Community and Public Health Advisory Committees Meeting. Wednesday 21 June am

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1 Community and Public Health Advisory Committees Meeting Wednesday 21 June am Venue Waitemata District Health Board Boardroom Level 1, 15 Shea Tce 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 1 AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEES (CPHAC) MEETING 21 June 2017 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 10.00am COMMITTEE MEMBERS Sharon Shea Committee Chair (ADHB Board member) Max Abbott - WDHB Board member Judith Bassett ADHB Board member Edward Benson Cooper - WDHB Board member Zoe Brownlie - ADHB Board member Sandra Coney - WDHB Board member Warren Flaunty - Committee Deputy Chair (WDHB Board member) Matire Harwood - WDHB Board member Lee Mathias - ADHB Board member Robyn Northey - ADHB Board member Allison Roe - WDHB Board member MANAGEMENT Dale Bramley - WDHB, Chief Executive Ailsa Claire - ADHB, Chief Executive Debbie Holdsworth - ADHB and WDHB, Director Funding Simon Bowen - ADHB and WDHB, Director Health Outcomes Peta Molloy - WDHB, Board Secretary Apologies: Judith Bassett AGENDA KARAKIA DISCLOSURE OF INTERESTS Does any member have an interest they have not previously disclosed? Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda? Items to be considered in public meeting 1. AGENDA ORDER AND TIMING 2. CONFIRMATION OF MINUTES 10.00am 2.1 Confirmation of Minutes of the meeting held on 29 March 2017 Actions Arising from previous meetings 3. INFORMATION PAPERS 10.05am 3.1 Regional status of Green Prescription, Active Families and Pre-School Active Families 4. STANDARD REPORTS 10.30am Planning, Funding and Outcomes Update 5. GENERAL BUSINESS 3

4 Auckland and Waitemata District Health Boards Community and Public Health Committees Member Attendance Schedule 2017 NAME MAR JUNE SEP DEC Sharon Shea Max Abbott Judith Bassett Edward Benson Cooper Zoe Brownlie Sandra Coney Warren Flaunty Matire Harwood Lee Mathias Robyn Northey Allison Roe attended absent * attended part of the meeting only ^ leave of absence # absent on Board business + ex-officio member 4

5 Community and Public Health Advisory Committee (CPHAC) REGISTER OF INTERESTS Committee Member Max Abbott Judith Bassett Edward Benson- Cooper Zoe Brownlie Sandra Coney Warren Flaunty Dr Matire Harwood Involvements with other organisations 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 Shareholder - Fisher and Paykel Healthcare Shareholder - Westpac Banking Corporation Husband Fletcher Building Husband - shareholder of Westpac Banking Corporation Granddaughter - shareholder of Westpac Corporation Daughter Human Resources Manager at Auckland DHB Last Updated 19/03/14 26/01/17 Chiropractor Milford, Auckland (with private practice commitments) 07/12/16 Community Health Worker Auckland DHB Member PSA Union Board member - RockEnrol Partner Youth Connections, Auckland Council Partner Aro Arataki Children s Centre Committee Son Aro Arataki Childcare Centre Member Waitakere Ranges Local Board, Auckland Council Patron Women s Health Action Trust Member Portage Licensing Trust Member West Auckland Trusts Services Member Henderson Massey Local Board Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder Green Cross Health Director Life Pharmacy Northwest Director Westgate Pharmacy Ltd Chair Three Harbours Health Foundation Director - Trusts Community Foundation Ltd Senior Lecturer Auckland University Board Director Health Research Council Director Ngarongoa Limited, which is contractor providing services to National Hauora Coalition. GP at Papakura Marae Health Clinic Advisory Committee Member State Foundation NZ (Maori Health) Member Te Ora, Maori Medical Practitioners 09/06/17 15/12/16 06/12/16 09/12/16 5

6 Committee Member Lee Mathias Robyn Northey Sharon Shea Allison Roe Involvements with other organisations Chair - Health Promotion Agency Chair - Unitec Acting Chair - Health Innovation Hub Director - Health Alliance Limited (ex officio Auckland DHB) Director/shareholder - Pictor Limited Director - Lee Mathias Limited Director - John Seabrook Holdings Limited Trustee - Lee Mathias Family Trust Trustee - Awamoana Family Trust Trustee - Mathias Martin Family Trust Member New Zealand National Party Trustee - A+ Charitable Trust Shareholder of Fisher & Paykel Healthcare Member New Zealand Labour Party Husband - member Waitemata Local Board Husband shareholder of Fisher & Paykel Healthcare Husband shareholder of Fletcher Building Husband Chair, Problem Gambling Foundation Husband Chair, Community Housing Foundation Principal - Shea Pita Associates Ltd Contracted to Manaia PHO delivery of workforce development training Provider - Maori Integrated contracts for Auckland and Waitemata DHBs Provider Ministry of Health National Results Based Accountability training for Maori health organisations Provider Plunket outcomes implementation framework Project member Auckland and Waitemata DHB Maori Workforce Development project Project member - Te Runanga o Te Rarawa Outcomes Project Provider - multiple management consulting projects for Te Putahitanga o Te Waipounamu Whanau Ora Commissioning Agency Strategic Advisor Alliance Health Plus PHO Strategic Planning Project Iwi Affiliations: Ngati Ranginui, Ngati Hine, Ngati Hako and Ngati Haua Husband - Part owner Turuki Pharmacy Ltd, Auckland Husband - Board member, Waitemata DHB Husband Director Healthcare Applications Ltd Chairperson Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council Last Updated 05/06/17 22/02/17 15/03/17 02/11/16 6

7 Confirmation of the Minutes of the Auckland and Waitemata District Health Boards Community and Public Health Advisory Committees Meeting held on 29 th March 2017 Recommendation: That the Minutes of the Auckland and Waitemata District Health Boards Community and Public Health Advisory Committees Meeting held on 29 th March 2017 (including the public excluded minutes) be approved. Note: the public excluded minutes of the above meeting are included under separate cover. It is suggested that, unless there are any issues which require discussion, approval of the public excluded minutes could be incorporated in the above resolution, without moving into public excluded session. 7

8 2.1 Minutes of the meeting of the Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Wednesday 29 March 2017 held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.03am Part I - Items considered in Public Meeting COMMITTEE MEMBERS: Sharon Shea (Committee Chair - ADHB Board member) Max Abbott (WDHB Board member) Judith Bassett (ADHB Board member) Edward Benson-Cooper (WDHB Board member) Zoe Brownlie (ADHB Board member) Sandra Coney (WDHB Board member) Warren Flaunty (Committee Deputy Chair - WDHB Board member) Matire Harwood (WDHB Board member) Lee Mathias (ADHB Board member) Allison Roe (WDHB Board member) ALSO PRESENT: Dale Bramley (WDHB Chief Executive Officer) Debbie Holdsworth (ADHB and WDHB, Director Funding) Karen Bartholomew (ADHB and WDHB, Acting Director Health Outcomes) Peta Molloy (WDHB, Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item) PUBLIC AND MEDIA REPRESENTATIVES: WELCOME: APOLOGIES: Holly Neilson (Maternity Services Consumer Council) Sue Claridge (Auckland Women s Health Council) Lynda Williams (Auckland Women s Health Council) Wiki Shepherd-Sinclair (Health Link North) The Committee Chair welcomed everyone to the first Committee meeting of the new Board term. The Board members and DHB staff each introduced themselves. Sharon Shea acknowledged and thanked Gwen Tepania-Palmer for her integrity and leadership of the Committee during her time as Committee Chair; the Committee endorsed these comments. Apologies were received and accepted from Robyn Northey and Alisa Claire. 8

9 2.1 DISCLOSURE OF INTERESTS There were no declarations of interests relating to the agenda. 1. AGENDA ORDER AND TIMING Items were taken in the same order as listed on the agenda, except that item 5.1 was considered before item. 2. COMMITTEE MINUTES 2.1 Confirmation of Minutes of the Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting held on 23/11/16 (agenda pages 7-12) Resolution (Moved Lee Mathias/Seconded Judith Bassett) That the draft minutes of the Community and Public Health Advisory Committee meeting held on 23 November 2016 be approved. Carried Matters Arising (agenda pages 13) That with regard to an update on the regional status of programmes such as Green Prescription, Active Families, Preschool Families and the like, a formal report will be provided to the Committee at its next meeting. A copy of the national report on green prescription will be uploaded to the Boardbooks resource centre. Lee Mathias advised that the action point seeking clarification on whether Auckland DHB separates acute bed days that are tertiary and secondary can now be removed. Work around this matter is now being undertaken at Auckland DHB. 3 DECISION ITEMS 3.1 Equally Well Consensus Position paper (agenda pages 14-24) Trish Palmer (Funding and Development Manager Mental Health and Addictions) and Sheryl Jury (Public Health Physician) were present for this item. Trish Palmer introduced the item and noted that the paper aligns with the strategic themes for both Auckland and Waitemata DHBs and the Waitemata DHB Our Health in Mind Strategy. Debbie Holdsworth noted that endorsing the paper will not commit the DHBs to any particular action and standard processes for consideration will be followed for any decision required. Matters covered in discussion and response to questions included: Noting the importance of working with primary care providers to ensure service users are receiving care in all areas, including physical health. Noting the Waitemata DHB Our Health in Mind business case proposes to initially engage with 120 people over a one year period using peer support and increased enhanced care support. The case will be shared with the metro Auckland DHBs and an update provided to the Committee. 9

10 2.1 Lee Mathias noted the WeVisit programme based in Christchurch. This programme matches young people with older people for visits to spend time together and provide assistance around the home. A link with programmes like this and lower level mental health could be investigated. Resolution (Moved Lee Mathias/Seconded Zoe Brownlie) That it be recommended to the Auckland and Waitemata District Health Boards: That the Board endorses the Equally Well consensus position paper. Carried 4 INFORMATION ITEMS Pacific Health Action Plan (agenda pages 25-33) Item was discussed after item 5.1. Bruce Levi (General Manager Pacific Health), Leani Sandiford (Pacific Health Portfolio Manager) and Corina Gray (Public Health Physician) were present for this item. An apology was received from Lita Foliaki (Pacific Health Gain Manager). Debbie Holdsworth introduced the item. She noted that as the funding envelope is not being released until late May, the report identifies what the team would like to progress recognising the DHBs do not yet know the available funding. Bruce Levi noted that the Plan has two additional objectives to the original six confirmed following the 2016 consultation, they are Pacific people experience optimal mind health and wellbeing and Pacific elders are valued and experience optimal health and wellbeing. In response to a question, it was noted that the DHB does engage with Pacific Churches; with coordinators and parish nurses assisting with health plans. There is also a strong presence at the Pacifika and Polyfest festivals. The Pacific Team was asked to come back to the Committee and report on progress; in particular, outcomes achieved. The Committee thanked the Pacific Team for their effort and commitment, noted the report, and supported the draft Pacific Health Action Plan. 5. STANDARD REPORTS 5.1 Planning, Funding and Outcomes Update (agenda pages 34 to 55) Dr Debbie Holdsworth (Director Funding), Dr Karen Bartholomew (Acting Director Health Outcomes), Ruth Bijl (Funding and Development Manager Child, Youth and Women s Health), Kate Sladden (Funding and Development Manager Health of Older People), Aroha Haggie (Manager Maori Health Gain) and Julia Peters (Clinical Director Auckland Regional Public Health Service). 10

