3. Burns requiring referral to a specialist registered medical practitioner or specialist outpatient clinic. 4. Loss of consciousness from lack of oxygen. 5. Loss of consciousness, or acute illness requiring treatment by a registered medical practitioner, from absorption, inhalation or ingestion of any substance. 6. Any harm that causes the person harmed to be hospitalised for a period of 48 hours or more commencing within seven days of the harm's occurrence. Health screening for new employees A hazard with the potential to cause serious harm. Might be those aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm. 52

53 Patients who are away without leave (AWOLs) PCBU Officer Worker Notifiable Injury/illness Notifiable Incident Notifiable Event Reasonably Practicable Patients under the Mental Health (compulsory Assessment and Treatment) Act 1992, who leave DHB premises without prescribed or approved leave Person conducting business or undertaking Person occupying the position of a director of a company or includes any other person occupying a position in relation to the business or undertaking that allows the person to exercise significant influence over the management of the business or undertaking. An individual who carries out work in any capacity for the PCBU e.g. employee, contractor or sub-contractor, employee of the sub-contractor, employee of labour hire company, outworker, apprentice or trainee, person gaining work experience, volunteer. (a) Amputation of body part, serious head injury, serious eye injury, serious burn, separation of skin from underlying tissue, a spinal injury, loss of bodily function, serious lacerations. (b) any admission to hospital for immediate treatment (c) any injury /illness that requires medical treatment within 48 hours of exposure to a substance (d) any serious infection (including occupational zoonoses) to which carrying out of work is a significant factor, including any infection attributable to carrying out work with micro-organisms, that involves providing treatment or care to a person, that involves contact with human blood or bodily substances, involves contact with animals, that involves handling or contact with fish or marine mammals. (e) any other injury/illness declared by regulations to be notifiable. An unplanned or uncontrolled incident in relation to a workplace that exposes a worker or any other person to a serious risk to that person s health or safety arising from an immediate or imminent exposure to an escape, spillage or leakage of a substance; an implosion explosion or fire; an escape of gas or steam; an escape of a pressurised substance; an electric shock; a fall or release from height of any plant or substance; collapse or partial collapse of a structure; interruption of the main system of ventilation in an underground excavation or tunnel; collision between two vessels or capsize; or any other incident declared by regulations to be a notifiable incident. Death of a person, notifiable injury or illness or a notifiable incident. Means that which is or was at a particular time reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters.eg the likelihood of the hazard/risk occurring and the degree of harm resulting, what the person knows about hazard/risk and how to eliminate/ minimise the risk and the cost associated with elimination of the hazard/risk. 53

54 6. Key Health and Safety Risks The table below outlines our key health and safety risks together with commentary on the current status/issues related to that risk and any actions to address issues. We have added residual risk (the portion of risk that is left after a risk assessment has been conducted) to this table. The actions reported each month are controls in progress and the residual risks from each of these identified risk areas will vary. The DHB has attempted to note the residual risk in the context of the original risk using a traffic light after each risk below. Risk Aggressionphysical and verbal Previous Report Action The Security Review project is moving ahead and a committee has been set up called the Community Alarms project. This group will look at the type of alarms required for our workers in the community. OH&S will be represented on this group. Terms of reference are currently being finalised. Current Action Residual Risk % Complete The Community Alarms As these projects are 20% project is progressing well, still underway, the with final review of tender residual risk has not documents having been changed. It is undertaken. Tender and envisioned that the tender evaluation should be residual risk levels will completed within the next reduce upon project two months. delivery. We have also arranged for a meeting to be held between OH&S, Legal and Mental Health, in order to identify the best way to escalate issues with clients who have assaulted staff. We are also arranging a similar meeting with WorkSafe NZ, so we are able to explain the residual risk or staff working in Mental Health. A meeting has been held with NZ Police, Inpatient Mental Health and H&S, to gain a better understanding of our options relating to client assaults on staff. This meeting was very collaborative in nature and suggestions from NZ Police were very gratefully accepted. This is being followed up with a scheduled meeting to begin work on developing some recommendations for an official approach to how these incidents are escalated and how we interact with NZ Police, to ensure the best possible outcomes (see Section 7). The scheduled meeting with WorkSafe NZ is due on 3 August. 10% 54

55 Original Risk A full hazard review has been undertaken by OH&S and the services, relating to reception areas of shared mental health/community health facilities, following two incidents. A risk assessment was also undertaken and recommendations have been provided to reduce the risk and potential harm of future incidents. Residual Risk Risk Blood and Body Fluid Incidents (BBFA) Original Risk Previous Report Action The review is still pending the needleless system pilot. Current Action Residual Risk % Complete The review is still pending the Nil change 30% needleless system pilot. Residual Risk Risk Hazardous Substances( HSNO) Previous Report Action A new hazardous substances and New Organisms (HSNO) coordinator has been recruited and started on 2 nd May. He brings a wealth of knowledge to this position and the auditing will be recommenced along with the introduction of health monitoring on exposure to hazards. Audits are due to restart the week commencing 6 th June. Current Action Residual Risk % Complete As this audit project 100% progresses and each area becomes compliant, this residual level of risk will reduce. All HSNO audit tools, including risk matrix and report templates, have been completed. The first audit has now been completed, with the audit report being finalised. The North Shore Hospital Laboratories was chosen for this audit, as it represents the most complicated and challenging area, with the largest number of hazardous substances and therefore the highest level of risk. The audit tools performed extremely well and the report template has been updated slightly to ensure that it allows for full and concise feedback. 10% 55

56 Original Risk A business case for a dangerous goods store for Waitakere is in progress. The costs were received for the Dangerous Goods Store for Waitakere Hospital, but were far in excess of what was initially considered and a complete review of quotes was requested of Facilities. This review is now underway and revised costs will be made available mid-august. Residual Risk 50% Risk Contractor and Procurement Management Previous Report Action The new Health, Safety and Environmental Advisor in Occupational Health and Safety has taken over the Facilities and Contractor Portfolio to oversee systems and processes and carry out training. Current Action Residual Risk % Complete The previous Health, Safety Nil change. 50% and Environmental Advisor has resigned. Advertising is underway to find a replacement. In order to reduce the risk associated with Facilities, the Group Manager, OH&S and the OH&S Clinical Team Leader are covering this area until a replacement can be found. The newly appointed H&S Investigator and Auditor, starting on 8 th August, will allow us to more proactively audit the systems and processes that Facilities have in place for contractor management, to ensure compliance. Original Risk The asbestos management group has been set up with OH&SS representation. Terms of reference have been finalised and work is currently underway reviewing our building portfolio. Additionally, an Asbestos Manager is currently being recruited to ensure day-to-day management of this activity and swift progress, with regular reporting to the committee. Asbestos auditing is continuing, with leased properties now being audited. Residual Risk 70% 56

57 Risk Manual and Patient Handling Previous Report Action A new model of engagement has been developed between occupational health and the moving and handling team to allow for quicker response to incidents and training requirements. Current Action Residual Risk % Complete Moving and Handling are now Nil change. 50% attending each OH&S team meeting, to ensure a closer working relationship. OH&S are engaging with Moving and Handling as soon as issues arise, allowing us to respond far more swiftly to incidents, but also to identify potential risk areas for intervention. Facility design checklist now includes moving and handling requirements. OH&S representation is now included with all new builds and refurbishments, with a much stronger focus on reviewing layout plans and providing recommended changes where required. 100% Original Risk Residual Risk Risk Health and Wellbeing (stress, fatigue, depression) Original Risk Previous Report Action The Healthy Workplaces Strategy is presently going through senior management review and is expected at the Board mid-year. Current Action Residual Risk % Complete The Senior Management team Nil change. 95% have endorsed the Strategy and it will be presented to the September Board meeting for information Residual Risk Risk Physical environment (ventilation, lighting, equipment) Previous Report Action Ventilation, cooling and heating issues still being worked through by priority order, with OH&SS providing to support to facilities to triage these requests by risk. Current Action Residual Risk % Complete OH&S have agreed an The residual risk 50% approach with Facilities for all remains the same at maintenance requests that present until we mention H&S as a risk factor. review the efficacy of These are being forwarded to the H&S maintenance the OH&S mailbox and the priority system. Duty Nurse is ranking them from 1 to 10 (where 1 is Critical H&S Risk Requiring Immediate Action and 10 is Not Considered a genuine H&S Risk). 57

