Capital & Coast and Hutt Valley District Health Boards Community and Public Health Advisory Committees Meeting

Transcription

1 Public Capital & Coast and Hutt Valley District Health Boards Community and Public Health Advisory Committees Meeting 25 October 2011

2 CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS Community Public Health Advisory Committees Public Agenda Board Room, Level 11, Grace Neill Block, Capital and Coast District Health Board, Wellington Tuesday 25 October at 9.00 am * Paper Item Action Presenter Min Time Page 1. Procedural Business Continuous Disclosure * To Consider # 1.2 Minutes of a Meeting held on To Approve # 19 September 2011 * 1.3 Schedule of Matters Arising * To Note # 2. Maori Health at C&C DHB To Consider Maori Health Report* To Note Jim Wiki # 3. Pacific Health at C&C DHB To Consider PHO/Pacific Update* To Note Taima Fagaloa # 4. Improving Inequality in 2010/11 To Consider 4.1 Report* - Deferred to November Meeting To Note Nicholette Pomana 5. Planning and Funding Report To Note Hutt Valley District Health Board * Bridget Allan # 6. Other/General Business To Consider Resolution to Exclude the Public * To Approve # 8. Date of Next Meeting Monday, 21 November at 9.00 am, Board Room, Pilmuir House, Hutt Valley District Health Board, Lower Hutt Close #

3 CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS Conflicts & Declarations of Interest Register 25 OCTOBER 2011 Name Mr Wayne Guppy Chair Dr Judith Aitken Deputy Chair Interest Upper Hutt City Council - Mayor Orongomai Marae Trustee Wife employed by various community pharmacies in the Hutt Valley Director, Medic Alert NZ Member, Capital & Coast District Health Board Deputy Chair, Community & Public Health Advisory Committee Member, Disability Support Advisory Committee, Capital & Coast District Health Board Member, Greater Wellington Regional Council Chair, Audit, Risk & Assurance Committee, Greater Wellington Regional Council Member, Social & Cultural Committee, Greater Wellington Regional Council Member, Te Upoko Taiao & Environmental Committee Chair, Speakers Assurance Committee Trustee, Carter Observatory Trust Ms Katy Austin Fergusson Home (Upper Hutt) Voluntary Input Mr David Choat Member, Capital & Coast District Health Board Manager, Policy Development, Leader of the Opposition s Office Director & Shareholder, Policy Progress Limited Partner, Ms Fleur Fitzsimons, employed as Solicitor, New Zealand Public Service Association Ms Kayleen Katene Maori Partnership Board Ms Muriel Tunoho Maori Partnership Board Ms Iris Pahau AWE Consultants Limited Director Community Sector Taskforce National Development Manager NZ Coalition to End Homelessness Co-Chair Maori Women s Welfare League Member Co-Chair of the Hutt Housing Forum Ms Helene Ritchie Member, Capital & Coast District Health Board Member, Disability Support Advisory Committee, Capital & Coast District Health Board Councillor, Wellington City Council Registered Psychologist, Private Practice Capital & Coast and Hutt Valley District Health Boards

4 Mr Darrin Sykes Member, Capital & Coast District Health Board Deputy Chair, Finance, Risk & Audit Committee, Capital & Coast District Health Board Member, Community & Public Health Advisory Committee, Capital & Coast District Health Board Deputy Chair, Touch NZ Board of Directors Name Interest Trustee, Wellington Regional; Sports Education Trust (Trading as Sports Wellington) Chief Executive, Crown Forestry Rental Trust Mr John Terris Trustee of Hutt Community Radio Dr Virginia Hope Chair, Capital & Coast District Health Board Ex Officio Chair, Hutt Valley District Health Board Employee, Institute of Environmental Science & Research Director & Shareholder, Jacaranda Limited Member, Pandemic Influenza Technical Advisory Group Fellow, Royal Australasian College of Medical Administration Fellow, Australasian Faculty of Public Health Medicine Fellow, New Zealand College of Public Health Medicine Mr Peter Glensor Deputy Chair, Capital & Coast District Health Board Ex Officio Deputy Chair, Hospital Advisory Committee, Capital & Coast District Health Board Member, Hutt Valley District Health Board Chair, Hospital Advisory Committee, Hutt Valley District Health Board Deputy Chair, Finance Risk & Audit Committee, Hutt Valley District Health Board Deputy Chair, Greater Wellington Regional Council Acting Chair, Wesley Community Action Director & Shareholder, Common Life Limited Director, Greater Wellington Rail Limited Director, Greater Wellington Infrastructure Limited Director, Greater Wellington Transport Limited Director, W R C Holdings Limited Director, Pringle House Limited Director, Port Investments Limited Member, Capital Investment Committee, National Health Board Trustee, Gillies McIndoe Foundation Son is nursing student at Whitireia Polytechnic Wife, Dr Joan Skinner, employed as a senior lecturer at Victoria University of Wellington Graduate School of Nursing & Midwifery Ms Debbie Chin Crown Monitor, Capital Coast District Health Board Crown Monitor Crown Monitor, Hutt Valley District Health Board Chief Executive, Standards New Zealand Capital & Coast and Hutt Valley District Health Boards

5 CPHAC DSAC Pub Min PUBLIC MINUTES OF THE COMMITTEE MEETING OF THE CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS COMMUNITY PUBLIC HEALTH ADVISORY COMMITTEE HELD AT BOARD ROOM, PILMUIR HOUSE, HUTT VALLEY DISTRICT HEALTH BOARD, PILMUIR ROAD, LOWER HUTT ON MONDAY 19 SEPTEMBER 2011, AT 9.00 AM PRESENT Mr Wayne Guppy Dr Judith Aitken Ms Katy Austin Mr David Choat Mr Peter Glensor Dr Virginia Hope Ms Helene Ritchie Mr Darrin Sykes Mr John Terris Chair Member, Deputy Chair (from 9.20am) Member Member (from 9.07am) Member (till 10.30am) Board Chair Member (from 9.07am) Member Member IN ATTENDANCE: Ms Mary Bonner Mr Graham Dyer Ms Bridget Allan Ms Taima Fagaloa Ms Alison Hannah Mr Shayne Nahu Mr Richard Schmidt Mr Wayne Skippage Ms Sandra Williams Ms Tricia Caughley CEO, C&CDHB CEO, HVDHB Director Planning & Funding and Public Health, HV Director Pacific Health, C&C Senior Manager, Primary Care & HHS Services, P&F, C&C Senior Relationship Manager, P&F, HV Strategic Development Manager, P&F, HV (from 10.15am) Senior Manager, Population Health, Integrated Care and Organisational Planning, P&F, C&C Director, Planning & Funding, C&C (from 11.15am) Minute Secretary Dr Margo McLean Medical Officer of Health, Regional Public Health Item Mr Keith Fraser Referred Services Portfolio Manager, P&F, HV Item Ms Bridget McFarlane Portfolio Manager, P&F, C&C 1 member of the public attended. APOLOGIES Ms Debbie Chin, Crown Monitor (ex officio) (overseas), Ms Iris Pahau, Ms Margaret Faulkner, Mr Wayne Guppy (Chair)(early departure), Dr Judith Aitken (for late arrival). WELCOME Peter Glensor was asked to chair the meeting by Wayne Guppy, due to a personal situation requiring Wayne s attendance. Peter advised that he had to leave the meeting at 10.30am, and the meeting would then be chaired by Judith Aitken. As the meeting was inquorate at the time of starting, the meeting began with the Rheumatic Fever Update by Dr Margot McLean of Regional Public Health followed by the Procedural Business once the meeting became quorate. 1