11 2.1 Debbie Holdsworth introduced the item and summarised the reported key highlights. Matters covered in discussion and response to questions included: Noting that the Ministry of Health are undertaking an external evaluation of the System Level Measure Improvement Plans. That an issue with obtaining reliable data extraction related to patients with diabetes continues; the issue relates to the variation of where data is recorded in each practice. That to address the low Asian enrolment rate with PHOs, a key priority is gaining connection with primary care. It was noted that within the Auckland area, there is a large number of students who are Asian and that this population is considered transient. Acknowledging the positive work in the healthy kids and youth health target areas. Noting that data is available for the oral health target: percentage of infants enrolled in dental service by 1 year, however, that due to the result level it does not show on the graph. Specific work is underway on the preschool strategy and importantly access to healthcare. Noting that the reporting age for the breastscreening indicator (50-69 years) is the routine reporting age for the Ministry of Health. In addition it was also noted that the cervical screening information reported is also the routine reporting age for the Ministry of Health (25-69 years); data on lower age ranges (20-25 years) screened, while not part of the target is received by the DHB. Noting the importance of pregnancy immunisation and the positive impact it has for infants. That audits of aged residential care facilities are planned audits and not random. That with regard to complaints from aged residential care facilities, the first point of call is the Manager of the facility and each facility has an HDC (Health and Disability Commission) point of contact. Complaints can also be made direct to those managing the auditing process. The Committee requested that the pre-audit team be advised of the importance of the complaint process being clearing and well communicated in each facility. That the Committee be provided with a report on options available or issues around housing for people impacted by mental health and/or addiction. That an update be provided to the Committee on support options available for people caring for someone with mental health and/or an addiction in the community. That with regard to the recent visit undertaken to China by Waitemata DHB representatives, Dale Bramley noted the areas visited and the progression seen in the health sector. He noted that the community health centres developed have a full range of diagnostics and are defined by a geographical area and residents attend the centre defined by that geographical area for healthcare. A briefing paper will be provided on learnings from the visit. Sandra Coney noted that she had received feedback from West Auckland community members about patients being refused enrolment with PHOs as the clinics are full. Stuart Jenkins noted that there are practices with closed books that are not taking new patients. The Committee will be updated on this matter. Julia Peters noted that the Auckland Regional Public Health Service continues to contribute to the revision of the Auckland Plan and that work is underway with the Council and those involved in writing the plan to take a more broad ranging environmental health approach to planning. Julia Peters also provided an update on the Mumps outbreak in Auckland noting that there now 36 confirmed cases. 11

12 2.1 The Committee received the report and the Committee Chair thanked those who had attended for the discussion of this item. 6. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Lee Mathias/Seconded Max Abbott) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following item, for the reasons and grounds set out below: General subject of items to be considered 1. Rheumatic Fever Prevention Programme Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution 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 or which any person has been or could be compelled to provide under the authority of any enactment where the making available of the information would be likely to; (i) prejudice the supply of similar information, or information from the same source, and where it is in the public interest that such information should continue to be supplied; or (ii) otherwise damage the public interest. [Official Information Act 1982 S.9 (2) (ba)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Carried The open meeting concluded at 11.16am (open meeting). 12

13 2.1 RESOLUTION TRANSFERRED FROM THE CONFIDENTIAL AGENDA TO OPEN AGENDA Rheumatic Fever Prevention Programme The following item was considered as part of the confidential agenda (item 2.1) and the Committee agreed that the following resolution be transferred to the open agenda. Resolution (Moved Lee Mathias/Seconded Allison Roe) That the Community and Public Health Advisory Committees recommend to the Boards: That the Board: a) Notes neither Auckland DHB nor Waitemata DHB has achieved the government s Better Public Services target of reducing Rheumatic Fever by two thirds by 2017; with rates in 2016 the highest yet at: 5.4/100,000 in Auckland against a target of 1.1/100, /100,000 in Waitemata against a target of 0.7/100,000. b) Notes that Acute Rheumatic Fever is a third world condition, which still exists in New Zealand and is associated with significant inequities. c) Notes that Auckland DHB and Waitemata DHB have implemented a multi-pronged prevention programme, some of which has been implemented well, but the existing programme does not provide sufficient coverage to the at-risk populations to achieve the required reduction in Rheumatic Fever rates. d) Endorses the development of business cases to be submitted to the respective Audit and Finance Committees to recommend to each Board additional investment to expand the current Rheumatic Fever Prevention Programmes, including: i. Continuing the implementation of the expanded healthy housing initiative ii. Intensifying awareness raising activities in targeted communities iii. Maintaining and strengthening the school-based primary care service in low decile schools iv. Ensuring appropriate and free healthcare to under 13s in traditional primary healthcare settings; and developing primary care chronic care management v. Offering more choices for free health care to young people years of age (such as through youth health clinics) vi. Continuing existing secondary prevention and disease management improvement activities. e) Note that any additional funding is dependent on availability of new funding and that at this time the 2017/18 Health Funding Envelope has not yet been issued. All calls on demographic funding will be brought back to each Board for review of confirmation once the complete funding envelope has been received. Carried The meeting closed at 12.03pm. SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 29 MARCH 2017 CHAIR 13

14 2.2 Actions Arising and Carried Forward from Meetings of the Community and Public Health Advisory Committees as at 15 June 2017 Meeting CPHAC 23/11/16 CPHAC 29/03/17 Agenda Ref Topic Update on regional status on programmes such as Green Prescription, Active Families, Preschool Families and the like. 5.1 Planning, Funding and Outcomes Update That the Committee be advised on support options available for people caring for someone with mental health and/or an addiction in the community Person Responsible Expected Report Back Comment Tim Wood 21/06/17 See agenda item 3.1 of this agenda. A copy of the national report on Green Prescription will be uploaded to the Boardbooks resource centre. Trish Palmer 13/09/17 Will be reported as part of the Planning, Funding and Outcomes Update report. 14

15 3.1 Regional Status of Green Prescription, Active Families and Pre- School Active Families 3.1 Recommendation: That the report be received. Prepared by: Leanne Catchpole (Programme Manager, Primary Care Team) Endorsed by: Dr Debbie Holdsworth (Director, Funding) and Tim Wood (Deputy Director Funding), Glossary AF GRx PSAF - Active Families - Green Prescription - Pre-school Active Families 1. Executive Summary This paper responds to a request from the Community and Public Health Advisory Committees meeting on 23 November 2016 for the DHB to provide an update on regional status on programmes such as Green Prescription, Active Families, Preschool Families and the like. The Ministry of Health contracts with Auckland DHB, Waitemata DHB and Counties Manukau Health to deliver a national Green Prescription (GRx) programme for inactive adults and an Active Families (AF) programme for inactive children and their families. Counties Manukau Health also received funding from the Ministry of Health in 2016/17 for a Pre-school Active Families (PSAF) programme for obese children and their families. The Ministry of Health is considering funding Auckland and Waitemata DHBs to deliver PSAF from 1 July Auckland and Waitemata DHBs undertook a joint procurement process to select providers to deliver these three services (PSAF, AF and GRx) from 1 July The procurement process selected Sport Auckland as the provider for Auckland DHB and Harbour Sport for Waitemata DHB. In 2016/17, Counties Manukau Health undertook a procurement process for AF and PSAF, selecting Otara Health as the provider for both services. Counties Manukau Health s current provider for GRx is Sport Auckland. As their GRx has not gone to the market since inception they are considering retendering the GRx service in 2017/18. There is a national service specification for AF and GRx; Auckland and Waitemata DHB have added additional clauses to this specification to target services to Maori, Pacific and South Asian, pregnant/of child-bearing age women. Counties Manukau Health is planning to align the services they procure with the Auckland and Waitemata DHB specification. The metro-auckland DHBs, GRx and AF providers regularly meet and share learnings and resources. An evaluation is currently being undertaken of the Sport Auckland programmes, which will be used to improve services across all three DHBs services. 15

16 Strategic Alignment Strategic Theme Community, whanau and patient centred model of care Emphasis and investment on both treatment and keeping people healthy Service integration and/or consolidation Evidence informed decision making and practice Outward focus and flexible, service orientation Alignment with PSAF, AF and GRx These programmes support people to live well and stay well, and inform them about lifestyle changes they can make to achieve the health outcomes they want. Investing in these programmes helps to prevent ill health, reduce illness and early deaths while reducing the downstream cost of hospital care. The programmes are targeted to communities of high need. These programmes are delivered in the community, particularly in high needs areas that are conveniently located and easy to access. A single provider for each DHB provides this suite of programmes across the lifespan and integrates AF and GRx into other services they provide. Evaluations of the AF and GRx programmes have shown that they are effective at helping people to make lifestyle changes. The AF and GRx programmes currently being delivered are being evaluated and will provide evidence for further service development. These programmes engage with services outside of health, such as sport and recreation facilities, and as such help to link people up with activities in their community. They focus on long-term population health outcomes to reduce inequalities in health status. 3. Introduction The GRx programme was developed by Sport and Recreation New Zealand in 1998 and is available nationwide to anyone aged 18 years and over. The programme provides referrers (usually General Practitioners and practice nurses) the option of prescribing physical activity where it may be considered beneficial to patients who are inactive and/or overweight. Patients often have medical conditions such as hypertension, obesity, diabetes, osteoporosis, anxiety and depression. Patients who receive a GRx are referred to the GRx provider in their area. Over a period of three months trained advisors give basic nutrition advice and help patients to set goals and get into regular appropriate physical activities such as walking or going to a gym in their local community. The advisors also provide encouragement, monitor progress and provide feedback to referring General Practitioners on progress. The service is predominantly provided over the phone, though providers have recently enhanced the service by providing some face-to-face sessions, exercise groups and nutrition education in community venues. In 2004, the AF programme was added for inactive children and young people at risk of adverse health effects from being inactive, overweight or obese. These children and young people are usually not participating in sports based activities. AF programmes are community based health initiatives designed to increase physical activity and improve nutrition in children and young people aged five to 18 years of age and their whanau/families. Priority is given to children aged five to 12 years. The programme supports children and their families to lead healthier and more active lifestyles through weekly physical activity and nutrition sessions. The AF advisor also provides encouragement and 16