58 Original Risk Hazards and risks associated with the Helipad are being reviewed by a newly formed advisory committee. A full hazard review and recommendations report has been undertaken for the Helipad and immediate concerns addressed (loose items in close proximity to helipad). Further recommendations will be reviewed by the Helipad Advisory Committee for action. Residual Risk 70% Risk Slips trips and Falls Previous Report Action All entrances now have slippery when wet signage on doors and a review of entrance way flooring has been completed. We have also introduced umbrella bag stands to entry ways. The next steps are to develop additional signage to introduce the umbrella bag stands, encourage their use, and educate visitors on why this is important. During wet weather, entry ways will be checked regularly to ensure that any additional necessary signage is in place and that excess water is mopped up. Current Action Residual Risk % Complete Audit checks for slippery The residual risk has 100% when wet signage during wet dropped for periods are progressing well, entryways, however with only three noted this makes up a small entryways missing a sign, out proportion of overall of 16 checks carried out slip, trip and fall during the period. Where events, requiring the signage is not present, Clinical residual risk to remain Support Services are notified, the same. As staff but OH&S staff also place communications are signage immediately. developed and delivered, it is expected that this residual risk will fall. Signage for umbrella bag systems is currently being finalised by Facilities. 80% Regular communications on slip, trip and fall risks are included in training and highlighted in the Waitemata Weekly and the Occupational Health website. Work is commencing with internal communications to develop posters to educate staff on this and raise awareness of what they can do to avoid incidents. Work has also begun on communicating the leading causes of slips, trips and falls to staff, to raise general awareness of where caution is necessary. This will include signage (posters). 20% 58

59 Original Risk As winter comes checks will be made in places like entrances, wards and communal areas for hazards associated with slips, trips and falls. Residual Risk 7. Stakeholder feedback Funding, Planning and Outcomes No update to report this period. NZ Police A meeting was held with the NZ Police to discuss the development of an agreed complaints processes for staff that are alleged to have been physically assaulted by patients. This proposed process, still under development, is designed to allow us to highlight specific incidents to Police for heightened investigation and potential action. It has also been recognised that there is an existing lack of consistent understanding of how staff should lay complaints, what information is required and what information we are legally allowed to release to the NZ Police. To address this, and to implement a process to allow WDHB to lodge a high level complaint is in development. It is important to note that the Waitemata DHB led complaints process will in no way replace staff members legal right to lay their own complaint, but will provide detail on the process required to do so. Regulatory Bodies WorkSafe NZ (WSNZ). A meeting with WorkSafe NZ has been scheduled for 3rd August, in order to form a collaborative relationship with them. The overall purpose of this meeting is to gain clarity of WSNZ expectations, but to also allow them to better understand the environments in which many of our staff work. It is hoped this collaboration will build a level of understanding of the inherent risks associated with some of the work we carry out, and how we can best mitigate those risks. 59

60 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun Staff Reported Incidents Glossary CO Corporate CWF Child, Women and Family Services ESC Elective Surgical Centre HO Hospital Operations MEDHOP Medical and Health of the Older Persons Service MH - Mental Health and Addictions Services OH&S - Occupational Health and Safety SA Surgical and ambulatory services 8.1 Staff incidents The number of reported incidents by staff during the month of May 2016 was 122 and in June 165 compared to 119 in April This is consistent with the wet weather we have experienced during this period and, although measures have been taken to reduce slips occurring due to wet shoes/floors, the likelihood of these events occurring is always raised during wet weather periods, which is then reflected in the number of occurrences. The rate of staff incidents per discharged patients is 1.67% (based on inpatients only). ( x100) The rate of staff incidents per FTE is 2.32% ( x100). 24 Months of Staff Reported Incidents Table 1: Number of reported staff incidents for June 2016 and prior 23 months 60

61 Table 2: Staff incidents by type for May 2016 Table 3: Staff incidents by type for June

62 Incidents by Service May Table 4: Staff Incidents by Service May 2016 Table 5: Staff Incidents by Service June Notifiable Events The DHB noted: 3 notifiable events in May 2016 Patient hit staff member at base of neck resulting in concussion and hospital admission. o Investigation completed that showed no processes or procedures were at fault. Tripped over own feet in carpark resulting in fracture of left humerus and left ankle. o No investigation required. 62

63 Tripped over wheel of bed and fell landing on right hip resulting in a broken femur. o Investigation showed that area around bed wheels should be marked with barriers, which was implemented immediately. Moving and Handling were also engaged to assist with raising staff awareness of this risk type. 2 notifiable events in June 2016 Staff member fell getting out of car resulting in a broken femur. o No investigation required. Infection in thumb resulting in surgery after needlestick injury. o Investigation showed that the needle was being used to clean equipment, contrary to standard operating procedures. Staff member was notified of failure to follow procedure and these procedures reinforced with relevant staff. 10. Top Incidents types that cause harm The main types of incidents that cause harm to our staff and their management are outlined in the following tables Aggression Work is underway to review staff training requirements, which includes dealing with aggressive behaviour, with a view to creating robust and complete training schedules for all staff. A review of Mental Health reception areas is also being carried out, with a view to ensuring that adequate precautions are taken to protect our staff. This work is being supported through a closer working relationship with both WorkSafe NZ and the NZ Police Table 6: Aggression Incidents by Service May

64 Table 7: Aggression Incidents by Service June 2016 Table 8: Physical assaults root cause May 2016 Table 9: Physical assaults root cause June

65 Table 10: Physical Assault outcomes May 2016 Table 11: Physical Assault outcomes June 2016 Table 12: Mental Health & MEHOP - Physical Assault (root cause Aggression) May

66 Table 13: Mental Health & MEHOP - Physical Assault (root cause Aggression) June Slips, Trips and Falls The 17 slips, trips and falls in May were caused by environment (5), inattention (7), uneven surface (2), unsafe/improper practice (1) and wet Floors (2). Internal communications are being developed, including posters, to assist in raising staff awareness of this risk type and we will raise this issue for discussion at a division level across the organisation. Slips, predominantly caused by wet floors through mopping or wet weather, have also been addressed, with Clinical Support Services being engaged to ensure all cleaners utilise slippery when wet signage and this same signage present at entry areas during wet weather. OH&S audits of these areas during wet weather is also assisting in raising awareness and ensuring signage is in place. Table 14: Slips trips and falls by service May

67 Table 15: Slips Trips and Falls by service June Moving and Handling Moving and Handling injuries to staff since January have been recorded in table 16. Of the five incidents recorded in May, four of these incidents resulted in sprain/strains to necks and backs. One incident was categorized as resulting in pain and discomfort. Of the five May incidents four of them occurred in MEHOPS and one in Child, Women and Family. Of the seven incidents recorded in June, the outcomes were as follows: Bruise and Contusion 1, near miss 1, Pain & Discomfort 2, and Strain/Sprain 3. The June 1 incidents occurred in the following divisions 1 in Mental Health, 1 in Hospital Operations, 2 in MEHOP and 3 in SA. A close relationship has been established with our Moving and Handling Coordinator, to allow OH&S staff to better understand the subject, but also to create consistency in messaging to staff. Additionally, communications have been sent to all Charge Nurse Managers to alert them to the fact that over-filling linen bags is causing injury to Orderlies (predominantly lower back). This communication outlines the recommendations from a report written by our Occupational Physician in 2014 addressing this risk, which is as relevant today as when written. Clinical Support Services have also agreed to let us know which areas are still over-filling linen bags, to allow us to directly intervene. 67

68 Table 16: Moving and Handling injuries to staff in Health, Safety and Wellbeing Activity 11.1 Occupational Health Influenza Vaccinations Current flu vaccinations levels stand at 56% (3,923 employees), with the extended programme into winter still underway. Additionally, we have vaccinated 582 non-workers (contractors, casuals, students etc), which equates to 13% of the total vaccinations administered. Influenza season has not yet started but we are seeing sick leave across the DHB for three types of viral infections fever/headache, gastro and respiratory. The Infectious Diseases Physician and OH&S are working on a communication for staff to receive during hand over on how they can keep themselves healthy at work given the prevalence of the current infections. Waterborne Pathogens OH&S have agreed to take responsibility for administering the new requirements for flushing water from low-use outlets on behalf of the Water Quality Group, in order to remove the risk of waterborne pathogens. Communications have been sent to all H&S reps across Waitemata DHB, using our Hazard Register, with instructions on how to identify low-use outlets and the weekly flushing requirements. Compliance with these requirements will be checked monthly through the Hazard Register and onsite audits will be conducted every six months. Compliance will be reported to the Water Quality Group Staff Vacancies Two positions remain to be filled, with interviews currently being scheduled. These positions are for two Health and Safety Advisors (following one resignation) and we currently have one role under offer. The previously advertised role of H&S Investigator and Auditor has been filled, with a start date of Monday 8 th August. 68