6 CPHAC DSAC Pub Min 1. RHEUMATIC FEVER UPDATE Dr Margot McLean advised that recent funding decisions by the Ministry of Health (MoH) for Rheumatic Fever will be applied to clusters of the disease. Seven (7) priority DHBs have been identified by the Ministry to receive funding for work on the disease in their areas. Regional Public Health (RPH) is working with health care providers to raise community awareness of this disease, found predominantly in areas of economic deprivation. Overcrowded housing is still an issue as it increases the risk of transfer. C&C is continuing with its long-standing programmes for children and young people, including an outreach nurse locating teenagers (16 to 21 years) and giving Bicillin injections in the community. C&C DHB has been identified as one of the seven priority DHBs and negotiations are underway with the Ministry of Health about how the additional funding will be applied (with a focus on the high numbers in the Porirua East area). A school programme of swabbing sore throats has been implemented in key areas, as early detection is critical. In HV, cases are more widely scattered rather than tightly clustered which presents challenges in planning and implementing preventative measures. The HVDHB focus is on working with primary and community providers to increase awareness of the potential dangers of sore throats and the need for early diagnosis and treatment. HVDHB are also investigating how best to reach the 16 to 21 years age group requiring regular follow up for Bicillin injections. CPHAC noted that the cost of treatment may be a barrier for some families, and asked management to investigate how Bicillin treatment can be provided free of charge to patients. CPHAC also noted that the data for the 2010/11 year, shows 4 cases in Porirua East and 3 cases in Naenae. CPHAC asked why MoH funding was not being provided to Hutt Valley DHB given these numbers and asked management to followup. NOTED AND RESOLVED: The Committee noted the Update on Rheumatic Fever, and resolved to: (a) (b) (c) (d) (e) (f) (g) Note the response to the May 2011 CPHAC request for an analysis of rheumatic fever at suburb level. Note that Hutt City has a rheumatic notification rate ( ) of 25.4/100,000 and Porirua City has a rate of 63.6/100,000. Note that the highest documented rates in the world have been found in Maori and Pacific people in New Zealand, Aboriginal Australians and those in Pacific Island nations. Note that almost all cases of rheumatic heart disease and associated deaths are preventable and are a significant cause of premature death in New Zealand. Note that once a person has been diagnosed with acute rheumatic fever, they require treatment of monthly injections of Bicillin for at least 10 years to prevent recurrent attacks, as repeated attacks greatly increase the risk of heart valve damage. Note that the Hutt Valley cases are widely scattered rather than tightly clustered (as in Porirua East), which presents challenges in planning preventive measures and means that initiatives such as school sore throat swabbing programmes are not feasible. Note that a review of prevention and management options to improve outcomes for the age group in the Hutt Valley is being discussed with key stakeholders. 2

7 CPHAC DSAC Pub Min (h) (i) (j) (k) Note the Ministry of Health update on rheumatic fever includes notification of additional funding to East Porirua (Capital & Coast DHB) for an early identification programme. Request further investigation by the two DHBs about a process where Bicillin can be provided free of charge to patients. Request that management clarify why MoH funding was not being provided to Hutt Valley DHB given the number of cases in Naenae compared to the number in Porirua East. Request management provide an update on progress to the next CPHAC meeting and advise how this will impact the CCDHB Children s Health policy. 2. PROCEDURAL BUSINESS 2.1 CONTINUOUS DISCLOSURE CONFIRMED: The Committees confirmed that it was not aware of any other matters (including matters reported to, and decisions made, by the Committee at this meeting) which would require disclosure. 2.2 Minutes of Meeting held on 22 August, P5: bullet point 6: the sentence regarding the housing consortium should read: In a previous CPHAC meeting members discussed initiating work with Housing New Zealand and other agencies through an housing consortium, to progress the housing issue. Based on discussions between the Board Chair and the Committee Chair, Judith Aitken has withdrawn from leadership of the proposed group. Peter Glensor advised that the Wellington Regional Council is interested in having a discussion on housing needs with the DHB, in an intersectoral setting. Virginia Hope said discussion on Board priorities will occur in the development of the 2012/13 Annual Plan, and the housing issue should be considered as one option within that process. The Committee requested that management should include intersectoral action on housing as one of the possible priorities for the 2012/13 Annual Plan for each DHB RESOLVED: The Committees resolved to approve the minutes of the Members (Public) meeting held on 22 August Moved: Katy Austin Seconded: David Choat CARRIED RESOLVED: The Committee resolved to (l) Request that management include intersectoral action on housing as one of the possible priorities for discussion during the development of the 2012/13 Annual Plan both DHBs. 2.3 Schedule of Matters Arising Discussion took place over the timing of the next Mental Health Report to CPHAC. This is currently expected early in 2012, but was requested to be brought forward. 3

8 CPHAC DSAC Pub Min Motion: That the next report on Mental Health be presented to CPHAC in November Moved: Helene Ritchie Seconded: David Choat Vote: For: 3 Against: 5 The motion was declared LOST Management were asked to provide a draft CPHAC work programme covering the remainder of the 2011 year and the 2012 year, for consideration by the committee. CPHAC suggested that future reporting on Mental Health should include information on services for young people (11-24 years), what sort of outcomes are expected, and what would be the anticipated needs, services and outcomes in 10 years time. The report on Surgical Interventions related to Rheumatic Fever was tabled. NOTED AND RESOLVED: The Committees noted the Schedule of Matters Arising, the report on the CCDHB breastfeeding clinic and the report on surgical interventions related to Rheumatic Fever. The Action Point requesting that management incorporate evaluation frameworks, criteria and feedback systems into reporting on projects was removed, as CPHAC expressed confidence that management were already progressing this 3. REFERRED SERVICES This report covered three key areas: Community Pharmaceuticals Community Laboratory Tests Community Radiology Community Pharmaceuticals National changes to the funding agreement for community pharmacies (moving to a more patient-centred approach) are being negotiated. If this is agreed, the changes will be implemented as from 1 May The DHBs are investigating high close control use in their areas and following up with outlier pharmacies. Community Radiology CCDHB management reported that their local scheme is working well, with good clinical guidance and demand management. There have been no complaints re access. HVDHB management reported that there are concerns about access under their current local scheme. New clinical guidelines are needed and are currently being developed by a group of general practitioners and specialists, as the current guidelines are 10 years old. Community Laboratory Tests The contract with Aotea Pathology has been renewed for a further 3 years (November October 2014). A project is underway to asses the feasibility of integrating the C&C and HV DHB hospital laboratory services. The equity of access to community /hospital radiology in the Hutt Valley was discussed and a report on this matter requested. 4

9 CPHAC DSAC Pub Min The Committee Received the report, and thanked the staff involved for their reports and attendance at two meetings. Moved: Judith Aitken Seconded: Katy Austin CARRIED NOTED AND RESOLVED: The Committees noted the discussion and resolved to: (a) Request management to report back on the equity of access to community/hospital radiology in the Hutt Valley. Refreshment break: am Peter Glensor left the meeting at 10.27am Judith Aitken took the chair from 10.40am 3. COMMUNITY BREASTFEEDING REPORT The Committee Received the report Moved: Katy Austin Seconded: David Choat CARRIED NOTED: The Committee noted the report. 4. HUTT VALLEY DISTRICT ANNUAL PLAN 2010/ MONTH REPORT; QUARTER 4 PERFORMANCE REPORTING. Hutt Valley DHB has performed well in 2010/11, making strong gains against the Health Targets and other important priorities, including collective leadership and primary care. The DHB has achieved a financial result slightly better than budget. The DHB has made incremental, sustained, performance gains in its hospital performance. Ground has been made in reducing inequalities for Maori and Pacific people, but continued focus is required. More information will be provided in the Improving Equity report, coming to October CPHAC. There is more work to do in relation to the Shorter Stays in ED Health Target and avoidable hospitalisation rates (of which Ambulatory Sensitive Hospitalisations (ASH) are the major contributor). The Committee raised the issue of elder abuse in the home There is a current national programme for notification through Age Concern and Grey Power. When the DHB becomes aware of elder abuse, it is referred to the appropriate agency. The national Violence Intervention Programme (VIP) is currently focused on addressing partner abuse and child abuse, but is expected to begin addressing elder abuse from 2012/13 onwards. NOTED AND RESOLVED: The Committee noted the Hutt Valley DAP 2010/ month report and Quarter 4 Performance Reporting and resolved to: (a) Record its approval and support for the general sustained improvement in performance of Hutt Valley DHB. 5

10 CPHAC DSAC Pub Min (b) Noted the continued focus on the complex drivers for Ambulatory Sensitive Hospitalisations rates and Shorter Stays in ED Target. Moved: John Terris Seconded: Helene Ritchie CARRIED 5. CAPITAL & COAST DISTRICT ANNUAL PLAN 2010/ MONTH REPORT; QUARTER 4 PERFORMANCE REPORTING CCDHB is currently achieving five out of 6 health targets elective surgery, cancer treatment, immunisation, smoking cessation, and diabetes/cvd. There has been significant improvements in smoking cessation during the year and the immunisation results at 91% remain higher than the national target. The ED target is beginning to show improvement. Other Key issues ASH Rates: Collaboration is occurring with Primary Care around the issues relating to ASH rates and an across the system approach is being taken within the hospital. Health of Older People: Respite services utilisation has not increased as expected. A report will come to CPHAC in 6 months. NOTED AND RESOLVED: The Committee noted the Capital & Coast DAP 2010/ month report and Quarter 4 Performance Reporting and resolved to: (a) Note the sustained progress in Electives and Help for Smokers to Quit Note the continued focus on improving sustained performance in ED and and the integrated care approach to improving the ASH rates Moved: David Choat Seconded: John Terris CARRIED 6. OTHER/GENERAL BUSINESS There was no other business. 7. RESOLUTION TO EXCLUDE THE PUBLIC 7.1 Recommendation It is recommended that the Committees: (a) Agree that as provided by clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons: Subject Reason Reference* Public excluded For the reasons set out in the Minutes 22 August 2011 Board Agenda *Official Information Act Moved: John Terris Seconded : Darrin Sykes CARRIED 6