17 3.1 education, nutritional guidance and advice, realistic goal setting and ongoing support to each family individually. In 2009, AF and GRx were transferred to the Ministry of Health to manage as the objectives of the programme were primarily health outcomes. In 2012, the Ministry of Health devolved the contracts to DHBs; however, they are still actively involved in overseeing the programme. Following the devolution to DHBs funding increased significantly for the first few years for additional adult volumes to address diabetes. In the last couple of years Auckland and Waitemata DHBs have put most of the additional funding into AF to address the gaps in service provision for children. Obesity is particularly concerning in children as it is associated with a wide range of health conditions and increased risk of premature onset of illness. It can also affect a child s immediate health, educational attainment and quality of life. The Ministry of Health introduced new funding in July 2016 as part of the Childhood Obesity Strategy for a PSAF programme in four high needs DHBs, including Counties Manukau Health. The Ministry of Health is considering extending the funding for this service to additional DHBs, including Auckland and Waitemata DHBs from 1 July Children that are identified as obese in the Before Schools Check will be referred to this programme. 4. Progress Auckland and Waitemata DHBs have recently undertaken a procurement process, selecting Sport Auckland as the provider for Auckland DHB, and Harbour Sport as the provider for Waitemata DHB for AF, GRx and PSAF (if funding becomes available). Prior to the procurement process the DHBs added additional clauses to the national service specification, including: face-to-face consultations and group sessions in high needs communities targets for Maori, Pacific and South-Asian populations, the targets are weighted at 2 or 2.5 times their prevalence in the population identified pregnant/child bearing age women as priority populations. The ethnicity targets require at a minimum, the proportion of participants engaged in the service to be: Auckland DHB: Ethnicity Active Families Green Prescription Maori 17% 11% Pacific 31% 17% South Asian* no target 18% *South Asian includes; Indian, Fiji-Indian, Pakistani, Sri Lankan, Bengali, Nepali and Afghani Waitemata DHB: Ethnicity Active Families Green Prescription Maori 24% 13% Pacific 20% 22% South Asian* no target 9% 17

18 The target service volumes that the DHBs will contract for in 2017/18 are in the table below: Auckland DHB Volume Waitemata DHB Volume Active Families 130 children and their families 140 children and their families Green Prescription 4,500 4,920 for 2017/18, increasing to 5,400 in 2018/19* *As Harbour Sport needs to establish a new service in West Auckland during 2017/18 a lower target is recommended for this year. 3.1 Counties Manukau Health also contracts with Sport Auckland to provide GRx services; they are considering adopting the revised Auckland and Waitemata DHB service specification for Green Prescription and re-tendering the service during the 2017/18 year. In 2016/17 Counties Manukau Health received new funding from the Ministry of Health for PSAF and undertook a procurement process to select a provider to deliver this new service. They took the opportunity to retender their AF programme selecting Otara Health to deliver both of these services through to An evaluation of Sport Auckland s GRx service for Auckland DHB and Counties Manukau Health is currently being undertaken by Ko Awatea. The findings and recommendations of the evaluation will be used to inform and improve services across the three DHBs programmes. The GRx and AF providers across the three DHBs regularly meet to share experiences, learnings and resources. The DHBs, PHOs, and GRx and AF providers have a regional quarterly meeting to share information and plan new service improvements. 5. Conclusion Auckland DHB, Waitemata DHB and Counties Manukau Health all receive funding from the Ministry of Health for AF and GRx. Counties Manukau Health also receive funding for PSAF; Auckland and Waitemata DHBs are anticipating they will receive funding for PSAF in 2017/18. The metro-auckland DHBs have all recently undertaken a procurement process for PSAF, AF and GRx services, or are considering undertaking one i.e. Counties Manukau Health s GRx service. Prior to the procurement process the service specifications were enhanced to improve services and set targets for priority populations. The metro-auckland DHBs, AF and GRx regularly collaborate on new initiatives and share resources. 18

19 Planning, Funding and Outcomes Update Recommendation: That the report be received. Prepared by: Wendy Bennett (Manager Planning and Health Intelligence), Trish Palmer (Funding and Development Manager Mental Health and Addiction Services), Ruth Bijl (Funding and Development Manager Child, Youth and Women s Health), Tim Wood (Funding and Development Manager Primary Care), Kate Sladden (Funding and Development Manager Health of Older People), Aroha Haggie (Manager Maori Health Gain), Lita Foliaki (Manager Pacific Health Gain), Bruce Levi (Pacific General Manager), Samantha Bennett (Manager Asian Health Gain) and Jane McEntee (General Manager, Auckland Regional Public Health Service) Endorsed by: Dr Debbie Holdsworth (Director Funding) and Dr Karen Bartholomew (Acting Director Health Outcomes) Glossary ARC - Aged Residential Care ARPHS - Auckland Regional Public Health Service HCSS - Home and Community Support Services PHAP - Pacific Health Action Plan PHO - Primary Health Organisation SACAT - Substance Addiction Compulsory Assessment and Treatment 1. Executive Summary This report updates the Community and Public Health Advisory Committee on Auckland and Waitemata DHB planning and funding activities and areas of priority, since its last meeting on 29 March It is limited to matters not already dealt with by other Board committees or elsewhere on this meeting s agenda. Highlights Continued high achievement against the Raising Healthy Kids target. Auckland and Waitemata DHBs were both successful with their separate proposals to provide and evaluate: Existing Initiatives for Investment in Building an Evidence Base (people with moderate mental health issues) within 15 months, with final evaluation report due to the Ministry of Health (MoH) on 30 September The In-Home Strength and Balance Programmes, part of the Falls Prevention work, are up and running. These programmes have been promoted to general practices and are now receiving referrals from GPs. Development of the Disposal of Unwanted Medicines Awareness Campaign to educate consumers about the importance of safely disposing unwanted medicines by returning these medicines to their local community pharmacy. The Primary Care Team has been part of collaboration with Medicines Control to Implement a Risk-Based Pharmacy Quality Audit Framework to improve the levels of compliance of community pharmacies to the regulatory requirements. 19

20 The second draft of the 2017/18 Māori Health Plan is now in its final stages. We continue to work with key stakeholders to finalise the development of one Plan for Auckland and Waitemata DHBs. The Auckland Waitemata PHO Alliance Leadership Team also recently endorsed the content relevant to primary care in the 2017/18 Māori Health Plan and agreed to support the implementation of activities relevant to primary care, with a view to improve health outcomes for Māori as a priority. 2. Planning 2.1 Annual Plans Due to the late funding advice received post-budget (and which was not formally confirmed at the time of writing this report), the Chief Executives with agreement from the Board Chair of both Auckland and Waitemata DHBs are delaying the submission of the 2017/18 Annual Plans to the MoH (due 16 June) until the implications of the advice received is fully understood and worked through. This will also effect the submission of the Northern Region Health Plan, which will be similarly delayed. Financial information is currently under development. DHBs received feedback from the MoH on 10 May and most of the non-financial aspects of this feedback have been incorporated into the Plans. 2.2 System Level Measure Improvement Plans The 2017/18 System Level Measures Improvement Plan is currently being finalised under the Auckland and Waitemata Primary Care Alliance Leadership Team and Counties Manukau Health Alliance. A tool has been developed to enable reporting to the Board and we continue to work on processes and tools to calculate and report measures in more detail. 2.3 Auckland and Waitemata DHB Quarterly Performance Scorecard The Auckland and Waitemata DHB scorecard is a standardised tool that is used by both Auckland and Waitemata DHBs to internally review and track performance against a range of measures including the national health targets. The scorecard shows for each measure the actual performance of both DHBs for Quarter three of the 2016/17 year. 20

21 Auckland and Waitemata DHB Quarterly Performance Scorecard CPHAC Outcome Scorecard March /17 a. Health Targets - Auckland DHB Health Targets - Waitemata DHB Actual Target Trend Actual Target Trend Better help for smokers to quit - primary care 88% 90% a. Better help for smokers to quit - primary care 88% 90% Increased immunisation (8-month old) Increased immunisation (8-month old) Total 94% 95% Total 92% 95% p Maori 90% 95% q Maori 86% 95% Pacific 93% 95% Pacific 94% 95% q Asian 98% 95% p Asian 98% 95% Other 91% 95% q Other 86% 95% q Raising Healthy kids Raising Healthy kids Total 99% 80% p Total 100% 80% Maori 100% 80% p Maori 100% 80% p Pacific 100% 80% p Pacific 100% 80% Asian 97% 80% Asian 100% 80% Other 98% 80% p Other 100% 80% Child, Youth and Women - Auckland DHB Child, Youth and Women - Waitemata DHB Actual Target Trend Actual Target Trend b. Rheumatic Fever rate b. Rheumatic Fever rate Total q Total q Māori q Māori q Pacific q Pacific q Other q Other q Oral Health - % utilisation by 2 years Oral Health - % utilisation by 2 years Total 50% 75% Total 63% 75% Māori 28% 75% Māori 36% 75% Pacific 43% 75% Pacific 37% 75% Asian 65% 75% Asian 71% 75% Other 51% 75% Other 74% 75% Cervical Screening Cervical Screening Total 71% 80% Total 75% 80% q Maori 55% 80% q Maori 59% 80% q Pacific 72% 80% q Pacific 73% 80% q Asian 59% 80% Asian 68% 80% Other 80% 80% q Other 80% 80% q Primary Care - Auckland DHB Primary Care - Waitemata DHB b. Actual Target Trend Actual Target Trend PHO enrolment PHO enrolment Total 84% 95% q Total 92% 95% Māori 76% 95% q Māori 81% 95% Pacific 106% 95% q Pacific 100% 95% Asian 69% 95% Asian 84% 95% Other 91% 95% q Other 96% 95% b. Diabetes management Diabetes management Total 65% 61% q Total 68% 69% Māori 61% 61% q Māori 58% 69% p Pacific 55% 61% q Pacific 60% 69% q Other 70% 61% q Other 71% 69% q Health of Older People - Auckland DHB Health of Older People - Waitemata DHB b. Actual Target Trend Actual Target Trend HBSS clients with Clinical interrai in last 2 yr 95% 75% b. HBSS clients with Clinical interrai in last 2 yr 81% 75% q ARC residents LTCF interrai w/in 230 days of previous 82% 75% q ARC residents LTCF interrai w/in 230 days of previous 76% 75% q ARC residents HC interrais prior to LTCF interrai 90% 98% p ARC residents HC interrais prior to LTCF interrai 83% 98% q 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. Source MOH quarterly report. b. December 2016 A question? Contact: Victoria Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 21