69 11.3 Systems and Process Review With a number of vacancies in the team, proactive work within the wider organisation has been very challenging; however we have focussed strongly on a review of all systems and processes within the OH&S Group, with the aim of streamlining these processes to achieve greater efficiency. This has also been an important focus for us, to ensure consistency of quality and approach across the team Training Requirements It is recognised that we have a responsibility to ensure that all of our employees (Officers and workers) are adequately trained in Health and Safety. To this end, we have been working with Learning & Development to develop a list of specific training requirements for each structural level of the organisation, from Board governance training, to front-line H&S basic training. Board level governance training is currently being arranged through an external supplier and will be delivered at the earliest opportunity, which is subject to Board member availability. Specific legislated NZQA certified training requirements for our H&S reps is currently underway and all training should be completed by the end of September Health and Safety Governance Audit The health and safety governance audit has been completed and the report presented to the Audit and Finance Committee. Progress on the recommendations is as follows. Recommendation Action Owner Action by We recommend a review of the integrity of contractor incident data and that it is being accurately reported. Agreed, we will review the contractor incident database and reporting process to validate the data integrity of reported contractor incidents. Group Manager OHSS and General Manager Facilities and Development August 2016 We recommend updating the LTIFR definition and calculation. Agree, and we have commenced a review of the LTIFR calculation in conjunction with the National health and safety managers group Group Manager Occupational Health and Safety Complete We recommend incorporating occupational health into H&S Governance Reports. We currently report occupational health statistics such as work related claims and organisation wide sick leave through the Hospital Advisory Committee and the Audit and Finance Committee. We will include this information in the Board report. Group Manager, Occupational Health and Safety and Director HR Complete (Section 10) 69

70 Recommendation Action Owner Action by We recommend developing an obligations register for external stakeholder requirements. We will add a section into the Board report on external stakeholder feedback. Group Manager, Occupational Health and Safety and Director HR. Complete We recommend that reports are updated with the activities to support the progress on the actions to address the Key Risks. Develop an annual presentation to the Board and EMT. This annual review should include an update on (but not limited to): Agreed will reformat the key risk section to show progress on actions from previous reports. Agreed, we will provide a review of health and safety each financial year. Group Manager, Occupational Health and Safety. Group Manager, Occupational Health and Safety and Director HR. Complete First annual report for 15/16 by October ) Progress on the strategy and objectives 2) Key initiatives 3) H&S risks 4) Audit results and progress 5) Lagging and leading indicators compared on an annual basis 6) Insights and trends 7) Focus for the next year 11.6 Hazardous Substances and New Organisms (HSNO) Audits and Compliance A large body of work has been completed regarding HSNO over the last month, including: Development of a Hazardous Substance Risk Assessment Form, to allow us to assess hazardous substances that are being introduced by healthalliance. This provides us with an opportunity to ensure correct training is supplied for staff using the substance, the correct personal protective equipment is available, but also to make recommendations regarding substitute chemicals that are lower risk. Development of HSNO Inventory Template. This is a standard template that all areas can use to keep records of the HSNO within their area. Risk Assessments conducted for five (5) products. These risk assessments are important as they notify staff of all of the risks associated with a substance, what personal protective equipment they are required to wear and also allows us to assess whether health monitoring is required. Development of Tracking Standard Operating Procedure (SOP). A number of chemicals that we use are listed as Trackable Substances, which means that we are required to record all aspects of their movement within our facilities, from initial delivery to our inwards goods and Hazardous Substances Store to final delivery to each area. The development of a standard operating procedure for this task, including the required forms, will greatly enhance our compliance in this regard. 70

71 HSNO auditing has also commenced and the following audit and compliance table has been developed. This table shows each of the high risk areas, notes the audit dates and the dates that reports were issued, but also shows the change in compliance within each area over time. The baseline audit rating will never change this is the outcome of the initial completed audit. As audits progress, the table will show the initial audit rating, the last reported audit rating and then the current audit rating. This will allow the DHB to see progress compared to the original rating, but also progress since the last audit was carried out. The latest audit table is below for information and we ll update on progress every 6 months. Compliance Chart (%) Preliminary HSNO Audit Report Compliance Rating Location Visit Issued Baseline Last Reported Current Rating Base Date Date Date Base Date Rating Date Rating Date Rating NSH Laboratory 03/06/16 08/06/16 06/07/16 06/07/ % 22/06/16 WTH Laboratory NSH OPD WTH OPD NSH SCCD ESC SCCD NSH SCCD NSH Theatres 26/05/16 WTH Theatres NSH - Renal 12/07/16 WTH Renal Apollo Renal ARDS Clinics (several site) NSH Cleaners WTH - Cleaners NSH - Facilities/ Trade Workshops WTH - Facilities/ Trade Workshops NSH Pharmacy WTH Pharmacy NSH Clinical Engineering WTH Clinical Engineering NSH Haematology NSH SPU 12/07/16 NSH Gastro WTH Gastro NSH Radiology WTH Radiology Mason Workshops 28/06/16 Mason Zoo Doo Mason Woodford 20/06/16 Gardens Wilson Centre 03/06/16 71

72 12. Health and Safety Prosecutions: In the September report we will add a section on learning for the DHB from each highlighted case. Delta Utility Services fined after worker injured while working on a live power line 1 June 2016 Dunedin electricity distribution network provider Delta Utility Services has been fined $35,000 and ordered to pay reparation of $49,600 after a worker fell six metres after low voltage arcing on lines he was working on. Delta had earlier pleaded guilty and was sentenced in the Queenstown District Court yesterday on a charge under the Health and Safety in Employment Act 1992 (HSE) of failing to take all practicable steps to ensure the employee was not exposed to the hazard of low-voltage electricity while at work. The worker was completing a service connection in Cardrona in November A WorkSafe New Zealand investigation found the worker did not disconnect the power supply before working on the line Delta should have had an effective policy in place that required the worker to eliminate of the risk of such an incident. In this case that would have meant disconnecting the power completely at the road, said WorkSafe Chief Inspector Keith Stewart. None of Delta s written policies specifically required elimination, nor any explanation of how the hazard could have been eliminated. Elimination of any hazard at work is always preferable to isolating it and Delta could have prevented this unfortunate incident if it had provided written guidance on how to eliminate the risk of low voltage arcing, Mr Stewart said. Companies ordered to pay over $120K after contractor seriously injured by fish deheading machine 3 June 2016 Two companies have been ordered to pay reparations of $30,126 to a worker who was left with serious injuries after his arm was cut by a fish de-heading machine. On-hire labour company AWF Limited (AWF) and Sanford Limited (Sanford) were fined $37,750 and $53,000 respectively and ordered to pay reparations of $15,063 each after pleading guilty to charges under the Health and Safety in Employment Act 1992 for failing to take all practicable steps to ensure the safety of the worker. On June the AWF employee, who was contracted through his employer to work as a chiller hand at Sanford, was preparing to clean up at the Sanford Bluff fish processing factory. The worker noticed a fish head lodged in the manual fish de-header machine and reached into the machine to try and remove it. In the process he inadvertently turned on the machine, causing the machine s blade to come down and cut his right forearm, slicing through muscles, an artery and tendons. A WorkSafe investigation found that AWF failed to ensure its own policy was followed by not completing a site visit to identify any high risk hazards before the on-hire employee started work. The company did not request a detailed job description for the worker s role and did not carry out adequate assessments of the workplace and the work processes that the worker would be subject to. 72