11 CPHAC DSAC Pub Min The Committees entered the Public Excluded section of the meeting at 11.30pm. DATE OF THE NEXT MEETING The next meeting will be Tuesday 25 October 2011, at 9.00am, Board Room, Level 11, Grace Neill Block, Wellington Regional Hospital, Newtown at 9.00am The meeting closed at 11.40am. CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting. DATED this day of 2011 PETER GLENSOR / JUDITH AITKEN ACTING CHAIR DEPUTY CHAIR COMMUNITY PUBLIC HEALTH ADVISORY COMMITTEE 7

12 MEMORANDUM FOR CPHAC COMMITTEES MEETING CPHAC DSAC Pub Min SCHEDULE OF MATTERS ARISING Minutes Matters Arising DHB Comments 19/09/2011 Rheumatic Fever Update: Further investigation by Management about a process where Bicillin can be provided free of charge to patients. CCDHB/HVDHB When available Management to clarify why MoH funding was not being provided to Hutt Valley DHB given the number of cases in Naenae compared to the number in Porirua East. Management provide an update on progress to the next CPHAC meeting and advise how this will impact the CCDHB Children s Health policy. 19/09/2011 Management to include intersectoral action on housing as one of the possible priorities for discussion during the development of the 2012/13 Annual Plan both DHBs. 19/09/2011 Management to provide a draft CPHAC work programme covering the remainder of the 2011 year and the 2012 year, for consideration by the committee. October meeting October meeting CCDHB/HVDHB Oct 2011 to Feb 2012 CCDHB/HVDHB October meeting 19/09/2011 Management to report back on the equity of access to community/hospital radiology in the Hutt Valley. HVDHB When available 22/08/2011 Management to a. Use relevant accountability measures in future mental health reports to the Committee and Board. b. Arrange a presentation to the Committee on HoNOS and (appropriate for governance) KPIs c. Include the results of client satisfaction surveys of Te Haika in future reports. 22/8/2011 The Committee requested that in future work on avoidable hospitalisations, comments should be included about the preventable hospitalisations as well as the ambulatory sensitive hospitalisations. 18/07/2011 Aged Residential Care Capacity Planning report to come to CPHAC. 20/06/2011 Report back to CPHAC on the progress and discussion with Hutt Valley DHB on Te Haika Services. CCDHB/HVDHB Next report on Mental Health to CPHAC CCDHB/HVDHB TBC CCDHB/HVDHB November 2011 CCDHB/HVDHB November

13 MEMORANDUM FOR CPHAC COMMITTEES MEETING CPHAC DSAC Pub Min SCHEDULE OF MATTERS ARISING Minutes Matters Arising DHB Comments 19/09/2011 Rheumatic Fever Update: Further investigation by Management about a process where Bicillin can be provided free of charge to patients. HVDHB When available Management to clarify why MoH funding was not being provided to Hutt Valley DHB given the number of cases in Naenae compared to the number in Porirua East. Management provide an update on progress to the next CPHAC meeting and advise how this will impact the CCDHB Children s Health policy. HVDHB CCDHB October meeting Nov meeting 19/09/2011 Management to include intersectoral action on housing as one of the possible priorities for discussion during the development of the 2012/13 Annual Plan both DHBs. 19/09/2011 Management to provide a draft CPHAC work programme covering the remainder of the 2011 year and the 2012 year, for consideration by the committee. CCDHB/HVDHB Oct 2011 to Feb 2012 CCDHB/HVDHB October meeting 19/09/2011 Management to report back on the equity of access to community/hospital radiology in the Hutt Valley. HVDHB October meeting 22/08/2011 Management to a. Use relevant accountability measures in future mental health reports to the Committee and Board. b. Arrange a presentation to the Committee on HoNOS and (appropriate for governance) KPIs c. Include the results of client satisfaction surveys of Te Haika in future reports. 18/07/2011 Aged Residential Care Capacity Planning report to come to CPHAC. 20/06/2011 Report back to CPHAC on the progress and discussion with Hutt Valley DHB on Te Haika Services. CCDHB/HVDHB Next report on Mental Health to CPHAC in 2012 CCDHB/HVDHB November 2011 CCDHB/HVDHB November

14 To: From: Community and Public Health Advisory Committee Riki Nia Nia Date: October 2011 Subject: Māori Health Indicators 1. Recommendations It is recommended that the Community and Public Health Advisory Committee: 1. Note the progress to date; 2. Note the report content is directly sourced from C&C DHB quarterly, six monthly and annual reporting and provides a particular focus on Māori Health; and, 3. Note this paper is a background document to underpin the Māori Health planning presentation and support future Māori Health planning. 2. Purpose The purpose of this paper is to provide the Community and Public Health Advisory Committee with: - the background to identifying the chosen Māori Health indicators; - an update to C&C DHB 2010/11 Annual Plan activity which is aligned to the indicators; and, - baseline data to monitor change. 3. Introduction 3.1. Origin of Request Since 2005 the C&C DHB Māori Partnership Board (MPB) has closely monitored a Māori Health Dashboard set of indicators which have provided a snapshot view of Māori Health gain areas for the district. MPB requested a more focussed view of key indicators in both Hospital and Primary Care services. The first Māori Health Indicators report was presented to MPB in November It was agreed that the report would be presented on a six monthly basis. The fifth iteration of the Māori Health Indicators report was presented to MPB in October At this meeting, it was noted that future iterations would be structured and aligned to the Annual Māori Health Plan framework Reporting Structure In preparation for 2011 / 12 reporting, the report has been structured in line with the Annual Māori Health Plan. For each indicator, the report structure provides: Background information; A analytical / pictorial view; and, Updates to planned DHB activities, as described in the 2010 / 11 Annual Plan. 1

15 This, and future reports will include C&C DHB progress on: Health targets; The fifteen key indicators, across nine priority areas, as described in the C&C DHB 2011/12 Māori Health Plan; Additional indicators including, yet not limited to: Māori Health and Disability services investment; Oral Health Services; Mental Health; B4 School Checks; Respiratory; and, Tikanga Māori Implementation. This report covers C&C DHB s performance for 2010/ Background 4.1. Strategic Direction C&C DHB s Māori Health Action Plan: Te Plan II states that accountability to Government, communities and Māori is supported by measuring progress and is a tool to evidence impact and outcome. 1 Te Plan II identifies a number of indicators to evidence the impact on Māori Health and will be monitored over time. Specific actions to support services to develop and implement the monitoring are: Milestones Services, organisations and or Māori Health Plans identify targets and for Māori health gain Development of Balanced Scorecards in HHS to address disparity Monitor and report on Māori Health gain areas as identified in the Māori Health Dashboard Monitor PHO Māori Health Plans and support their implementation Assist with IT developments to support the improved capture/flow of data Improvement in ethnicity data quality and reporting Ability to identify, track and monitor access, assessments and treatments 4.2. National Direction Health Targets In May 2009, Health Minister Tony Ryall announced a slimmed down set of Health Targets aimed at simplifying requirements on District Health Boards and enabling DHBs to focus more tightly on front line services. 2 The confirmed targets are: - Shorter stays in Emergency Departments - Improved access to elective surgery - Shorter waits for cancer treatment - Increased immunisation 1 C&C DHB. (2007). Māori Health Action Plan: Te Plan II 2 2

16 - Better help for smokers to quit - Better diabetes and cardiovascular services Health Targets are a set of national performance measures specifically designed to improve the performance of health services. They are reviewed annually to ensure they align with government health priorities Whānau Ora Whānau Ora is driven by a focus on outcomes: that whānau will be self-managing, living healthy lifestyles, participating fully in society, economically secure, successfully involved in wealth creation, cohesive, resilient and nurturing. Perhaps the biggest immediate difference is that services, providers and agencies are required to work differently to centre their focus on whānau. Twenty-five provider collectives involving more than 150 health and social service providers are beginning work to develop and deliver Whānau Ora. 4 Given the direction of Whānau Ora, it is important to capture and report quality data and narrative to evidence the contribution to improved Māori Health outcome. C&C DHB have two providers currently developing Programmes of Action Local Direction Annual Māori Health Planning DHBs have been required to Māori Health Plans (MHP) since 2006/2007, however, there have been no guidelines relating to content or monitoring requirements. Section 6.4 of the 2011/12 Operational Policy Framework now requires District Health Boards to produce an annual MHP which describes how they are going to improve the health of Māori and reduce inequalities in their district. For 2011/12 Ministry of Health required District Health Boards to produce an annual Māori Health Plan (MHP) describing how they are going to improve the health of Māori and to reduce inequalities in their district. During 2011/12, fifteen key indicators across nine priority areas will be monitored for improvement. Additionally, the Ministry of Health (MOH) produced a standardised MHP template for DHBs to utilise when developing annual MHPs. Due to the short time frames for completing this plan, a basic planning approach was adopted, in order to meet the Ministry s requirements. All draft versions and the final MHP are aligned to the C&C DHB 2011/12 Annual Plan and Te Plan II (C&C DHB five year Māori Health Plan ) Conclusion This report covers the period July 2010 to June 2011, and provides results and commentary against the C&C DHB 2010/11 District Annual Plan activity. C&C DHB is currently achieving five out of six health targets (Elective surgery, cancer treatment, immunisation, smoking cessation, and diabetes and CVD). Additional monitoring shows Oral health and Mental health needs attention in 2011 / 12. RIKI NIA NIA Director Maori Capital & Coast District Health Board Ministry of Health: Whānau Ora Update for District Health Boards 3