22 Kilogram 3. Primary Care 3.1 Highlights Development of the Disposal of Unwanted Medicines Awareness Campaign to educate consumers about the importance of safely disposing unwanted medicines by returning these medicines to their local community pharmacy. The team has been part of collaboration with Medicines Control to Implement a Risk-Based Pharmacy Quality Audit Framework to improve the levels of compliance of community pharmacies to the regulatory requirements. A continued issue is both Auckland and Waitemata DHBs not achieving the Better Help for Smokers to Quit primary health care target in Quarter three, 2016/17. At a PHO level, only ProCare (Auckland and Waitemata) and Auckland PHO successfully achieved the target. However, based on the weekly reports received PHOs are making good progress towards achieving the target and to further mitigate the risk of not achieving the target in Quarter four, PHOs have additional staff providing brief advice to smokers that have not received this at Practices. To further improve the outcomes of diabetes population, the Auckland Waitemata Diabetes Service Level Alliance has developed a five year activity plan, resourcing requests have not been endorsed at this stage due to the delayed funding envelope. 3.2 The Disposal of Unwanted Medicines Awareness Campaign Background The metro Auckland Community Pharmacy Waste Management Service commenced in February International Waste Ltd (Interwaste), a specialist hazardous waste collection, treatment, recycling and disposal company, was recruited to collect and dispose of pharmaceutical waste. According to data provided by Interwaste approximately 20 tonnes of pharmaceutical and sharps waste has been disposed of since February The disposal is a free service provided by the metro Auckland DHBs, there is concern that consumers may not be aware of the service, however, we are seeing a steady increase in the amount of pharmaceutical waste collected as shown in Figure 1 below. Figure 1: Amount of pharmaceutical waste collected (in kilograms) between March March ADHB CMDHB WDHB Note for Figure 1 Collections during March 2016 and April 2016 did not occur as community pharmacies were provided with empty containers at the beginning of the service. 22

23 Kilogram It is important to note that the trend observed with the collection of sharps waste (Figure 2) is different to the pharmaceutical waste. Large amounts of sharps waste was collected at the start of waste disposal service and appears to have reached a steady level since July Figure 2: Amount of sharps waste collected (in kilograms) between March March ADHB CMDHB WDHB Current use of the waste management service is a result of routine patient engagement and information through community pharmacies. It has not been influenced by any additional marketing by community pharmacies or DHBs. Campaign Disposal of Unwanted Medicines Properly The metro Auckland DHBs are working together to develop and launch a regionally consistent pharmaceutical waste management awareness campaign. The campaign will ensure consumers who receive medicines understand the importance of safely disposing of unwanted medicines and sharps, by returning the waste to their local community pharmacy for free. This campaign will be launched in collaboration with Auckland Council and Interwaste in June The targeted benefits of the campaign include: Increased public awareness of the availability of waste disposal service in community pharmacies Increased awareness that the safe and proper disposal of pharmaceutical and sharps waste is likely to reduce the risk of accidental poisoning and environmental harm Progress to date An information brochure has been designed and developed with key messaging (Appendix 1). The brochure has been reviewed by Waitakere Health Link (Consumer Health Literacy Group), community pharmacists and Planning, Funding and Outcomes Programme Managers. It has also been endorsed by the metro Auckland Community Pharmacy Advisory Group. The key messages that will be delivered to the general public include: Bring all unwanted and expired medicines to your local pharmacy Don t flush medicines down the toilet Don t pour medicines down the sink Don t throw medicines into the garbage bin. 23

24 Next Steps The Auckland Council will be disseminating the messages using the various communication channels available to them. For example: Auckland Council website: a newly formatted search for waste on the Auckland Council website will be launched in October to direct the public to information about disposing of medical waste, including a link to the information brochure. Our Auckland an information booklet distributed to all rate payers will also contain this information. Auckland Council Staff Intranet. Communication teams within each DHB will also raise employee awareness through the staff intranet and community healthcare providers will be informed through the Primary Care Newsletters. Pharmacies will use the brochures as an aide to educate consumers and encourage them to return any unwanted medicines stored at home. The Planning, Funding and Outcomes team will continue to monitor the utilisation of the waste management service and capture the amount of pharmaceutical and sharps wastes collected by Interwaste both during and after the marketing campaign. The brochure will be translated in the future to target commonly used languages i.e. Te Reo Maori, Samoan, Chinese and Hindi. 3.3 Implementing a Risk-Based Pharmacy Quality Audit Framework Background At present, Medicines Control executes pharmacy quality audits to review pharmacy licence holders compliance against the regulatory and quality requirements set out in the Community Pharmacy Services Agreement. Medicines Control and DHBs consider these audits to be capable of identifying most of the non-compliances and safety-related risks, but acknowledge there are areas where improvements and efficiencies could be gained. Risk-Based Audit Framework Recently, Medicines Control developed a new risk-based audit framework with the intent to: 1. Drive continuous improvements in the behaviour of licensees to be compliant with the quality requirements of the license 2. Enhance the patient safety intent of the legislative framework 3. Reduce the compliance burden for pharmacies during audit processes, for example, less onsite contact time between the auditor and the pharmacist in an inspection audit. The implementation of inspection audits as part of a risk-based pharmacy quality framework is also strategically aligned to the New Zealand Health Strategy 2016, Pharmacy Action Plan and the Pharmacy Audit Strategy Table 1 outlines the key differences between the current framework and the risk-based framework for pharmacy quality audits. 24

25 Table 1: Differences between the current Pharmacy Quality Audit framework and the new Risk-Based Audit framework Framework Number of pharmacies audited per audit year % licensed pharmacies audited per year Time interval between audits at each pharmacy Current Pharmacy Quality Audit framework 200 pharmacy quality audits conducted nationally across the DHBs per audit year. 19.0% 47.6% New Risk-Based Audit framework 50 pharmacy quality audits and 450 inspection audits conducted nationally across the DHBs per audit year. years (average) 2.0 years (estimated) Medicines Control completed a small pilot, in other parts of New Zealand, by conducting inspection audits at 20 pharmacies to establish the reliability and validity of the newly developed framework. The findings of this framework were compared with findings from the standard pharmacy quality audit tool, with the new framework findings demonstrating: 1. Auditors were able to complete up to three pharmacy inspection audits during the same time as one pharmacy quality audit (under the current framework), highlighting the effective and efficient use of resources 2. An inspection audit was equally good at identifying good practice and non-compliance issues comparable to a standard pharmacy quality audit, within the scope of the criteria assessed 3. The level of compliance during an inspection audit was generally less than observed during the pharmacy quality audits as inspection audits were unannounced 4. The inspection audit provides a robust indicator of day-to-day standards of pharmacy practice being conducted at the premise and is a key component of the risk-based pharmacy quality audit framework. Medicines Control is now working in collaboration with the metro Auckland DHBs to trial the inspection audits with more community pharmacies in the Auckland region, with these focusing on 10 audit criteria (shown in Appendix 2). These criteria are generally applicable to all pharmacies, irrespective of the specialised services that may be provided from the premises. They have been based on Medicines Control s observation that the greatest proportions of critical and high risk noncompliance issues were related to these areas. Pilot Activity As part of the extended pilot, inspection audits are being conducted at 90 community pharmacies contracted by Auckland DHB, Waitemata DHB and Counties Manukau Health. The inspection audits started in April 2017 and are scheduled to be completed by June Counties Manukau Health has the largest number of planned inspection audits during the pilot as the Medicines Control completed the least number of pharmacy quality audits for Counties Manukau Health during the 2016/17 financial year (Table 2). Table 2: Number of inspection audits to be carried out in each DHB during the 3 month pilot period (April 2017 to June 2017) District Health Board Number of Inspection Audits Auckland 15 Counties Manukau 48 Waitemata 27 25

26 In order to further establish the reliability and validity of the inspection audit, a range of pharmacies are being audited across the risk spectrum. The pharmacies selected were determined by Medicines Control with guidance from the DHBs. Medicines Control will also be requesting feedback from pharmacies that have received an inspection audit during the pilot period, and will update the framework as necessary before moving to the implementation phase during 2017/18 audit year. Evaluation of the inspection audit pilot will be provided to Community and Public Health Advisory Committee once completed. 3.4 National Health Targets Better Help for Smokers to Quit DHB Target: 90% of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. Both Auckland and Waitemata DHBs have not achieved the primary care Better Help for Smokers to Quit health target in Quarter three, 2016/17. Final results provided by the MoH, showed Auckland DHB performance at 88.4% and Waitemata DHB at 88.0%. Auckland DHB is ranked eighth and Waitemata DHB is ranked ninth nationally for Quarter three. Auckland PHO successfully achieved the target with Quarter three performance at 89.9%. Target results for ProCare showed performance at 90.8% for Waitemata and 90.2% for Auckland DHBs. Alliance Health Plus, National Hauora Coalition and Waitemata PHOs have yet to meet the target, but all are making good progress towards achieving it and it is anticipated that this will happen by Quarter four, 2016/17. Results by PHO as follows: Table 3: PHO Results for Better Help for Smokers to Quit 90% Target, Quarter three, 2016/17 Auckland DHB Auckland PHO 89.9% Alliance Health Plus 85.4% National Hauora Coalition 78.0% ProCare 90.2% Waitemata DHB ProCare 90.8% Waitemata PHO 84.6% The PHOs have increased their staffing and are undertaking additional activities to support Practices to achieve the target. Auckland and Waitemata DHBs are working closely with PHOs to ensure that they are focussed on achieving the target in Quarter four. All PHOs are required to provide a weekly report with activities and updated data to the DHB. The weekly updates provide useful information on the progress being made and interventions and activities applied at a practice level by the PHOs. The DHB is unable to include an ethnicity breakdown of the health target results, as the MoH no longer provides this ethnicity data to the DHBs. 26