73 It was also revealed that Sanford, as the principal, failed to manage the hazard posed by the inadequately guarded blade, and did not provide supervision or clear instructions to on-hire personnel including the victim. Before the incident occurred, a third party had conducted a machinery assessment and categorised the fish de-heading machine as a 5 out of five in respect of the risk that the inadequately guarded blade posed five being the highest risk. Despite Sanford being aware of this risk, the company continued to keep the machine in operation, and did not inform all people working nearby the machine of the identified hazard. WorkSafe Chief Inspector Keith Stewart says the incident was the direct result of both companies not meeting their health and safety obligations. Both parties failed in their duties to this employee AWF should have ensured the employee was assigned to a safe work environment, while Sanford should have made sure that people in the workplace were aware of the blade hazard and were not exposed to direct contact with the blade, says Mr Stewart. Taranaki employer fined for worker's death 3 June 2016 The widow of a forestry dump truck driver killed at work will receive $97, in emotional harm reparations from his employer. The victim was killed when an 800kg log fell from an overloaded articulated dump truck as he was taking off the strops holding the load in place. The incident occurred in the Te Wera forest 40km east of Stratford on 26 March His employer, G J Sole Ltd had earlier pleaded guilty to one charge under the Health and Safety in Employment Act of failing to ensure the safety of the victim by failing to ensure he was not exposed to hazards arising from logging cartage work. Today at the New Plymouth District Court G J Sole Ltd was fined $39,375 in addition to the reparations. A WorkSafe investigation found that there were at least five practicable steps the company could have taken to protect the victim. The company should have implemented an alternative method of carting the logs, ensured the logs remained below of the level of the sides of bin of the dump truck, extended the sides of the bin with certified extension, put in place a written safe operative procedure and to have identified the risk of logs falling from the side of the dump truck in the company hazard register. "These are not onerous requirements, particularly when they're contrasted with the loss of a worker's life and the impact of his death on his family and co-workers," Keith Stewart, WorkSafe's Chief Inspector said. Fertilizer spreading company ordered to pay $150K after contractor fatally injured on the job 9 June 2016 An agricultural services operator, who was found guilty during a judge-alone trial, has been ordered to pay reparations of $85,000 to the family of a contractor who was killed on the job. PJ Wright Limited, formerly known as Te Anau Bulk Haulage (TBHL), was also ordered to pay $65,000 in fines after being found guilty of one charge under the Health and Safety in Employment Act 1992 (HSE) for failing to take all practicable steps to ensure the safety of Leslie Cain. 73

74 Mr Cain was a self-employed contractor engaged by TBHL to drive a Bulk Fertiliser spreader, also known as a bulky, which weighed an estimated tonnes. On June Mr Cain was contracted by TBHL to spread fertiliser at a Waituna farm in a vehicle owned by the company. As he was driving the bulky down a grassed hill, Mr Cain lost control of the vehicle and it rolled, coming to rest on its roof. Mr Cain was not wearing a seatbelt and he died as a result of his injuries. Judge Henwood found at trial that TBHL failed to take six practicable steps to ensure Mr Cain s safety. She noted that no steps were taken by TBHL to formally educate or train itself or its contractors about up-to-date health and safety practices in the industry. Judge Henwood also found that TBHL failed to ensure Mr Cain wore a seatbelt while driving the bulky off road, despite it being recommended by the Ground Spreader Fertilisers Association, the police and the Department of Labour. Her Honour concluded that [a] more professional and robust approach about health and safety is needed by this company. At sentencing, the Court also noted that TBHL had sold off all its assets after charges were laid against them. Despite the company no longer having financial capacity to pay the fine, the judge still imposed the $65,000 fine, maintaining that the law did not allow for such behaviour. WorkSafe Chief Inspector Keith Stewart says TBHL skipped basic steps that would have helped to ensure that any contractor engaged by the company was equipped to do their job safely. The company s lack of health and safety policy, failure to communicate hazard and risk identification with its contractors, and optional approach to wearing safety belts clearly demonstrate its handsoff approach to workplace safety, This tragic death isn t a case of accidents just happen there needs be a systematic approach to good health and safety otherwise you are relying purely on chance. Sadly, this has been proven time and time again not to work. Litany of failures leads to quarry worker death company and director fined 15 June 2016 WorkSafe New Zealand says employers must learn from health and safety failings occurring under their control. Last April, a 24 year-old father of one died at a Bay of Plenty quarry after he was thrown from a fully laden dump truck. That "tragic and preventable death" had its sequel in the Tauranga District Court yesterday when the company and its director were fined. It was revealed in Court that in March this year - 11 months after this death - WorkSafe had to prohibit work at the same quarry after finding similar health and safety failings that led to the worker's death. At a sentencing hearing last Friday, the employer, Oropi Quarries Limited (OQL) and its sole director Catherine Renner were accused of a "litany of health and safety failures" by the prosecutor. In a reserved judgment released late yesterday, the Judge ordered emotional harm reparations of $100,000 to be paid to the family (OQL $80,000 and Catherine Renner $20,000). He also fined OQL $54,000 and Catherine Renner $9,600. WorkSafe outlined to the court 14 steps OQL should have taken to ensure the victim's safety. "There were significant issues with vehicle maintenance; failures to train the worker; a lack of policy on wearing seatbelts; and a lack of supervision," Mr Stewart said. 74

75 "After the incident, WorkSafe had the vehicle inspected by independent experts their reports identified 32 faults with the vehicle ranging from mismatched and over-inflated tyres to a missing door on the cab. Silver Fern Farms fined for burns to worker 21 June 2016 Business are being urged to regularly check the safety of their electrical systems after Silver Fern Farms Limited was fined $38,500 and ordered to pay $12,500 (of which $10,000 has already been paid by the company) in reparation after a worker suffered serious burns from an exposed live cable. During electrical work about ten years before the incident, a redundant electrical cable in a switchboard room was set in concrete facing up, with wiring exposed and unprotected and connected to a switchboard in another part of the plant. At the time of the incident the cable was live with 400 volts of electricity. A WorkSafe investigation was unable to establish whether it had been live since the work was undertaken, or whether it had been livened since. On 8 June 2015 the victim was cleaning in the switchboard room. He came into contact with the exposed live cable and a flashover occurred. He was knocked over by the force of the explosion which caused burns to his face and both hands. At sentencing today Judge Maze said it was hard to understand how an accident had not happened earlier and noted the outcome in this case could have been much worse. This wire should have been deactivated, buried or otherwise isolated to ensure no-one could come into contact with it, Keith Stewart, WorkSafe s Chief Investigator says. The company failed to identify hazards in relation the exposed wire and should also have ensured the worker was adequately trained in working around electrical installations. This incident reinforces the need for companies to identify and manage risk in the workplace to ensure no-one has to suffer debilitating injuries as this worker did, Mr Stewart says. Slaughter house crushing victim awarded $68, June 2016 CMP Canterbury Limited (part of the ANZCO Group) has been fined $39,000 and ordered to pay reparation of $68,250 in addition to $12,000 previously paid by the company after a worker was crushed by the door of a stun box. A WorkSafe investigation discovered failures by the company to identify appropriate safety controls for the door. We found there were a number of easily achievable methods of making this door safe which would have ensured in this case that injury was averted, says WorkSafe s Chief Investigator Keith Stewart. We have a menu of easy to understand health and safety information and guidance available free from our website to help businesses keep their workers safe, says Keith Stewart. 75

76 5.3 Communications Recommendation: That the report be received. Prepared by: Matthew Rogers (Director, Communications) Communications support The communications team provided advice and support to the following projects/campaigns/issues/events over the last six weeks: Communications support following Lake Pupuke diesel leak, including four rounds of direct community information Liaison with TVNZ over formal complaint about Marae programme content Support for feature on patient experience programme in Employment Today magazine Communications support for changes to parking tariffs Communications for Sky Bridge opening Communications to promote hospital shuttle Communications support for Primary Birthing Consultation Communications advice for DHB elections Media relations around nomination of DHB Pharmacy Operations Manager as a finalist in the IT Excellence awards Communications for Waitakere staff gym announcement Communications for National Falls Prevention & Fracture Liaison programme Communications support for EDARS (Early Discharge and Rehabilitation Service) launch Communications support for Pasifika Week Launch event for new childhood obesity national health target Preparation for new Waitakere Hospital ED opening event Communications support for Ministry of Social Development STEP initiatives Liaison with the office of the Minister of Health on upcoming events Communications advice for immunisation programme Development of where should I go for healthcare? multi-channel campaign Management of requests for assistance on university and school student assignments Assistance with advertising placements for services Oversight of the communications roll-out of the Our Health in Mind action plan Coordination of 2016 CEO Lecture Series Liaison with Well Foundation Marketing and Communications Liaison with Waitakere Health Link Ongoing after-hours and weekend media line cover and senior management communications support Proof read leaflets, booklets and brochures for various departments Ongoing management of Official Information Act requests and responses Management of requests to film on DHB sites Preparation of community update on major capital works projects Ongoing social media strategy, activity and issues management Responses to Dear Dale questions and comments from staff Event photography Fortnightly CEO recognition award communications 76