17 Capital & Coast District Health Board Māori Health Indicators Report October

18 TABLE OF CONTENTS 1. Recommendations Purpose Introduction Origin of Request Reporting Structure Background Strategic Direction National Direction Health Targets Whānau Ora Local Direction Annual Māori Health Planning Conclusion Health Target Monitoring Summary Performance Dashboard Health Target One:...8 Shorter stays in Emergency Departments Health Target Two:...10 Improved access to elective surgery Health Target Three:...11 Shorter waits for cancer treatment Māori Health Plan Monitoring...12 Data Quality...12 Access to Care...12 Maternal Health...14 Cardiovascular Disease...16 Diabetes...18 Cancer...20 Smoking...22 Immunisation...24 Workforce Additional Monitoring...26 Māori Health and Disability services investment...26 Oral Health Services...27 Mental Health...28 B4 School Checks...29 Respiratory...29 Tikanga Maori - Implementation

19 5. Health Target Monitoring 5.1. Summary 5 Capital and Coast DHB (C&C DHB) has improved its performance in most health target areas in Quarter 4 of the 2010/11 year: Health Target 2: Improved access to elective surgery. C&C DHB has a year end target of 7431 for the 2010/11 year, and has exceeded the target by 239 elective surgery discharges. Health Target 4: Increased Immunisation. C&C DHB has had sustained success with immunisation, and continues to perform above the national year end target of 90%. Health Target 5: Better help for smokers to quit. C&C DHB has seen continued improvement in this area as projects are embedded. The 2010/11 Q4 result was 97%, exceeding the national year end target of 95%. Health Target 6: Better diabetes services. All targets were achieved for the number of annual checks and management with HbA1c of less than equal to 8. Māori and Pacific populations exceeded targets for these measures. This indicates that investment in these populations is having a positive effect. 120% Capital & Coast health targets quarter four 2010/11 results 100% 80% 60% 40% 20% 0% Shorter stays in Emergency Departments Improved Access to Elective Surgery Shorter Waits for Cancer Treatment Increased Immunisation Better Help for Smokers to Quit Ranking quarter four 2010/ Quarter three 2010/ % 98.9% 100.0% 91.6% 66.0% 73.8% Quarter four 2010/ % 103.2% 100.0% 91.0% 96.8% 73.1% National goal 95.0% 100.0% 100.0% 90.0% 90.0% - Better Diabetes and Cardiovascular Services Identified areas of concern, along with relevant actions to address them, are set out below. Area C&C DHB did not meet the ED health target Comment It was recognised that in order to achieve a better level of compliance, a change in approach and accountability was required. 5 Adapted from C&C DHB Q4 Final Report 6

20 C&C DHB is not meeting cardiac surgery elective intervention rates Ambulatory Sensitive Hospitalisations (ASH) The new project structure has four work streams with clearly identified priorities and initiatives and will report monthly to Hospital Health Services executive meeting (HHS) on progress, risks and barriers to achieving the target. Priority has been given to those work streams that are expected to have the biggest impact on improving the patient journey and therefore compliance with the target. The four workstreams are: General Surgery and Orthopaedics General Medicine Emergency Department Organisational Communication The new project plan will reinvigorate commitment to the target and re-establish accountability within the clinical areas. Embedding the new structure began in November 2010 with work stream project plans under development to enhance focus on achieving results moving forward. It is expected that this refocus will gain the largest increase of compliance on a sustainable basis. C&C DHB is committed to achieving increasing elective surgery targets each year and expects that the SIR will increase over time. In addition, there is a need to increase resources to deliver more discharges, which will happen over a period of time. C&C DHB performance in this area worsened in Q2 2010/11, however has since improved. ASH rates increased but this is due to non- primary care factors and is currently being explored (possibly capacity in new hospital, MAPU and changes in models of care in hospital) Performance Dashboard 6 The following table provides a quick view of C&C DHB s performance against the Health Targets to the end of Quarter Four 2010/11: Health Target Performance Measure Target Q4 Result Status HT1 Shorter stays in ED 95% 74% HT2 Improved access to elective surgery HT3 Shorter waits for cancer treatment 100% 100% HT4 Increased immunisation 91% 91% HT5 Better help for smokers to quit 90% 97% HT6 Better diabetes services annual checks 55% 68% Better diabetes services diabetes 74% 74% management Better CVD services 78.4% 77.1% KEY: Improvement from previous quarter Results have worsened from previous quarter Same result 6 Adapted from C&C DHB Q4 Final Report 7

21 5.3. Health Target One: Health Target Shorter stays in Emergency Departments Background C&C DHB remains significantly below target for the ED under six hour health target. Compliance in quarter 4 has decreased by 1% compared to quarter 3. However there has been a month on month increase in compliance over the last 3 months. A number of actions have been taken to improve C&C DHB performance for this target: Additional ED SMO position has been advertised. ED Patient Flow Coordinator time has been extended to work between 7am and 11pm to support flow out of ED. Communication of the project is now focussed on Acute Flow and Valuing the Patient s time. Exploring options of having transitional beds in rest homes for patients awaiting placement in aged residential care facilities. Current Status 75% 2010/11 C&C DHB Target 2010/11 National Target 90% 95% The Six hour rule health target was not achieved in 2010/11; however there has been a month on month increase in compliance over the last 3 months of 2010/11. It was recognised that in order to achieve a better level of compliance, a change in approach and accountability was required. The new project structure has four work streams with clearly identified priorities and initiatives and will report monthly to Hospital Health Services executive meeting (HHS) on progress, risks and barriers to achieving the target. Priority has been given to those work streams that are expected to have the biggest impact on improving the patient journey and therefore compliance with the target. The four workstreams are: General Surgery and Orthopaedics General Medicine Emergency Department Organisational Communication The new project plan will reinvigorate commitment to the target and re-establish accountability within the clinical areas. Embedding the new structure began in November 2010 with work stream project Quarterly breakdown of 6 Hour Targets by Ethnicity NZ Maori Pacific Island Other Total Q1 % Compliance Q2 % Compliance Q3 % Compliance Q4 % Compliance Target 8

22 plans under development to enhance focus on achieving results moving forward. It is expected that this refocus will gain the largest increase of compliance on a sustainable basis. These included: Quality initiative rapid analysis and implementation o Coordinating and evaluating flow mechanisms o Surge plan review (ED trigger) o Weekly long stayer alert Increased engagement process at HHS level Focus on the escalation path out of ED Revamped reporting and continuing to refine Communication strategy focussed on patient safety Quality Initiative - Rapid Analysis In May 2011 a quality initiative was commenced that over a period of four weeks reviewed all aspects of the 6hr rule components within C&C DHB to help identify the barriers to achieving the 6 hour target for patients stays. This analysis project included a visit to Auckland District Health Board which was a key component of the work as it allowed the team to review the work undertaken by ADHB in successfully improving their target compliance and assess how this may translate to C&C DHB. A number of actions have been taken as a result of the early findings. Focus on the escalation path out of ED This area of work has focussed on improving the pathway out of ED for admitted and Non- admitted patients. Additional Patient Flow Coordinators (PFC) have been appointed in ED to cover the 7am to 11pm period. Bed meetings across the medical and surgical directorate have been increased to twice a day as a standard, and are attended by the PFCs. Depending on hospital occupancy bed meetings are flexed to 3 times a day, to support flow out of ED. 2011/12 Focus going forward will be on implementing the work plan that has resulted from the Rapid Analysis project. 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 No. of DNW patients x ethnicity NZ Maori Pacific Island Other Total Q1 Q2 Q3 Q4 9

23 5.4. Health Target Two: Health Target Improved access to elective surgery Background The minimum level of surgery to be provided to the people living in this region is identified in the annual DAP and determined by reviewing the DHBs actual level of service in the previous financial year, the level of service planned in the current financial year and achievement of equitable access to elective surgery relative to other DHBs. This data is reported on a DHB of domicile basis with results calculated by the MoH. Current Status 7670 DHBs have targets to increase theatre productivity, surgery performance on a day case basis and surgeries performed on the day of admission. C&C DHB is meeting our targets for day surgery and day of surgery admission. Theatre productivity was a new measure in 2010/11, and the target was attained by Q /11 C&C DHB Target 2010/11 National Target ,000 (Increase nationally) C&C DHB achieved the target for elective and arranged day surgery. By increasing the proportion of surgery carried out on a day surgery basis, C&C DHB can increase hospital throughput and allow resources to be used efficiently. For elective and arranged day of surgery admission, C&C DHB met the 72% target for monitoring across most of 2010/11; however the year end result comprising the twelve months to 31 March 2011 slipped under target by 1%. C&C DHB anticipates achievement of the target for 2011/ Jul - Sept Jul - Dec Jul - Mar Jul - Jun Actual Target Surgical Elective Discharges 2010/11 by Ethnicity Surgical Elective Discharges 7669 Target Maori Pacific Island Other Total 10