27 The quarterly results are shown in Figure 3 below: Figure 3: Auckland and Waitemata DHBs Better Help for Smokers to Quit Performance (Quarter three, 2016/17) Improving Population Health Diabetes Management DHB Target: A minimum of 75% of people who have had a Diabetes Annual Review will have an HbA1c of <= 64mmol/mol. According to MOH Quarter two, 2016/17 report, the percentage of enrolled patients with diabetes (aged 15 to 74 years) who have good or acceptable glycaemic control (HbA1c <= 64mmol/mol ) was 65% for Auckland and 68% for Waitemata for the last 12 months at a DHB level. However, these results are affected by the ongoing data mapping and extraction issues as reported previously in March 2017 Community and Public Health Advisory Committee report. Since then, the PHOs have applied a number of solutions to improve the HbA1c reporting. Approximately 70% of the data is captured now and work continues to get greater data capture. Improving the health outcomes of people with diabetes continues to be a priority area for both Auckland and Waitemata DHBs. To support this priority the Auckland Waitemata Diabetes Service Level Alliance has developed a five year activity plan which was endorsed by the Auckland and Waitemata DHB Alliance Leadership Team in April Due to the lack of clarity regarding the DHBs funding envelope for 2017/18, the resourcing requests were not endorsed and business cases will be submitted to the Auckland and Waitemata DHB Boards where new resource or investment is required. The priority areas from this activity plan for 2017/18 include: Creating an environment that facilitates people with type 2 diabetes to be leading partners in their own care. The first step to creating this environment is prototyping solutions to issues identified by patients during the co-design process 27

28 Improving the care of those already accessing services by implementing the recommendations from the podiatry and retinal screening reviews. It is of note that New Zealand Society for the Study of Diabetes (May 2017) conference awarded the best innovative service delivery award to the West Auckland Quality Improvement Pilot. This pilot supported five general practices in West Auckland to undertake quality improvement initiatives that improved the clinical management of people with diabetes. This resulted in better glycaemic control of diabetes patients of these practices. Cardiovascular Disease Since September 2014, both Auckland and Waitemata DHBs have achieved and sustained the 90% More Hearts and Diabetes Checks target for all population groups except for Māori (whose screening coverage is currently 88.1% in Auckland DHB and 86.6% in Waitemata DHB of the eligible population). 4. Children, Youth and Women Highlights and Issues The team s highlight is the continued high achievement against the Raising Healthy Kids target. Achieving the immunisation health target remains an ongoing challenge, as does Rheumatic Fever. There are now two new government Better Public Service targets: Result 2 Healthy Mums and Babies: By 2021, 90% of pregnant women are registered with a Lead Maternity Carer in the first trimester, with an interim target of 80% by 2019, with equitable rates for all population groups. Result 3 Keeping Kids Healthy: By 2021, a 25% reduction in the rate of hospitalisations for avoidable conditions in children aged 0-12 years, with an interim target of 15% by 2019 Both areas have been a priority for the DHBs, with work under the Maternity Quality and Safety Programme directed at increasing registration in the first trimester and the System Level Measures work focusing particularly on avoidable hospital admission. Both immunisation and Rheumatic Fever work will contribute to this Better Public Service target. 4.2 Immunisation Health Target For the year to date at 20 May 2017, Auckland DHB achieved 94.4% and Waitemata DHB achieved 91.8% of infants fully immunised at eight months of age. This is the same in Auckland and an increase in Waitemata on last quarter s result. Results are summarised in the table below. Auckland DHB Target: 95% Total Māori Pacific Dep 9-10 Change: total Change: Māori Q1 2016/ % 87.5% 95.1% 92.3% 0.3% -1.3% Q2 2016/ % 90.7% 94.5% 95.3% 1.4% 3.2% Q3 2016/ % 89.4% 93.4% 93.6% -1.0% -1.3% YTD 20/5/ % 89.9% 92.7% 93.0% - 0.5% 28

29 Summary of changes since last quarter No change total coverage in year-to-date compared with Quarter three 2016/17 coverage still 0.7% higher than Quarter four 2015/16 results Increase of 0.5% in coverage for Maori in year to date compared with Quarter three 2016/17 coverage still 1.1% higher than Quarter four 2015/16 results Decrease of 0.9% in coverage for Pacific in-year-to date compared with Quarter three 2016/17. Waitemata DHB Target: 95% Total Māori Pacific Dep 9-10 Change: total Change: Māori Q1 2016/ % 89.3% 95.8% 95.4% 0.6% 0.9% Q2 2016/ % 87.2% 100%% 94.9% -1.2% -2.1% Q3 2016/ % 85.7% 93.7% 91.6% -0.8% -1.5% YTD 20/5/ % 84.8% 94.2% 93.2% 0.1% -1.0% Summary of changes since last quarter Increase of 0.1% in total coverage in year-to-date compared with Quarter three 2016/17 coverage 0.8% below Quarter four 2015/16 results Decrease of 1.0% in coverage for Maori year to date compared with Quarter three 2016/17 coverage 3.5% below Quarter four 2015/16 results Increase of 0.5% in coverage for Pacific year to date compared with Quarter three 2016/17. Our focus continues on Maori infants and addressing the growing decline rate which is particularly evident in Waitemata. Activities currently underway to increase coverage include: Remedial Activities End to end process review. We have followed a cohort of babies born 01 August to 31 October 2016 as these are the babies who will turn eight months old in Quarter four 2016/17, tracking their enrolment with primary care and six week immunisations to identify children that require additional follow-up. We are currently analysing this cohort for their three month and five month immunisation coverage rates and identifying babies requiring further follow-up Holistic approach for tamariki Maori. A monthly hui occurs to discuss Maori babies turning six months to identify any tamariki that have not received their immunisations (as well as not engaged with other services such as Well Child Tamariki Ora, general practice and the dental service) Promotion Campaign. We began a social media promotional campaign for immunisation with GSL Promotus in March This is targeted at people residing in the Waitemata DHB catchment area, particularly young Maori mums and targeted at suburbs where we have a known high decline and delay rate. o As part of this social media promotion we have undertaken focus groups within the high decline/delay areas to identify enablers to promotion and test the messages to ensure they resonate with our population o o We are also seeking Champion voices to promote positive messages We have benchmarked with local DHBs and Northland DHB and Counties Manukau Health are also reporting increases in vaccine hesitancy. We are preparing a request to the MoH for a national campaign supporting immunisation uptake. 29

30 Early Start in Pregnancy. Opportunistic vaccinators at Waitakere Hospital have aligned their service hours with antenatal clinics and high-volume children presentation to the Emergency Department to provide immunisations. It is recognised that antenatal immunisations provide a timely discussion for childhood immunisation Improving Access. The Outreach Immunisation Service continues to prioritise babies approaching 8 months of age. o We are reviewing the changes to Outreach Immunisation Service provision made in 2016/17 to understand potential impact this may have had o We are reviewing General Practice opening hours in West Auckland and considering a proposal to develop a Saturday drop in clinic for working parents. 4.3 Obesity Health Target Raising Healthy Kids Both Auckland DHB and Waitemata DHB continue to top the country for the Raising Healthy Kids (obesity) health target. Auckland DHB achieved 99% and Waitemata DHB 100% of obese children identified had their referral acknowledged, as at 23 May Rheumatic Fever As previously reported, the rate for first hospitalisations for episodes of Rheumatic Fever in the 2016 calendar year was 5.4 in Auckland DHB and of 3.1 per 100,000 in Waitemata DHB against the June 2017 target of 1.1 (Auckland DHB) and 0.7 (Waitemata DHB). Provisional results for 2016/17 will not be available until August. We continue to work with the MoH and members of the Rheumatic Fever Steering Group to plan activities for 2017/18. Details of this are not yet confirmed, but will include: A revised contract with Primary Care (PHOs) for the target group aged over 13 years on a fee for service basis Swab and treatment services through low decile secondary schools (10 schools in Auckland and seven in Waitemata plus Alternative Education and Teen Parent Units) as part of our general enhanced school based health services Pacific Community Awareness social and other media campaign, encouraging Pacific families to get sore throats checked and take the full course of antibiotics Targeted awareness for Pacific, Maori and those living in economically deprived households delivered through the B4 School Check (importance of getting a sore throat checked, of taking antibiotics as prescribed, and tips for warm, dry homes) The Healthy Housing Initiative (Kainga Ora) which is now receiving around 35 referrals a month per DHB. We have agreed with the MoH that our primary focus for the Rheumatic Fever programme is Pacific young people aged five to 12 years of age. There are two key strategies being considered to engage and treat those with a sore throat, that is primary school based services and initiatives delivered through Pacific communities such as churches (these are not mutually exclusive). In either case, solutions that may involve engaging different workforces and/or technology solutions will be considered. The outcome of this will require additional funding and be brought to the relevant Finance Committees. 4.5 Child Health The oral health preschool strategy has been drafted and is being agreed with Counties Manukau Health. This has a strong focus on Pacific children, reducing inequity and ensuring earlier access to the oral health service. In particular, preventative techniques will be delivered earlier to protect baby teeth. A working group has been convened to agree regional messages for healthy eating and oral health. 30

31 4.6 Women s Health The Pregnancy and First Year of Life Service Alliance has approved the project charter for the first two priority projects under the banner, the First 1,000 Days. These are: Improving information flows between Lead Maternity Carer/GP/Well Child Tamariki Ora /DHB in the absence of a shared electronic record (which is understood to be still two to five years away). Improving access to free Long Acting Reversible Contraction. The New Zealand College of Midwives presented to the Pregnancy and First Year of Life Service Alliance at the May meeting. The presentation included the model of delivery of midwifery services within both employed and self-employed roles. Priority areas of focus for the College of Midwives were outlined which had significant alignment with other health providers around most issues, including such items as obesity and gestational diabetes. Some of the challenges of delivering integrated care within the context of many separate health services were identified. The integration of public health messages and interventions within delivery of midwifery services and capacity issues within the workforce were also discussed. 5. Health of Older People 5.1 Highlights and Issues A recent highlight is the In-Home Strength and Balance Programmes, part of the Falls Prevention work, are up and running. These programmes have been promoted to general practices and are now receiving referrals from GPs. A number of issues have been managed concerning Aged Residential Care (ARC). There was a cold chain failure in the flu vaccination programme at a Waitemata ARC facility. The residents have been revaccinated and HealthCERT has communicated with the ARC sector around requirements for vaccine storage and transport, and Cold Chain Accreditation. A recent complaint to the DHB highlighted that facilities may not always have good understanding of the impact of Enduring Power of Attorney and Advance Directive documents on care delivery; this topic will be covered at ARC forums later in the year. 5.2 Pay Equity Settlement Agreement In April, the Government announced a $2 billion pay equity settlement for care and support workers in the aged (and disability) residential care and home and community support services (HCSS). This Settlement Agreement stems from initial proceedings in 2012 under the Equal Pay Act claiming that because support workers are predominantly women, a support worker is paid less than what would be paid to a man performing work involving the same, or substantially similar, degrees of skill, effort and responsibility, and that the conditions of work are the same or substantially similar. From 1 July, support workers will receive a pay rise between 15 and 50 per cent (i.e. a wage increase on a range between $19 and $27 per hour) depending on their qualifications and/or experience. Payment mechanisms will differ for ARC and HCSS. ARC providers will receive an increase to their daily bed rates to cover pay equity. HCSS providers will receive an interim payment on the first working day of each month based on anticipated costs with a wash up process in December 2017 and June The intention is this interim process will revert back to normal contracting and funding arrangements in 12 months or earlier if agreed between the MoH, funders and providers. 31