77 Drafting of correspondence from the corporate office Review of copy for DHB website Planning next edition of Healthlines magazine Planning for 2016 Yearbook Management of requests from external organisations to place collateral in the hospital foyers Management of DHB general all-user screen saver content Approval for all-user staff s Weekly Board update Publications The communications team published the following during the last six weeks: Booklet: Advance Heart Failure Booklet: Advance Lung Disease Booklet: Angioplasty Discharge info Booklet: Health Careers Booklet: CADS Maintaining Change Campaign: If you need us, call us Diagram: Strategic Themes (joint ADHB & Waitemata DHB) Form: ASAP Assessment and Planner 2016 Info sheet: HBHF lifestyle Invite: WTH ED opening/blessing Leaflet: NETP Interview Leaflet: NZ Health System Leaflet: Sleep Hospital Advice Leaflet: What is DAFNE Logo: ASAP Logo: Te Hononga Oranga Poster: Care Standard Waitemata Weekly, ed to all staff users Weekly national health targets updated and communicated Waitemata DHB, Careers and Awhina websites Google Analytics Statistics Waitemata DHB website Number of visits June 2016 Total visits to this site 42,132 New Zealand 39,647 Australia 816 United Kingdom 313 United States 287 Top areas June 2016 Home page 14,834 Waitemata DHB staff page 18,385 North Shore Hospital 7,661 Waitakere Hospital 3,020 Contact us 2,097 77

78 Traffic sources June 2016 Search traffic 72% Direct traffic 20% Referral traffic 8% Careers website Number of visits June 2016 Total visits to this site 15,646 New Zealand 13,564 United Kingdom 597 Australia 448 United States 158 Philippines

79 Awhina Health Campus website Number of visits June 2016 Total visits to this site 1,275 New Zealand 1,011 United Kingdom 166 Brazil 20 Australia 14 United States 13 Social media Waitemata DHB Facebook page likes 1,911* Waitemata DHB Facebook star rating - 4.3/5 (168 reviews)* Twitter 1,545 followers* *As at 29 July 2016 OIAs received A total of 26 new OIA requests were received between 14 June and 27 July 2016: A. Marett (Labour) - Total amount of efficiencies achieved against budget in 2015/16. A. Marett (Labour) - Number of contracts held or transferred with Maori Health providers. Individual requester (name withheld) - How many patients seen by an individual forensic psychiatrist in the last four years. B. Howse (Joyce & Howse Consulting) - Cost and referral times for providing needs assessment and service co-ordination. C. Broughton (Fairfax Media) - Amount spent on bariatric equipment. Pia Lupis - Office locations and staff numbers for Waitemata DHB. M. Taylor - Information regarding transport of patients by helicopter from the Rodney district. A. Smithson - Information regarding Lake Pupuke diesel spillage from North Shore Hospital. A. Marett (Labour) - Amount required to spend on mental health services as per ring fence. A. Marett (Labour) - Information regarding any failures to secure training accreditation. 79

80 R. Bollard (Parliamentary Research Service) - Amount spent on mental health for the last five years. A. Leask (NZ Herald) - Assessment/care of Special Patient Martin Lyall at the Mason Clinic. A. McLeod (NZ First) - Permissions since 2005 for aerial 1080 use. Individual requester (name withheld) - internal correspondence re disputed liability for costs of father's care. L. Hopkins (NZ First) - Expenditure and output by clinical service by year since 2007/08. A. Marett (Labour) - Number of contracts held with Pacific health providers transferred/tendered and then awarded to non-pacific health providers. R. Bollard (Parliamentary Research Service) - Process and policy information regarding seclusion under the Mental Health Act. O. Hamed (APEX) - number of psychologists, audiologists, dental therapists and biomedical engineers employed. A. Marett (Labour) - CPAC threshold/commitment to treatment threshold for cataract surgery, hip joint replacement and knee joint replacement. O. Hamed (APEX) - Health and safety policies, meeting minutes and agendas. A. Marett (Labour) - Budget for hospital and building maintenance. C. Burns (Deloitte) Complex range of data on hearing loss sought. Individual requester (name withheld) - Request for personal health records of step-father. A. Marett (Labour) - Behavioural support services waiting list details. Individual requester (name withheld) - Copy of criteria and assessment regarding rejection of referral for knee injury. J. Anderson-Bidois (Human Rights Commission) - Policies regarding seclusion and restraint practices for patients receiving mental health care. Positive + Neutral 0 Negative - Media Clippings 14 June 27 July 2016 Channel Auckland Pro Vice-Chancellor s Perspective + Dominion Post Screening plan still needed 0 Labour hits out at patients not getting to see specialists - Bowel cancer screening plan delayed 0 North Harbour News Making care easier + Marathon challenge for charity + North Shore Times POW s patience in love and war 0 What s on ice skating + Patient care + To do list - skating + Visitor shuttle + 80

81 Waitemata DHB welcomes new hospital Sky Bridge + WDHB response - Icy weekend excites + Lingering Effects - Lake Pupuke - Pilot gets green light + On the mend + Dead birds from diesel spill - WDHB respond + Teenager left waiting for help - Roe makes marathon effort + Nor West News Brief Ka pai west Auckland says kia ora lady 0 Smoking cessation 0 NZ Doctor Surgeon offers colonoscopies on the house to colleagues + Alley s unflinching stare at challenges facing health 0 GPs lend names to campaign for methadone funding fairness - The management of epistaxis: Staunching the flow 0 Ministry kicks butt to chase more quitters 0 NZ Herald/Herald on Sunday/NZherald.co.nz/Weekend Herald Rave North Shore Hospital A & E + Lake Pupuke birdlife threatened by diesel leak from hospital tank - DHB apologises - Rave North Shore Hospital staff + Cruel, degrading care in hospitals - Thousands miss specialist referrals - Patients suing Govt - Urgent care bid DHB seeks tighter hold on murder-accused + Thousands denied specialists 0 NZ Nursing Helping patients use apps and ehealth for self-management 0 Otago Daily Times No specialist for thousands shocking - Sunday Star Times / Sunday News Killer set to escape charges - The Press/Weekend Press Christchurch Apology over ghost sandwich 0 Death will win due to test delay 0 Bowel cancer screening plan delayed 0 Labour hits out at patients not getting to see specialists - Western Leader Volunteers wanted Stroke Scheme + 81

82 Pyjamas needed in June + Ka pai west Auckland says kia ora lady 0 Sky Bridge links hospital + Smoking cessation 0 Bowel screening to be rolled out nationally + Funding preventing falls among our older people + Bowel cancer screening plan delayed 0 Pyjamas to keep five siblings snug + TOTAL: Positive + 23 Neutral 0 16 Negative - 15 Total items 54 82

83 6.1 Appointment of Meng Cheong to healthalliance NZ Limited Board Recommendation: That the Board: a) Note that Anthony Norman has resigned as the Northland DHB Director of both healthalliance NZ Ltd and healthalliance FPSC Ltd as of 1 July b) Note that Northland DHB has proposed that Meng Cheong, Northland DHB Chief Financial Officer be appointed as a Director of healthalliance NZ Ltd and healthalliance FPSC Limited, to replace Anthony Norman. c) Note that the Constitution of healthalliance NZ Ltd and the Shareholder s Agreement provides that all shareholders appoint directors. Waitemata DHB is a shareholder in healthalliance NZ Ltd. d) Approve the appointment of Meng Cheong, Northland DHB Chief Financial Officer, as a director of healthalliance NZ Ltd. Prepared by: Robert Paine (Chief Financial Officer) Glossary DHB - Northland District Health Board 1. Executive Summary The Board is asked to approve the appointment of Meng Cheong, Northland DHB Chief Financial Officer as a director of healthalliance NZ Limited. 2. Background Following the resignation of Anthony Norman as a Director of healthalliance NZ Limited and healthalliance FPSC Limited as of 1 July 2016, Northland DHB have proposed that Meng Cheong, Northland DHB CFO be appointed as a Director of both these companies. The Constitution of healthalliance NZ Limited and the Shareholder s Agreement provides that all shareholders appoint Directors. Northland DHB has recommended that Meng Cheong be appointed to the Boards until such time as a newly constituted Northland DHB Board reviews the position. 83

84 7.1 Performance Recommendation: That the following performance reports for the month and attachments be received: 1 Financial Overview of the 2015/16 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury Prepared by: Rosemary Chung (Deputy Chief Financial Officer) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services) 84