24 5.5. Health Target Three: Health Target Shorter waits for cancer treatment Background Waiting times for radiation oncology treatment has been chosen as a representative indicator of specialist treatment and an area with waiting time issues for patients. Because radiotherapy is of proven effectiveness in reducing the impact of a range of cancers and delays to radiotherapy likely to lead to poorer outcomes of treatment - a six week wait time has since been reduced to 4 four weeks. On average, the wait list for radiation treatment at the end of each month is 100 patients. C&C DHB has an obligation to start treatment within 6 weeks once a decision to treat is made. In most cases the decision to treat is made at the first specialist assessment (FSA) and patients go onto a wait list. Current Status 100% 2010/11 C&C DHB Target 2010/11 National Target 100% 100% C&C DHB has had continuous success against this target, achieving the 4 week target throughout 2010/11. Despite this success, there are identified areas needing improvement. Clinical staff have indicated performance in oncology could be improved through measures they have begun such as actively recruiting for the medical oncologist vacancy and the identification and implementation of additional medical oncology resources where possible. The graphs opposite show the overall percentage (100%) of patients by ethnicity that started treatment within the C&CDHB health target guideline of 6 weeks. 100% 80% 60% 40% 20% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Patients starting radiation therapy within 4 weeks Q1 Q2 Q3 Q4 Actual Target Radiation treatment started within the health target guideline Maori Pacific Other Maori Pacific Other Maori Pacific Other Maori Pacific Other Island Island Island Island Q1 Q2 Q3 Q4 11

25 6. Māori Health Plan Monitoring PRIORITY ONE Indicator Data Quality 1. Accuracy of ethnicity reporting in PHO registers. Current Status Baseline not yet determined. 2011/12 Target Baseline not yet determined. PRIORITY TWO Access to Care Indicator 1. Percentage of Māori enrolled in PHOs. Background C&C DHB provides funding to four PHO s across the three TLA s comprising 67 Medical practices Compass PHCN 56 practices Cosine PHCN 2 practices Ora Toa PHO 4 practices Well Health 5 practices Note: Cosine is a cross boundary PHO managed by C&C DHB including Ropata Practice in HV DHB and Karori Practice in C&C DHB C&C DHB has reduced from 7 PHOs to 4 PHOs in 2010/11 Current Status M 82% 2011/12 Target M 80% P 98% P 95% Total 91% The graphs present a picture of C&C DHB PHO enrolment. PHO enrolment has steadily increased however the Coverage of Māori by age group graph indicates that there needs to be a concentration on enrolling Māori, 0-4 years of age. Caveats: This coverage excludes C&C DHB population who are enrolled in PHOs outside the district boundary like in Hutt Valley DHB, MidCentral etc. There is likely to be over-counting of Māori and under-counting of Pacific in the denominator due to ethnicity prioritisation. Total 89% Percentage of population enrolled in a PHO 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Other Total 06/07 75% 88% 86% 83% Jun-10 78% 94% 90% 87% Jul-11 82% 98% 91% 91% 12

26 100% PHO Maori Population Coverage by Age 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Indicator Background 2. Ambulatory Sensitive Hospitalisations Ambulatory sensitive hospital admissions are avoidable inpatient events that may be prevented through timely access to primary care interventions and other ambulatory services. The performance measure is a ratio comparing DHB rates to national, ethnicspecific averages (100 = New Zealand average). Ratios have increased slightly in the most recent quarter however this is partly influenced by the opening of the Medical Assessment and Planning Unit (MAPU) and other administrative changes to admission processes. Current Status Age 0-74 M /12 Target Age 0-74 M <95 P 102 P <95 O 103 O <95 Age 0-4 M 99 Age 0-4 M <107 P 95 P <110 O 114 O <95 Age M 95 Age M <95 P 101 P <95 O 102 O <95 13

27 Rates for Ambulatory Sensitive Hospitalisations (ASH) have increased above the target of 95. Dental and skin conditions are the leading causes of ASH for 0-74 years. Analysis has begun on how to address these issues and reduce ambulatory sensitive hospitalisations. Currently, at the community based Eczema Nurse Clinics, urgent new appointments are being made available, referrals are prioritised and extra clinics have been consistently provided. Rates for Ambulatory Sensitive Hospitalisations (ASH) have increased above the target of 95, although achieved target for Maori in the second half of the year. The leading conditions for this age group are angina and chest pain and cellulitis. With improving performance in the diabetes and cardiovascular health target, a reduction in the number of ASH presentations for angina and chest pain may occur. A strategy that comprises primary, secondary & public health measures is underway for cellulitis treatment and prevention. C&C DHB will continue working to reduce ASH admissions. Ambulatory Sensitive Hospitalisations, 0-74 years 120 ISDR Maori Pacific Other YE March YE March Target Ambulatory Sensitive Hospitalisations, 0-4 years SDR Maori Pacific Other YE March YE March Target Ambulatory Sensitive Hospitalisations, years 120 ISDR Maori Pacific Other YE March YE March Target PRIORITY THREE Indicator Background Maternal Health 1. Exclusive breastfeeding at 6 months Breastfeeding helps lay the foundations of a healthy life for a baby and also makes a positive contribution to the health and wider wellbeing of mothers and whānau/families. Exclusive breastfeeding is recommended until babies are around six months

28 PRIORITY THREE Indicator Current Status Maternal Health 1. Exclusive breastfeeding at 6 months Māori 2011/12 Target Māori 27% Pacific Pacific 27% Other Other 44% Total C&C DHB breastfeeding rates compare favourably with national statistics; however in 2010 the above targets were not met in most instances. Pacific figures show an increase reflecting the stable Pacific breastfeeding support workforce and major breastfeeding promotion in the Pacific community by the breastfeeding team. There is a Healthy Eating Healthy Activity (HEHA) Breastfeeding Administrator working with Maori providers in addition to a Community Lactation Coordinator / Consultant in Women s Health. These positions work to encourage breastfeeding. C&C DHB was reaccredited to the Baby Friendly Hospital Initiative (BFHI) for the third year running this year which has effectively raised the rate of mothers exclusively breastfeeding their babies on discharge from maternity to over 80%. The next step is taking this initiative beyond the hospitals and collaborating with community providers. Total 38% Full or exclusive breastfeeding at six weeks 80% 60% 40% 20% 0% Māori Pacific Other Total National Average 62% 67% 70% 67% CCDHB 61% 63% 71% 70% CCDHB Target 70% 64% 78% 74% Full or exclusive breastfeeding at three months 80% 70% 60% 50% 40% 30% 20% 10% 0% Māori Pacific Other Total National Average 46% 51% 59% 55% CCDHB 49% 53% 65% 62% CCDHB Target 57% 53% 70% 66% Full or exclusive breastfeeding at six months 15

29 PRIORITY THREE Indicator Maternal Health 1. Exclusive breastfeeding at 6 months 50% 40% 30% 20% 10% 0% Māori Pacific Other Total National Average 18% 22% 29% 26% CCDHB 25% 26% 37% 34% CCDHB Target 27% 27% 44% 38% PRIORITY FOUR Cardiovascular Disease Indicator Background 1. Percentage of the eligible population who have had their CVD risk assessed within the past five years The PHO Performance Programme includes an indicator based on CVD risk assessment. This data will not be available in a robust enough form for use in establishing targets and reporting as a national target during 2009/10. For this reason, it has been decided to use an interim indicator for CVD based on laboratory data. This decision is based on the assumption that whenever a CVD risk assessment is performed, the individual must have had a fasting lipid group test (FLG) and a serum glucose or HBA1c (if the person has diabetes). The Ministry expects that the PHO Performance Programme data will be available to use to establish targets for the 2010/11 year. 8 CVD Risk Assessment services are provided by all PHOs. The programme supports systematic cardiovascular risk assessments of the NZGG 9 targeted population. The resource is specified to be utilized for initial assessment and follow-up. The service is specified to be targeted to Māori and Pacific in specified age groups as well as people with diabetes. The systematic screening of people at high risk of cardiovascular disease allows for early identification and management of their disease/risk factors. 8 Better diabetes and cardiovascular disease services; Target documentation 9 New Zealand Guidelines Group 16