32 Information sessions have been held with ARC and HCSS providers in the Northern Region hosted by the MoH. HCSS providers have been completing a Data Collection Tool on their workforce and ARC providers have been completing a Workforce Translation Tool. These tools are to ensure accurate funding, assist providers in making changes to their pay roll systems, and establish an initial baseline for workforce monitoring in order to measure outcomes and benefits of this investment. A number of issues have emerged in planning for the 1 July start date of the new Pay Equity rates. Providers have raised concerns around the financial risk of accrued leave liability; the MoH intended to respond to this concern after the Budget was announced. For ARC providers, passing though the Pay Equity funding via the daily bed rate will mean there will be overs and unders in terms of how individual providers fare. There is significant concern in the ARC Sector that there will be a cohort of providers who will receive insufficient funding to cover the Pay Equity Settlement rates and they have requested a process to follow for compensation should this be the case. There are still some DHB services where it is not clear whether they are in scope for Pay Equity (e.g. Interim Care in ARC) and there are services, outside aged and disability care, that are clearly excluded but there is likely to be a view they have a legitimate case for similar funding (e.g. Mental Health residential care). The method of allocating the Pay Equity funding to DHBs has not been finalised. However, the principle is that the mechanism should not advantage or disadvantage DHBs through PBF allocation. The current model proposed to calculate the funding flow from the MoH to DHBs is payment for the first two years on actual, and the third year PBF. Overall the impact of Pay Equity from a DHB perspective is not yet fully understood and will become clearer once the funding allocation for each DHB is known. 5.3 Aged Residential Care Audits There were a total of 29 audits across both Auckland DHB and Waitemata DHB for Quarter /17 Quarter 1 Quarter 2 Quarter 3 Auckla nd DHB Waitem ata DHB Aucklan d DHB Waitem ata DHB Aucklan d DHB Number of audits Average number of corrective action per audit Waite mata DHB facilities > 5 corrective actions Corrective actions relating to health & safety (% of total CAs) 4 (22%) 21 (49%) 16 (59%) 16 (42%) 25 (48%) Facilities with no corrective actions Facilities achieving a continuous improvement* 23 (60%) Number of complaints the DHB received on ARRC * The gold standard attainment against an audit criterion is continuous improvement (CI). CI is achieved when a criterion is fully attained and continuous improvements against the Health and Disability Sector Standards are demonstrated indicating quality improvement processes in place against service provision and consumer safety or satisfaction. 32

33 6. Mental Health and Addictions 6.1 Fit for the Future Auckland and Waitemata DHBs were both successful with their separate proposals to provide and evaluate : Existing Initiatives for Investment in Building an Evidence Base (People with moderate mental health issues) within 15 months, with final evaluation report due to the MoH on 30 September Substance Addiction Compulsory Assessment and Treatment (SACAT) Legislation The Substance Addiction Compulsory Assessment and Treatment (SACAT) Act will come into effect on 21 February In preparation, at the request of the MoH, a Northern Region Model of Care has been developed, based on contributions from regional Alcohol and Other Drugs stakeholders. The Northern Regional SACAT Model of Care is designed to safely and effectively meet the requirements of the highly vulnerable group of people who will meet the criteria for treatment under the SACAT legislation. The Model of Care is premised on significant new investment to provide a safe and effective response to a group of people requiring specialised and intensive interventions, to improve their health outcomes, as mandated by the new legislation. The Northern Region Mental Health and Addiction Network have approved the Model of Care and are referring it to the Regional Funding Forum for endorsement. The implementation of the SACAT legislation will not be cost neutral as the target population has high and complex needs, and currently does not have access to services appropriate to assess and treat serious cognitive impairment due to addiction. In addition, the Northern Region Mental Health and Addictions Network have submitted a copy of the Model of Care with a detailed funding proposal to the MoH to support implementation of the Regional SACAT Model of Care. The current detox and Alcohol and Other Drugs treatment options are not adequately designed to provide compulsory treatment to meet the legislative requirements set out in the SACAT Act and there is no capacity to provide treatment under the SACAT pathway within existing mental health inpatient units in the Northern Region. To date, the MoH has no identified funding sufficient to implement the Northern Region Model of Care, or any other Model of Care, developed across other Regions. Collectively the Network is concerned that there is insufficient time and resources to implement safe and effective services for the enactment of the SACAT Act by 21 February 2018 and considers it be unethical to detain people for compulsory treatment in the absence of safe and effective treatment of the condition for which they have been detained. 7. Maori Health Gain 7.1 Highlights and Issues A key highlight is the progress made on the second draft of the 2017/18 Māori Health Plan. This is now in its final stages. We continue to work with key stakeholders to finalise the development of one Plan for Auckland and Waitemata DHBs. The Auckland Waitemata PHO Alliance Leadership Team also recently endorsed the content relevant to primary care in the 2017/18 Māori Health Plan and agreed to support the implementation of activities relevant to primary care, with a view to improve health outcomes for Māori as a priority. 33

34 The Whānau House Health Needs Assessment report has shown that Whānau House is successfully reaching a high proportion of Māori whānau, and that clients have substantial challenges of poorer health status and high health need. Achieving the eight month immunisation target for Maori is an ongoing challenge. In addition to the suite of activities described in the Child, Youth and Women s Remedial Activities Section the Māori Health Gain Team is leading the development of a 90 Day Action Plan focused on improving immunisation coverage for Māori. This piece of work will be guided by the recently completed review of the Māori Infant Immunisation Review Group. 7.2 Maori Infant Immunisation Review Group Waitemata DHB established a Māori Infant Immunisation Review Group in 2014 as a direct action to improve coverage rates for Māori at eight months after noting that timely immunisation uptake had declined. In late 2016 Waitemata DHB Planning and Funding commissioned a review of the Māori Infant Immunisation Review Group. The aims of the evaluation were to: Determine the success of the Māori Infant Immunisation case review group. Assess the value of continued investment of time and resources in said group. Identify potential areas for improvement for the Waitemata DHB and for these to be incorporated into the establishment of an Auckland DHB Māori Infant Immunisation case review group. The review found: While there was no formal terms of reference developed there was a willingness by all parties to discuss and share case by case details to enable a comprehensive assessment of touch points and engagement across the system. This includes the sharing of case details to determine gaps and opportunities for improvement in the delivery of a comprehensive, complete package of care for the children discussed. As a wider group it was established sharing information enabled purposeful discussions that could and did effect system change as well as addressing issues that affect delivery of a comprehensive service package of care to our Māori infants. In the same way as the development of children s teams in other locations, the sharing of information for this population raised privacy and security concerns. A limitation of the review group was shown to be in not having all requisite parties in attendance (for example, Well Child Tāmariki Ora providers etc.) at each meeting. To maximise health gains it requires that each member commit to actively engage and participate in the review group process and meetings. The review presented the following recommendations: Development and completion of terms of reference for the Waitemata DHB Māori Infant Immunisation Review Group underway. Waitemata DHB Māori Infant Immunisation Review Group Terms of Reference form the basis for the Auckland DHB Māori Infant Immunisation Review Group underway. Develop information sharing protocols which are compliant with privacy and security legislation. Expand participants of the Waitemata DHB Māori Infant Immunisation Review Group to increase likelihood of supporting whānau to immunise their children completed. 34

35 7.3 Whānau House Health Needs Assessment The Whānau House Health Needs Assessment report is a collaborative effort between Te Whānau o Waipareira, Waitemata District Health Board and East Tamaki Health Care PHO. The analyses undertaken offers a unique view on the overlapping populations of interest for these three organisations, and the opportunities for development of the Whānau House co-located whānau ora model in West Auckland. The report demonstrates that Whānau House is successfully reaching a high proportion of Māori whānau, and that clients have substantial challenges of poorer health status and high health need. In addition to the alignment with the Te Whānau o Waipareira collective impact activity, the report identifies pathways to improve health outcomes, and provides recommendations. The next steps for Waitemata DHB and Te Whānau o Waipareira are to work on improving data completeness, an evaluation of the diabetes and paediatric clinic models, consideration of potential additional clinics at Whānau House and development of data match projects to identify specific clients for offer of service. 7.4 Māori Health Plan The second draft of the 2017/18 Māori Health Plan is in its final stages, we continue to engage with key stakeholders throughout the development of this Plan. We have provided our Māori board members, Manawa Ora, MoU partners, Māori providers and key internal stakeholders with opportunities to provide feedback. Due to the strong alignment of the Auckland and Waitemata DHB Māori Health Plans, these have been merged to have one Māori Health Plan for both DHBs. We recently presented the Plan to the Auckland Waitemata PHO Alliance Leadership Team who: Endorsed the content relevant to primary care in the 2017/18 Māori Health Plan for Auckland and Waitemata DHBs Agreed to support the implementation of activities in the 2017/18 Māori Health Plan for Auckland and Waitemata DHBs, relevant to primary care, with a view to improve health outcomes for Māori as a priority. In addition, the Alliance Leadership Team also agreed to support the implementation of the Ready, Steady, Quit Smoking Cessation Programme and to collect and report workforce demographic data, including ethnicity, to Auckland and Waitemata DHB Planning and Funding on an annual basis. Both smoking cessation and workforce development are key focus areas for improvement for the 2017/18 year. 8. Pacific Health Gain 8.1 Highlights and issues Our key highlight is the completion of the three day Health Science Academy (career exposure) leadership camps for Onehunga High School and Waitakere College at Narrows Park Hamilton, coordinated by Health Science Academy Programmes Manager and Coordinator Tuliana Guthrie and Malcolm Andrews The Pacific Team had the honour of supporting the official opening of Waitakere Hospital s Emergency Department on May