85 1 Financial Overview of the 2015/16 result The provisional unaudited result for the DHB is a Surplus of $2.956m which is $143k favourable to the Budget of $2.811m. This result includes the surplus of Three Harbours Trust of $1.107m. For the month of June, the DHB Parent result is a deficit of $672k against a budgeted surplus of $1,078k and is therefore $1,751k unfavourable to budget. The Provider arm is $0.298m favourable to budget, the Funder Arm is $1.970m unfavourable to budget. The Governance and Funding Arm is $78k unfavourable to budget. The financial result for the month of June 2016 compared to the budget is summarised in the table below. WAITEMATA DISTRICT HEALTH BOARD Reporting Date 30 June 2016 CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE ($000's) MONTH YEAR TO DATE Actual Budget Variance Actual Budget Variance REVENUE Crown 132, ,933 4,139 1,547,800 1,535,311 12,489 Other 3,123 3,554 (431) 26,742 28,149 (1,407) 135, ,487 3,708 1,574,542 1,563,460 11,082 EXPENDITURE Personnel - Medical 15,043 14,017 (1,026) 169, ,693 (5,844) - Nursing 18,248 17,569 (680) 220, ,626 (6,481) - Allied Health 9,585 9,413 (171) 107, ,005 (1,791) - Support 1,377 1,231 (146) 15,700 15, Management / Administration 5,791 5, ,078 67,467 (1,611) Total Personnel 50,043 48,189 (1,854) 582, ,650 (15,569) Other Outsourced Services 5,121 5, ,570 67,023 (4,547) Clinical Supplies 9,003 7,693 (1,311) 110, ,429 (9,193) Infrastructure & Non-Clinical Supplies 6,418 7,840 1, ,219 93,882 (11,336) Funder Provider Payments 65,283 60,972 (4,310) 703, ,666 28,600 85,824 82,220 (3,604) 990, ,000 3,524 Total Expenditure 135, ,409 (5,459) 1,572,695 1,560,649 (12,046) TOTAL DHB PARENT (672) 1,078 (1,751) 1,847 2,811 (964) THREE HARBOURS 1, ,107 1, ,107 TOTAL DHB GROUP 435 1,078 (644) 2,954 2, Comment On Major Variances Revenue Revenue is $11.082m YTD favourable to budget. ACC revenue is $710k favourable due to additional volumes in non acute rehab beds. 85

86 Expenditure Overall expenditure was unfavourable to budget by $12.046m year to date. The key variances are summarised below: Personnel Costs ($15,569k unfavourable year to date) Variances in Personnel Cost categories were as follows: Medical staff costs are unfavourable by $5,844k year to date. This unfavourable variance was contributed to by Medicine and Health of Older People Services of $1,916k, Surgical and Ambulatory Services $604k. Child Women and Family of $501k, largely due to leave balance expenses greater than expected, and having to cover shortfalls with higher qualified staff. This is offset in Mental Health and Corporate by $475k due to vacancies and use of contract staff and $670k in relation to unpaid day leave accrual reversals. Nursing staff costs are unfavourable by $6,481k year to date. This unfavourable variance is contributed to by higher than expected volumes and acuity resulting in additional individual patient observations (watches) on the wards and in the Mental Health inpatient units (including Forensic Mental Health), the cost of statutory holiday adjustments and Meca holiday revaluations. Mental Health includes nine patients requiring either 1-on-1, 2-on-1 or 3-on-1 care. Allied Health staff costs were unfavourable to budget by $1,791k for the year to date mostly due to vacancies savings due to difficulties in recruitment. Support staff costs are favourable by $158k mainly reflecting cleaners and orderly not incurred as support personnel as budgeted, with corresponding unbudgeted costs in the outsourced services cost category. Management and Admin staff costs are unfavourable by $1,611k. This result is contributed to by under spends in corporate of $247k, partly offset by use of contractor costs incurred as part of outsourced services. Outsourced Services Costs ($4,547k unfavourable for the year to date) Overall, outsourced nurse bureau costs were adverse by $2,288k reflecting high external bureau for nursing cover. Agency costs for casual orderlies and cleaners are greater than budget by $1,110k. The total cost also includes savings targets. Clinical Supplies Costs ($9,193k unfavourable for the year to date) Significant overspends in clinical supplies were incurred in: Medicine and Health of Older People services unfavourable to budget by $486k. Mobility aids unfavourable at $284k continues to be the major contributor. Renal fluids are favourable to budget by $268k. Hospital Operations is unfavourable to budget by $1,798k, due to increased volumes and centrally budgeted savings. Laboratory consumables and send-away tests are unfavourable primarily due to an 8% increase in Microbiology testing for influenza and VRE screening. Blood product (Intragram) has increased 55% on last year. Provider Management and Corporate Services is unfavourable to budget by $3,867k, due to actual depreciation greater than budget ($1,045k) and budgeted savings not being achieved on the same expense line of $2,005k. Infrastructure costs ($11,336k unfavourable for the year to date) The unfavourable variance relates in part to unbudgeted maintenance of $1.169m, fire levy price increase $297k and utility budget variances of $766k. The variance also includes $7,550k savings targets. Whilst some actual savings are included in relevant expense lines, overall savings are 86

87 tracking behind budget. The Provider has a number of patient care/patient flow reviews underway to identify opportunities for greater patient experience and efficiencies. Funder Provider Payments ($27.74m favourable for the Year) Funder Provider payments as reported in the Consolidated Statement of Financial Performance table are inclusive of Funder payments to third party NGO providers as well as Funder payments to other District Health Boards through Inter District Flow expenditure. It does not, however, include payments made to the Waitemata DHBs own Provider Arm. The $27.7M favourable variance is gross of corresponding additional Provider Arm payments of $24.6M that offset. Commentary on key drivers of the favourable Funder position are summarised under the Funder Financial Performance section that follows later in the report. Cost Management Strategies Personnel Costs and Outsourced Service Costs Various measures are in place to manage get the unfavourable Personnel and Outsourced Service Costs variances back on track. These measures include constant monitoring of overtime hours, follow up with staff on sick leave taken, introduction of a pilot programme to more closely manage the use of watches. Tighter controls have been placed to ensure the creation of new positions or filling of vacancies is limited to absolutely necessary positions. New HR reporting is being introduced to enable Managers to more closely manage Personnel expenditure. It should be noted that the tight controls over personnel costs will not impact on patient care. Clinical Supplies and Infrastructure Costs To get Clinical Supplies and Infrastructure costs back on track, management are continually working on procurement initiatives to identify savings. Savings have included successful price negotiations completed by Healthalliance, substitution of products to achieve greater value, increasing the number of products available on catalogue to take advantage negotiated prices, introduction of a Kanban stock system in some wards, which has reduced stock levels and creation of available space for alternative usage. 87