30 Current Status Maori 72.7% 2011/12 Target Maori 74.4% Pacific 75.1% Pacific 76.1% Other 79.4% Other 80.9% Total 78.5% The cardiovascular disease (CVD) indicators for all populations were close to achieving target. PHOs continue to have good Care Plus enrolment rates. Long term conditions working group has not been established, however, this has been incorporated into the wider strategic focus of the Integrated Care Collaborative workstreams with a Long Term Conditions. Workstream due to start in September After hours access to palliative care medicines implemented. PHOs are focusing on achieving health target and working with practices to improves diabetes detection and management sharing strategies across GP practices 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total 79.9% CVD interim indicator of lipids and glucose testing Maori Pacific Other Total 2009/10 Q4 71.0% 74.0% 78.0% 77.0% 2010/11 Q1 71.6% 73.4% 78.4% 77.4% 2010/11 Q2 72.4% 74.1% 78.9% 77.9% 2010/11 Q3 72.7% 75.1% 79.4% 78.5% 2010/11 Target 71.60% 73.90% 79.60% 78.40% It is important to note that there is a three month lag in the reporting of this data by the MoH; therefore Q2 2009/10 is actually Q1 2009/10 data. Indicator 2. Number of tertiary cardiac interventions Current Status Standardised intervention rate: /12 Target 6.2 per 10,000 15% increase in cardiac surgery referrals in 2011/12 C&C DHB is not meeting our standardised intervention rate (SIR) targets for cardiac surgery. C&C DHB is committed to achieving the increasing elective surgery targets each year and expects that the SIR will increase over time. In addition, there is a need to increase resources to deliver more discharges, which will happen over a period of time. Standardised elective intervention rates for C&C DHB and national target, 2010 calendar year C&C DHB National Target Cardiac Surgery Major Joint Replacement (hips & knees) Cataract procedures 17

31 PRIORITY FIVE Diabetes Indicator Background 1. Percentage of people who attend their diabetes annual review (DAR) Diabetes Get Checked (DGC) services are provided by all PHOs. The service is free to people with diabetes and aims to encourage and support the uptake of DGC. The annual review of people with diabetes through DGC enables a wellness check, early identification of possible complications of the disease and review of their management plans. Additionally, a range of Diabetes Education & Management services a delivered across C&C DHB and includes: Diabetes nurses to support practices nurses and complex patients. Broad approaches to support diabetes education and management through a multidisciplinary approach to diabetes management Collaborating with the HHS community diabetes team and the follow up of difficult to manage patients. Services for individuals with diabetes and their whanau which focuses on early intervention that reaches the people who are most at risk to support lifestyle change and self-management of their diabetes. Current Status Maori 68% 2011/12 Target Maori 56% Pacific 64% Pacific 57% Other 67% Other 58% Total 68% Primary care based diabetes nurse specialists whose roles include the more intense support for vulnerable patients, improvements to practice recall systems, development of diabetes resource toolkits for practices and linkages with cardiovascular risk assessments are also being resourced and should help move towards the attainment of the diabetes health targets. The secondary care diabetes service continue their collaborative role of working within primary care to support Māori and Pacific people, as well as those in the Kapiti area and those with complex needs. The model of combined primary and secondary patient reviews by the diabetes teams across the sector and includes multidisciplinary input have also been developed to provide management plans for the individual patients and support the ongoing learning processes that would be able to be applied across a wider range of patients. Total 57% Percentage of estimated diabetics recieving Annual Checks 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Maori Pacific Other Q1 10/11 58% 50% 52% 60% Q2 10/11 67% 63% 68% 68% Q3 10/11 69% 66% 67% 70% Q4 10/11 68% 64% 67% 68% Target 55% 47% 53% 56% 18

32 In addition to these services that support all patients with diabetes, there are Māori and Pacific services that are under development that are being targeted for improvements in diabetes. It is likely that these services will have a significant focus on supporting self management of diabetes, which will contribute to improvements in HbA1c. In line with these service developments the diabetes secondary team and dietitians are involved in trialling a NZ based diabetes self management course, which may be utilised in these services. C&C DHB has achieved the target set for annual diabetes checks for all ethnicities. The best result is for Maori and Pacific populations that exceeded target by 17% and 14% respectively. Over the past 12 months C&C DHB has seen an absolute increase in annual reviews of 9%.. Indicator Current Status 2. Percentage of people with diabetes who complete a DAR and have a HbA1c level less than or equal to 8% Maori 65% 2011/12 Target Maori 66% Pacific 53% Pacific 55% Other 79% Other 80% Total 74% The chart shows that the percentage of diabetics checked with HbA1c 8. C&C DHB has met all targets for the proportion of people with diabetes who have HbA1c of less than or equal to 8%. Māori and Pacific patients achieved results favourable to target. This indicates that investment in these populations is having a positive effect. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total 75% Percentage of diabetics checked with HbA1c 8 recieving Annual Checks Total Maori Pacific Other Q1 10/11 69% 66% 49% 73% Q2 10/11 67% 62% 52% 71% Q3 10/11 74% 64% 53% 79% Q4 10/11 74% 65% 53% 79% Target 74% 63% 50% 79% 19

33 PRIORITY SIX Indicator Background Current Status Cancer 1. Breast Screening BreastScreen Aotearoa is a free national breast screening programme for eligible women aged 45 to 69. It checks women for signs of early breast cancer by using mammograms. Regular mammograms reduce the chance of dying from breast cancer among women aged But the benefit is greatest for women aged Maori 66.5% 2011/12 Target Maori 60% Pacific 61.2% Eligible women (50-69 yrs) Pacific 54% having breast screening in Other 71.9% the last 24 months Other 70% Total 71.9% Total 68% Breast screening is provided by Regional Screening Services based at Hutt Valley DHB. Regional Screening Services also coordinates the national cervical screening programme in the region, however screening is delivered by primary healthcare providers. C&C DHB achieved target for all population groups for the percentage of eligible women (50-69 yrs) having breast screening in the last 24 months % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Percentage of eligible women (50-69 yrs) having breast screening Maori Pacific Other Total Jun-10 Dec-10 Apr-11 Target Indicator Background 2. Cervical Screening The National Cervical Screening Programme is available to all women in New Zealand between 20 and 70 years old. The screening test checks for abnormal cell changes to the cervix, reducing the risk of women developing cervical cancer. 11 Current Status Eligible women having cervical screening in the last 36 months 2011/12 Target Eligible women having cervical screening in the last 36 months Maori 58% Maori 62% Pacific 51% Pacific 56% Asian 55% Asian 60% Other 91% Other 90% Total 81% C&C DHB achieved target for some population groups for the percentage of eligible women having Total 81% Percentage of Eligible Women Having Cervical Screening in the Last 3 Years

34 cervical screening in the past three years. Targets for Maori and Pacific were not attained, and initiatives for these groups are underway to improve the percentage having cervical screening. 100% 80% 60% 40% 20% 0% Maori Pacific Asian Other Total 3 yrs to Dec % 51% 55% 91% 81% Target 62% 52% 55% 89% 80% 21

35 PRIORITY SEVEN Smoking Indicator Background Hospitalised smokers provided with advice and help to quit Smoking kills an estimated 5000 people in New Zealand every year, and smokingrelated diseases are a significant opportunity cost to the health sector. Most smokers want to quit, and there are simple effective interventions that can be routinely provided in both primary and secondary care. This target is designed to prompt providers to routinely ask about smoking status as a clinical vital sign and then to provide brief advice and offer quit support to current smokers. There is strong evidence that brief advice is effective at prompting quit attempts and long term quit success. The quit rate is improved further by the provision of effective cessation therapies pharmaceuticals, in particular nicotine replacement therapy (NRT), and telephone or face-to-face support. Current Status 95% of hospitalised smokers have been provided with advice and help to quit. 2011/12 Target 90% of hospitalised smokers will be provided with advice and help to quit by July 2011; and 95 % by July The Smoking Cessation ABC programme provides health care professionals a guideline to Ask all people about their smoking status and document this, provide Brief advice to stop smoking, and offer Cessation treatment. To date C&C DHB have provided Smoking Cessation ABC in-service and study day trainings for nurses, midwives, physicians and resident medical officers. Information sharing between C&C DHB and Hutt Valley DHB in relation to the ABC intervention strategy and tobacco control across the region continues. The Smoking Cessation Advisor position (1.00FTE) was recruited to on 30 August This contract is for a fixed term period and ends on 30 June Since August the Smoking Cessation Advisor has delivered ABC smoking cessation training to staff and provided direct smoking cessation support to HHS patients. The Smoking Cessation Advisor has also Hospitalised smokers provided with advice and help to quit smoking Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Maori Other Pacific Total Smokers Identified Smokers Offered Advice Table 1: % of Smokers Offered Advice to Quit Q1 Q2 Q3 Q4 Maori 53% 64% 71% 94% Other 53% 62% 63% 95% Pacific 51% 63% 58% 97% Total 53% 63% 65% 95% The percentage of Maori smokers admitted to the HHS who were offered advice and support to help quit smoking has increased significantly from 53% to 94% over 2010/