36 The official launch of the new Starship Community team took place on May 10 as part of the Starship redesign that commenced last year. The Pacific General Manager in conjunction with Maori General Manager are part of the Governance Group for this initiative. The Stroke Foundation reported on their recent quarter of work to the Pacific General Manager and Pacific Health Gain Manager. Twenty two education sessions were delivered during this period, to 621 people across Auckland and Waitemata DHBs. Key areas of risk mitigation include, planning to increase rheumatic fever awareness, education and treatment when appropriate, amongst Pacific communities. Securing funding to continue the implementation of the Triple P and Living without Violence programmes in 2017/18 and strengthening the referral pathways between Parish Community Nurse and Primary care providers. Discussions have begun with Counties Manukau Health regarding Metro Auckland Pacific Health planning to focus on Child Health and Workforce Development as well as setting up an equivalent group to the Maori Alliance Leadership Team. The Pacific Team has also been involved supporting ARPHS in responding to the Typhoid outbreak, including community work, communications via Samoan radio and the process of Teu Le Va reconciling the space with the church involved. There is also a Chair commissioned review with the Director of Communications for Waitemata DHB, completed 15 May PHAP Priority 1 Children are safe and well and families are free of violence Triple P parenting programmes were delivered across five Pacific churches. More than one hundred people enrolled in the programme and approximately 90% completed the training. A Triple P certificate will be presented to each person that took part and completed the course. Three churches remain on a waiting list to begin the programme in 2017/18. We continue to engage with the Child health team, MoH, Pacific providers and community groups about rheumatic fever and prevention amongst Pacific communities. Much work has focussed on how we can increase rheumatic fever awareness, education and improve access to treatment across both Auckland DHB and Waitemata DHB. Plunket is currently piloting a one-on-one breastfeeding support service in Central and West Auckland (Wahine Atawhai). This has a focus on Maori, Pacific and Asian women, currently the highest referral rate is in Asian women. There is also a Pacific breastfeeding support group (Titifaitama Antenatal Breastfeeding Group) in Ranui, which has teamed up with Healthy Babies Healthy Futures, that meets fortnightly. Within the Well Child Tamariki Ora contracts for the 2017/18 financial year the DHBs will be setting targets for providers in regards to the volume of children seen for each component of the Well Child service model, including core contacts. This will include a target set for number of Pacific children seen. Both DHBs have also established quarterly governance meetings to monitor progress on the quality indicators, including timeliness of first core contact and the completeness of the first five cores. 8.3 PHAP Priority 2 Pacific People are smoke-free A co-design process started with two Samoan church congregations in the Auckland DHB area to explore how to increase the quit rates amongst Samoan smokers. Two groups have agreed to participate in a quit smoking assistance programme. Meetings will be held in June to explore and discuss further what approaches will support them. The church groups have asked for further 36

37 education about the benefits of being smokefree. We intend to work with other churches in similar ways. A Seventh Day Adventist Tongan Church in Penrose completed an annual Health Week programme in their church on Sunday 21 May The week ended with a prize giving where church members completed an eight week weight loss challenge. Health Screening, health education and nutrition formed part of this event. The Certificate of Pacific Nutrition Course with Pacific Heart Beat which is a NZQA Level three course continues to be promoted amongst the Healthy Village Action Zones (HVAZ)/Enua Ola church and community groups. Three community members are currently undertaking this course which will end in June. 8.4 Priority 3 Pacific people are active and eat healthy The Auckland and Waitemata DHBs Childhood Obesity Action Plan will be out for consultation shortly. Healthy Village Action Zones and Enua Ola Pacific church programmes have a focus on healthy nutrition and physical activity for the whole family. The Pacific team is also engaging with Healthy Families Waitakere to support work with Pacific ECEs and schools (for example, the Kelston Boys and Waitakere High School Water Only Projects). We are currently working to align childhood obesity and oral health promotion messages. Fourteen church groups continue to actively participate in an eight week Aiga weight loss challenge as part of the Healthy Village Action Zones programme. The competition will end in June Free Tabata sessions are now being offered in three church halls located in Grey Lynn, Westmere and Sandringham. Members of different church groups are utilising the opportunity to exercise and also connect with members of other churches through this programme. Church ministers and their wives, leaders, parents and youth members are attending the Tabata sessions. 8.5 PHAP Priority 4 People seek medical and other help early A review of the Parish community nursing service has provided an opportunity to reflect and consider the opportunities this role provides within the varied church contexts and with primary care. The Pacific team is working with PHO and DHB Nurse Leaders to discuss how we can support and increase the access of Pacific communities to health services. In Waitemata DHB, four Self Management/Diabetes Self Management education programmes are currently being delivered through the Enua Ola programme. A further three programmes will start in June In Auckland DHB, two Self Management programmes are currently being delivered. Health screening days continue to be delivered by Parish Community Nurses in Healthy Village Action Zones and Enua Ola churches and community groups across Auckland DHB and Waitemata DHB. To date, 18 health screenings days have been held in Auckland DHB and 15 in Waitemata DHB. 8.6 PHAP Priority 5 - Pacific people use hospital services when needed Pacific Best Practice training (target 200 staff per year) We continue to pursue the Organisation s vision to have a culturally competent workforce. To improve Patient engagement and experience for Pacific patients and their families through training Pacific best Practice fundamentals training. 37

38 Period: January to March 2017 Auckland DHB Waitemata DHB Total: 83 (including non-dhb staff) Total: 253 (including non DHB staff) Pacific Best Training to be offered to: Starship Community, May 2017 Women s Health Auckland DHB, June 2017 Auckland Radiology Group, TBC North Shore Hospice, TBC Tautai Fakataha Hospital Pacific Navigators Trendcare The Tautai Fakataha Hospital Pacific Navigators team had their first Trendcare training workshop, with the goal of the team adopting the Trendcare database system by June This is a first for cultural workers within the hospital. The team have worked hard with the Trendcare coordinators to ensure the system activity codes reflect the effort of the Pacific navigators. This will give us greater visibility to their effort with the patients, families and staff in the wards. Patient Contact Patient Contact April 2017: Patients Visited: Auckland DHB Waitemata DHB TOTAL Total: Co-design projects The Pacific Health Clinical Advisor in conjunction with the Pacific health Public health Physician are currently working on the Bariatric (Auckland DHB/Waitemata DHB) project with members of the Health Gain Team to lift Pacific peoples uptake through understanding the barriers to access. We are also looking at what happens to people with hepatocellular cancer who are not eligible for a liver transplant (Auckland DHB), to lift uptake and reduce barriers to the access of these services. The Tautai Fakataha team are currently supporting two patients and their families, one Samoan and the other Tongan, who are declining Liver transplant due to their cultural, personal and family beliefs. Bowel Screening Pilot The Pacific Team met with the Pacific unit of Bowel Screening Pilot Waitemata DHB to look at opportunities in the hospital and raising return kits rates. Initial results indicate there are potentially 14 Pacific people walking around in the community with undiagnosed Bowel cancer. We will be proposing a Bowel screening project in outpatient clinics with Pacific Cancer Specialist Nurse Waitemata DHB. Did Not Attend Rates Did Not Attend rates for Pacific people within Auckland DHB are sitting at 16.1% (target 9%), rates for Waitemata DHB are 12.6% (target 10%). The Tautai Fakataha Pacific team are focusing on high readmission diabetes patients in an assertive outreach approach for Waitemata DHB and Oncology clinics and clubfoot cases in Auckland DHB. Faster Cancer Treatment Target Waitemata DHB has a Pacific Cancer Navigation Service (1.0 FTE Pacific cancer nurse who liaises with specialist cancer coordinators and Pacific patients). The Pacific provider and funding teams will meet 38

39 with Dr Richard Sullivan and Barbara Cox from the Auckland City Hospital Cancer service to discuss the Faster Cancer Treatment targets for Pacific to better understand the barriers to achieving this target and identify potential areas of intervention. Ambulatory Sensitive Hospitalisations 0-4 and years Ambulatory Sensitive Hospitalisations rates for Pacific 0-4 year olds for the 12 months to December 2016 were 14,466 for Auckland and 11,418 per 100,000 for Waitemata DHB (the national Pacific rate was 12,168 per 100,000). Ambulatory Sensitive Hospitalisations rates for Pacific year olds were 8510 for Auckland and 9783 per 100,000 for Waitemata DHB (national Pacific rate 8963 per 100,000). Waitemata DHB and Auckland DHB have an integrated primary care approach to improve Ambulatory Sensitive Hospitalisations rates in four areas: improving acute care, better long term condition management, better preventive care, improving integration between primary care and other areas of the health and non-health sector that impact on Ambulatory Sensitive Hospitalisations. 8.7 PHAP Priority 6 That Pacific people live in houses that are warm and are not over crowded We are working with the Healthy Homes Kainga Ora team to improve access of Pacific families to the Kainga Ora service through our Pacific church and community group networks. Three referrals were made in Auckland DHB that met the criteria for gaining support in acquiring new and suitable homes. This pathway has proven positive for the families, who are close to receiving new housing. 9. Asian, Migrant and Refugee Health Gain 9.1 Highlights and issues The key highlight is the roll out of the Healthcare where should I go? Multilingual social media campaign to Asian migrants and students living in the Auckland DHB until 30 June Our key issue is the Primary Care Refugee Wrap Around Service ProCare Agreement (Auckland DHB). ProCare have exhausted their funding to participating general practices for this financial year as at January. That meant that participating practices had to charge their enrolled former refugee patients full fee for GP consultations rather than offering free or subsided services. 9.2 Increase the DHBs capability and capacity to deliver responsive systems and strategies to targeted Asian, migrant and refugee populations A recommendation from the findings of the International Benchmarking of Asian Health Outcomes Waitemata and Auckland DHBs report has been to identify cultural nuances and barriers that lead to disparities for high needs Asian subgroups for priority areas such as cardiovascular disease, diabetes, youth mental health, Chinese smoking and childhood obesity. A regional collaboration with Counties Manukau Health s Asian Health Advisor and Master Planner as part of the development of their Asian Health Plan will aim to decrease duplication of effort, cross-sharing and streamlining of information to better understand how to plan for interventions to key Asian subgroups across priority areas. 9.3 Increase Access and Utilisation to Health Services Indicators: Increase by 2% the proportion of Asians who enrol with a PHO to meet 75% target by 30 June, 2017 (current rates 69% (Auckland DHB) and 84% (Waitemata DHB) as at Quarter four 2017) 80% of eligible Asian women will have completed a cervical sample by 2020 (current rates 58.4% (Auckland DHB) and 68.0% (Waitemata DHB) as at Quarter four 2017) 39