88 2 Financial Performance - DHB Arms The financial performance for each of the DHB Arms for the month and the year is summarised in the table below, and the detailed Statement of Financial Performance by DHB Arm is attached to this report (Attachment 1). WAITEMATA DISTRICT HEALTH BOARD Reporting Date 30 June 2016 FINANCIAL PERFORMANCE BY DHB ARM ($000's) MONTH YEAR TO DATE Actual Budget Variance Actual Budget Variance REVENUE Provider Arm - Clinical Services 4,912 4, ,781 53,838 4,943 Provider Arm - Corporate & Support Services 65,586 64, , ,174 19,604 Governance & Funding Admin Arm 1, ,512 11, Funder Arm - Own Provider/Governance 63,995 62,411 1, , ,929 5,309 Funder 127, ,534 4,461 1,493,871 1,482,406 11,465 Elimination (64,532) (62,411) (2,121) (774,399) (748,929) (25,469) Consolidated 135, ,487 3,708 1,574,542 1,563,460 11,082 EXPENDITURE Provider Arm - Clinical Services 61,726 57,541 (4,185) 651, ,627 (22,827) Provider Arm - Corporate & Support Services 7,546 10,898 3, , ,385 (17,965) Governance & Funding Administration 1, (315) 11,826 11, Funder Arm - Own Provider/Governance 63,672 62,411 1, , ,929 24,609 Funder 129, ,383 (6,432) 1,477,464 1,480,595 3,131 Elimination (64,532) (62,411) 2,121 (774,399) (748,929) 25,469 Consolidated 135, ,409 (5,459) 1,572,695 1,560,649 (12,046) NET RESULT Provider Arm - Clinical Services (56,814) (53,060) (3,754) (592,672) (574,789) (17,884) Provider Arm - Corporate & Support Services 58,040 53,988 4, , ,789 1,639 Governance & Funding Admin Arm (78) 0 (78) Funder Arm - Own Provider/Governance 323 (0) 323 (19,300) 0 (19,300) Funder (1,820) 151 (1,971) 16,407 1,811 14,596 Elimination 0 0 (0) Total DHB - Parent (672) 1,078 (1,751) 1,847 2,811 (964) Three Harbours 1, ,107 1, ,107 Total DHB - Group 435 1,078 (644) 2,954 2, Provider Clinical Services The Provider Clinical services result for the twelve months ended 30 June 2016 is $17,884k unfavourable to budget. This is attributed to by an unfavourable performance in Child, Women and Family services $2,177k, Medicine and Health of Older People services $6,898k, Surgical and Ambulatory Services $1,900k, Elective Surgery Centre $295k offset by a favourable performance in Mental Health services $859k. The key drivers of the services financial performance are summarised below. Medicine and Health of Older People The service is $9,188k unfavourable for the year ended 30 June Medicine and Health of Older People YTD result is driven by a significant increase in demand for constant observation (watch) shifts $1,067k unfavourable, as well as increased nursing demand, particularly in the two Emergency Departments. The service was also impacted by leave revaluations following the MECA uplift, this is compounded by a general problem of enabling staff to take all of their annual leave entitlement. Acute demand continues to exceed contracted levels with General Medicine WIES and emergency department presentations both running at 108% and 104% of YTD contract respectively, resulting in higher than anticipated demand for personnel and supply costs. Surgical and Ambulatory Services The service is $5,272k unfavorable for the year ended 30 June Contributing to the unfavourable position are costs associated with higher than planned acute volumes 103% and over-delivery on elective 88

89 volumes 104% in addition to the financial impact of lower ACC revenues $350k, unmet savings lines $3,400k and unbudgeted nursing costs associated with running additional beds in the short stay ward $700k. Cost containment initiatives have been partially successful in mitigating unbudgeted costs incurred this year, however, it is clear that a more proactive approach will be needed to secure financial sustainability in FY16/17. Operational planning is well underway to ensure a strong start to 2016/17. The new HR reporting series will afford better visibility of external agency and overtime hours, sick leave taken and the progress of active leave management plans for all staff. Cover models have been updated for all wards and theatres and coupled with the Bureau Booking system will afford better reporting and compliance of acuity cover and the standard hours rostered on the floor. The Procurement Management Team are seeing some good initiatives coming through and work is being done to secure better reporting for services in order to track savings realised within the new financial year. Other initiatives such as ERAS and OPIVA while not contributing direct savings will continue next year and do provide greater efficiencies through reduced lengths of stay and better patient outcomes, delaying the need for additional beds. Elective Service Centre The service is $1,183k unfavorable for the year ended 30 June Contributing to the unfavourable position are costs associated with the over-delivery of elective discharges 105%, unbudgeted acute volumes $284k and unmet savings $450k. While patient numbers are a key cost driver it is noted the service has under-delivered on elective WIES. This is attributed to a higher than planned number of day cases and the lower complexity of cases has led to savings in areas such as ward nursing. In the new financial year careful management of elective volumes between SAS and ESC will limit over production (leading to budget overspends) while managing ESPI compliance. The opening of the ESC bridge should enable an increase in the complexity of cases at ESC. Child, Women and Family Services The service ended the 2015/16 financial year with a $2,924k unfavourable budget result. Revenue was $709k favourable for the year due in part to new service level agreements or existing contract variations $564k and to a large number of unexpected new funding streams predominately from the University of Auckland and Auckland District Health Board. Personnel costs were $1,529k over budget and attributed to a combination of high Medical allowances for covering registrar shortages, high sick leave and sabbatical leave, cover for a regional shortfall in midwives, budget pricing issues and increased staffing requirements relating to new contracts within Nursing and Allied Health staffing, unexpected back pay and several retirements. Personnel costs over spends were partially offset by under spending in other Allied Health and Management/Admin due to vacancies. Over spending in Outsourced costs $763k was being driven by unmet savings of $222k, nursing bureau services to cover sick and roster shortages $184k, unbudgeted anaesthetist costs $105k and external postnatal services. Clinical Supplies and Infrastructure cost over spends of $1,341k related mainly to embedded savings initiatives $1,464k. The service managed to achieve 25-30% of these savings despite other cost pressures associated with increased cleaning, uniform purchases and unbudgeted rental costs. Child, Women and Family Services remain focused on identifying opportunities for further cost reductions within community based logistics, telecommunications plans, cleaning and repairs and maintenance contracts. 89

90 The service has already realised cost benefits through annual leave reductions, pricing benefits on community nursing continence supplies, specific dental and maternity products. The introduction of the Kanban stock management system across all inpatient wards and the creation of clinical supplies coordinator roles across North Shore and Waitakere Hospitals to reduce the risk of potential over ordering and purchasing errors along with and a new, more cost effective, efficient and less invasive model of care for gynaecology patients are other strategies that are being embedded into the service. Mental Health Services The service finished 2015/16 favourable to budget by $694k. Key drivers include the impact of vacant nursing posts +$1,277k most notably during the first half of the year, contribution from the new and unbudgeted CADs contract for drug referrals from the Ministry of Justice +$300k and the one-off release of an historic provision +$266k. These points of favourable variance are partially offset with high overtime and penals in nursing -$512k due to the combination of a) higher roster/sick cover particularly in the Adult and Forensic services, b) high acuity care in the Forensic inpatient units where additional patients (currently nine) require dedicated 2-on-1 or 3-on-1 observations and c) additional security in the Adult Mental Health Services, where staffing has been increased in Waiatarau and He Puna Waiora units to improve supervision of the courtyard areas as a result of security concerns earlier in the year. Control of overtime remains a priority for the MHSG and introduction of better management tools has resulted in a 183 hour (15%) reduction per week in average forensic overtime hours since July Also, SMOs covering gaps in the registrar roster -$373k in Adult and Forensic services follows an increased number of Registrar vacancies this year and excessive targeting of this account for budget savings in previous years. Additional security -$190k has been required at the Mason clinic following a review (the Greet Report), this includes repairs and maintenance of duress responders and floodlights. 2.2 Corporate and Support Services The overall result for Provider Support is $5.529m favourable for the year to date. Expenditure budget is overspent by $17.965m mainly due to unbudgeted repairs and maintenance $1.169m, outsourced colonoscopies $1.205m, unbudgeted gratuity and maternity leave payments $2.740m, additional capital charge as a result of revaluation of Land and Buildings (offset unbudgeted capital expenditure) $4.340m, overspends in additional cleaning and orderlies costs and clinical supplies in Hospital Operations due to increased volumes and centrally budgeted savings. This is offset by additional revenue received of $19.604m received being $1.205m for outsourced colonoscopies (offset by unbudgeted outsourced costs), deficit support of $7.048m, additional funding for acute over delivery of $6.200m, additional revenue for outpatient pharmacy $373k and orthopaedic outsourcing $346k and capital charge of $4.340m. 2.3 Financial Performance Funder The Funder position as reported in the Financial Performance by DHB Arm table represents the totality of the Funder and is inclusive of Funder Own Provider Arm Services, Funder NGO Services and Funder IDF Services. The Funder net result is $1.97M unfavourable to budget for the month and $14.60M favorable to budget for the year to date. The unfavourable month variance is driven by the net impact of year end accounting adjustments inclusive of year end wash-ups. Of note in this regard is the late change by Pharmac in their year-end rebate advice to DHBs, which had an adverse impact for Waitemata DHB of $2.1M in June. The $14.60M favourable year to date variance includes a $4.0M net upside that relates to demand utilisation across NGO demand services (mainly Pharmacy $1.8M and Age Related Residential Care $2.4M). It also includes favourable PHARMAC GST adjustments of $2.5M ($1.3M relating to 2014/15 and $1.2M to 2015/16). It includes a further Pharmacy upside of $4.9M being an upward revision by PHARMAC of drug rebates receivable for (net of the $2.1M downward adjustment accounted for in June). Also impacting favourably on the year result are budget lines not fully expensed against (including risk contingencies that have not fully materialised). 90