36 provided smoking cessation support sessions to Mental Health clients and staff and was instrumental in transitioning the Mental Health Services in Porirua to smokefree status. 95% of hospitalised smokers received brief advice to quit in Q4 of 2010/11, exceeding the national target of 95%. C&C DHB s Smoking Prevalence Rates by Ethnicity 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Maori Other Pacific Total Table 2: C&C DHB s Smoking Prevalence Rates by Ethnicity Q1 Q2 Q3 Q4 Maori 36% 41% 37% 36% Other 13% 13% 13% 12% PI 19% 20% 22% 22% Total 16% 17% 17% 16% Overall C&C DHB s smoking prevalence rates remain constant at 16%. Data for all Maori smokers admitted to the HHS over the twelve month period show that prevalence rates increased from 36% to 41% between Q1 and Q2, however this has since decreased. Indicator 2. Current smokers enrolled in a PHO and provided with advice and help to quit Current Status Nil baseline available 2011/12 Target 90% of enrolled patients will be provided with advice and help to quit by July 2012 Data collection systems have been developed or adapted to improve collection of smoking status and recording advice to quit information and referrals to smoking cessation services. These improvements are vital to ensure accurate reporting of progress toward the health target that 90% of enrolled patients who smoke and are seen in general practice, will be offered advice and help to quit by July The ABC Facilitator has been delivering ABC smoking cessation education to a range of health professionals in Primary Care including doctors and nurses in medical practices; Plunket midwives; mental health and rest home nurses; community organisations; outreach and asthma services; diabetes and immunisation nurses; psychiatrists and psychologists; and allied health staff such as social workers, occupational therapists and dietitians. A new smoking cessation service has been established at Ora Toa and will enhance the work that the ABC Facilitator provides and is located. ABC education has also been delivered to non-health professionals who work with populations in areas with high smoking rates. The ABC Facilitator continues to work collaboratively with Capital & Coast and Hutt Valley DHB Smokefree teams, the Primary Health Organisations and other smoking cessation groups. 23

37 PRIORITY EIGHT Immunisation Indicator Background 1. Percentage of two year olds fully immunised Immunisation Coordination and Outreach Immunisation is provided by all PHOs. The services aim to support C&C DHB to achieve the 95% of children fully immunised through workforce development, provider feedback, linking with other Immunisation providers, communication strategy and outreach services. Current Status 91% of two year olds fully immunised by /12 Target 95% of two year olds fully immunised by 2012 The national target is 90 percent of two year olds will be fully immunised by July 2011, however C&C DHB has set itself a higher target of 91% given sustained success in this area. Community Immunisation Outreach services are noteworthy for their commitment and responsiveness. The continued progress in increasing immunisation is shown with a total result of 91%. When broken down by ethnicity, Māori are at 89%, 1% below target and Pacific are at 94%, 5% above target. 100% 90% 80% 70% 60% 50% 40% 30% 20% Percentage of 2 year olds fully immunised C&C DHB facilitated an Immunisation Stakeholder Group Meeting, including Outreach Immunisation. Relationships with PHOs and primary health nurses have improved data reporting and immunisation rates. With increased reporting, PHOs are becoming skilled at reviewing their reports and their responses to opportunities for improvement. Continuing to build these relationships through working with PHOs and training courses for primary health nurses run by C&C DHB will maintain our success in increasing immunisation. Weekly datamart coverage data are sent to each PHO Immunisation Co-ordinator, which includes unidentifiable PHO ranking across the region. DHB Facilitator and Immunisation Co-ordinators attended IMAC Workforce Development in Auckland Two To the Point newsletters have been disseminated to Primary Care practices from NIR and DHB Immunisation Facilitator. 10% 0% Maori Pacific Total Q1 10/11 90% 97% 91% Q2 10/11 89% 94% 91% Q3 10/11 90% 95% 92% Q4 10/11 89% 94% 91% Target 10/11 90% 89% 91% C&C DHB has met or exceeded targets for total and Pacific groups for Q4. Total immunisation at two years is on target at 91%, with Pacific exceeding target of 89% at 92%. Maori are 1% below target at 89%. Positive relations with PHOs have enabled practice-led success in this initiative. Targeted programmes to reduce disparities have proven successful and C&C DHB is preparing for the increase to 95% by 30 June A 1% fluctuation can be attributed to: Data being entered late Transient population ie. Children moving out of the country Total coverage for fully immunised two year olds is currently being achieved at 91%. C&C DHB has continued success in the area of immunisation. 24

38 Indicator 2. Seasonal influenza immunisation rates in the eligible population (65 years and over) Current Status 66% of 65+ eligible total population receive annual flu vaccination 65% of 65+ high needs population receive annual flu vaccination 2011/12 Target 68% of 65+ eligible total population receive annual flu vaccination 66% of 65+ high needs population receive annual flu vaccination C&C DHB has not achieved targeted flu vaccination coverage to 30 June 2011, but is above the national average. For the High Needs population, coverage for C&C DHB is slightly higher than for the total population, and is also above the national average. 70% 60% 50% 40% 30% 20% Total High Needs C&C DHB 66% 65% National Average 65% 64% C&C DHB Target 68% 66% PRIORITY NINE Indicator Background Workforce 1. Percentage of Māori staff in DHBs by occupation class Management Clinical Administrative The development of a sustainable workforce is critical to the provision of quality health services in the future. More so, Māori are disproportionately represented within the clinical professions therefore, the development of a clinical workforce with a focus on specialising in key health areas. Current Status Occupation Class FTE % Medical Nursing & Midwifery Allied Health /12 Target No target required. Information only indicator with numbers monitored annually. Support Services Management Total

39 PRIORITY NINE Workforce FTE by Occupation Class C&C DHB Māori FTE Management Support Services Allied Health Nursing& Midwifery Medical Māori Pacific Peoples Asian Peoples New Zealanders* Other Ethnic Peoples Not Disclosed Total Medical Nursing& Midwifery Allied Health Support Services Management 7. Additional Monitoring Indicator Māori Health and Disability services investment 14 Identified Maori Funding Current Funding Iwi/Māori-led PHOs Total Te Plan II Target Millions ($) / / / / / /12 Current Funding 6,417,901 6,989,604 7,803,753 7,929,065 8,036,360 Iw i/māori-led PHOs 2,441,349 3,082,612 3,448,703 3,732,075 Total 6,417,901 9,430,953 10,886,365 11,377,768 11,768,435 Te Plan II Target 6,417,901 7,697,901 8,977,901 10,257,901 11,537,901 12,817,901 Te Plan II Te Plan II states: Strong relationships, providing a well resourced base and inter-sectoral action are fundamental elements that will support developments in Māori Health. Ensuring these core assumptions are inherent in all aspects of implementing Te Plan II will be vital. By 2012, C&C DHB will: 26

40 ACTIONS Increase investment in Māori Health and Disability services by 100% based on the 06/07 budget of $6.4 million Increase investment in Māori Capacity Building fund by 100% based on the 06/07 budget of $385,000 per/annum MEASURES Investments in Māori Health and Disability services total $12.8 million by 2012 Investments in Māori Capacity Building fund to total $770,000 by 2012 To date, there has been a nil increase in Māori Capacity Building fund and identified funding increases in Māori Health and Disability services have been minimal. This has been due the current fiscal environment: Year Sustainable funding (excl. GST) Funding Increase (excl. GST) 2006/07 $6,417, /08 $6,989, $571, /09 $7,803, $814, /10 $7,929, $125, /11 $8,036, $107, Total Increase $1,618, Risk It is clearly evident that C&C DHB is behind schedule in reaching the Te Plan II target of $12.8 million total investments in Māori Health and Disability services by The political risks of not achieving the Te Plan II target is likely to impact on the credibility of C&C DHB in: - Acting on commitments and priorities signaled in planning documents agreed by the Board; - The relationship with; and commitment to Māori; - Commitment to Treaty principles; and, - Commitment to reducing inequalities and equity. Mitigation Work is continuing in assessing further risks to C&C DHB s Te Plan II. To date, MHDG: - Have been involved in the key discussion in relation to the Planning & Funding Savings Plan for 2011/12; - Continued to closely monitor all providers and contract agreements, after updating all service specifications and reporting requirements during 2010/11; and, - Continued to work closely with providers in their understanding of finding efficiencies and awareness of the DHB s 2011/12 savings plan. Indicator Background Oral Health Services Oral Health Services 13 Include services provided by Hutt Valley DHB to Capital & Coast DHB as well as services contracted with private dentists. Child Oral Health Service is the provision of a range of dental care to bring about an improvement in oral health status of the population. It includes preventive care, oral health promotion and education, treatment of oral disease and the restoration of tooth tissue. The objective is to achieve a standard of oral health that leads to all children retaining good use of their natural teeth for life Ministry of Health Oral Health data covers calendar years, therefore the reportable period for the 2010/11 year pertains to the 2010 calendar year. 14 Nationwide Service Framework; Service Specifications; Child Oral Health, Ministry of Health 2010/11 27