40 The Asian PHO enrolment rates for both Auckland and Waitemata DHBs have remained unchanged between Quarter three and Quarter four. There were 1,152 new enrolments (Auckland DHB) and 2,392 (Waitemata DHB). As at April 2017 (MoH, National Cervical Screening Programme monthly report), the three year cervical screening coverage rate for Asian women was 58.4% (Auckland DHB) with a 0.8% decrease between Quarter three and Quarter four. The Waitemata coverage rate has remained unchanged between Quarter three and Quarter four at 68.0%. An eight week multi-lingual social media campaign has rolled out (April to June 2017) with a focus on Asian new migrants and students primarily Chinese, Indian, Korean and Filipino living in the Auckland DHB area. Other languages incorporated in the Campaign include migrants who speak Russian, Japanese, Vietnamese and Arabic. The aim of the campaign is to reduce acute flow to Auckland Hospital s Emergency Departments by highlighting the benefits of seeing a family doctor (GP), pharmacist or urgent care clinic, and promoting cervical screening to Asian women in the age group who have low coverage. The Campaign leverages Asian media, and partner online social media platforms such as Universities and Private Training Establishments, cross central government agencies, settlement agencies, ethnic associations, libraries and sporting bodies e.g. Sport Auckland, Auckland Badminton Association. For more information, visit An Asian migrant and student centric general practice Caring Clinic has opened in the city centre at 175 Queen Street formally launched by Dame Susan Devoy on 1 June. The Asian, Migrant and Refugee Health Gain Manager - in her role in the Auckland Agency Group that supports the development of the New Zealand International Student Wellbeing Strategy, has been working with Alliance Health Plus and the Chinese speaking GPs/clinic staff to develop a culturally appropriate model of care. The intent is to better support Asian migrant and primarily Private Training Establishment students (International and domestic) who do not study at universities to connect to primary care. Services include Skype consultations after hours and e-prescriptions. The practice is taking new enrolled or casual patients. Indicator: Increase opportunities for participation of eligible refugees enrolled in participating general practices as part of the Refugee Primary Care Wrap Around Service funding Professional development opportunities for primary health and the frontline workforce to up skill them on the soft skills and cultural competencies required to support refugee families at the practice level included: Receptionists cross-cultural training to frontline primary health staff delivered on 10 May Refugee health network forum delivered to primary health professionals on 8 June. 10. Auckland Regional Public Health Service (ARPHS) 10.1 Typhoid Fever and Mumps Outbreak The Auckland region is experiencing concurrent outbreaks which are requiring careful management. Typhoid outbreak ARPHS continues to follow up the typhoid outbreak, which was initially identified in March To date, all cases are connected to the same church group, the Mt Albert Samoan Assembly of God church which met at a school hall in Mt Roskill. 40

41 As at 23 May 2017, two new cases have been identified that are associated with the Auckland typhoid outbreak, bringing the number of confirmed cases to 24 (20 symptomatic, four asymptomatic). There is one probable case and no cases under investigation. There has been one death. The two new cases are being managed outside of Auckland, but are linked to the same families and church group as the other cases associated with this outbreak. There is no evidence of anyone from outside these groups being infected. The new cases are in line with the expected pattern of a typhoid outbreak. ARPHS still considers the outbreak is waning but the two new cases do reinforce the importance of continued vigilance and follow up. Prior to the two new cases, there had been no new symptomatic cases confirmed since 5 April APRHS is continuing to work with colleagues in the wider health sector and those affected by the outbreak, ensuring appropriate testing, advice and treatment. The outbreak investigation has revealed a relatively high proportion of asymptomatic carriers within the affected population. Management of these individuals is being undertaken in consultation with infectious disease physicians. ARPHS has undertaken some general media messaging across Pacific radios to distribute some general messages about typhoid. Translated information was also sent to Pacific churches across Auckland on 9 April. As a result of the typhoid outbreak the public has become more aware of and interested in public health. ARPHS has established a landing page on its website where all media updates and information is located: Mumps outbreak ARPHS is also dealing with an outbreak of mumps in the Auckland region, which started in January The burden of mumps is borne by those aged 10 to 19 years, those residing in West Auckland (including a large outbreak in a secondary school) and those who are most deprived (based on NZDep13 index). As of 25 May 2017, there were 92 confirmed/probable cases notified to ARPHS, with three of these notified over the previous week. Massey High School has 18 cases with two of these being fourth 1 generation mumps cases. There are seven cases arising in the community who have been associated with Massey High School (household or social contact), two of whom have documented two doses of the MMR vaccine, and three who are fourth generation cases. There have been four mumps cases that have developed orchitis 2, and all required hospitalisation. Despite public health advice to immunise with MMR, the proportion of partially vaccinated (15%) or non-vaccinated (62%) mumps cases remains high, making management of this outbreak challenging. At least half of the mumps cases are epidemiologically linked i.e. students, household contacts, or friends, while almost 20% are incursions from overseas (mostly Fiji where mumps is not included in their vaccine programme). Due to the ongoing extent of this outbreak, ARPHS is implementing the ARPHS Mumps 2017 Outbreak Manage it phase. This primarily means ARPHS will focus on directing health sector and 1 i.e. 4 passes through the local population 2 Orchitis is an inflammation of the testis, accompanied by swelling, pain, fever, and a sensation of heaviness in the affected area. 41

42 public health resources to those actions likely to be most effective in limiting further community spread of mumps. This includes identifying cases, provision of public health information, and promotion of MMR vaccination Watercare Ardmore Water Treatment Plant The Ardmore Water Treatment Plant, which supplies raw water from the Hunua Ranges, contributes up to 65% of Auckland s metropolitan drinking water supply. Between 3pm on Tuesday 7 March and 3pm on Wednesday 8 March 2017 the Hunua Ranges received over 250 mm of rain. This event resulted in a significant increase in the turbidity of the raw water supplied to the Ardmore Water Treatment Plant, severely impacting its production capacity. The reduced capacity at Ardmore increased the risk of the system being over-loaded. As a result, Watercare asked customers to reduce their water consumption by 20 litres per person per day until 1 April Following the rainfall event ARPHS worked with Watercare Services Ltd to mitigate risks to the Drinking Water Supply for the Auckland Region. ARPHS attended emergency meetings, reviewed operations, and collaborated with Watercare to provide technical input into messaging regarding the security of Auckland s water supply Healthy Auckland Together (HAT) update Following on from last year s first Baseline Monitoring Report, the second annual Healthy Auckland Together monitoring report has been completed and released on 3 May Results have been presented to the Healthy Auckland Together interagency group, and requests made for members to integrate these results into their work. An illustrated summary was developed to assist with communicating the key findings. Key findings from the monitoring report include: There has been a decline in rates of children who are overweight or obese from 22% to 20%. However, there has been a decline in the percentage of children who usually bike, walk or scoot to school. Only 43% of all children aged 5-14 years old used active transport to get to school. Almost all genders and ethnicities are being driven to school in greater numbers. There has been no change in the rates of child tooth decay in the past decade, with persistently high rates for Pacific and Māori children. The overall proportion of obese adults in Auckland is now 27.8%, up from 24% in The percentage of adults meeting both fruit and vegetable guidelines is now 36.3%. This is a very small increase from last year, but most adults are still not eating enough fruit and vegetables. The number of trips taken on public transport per person continues to rise. There has been huge growth in expenditure on cycle and walking infrastructure. It is noted that 39% of Aucklanders can walk to a suburb park in five minutes. The release of the monitoring report received good media coverage and was picked up by several major print and radio news media outlets. The full monitoring report can be accessed via: Submissions ARPHS completed and submitted five submissions during March to May Date Topic Brief note 8 March Proposed Waikato Regional Plan Change 1 - Waikato and Waipā River Catchments The plan change seeks to reduce key contaminants (nitrogen, phosphorus, sediment and microbial pathogens) entering 42

43 Date Topic Brief note (Waikato Regional Council) water bodies in the Waipā and Waikato river catchments, with much of the emphasis on reducing contaminant losses from pastoral farm land, and better management of diffuse discharges to land and water. ARPHS supports the overall intent of the proposed plan change to maintain and improve the overall quality of the freshwater resources, as well as a number of specific initiatives such as the application of farm management plans and a registration system. ARPHS considered farming activities should be required to fence off water bodies much sooner than anticipated by the plan change. 27 March Draft Air Quality Bylaw for Indoor Domestic Fires (Auckland Council) ARPHS supports the adoption of a proposed bylaw to re-establish the regional rules for indoor domestic fires previously contained in the former Auckland Council Regional Plan: Air, Land and Water. ARPHS also supports the proposal to update the Auckland Urban Air Quality Areas to reflect the urban zones in the Unitary Plan and the Auckland Council District Plan: Hauraki and Gulf Islands. ARPHS advocated that more needs to be done to reduce harmful emissions from indoor 27 March Auckland Council s 2017/18 Annual Budget consultation domestic fires. The 2017/18 budget had no smokefree implementation budget identified, despite the 2016 review of Council Smoke-free policy that highlighted areas for further improvement. As such, ARPHS s comments on the budget were restricted to Auckland Council s leadership role tobacco control, and, in particular, the implementation budget for the smoke-free policy ARPHS emphasised: The importance of continuing action in tobacco control, and The need for strengthening and effective implementation of Auckland Council s Smoke-free Policy which aims to increase smoke-free public outdoor spaces across the region. Furthermore, ARPHS recommended that the implementation budget be included in baseline budgets from 2017/18 onward, presenting a consistent and integrated approach to sustaining this important activity. 43

44 Date Topic Brief note The finalised Annual Budget 2017/18 will be adopted at the Governing Body meeting on 29 June March Draft Government Policy Statement on Land Transport (Ministry of Transport) 19 May Urban Development Authorities discussion document (MBIE) The Government Policy Statement on Land Transport sets out the government s priorities for expenditure from the National Land Transport Fund over the next 10 years. ARPHS recommended: The investment class allocations in the Government Policy Statement should be reassessed to prioritise public transport and active transport above state highways and local roads in New Zealand s cities For Auckland, alleviating congestion and increasing travel time reliability should be the main focus of the Government Policy Statement funding and policy outcomes. This will require increased investment in the Public Transport allocation class There is a need for the Government Policy Statement funding and policy outcomes to better recognise the different transport demands of cities and regional areas especially in the case of Auckland. New legislation is being considered that will enable local and central government to: Empower nationally or locally significant urban development projects to access more enabling development powers and land use rules Establish new urban development authorities to support these projects where required. ARPHS recommended that Urban Development Authorities projects prioritise: Meeting housing needs Building liveable, functioning, healthy neighbourhoods that establish links to public transport as part of robust infrastructure Integration of housing within local community facilities and services, and local employment. 44

45 Appendix 1: Disposal of Unwanted Medicines Properly patient information brochure (Double-click below to view) 45