91 2.4 Financial Performance - Governance and Funding Administration Arm The Governance and Funding Administration (GFA) represents the Waitemata DHB share of the Joint Planning Funding and Outcomes Arm and includes the Waitemata DHB share of the Northern Regional Alliance. The GFA Core Net Result is $686k favorable to budget for the year, largely driven by the Waitemata DHB share of Northern Region Alliance expenditure being lower than budget 3 Financial Performance Other Indicators/Trends 3.1 Net Result The actual net result performance against the budget for the DHB tracked over time is illustrated in the graph below. The overall DHB result for the twelve months to 30 June 2016 is $2,954k surplus which is $143k favourable to budget. 3.2 Business Transformation Savings The 2015/16 financial plan includes business transformation savings of $4.150M. The savings plan is summarised in the table below: 91

92 Waitemata DHB Summary of Key Actions that will impact Financial Performance $000's Full Year Year to Date June -16 KEY ACTIONS - with brief description* Plan Actual Plan Variance Commentary on / Explanation of Variance FY14/15 Service Reconfigurations Regional Dental Service Reconfiguration (510) Invoicing arrangements were not resolved prior to year end. Standardisation of Clinical Supplies - Renal Fluids Savings are on track year to date. Standardisation of Clinical Supplies - Respiratory Savings are on track year to date. Standardisation of Clinical Supplies - Clinical Supplies Management Savings are on track year to date. Standardisation of Clinical Supplies - Food service contract The contract was delayed until August, savings are anticipated for the remainder of the year. Standardisation of Clinical Supplies - Gastro supplies Savings are on track year to date. Standardisation of Clinical Supplies - Gastro chemicals (30) Savings not realised current year Standardisation of Clinical Supplies - Dental Suppplies (25) Savings are a little lower than anticipated due to some more costly items being required. Investment in Revenue Generation - Child Rehab - ACC Funding / Referrals Additional ACC revenues have been realised year to date within Child Rehab services. Review and rationalisation of facilities - Rental space in Mental Health Savings are on track year to date. Review and rationalisation of facilities - Opthalmology facilities at Waitakere to accomodate additional volumes Savings are on track year to date. Review of staffing rosters and models of care (2) Savings are on track year to date. Pharmaceuticals - Cost management 1,100 1,100 1,100 0 Rebates were indeed at above FY15 levels Banking and finance - Treasury management 1,000 1,000 1,000 0 Savings are on track year to date. Total 4,150 3,871 4,150 (279) ha plan to complete new savings projects with a total value of $1.867m in the financial year. The benefits from these projects were spread between 1 July 2015 and 30 June 2017, as follows: FY1516 FY1617 Total Annual Target 1,048, ,750 1,867,000 Carry forward from FY1415 projects 1,154,821 Total Predicted (incl. 14/15 carry fwd) 3,021,821 Savings Predicted from Contracts Issued Budgetary 984, ,434 1,439,511 Non Budgetary 541, ,931 1,331,400 Total Reported 2,770,911 DHB Local Activity Once contracts are completed and issued by HA FPSC, some of the contracts require implementation activity by the DHB to achieve the benefits. For approximately eight months, the Corporate team has been working with the Provider identifying and pursuing procurement savings. This work has involved: Identifying substitution opportunities Rationalising catalogue items Identifying credits where implementation packs have been received late Identifying changes to the catalogue where prices had not been correctly updated 92

93 As at the end of the year, the benefits from these projects and other in-flight projects which will result in annualised benefits of $1.33m. 4 Capital Expenditure Capital expenditure planned for the 2015/16 year was $85.652M. The table below summarises performance against the capital expenditure budget for the month and for the year. The detailed capital expenditure statement is attached to this report (Attachment 2). $'000s Full Year Budget Month (Jun-16) YTD (Jun-16) Actual Budget Variance Actual Budget Variance Land 5, ,850 5,000 3,850 Buildings & Plant 48,954 3,602 1,285 2,317 49,752 48, Clinical Equipment 10, (357) 6,390 10,021 (3,631) Other Equipment 3,850 (34) 318 (352) 1,719 3,850 (2,131) Information Technology 12, ,105 (538) 4,050 12,819 (8,769) Motor Vehicles 1, ,678 (815) Purchase of softw are 3, ,330 (3,330) Total Capital Expenditure 85,652 4,895 3,682 1,213 71,624 85,652 (14,028) As at June 2016, capital expenditure is $14.028m below the plan. This is mainly due to underspend in Information Technology due in part to resourcing issues. Progress on implementation of major facilities capital projects is reported monthly to the Audit and Finance Committee via the Facilities and Development report. There are no significant departures from the plan. 5 Financial Position The financial position as at 30 June 2016 is shown below. This indicates a strong balance sheet, with net worth of $ m including $82m in cash and deposits. The favourable equity position to budget was due to the increase in property valuation ($54m) in June 2015 following detailed valuations. The detailed Statement of Financial Position for the DHB Parent is provided as Attachment 3. Opening Jun-16 Jun-16 Jun-16 Full Year In $'000s 30 Jun-15 Actual Budget Variance Budget Crown Equity 304, , ,897 97, ,897 Represented by : Current Assets 185, , ,177 33, ,177 Current Liabilities 267, , ,051 (24,656) 252,051 Net Working Capital (81,576) (139,397) (147,874) 8,477 (147,874) Fixed Assets 667, , ,900 59, ,900 Term Liabilities 281, , ,129 29, ,129 Total Employment of Capital 304, , ,897 97, ,897 6 Cash flow Position Summary of the cash flow statement as at 30 June 2016 is shown below. The detailed Cash flow statement is provided as Attachment 4. $'000s Month YTD Actual Budget Variance Actual Budget Variance Opening cash 0 62, ,385 Operating (15,360) 2,137 (17,497) 9,862 25,644 (15,782) Investing (4,895) (3,682) (1,213) (99,624) (85,652) (13,972) Financing 20,255 (1,000) 21,255 89,762 (1,000) 90,762 Closing cash 0 60,377 2, ,377 61,008 Closing Cash Balance in HBL Sw eep account 53, ,

94 The DHB s cash position in the HBL sweep as at 30 June 2016 is $54m (last month $74m). The DHB also monitors performance in collecting amounts owed by other organisations; the total amount owed to the DHB as at 30 June 2016 was $14.4m (last month balance owed was $13.0m). 73% of this is within the 60 days period (18% of this relates to Ministry of Health and 23% to other DHBs). 27% is over 60 days and the majority of this is in the area most difficult to collect, i.e. non-residents income. An Accounts Receivables report and explanation for amounts overdue for more than 60 days is provided as Attachment 5. 7 Treasury 7.1 Financing Activity Term debt drawn and average interest expense and rates are shown in the tables below. Month Term Debt ($ 000s) CHFA Interest Expense ($ 000s) Jul , Aug , Sep , Oct , Nov , Dec , Jan , Feb , Mar , Apr , May , Jun , YTD 276,706 10,712 $ m of Crown debt was fully drawn as at 30 June All loan facilities have been drawn down as at 30 June The average interest rates on the loan portfolio are provided in the table below: NZD Available Facilities $000 Drawn Debt Current Month $000 Drawn Debt Last Month $000 Interest Rate Current Month CHFA Fixed $272,996 $272,996 $272, % CHFA Floating $3,710 $3,710 $3, % Total Facilities $276,706 $276,706 $276, % Monthly Weighted Average Interest Cost (Including Hedges & Margin) % 7.2 Treasury Policy All Waitemata DHB debt shall be borrowed on either a fixed interest rate or floating interest rate basis, subject to the requirement that the overall percentage of fixed (fixed/floating master limit) in any time bucket must be in accordance with the following limits: 94

95 $ Millions The fixed rate amount at month-end reporting dates must be within the following maturity bands (percentages calculated on the fixed rate amount at month end): The interest rate repricing risk profile for the WDHB Crown debt is shown in the graph below: WAITEMATA DISTRICT HEALTH BOARD Interest Rate Repricing Risk Profile 30-Jun yrs 10% - 70% 27% Interest Rate Re-Pricing 3-5 yrs 10% - 70% 27% Years Fixed Debt Maturity 5-10 yrs 10% - 70% 46% Floating 7.3 Financial Covenants Waitemata DHB s performance against financial covenants (which are currently waived) is summarised below and compliance was achieved. Financial Covenants Actual Budget Covenant Met Shareholders Funds (=> $70 million) 336 m 239 m Yes Net Total Debt / (Net Total Debt + SHF) < 65% 47% 56% Yes ANZ Interest Cover EBITDA / Net Interest (> 1.5:1) Yes CHFA Interest Cover EBITDA / Net Interest (> 2.5:1) 7 8 Yes 95