41 Adolescent oral health utilisation for the 2010 calendar year has improved from that of 2009 calendar year. Adolescent oral health utilisation for 2010 is 51%, which is less than the target of 54%. While disappointed not to have achieved the target, C&C DHB has increased utilisation by 9%, and believes that this strong growth will continue in the 2011 calendar year. Percentage of Adolescents Using DHB Funded Oral Health Services 60% 50% 40% 30% 20% 10% 0% Percentage Utilisation (%) 34% 36% 39% 42% 51% Target 54% Through this measure C&C DHB is looking to increase the percentage of children age 5 who are caries free. Caries free means that a child has no teeth that are decayed, missing, or filled. The proportion of children caries free has improved in 2010, however, it is much lower for Maori and Pacific than for Other. Work to increase the number of enrolled pre-schoolers will help to improve outcomes for this age-group. This work will be focused on Maori and Pacific children. Percentage of Children Caries Free at 5 years 100% 80% 60% 40% 20% 0% Maori Pacific Other Total % 38% 74% 64% % 40% 77% 68% 2010 Target 55% 46% 77% 68% Through this measure C&C DHB is looking to reduce the mean DMFT in Year 8 students. In 2010 the DMFT results are significantly different than previous years, in particular for Maori. The change in DMFT is reflective of the increased number of children who are being seen in a timely way. Increased access for children with higher needs has a short to medium term impact on DMFT rates. Over the longer term the oral health outcomes should show improvement from this increased access. Mean Number of Decayed, Missing or Filled Teeth (DMFT) at Year Maori Pacific Other Total Target Indicator Background Mental Health This measure targets improved access, as sufficient access to services will lead to improvements in quality of outcomes. The Mental Health and Addiction Plan confirms that the government remains committed to providing services for people who are severely affected by mental illness, especially those who have enduring severe illness. 28

42 C&C DHB met the access targets for Maori and Other children and young people, and Maori adults aged 20 to 64. Although other targets were not met, rates have been consistently improving since 2006 with an overall increase in the proportion of the DHB population accessing secondary mental health services. C&C DHB is moving towards the national target of 3%. A discrepancy between actual and reported rates for clients accessing mental health services is largely due to the DHB's inability to directly link key activity data to client referrals. During 2011/12 the DHB will implement a referral management system, which will significantly reduce the current issues and result in more accurate reporting to better reflect the actual access rates being achieved by C&C DHB Mental Health & Addiction Services. Percentage of the Total population accessing secondary mental health services 4.0% 3.0% 2.0% 1.0% 0.0% Maori Pacific Other Total Actual 3.40% 1.60% 2.50% 2.52% Target 2.86% 2.58% 2.71% 2.72% Indicator B4 School Checks The number of B4 School Checks exceeded target for high needs with 546 checks completed in 2010/11. The total number of B4 School Checks was below target but much improved from the trend throughout the year, attaining 91% (2903 checks). B4 School Checks 3,000 2,500 2,000 1,500 1, % 80% 60% 40% 20% 0 Q1 Q2 Q3 Q4 0% High Needs Total High Needs Percentage Total Percentage Indicator Respiratory The age bracket 0-14 years account for more than half of the asthma admissions. Of this age bracket, Māori and Pacific is almost double that of Non- Māori ASH Asthma admissions for 2010/ Maori Pacific Other Total 29

43 Indicator Tikanga Maori - Implementation A recent analysis on Inpatient Satisfaction was completed in March 2011.The results of this patient survey is illustrated in the accompanying graph. Of significance is the higher proportion of satisfaction by Maori patients and their whanau with service delivery compared to non Maori. This is largely attributed to building the capability of the C&C DHB health workforce to work with Māori patients and their whanau is important in influencing Māori health outcome and reducing disparity. To do this requires that all C&C DHB staff understand the context in which Māori live and operate, particularly in relation to health. As a first step towards a more coordinated approach to raising staff awareness, an education resource in relation to Māori protocols and practice relevant within a hospital setting was developed - Tikanga Guidelines A guide for health care workers. Satisfaction with Inpatient Services Cultural and Spiritual Needs C&CDHB Tikanga & Treaty Session Attendance 2011 Aligned with the Guidelines were education programs developed to support staff in their delivery of health services to Maori. An online assessment tool was also developed that enable staff to test their knowledge and learning. The aim of this education program was the provision of reliable and easily accessible Māori tikanga education and support resources; an easily accessible assessment tool that linked into a robust performance management system; and an evidence base on which to plan and improve future cultural education at C&C DHB January February March April May June July August September October November December Treaty Tikanga The benefits associated with the Tikanga Māori Guideline Evaluation include: expansion and sharing of key learnings associated with the Tikanga Māori Guideline implementation; examination of the critical components of the Tikanga Guideline programme within a large district health board; identification of facilitators of and barriers to implementation in the services; and transferability of the programme across the district, region and / or sectors. C&C DHB have engaged the University of Otago to evaluate the effectiveness of the Tikanga Māori Guidelines project and particularly the elements 30

44 that work well in improving the delivery of services to Māori. To date: 251 presentations have been delivered to 3169 staff 2581 staff have participated in the e-learning online assessment Implementation will continue with the goal of achieving 100% staff participation rates. 31

45 TO: Community and Public Health Advisory Committee FROM: Taima Fagaloa Director, Pacific Health Directorate DATE: 18 October 2011 SUBJECT: DRAFT Pacific Stocktake Project and Pacific Reconfiguration Programme Purpose This paper provides an update for Community and Public Health Advisory Committee (CPHAC) on the progress to date of the Pacific reconfiguration project. In April 2010 a Board report presented two future options for the Pacific Primary care fund, these options included: One Pacific service provider across the District; or PHO based model with PHOs enhancing the Services they deliver to their enrolled Pacific population; The Board endorsed the PHO based model in May A process of engagement with PHOs commenced. In November 2010 PHOs were invited to submit proposals for services that would meet the needs of their population, and would lead to improved health outcomes for children and people with long term conditions. The proposals would need to provide evidence that Pacific providers were involved in developing the proposals where this was appropriate. Proposals were received from PHOs in February, and the evaluation process is nearing completion. Following this, negotiations with the PHOs will take place to agree service details, targets, reporting structures and funding. In April 2011 a paper and presentation was prepared by the Director of Pacific Health. This presentation provided background information on the Pacific Reconfiguration programme for current and new Board members. The paper and presentation is attached as an appendix.

46 Proposals All four PHOs submitted proposals. Cosine PHO s Pacific population needs could be addressed in current SIA and HP funding received for their population of approximately 400 Pacific people. At this stage Well Health PHO and Compass Primary Care Network (CPHCN) decided despite individual proposals being submitted, that given the current health environment, it was important to consider a collaborative approach to the Pacific reconfiguration programme. It was envisaged that this would include Ora Toa at a time that Ora Toa could identify how the new service model would fit within their own service delivery model. Pacific Reconfiguration Stakeholder Working Group As of the 1 July 2011, the Pacific primary care funding was contracted to Well Health PHO sub-contracting Pacific Health Service Wellington (PHSW), and CPHCN who have sub contracted Pacific Health Service Porirua (PHSP). The contracts involve delivering a component of the facilitation contracts in addition to setting up a Pacific Governance steering committee that will develop the new model for Pacific primary care delivery. A working group consisting of the two Pacific Primary care providers Chairpersons and Managers, Well Health and CPHCN represented by staff including senior Pacific staff, have held meetings fortnightly from July September The Terms of This working group was facilitated by Jean Mitaera and Riripeti Reedy. This working group has now become an advisory group and has appointed a smaller working group to progress implementation. The benefits of the satellite model include the: Streamlining of services and processes through a one-door approach Ability to exchange skills amongst Pacific and non-pacific staff Existing PHOs systems to support activities to be delivered to Pacific communities Shared experiences of Governance Collection of one set of data for analysis to understand and meet the needs of the communities Workforce development opportunities are expanded for Pacific workers Availability of other funding possibilities Opportunities to take the services to the people - raising the Pacific service profile Consistency of reporting on all levels Alignment of the services with the political environment and directions of the wider health /government sector; Increased confidence of the DHB to receive reports through peer review processes already exist; More efficient financial, service, and health benefits to Pacific communities. 2

47 Risks Loss of ownership and autonomy by Pacific; Loss of confidence by the community through change of leadership; Time; PHO Leadership This will be operated through an alliance agreement between Well Health and CPHCN for the operation of the service. There will be a joint project governance / steering group to oversee the service and provide ongoing monitoring and support. Other PHOs will continue to be kept informed and linked around the implementation of this service. The working group agreed that implementation of the new model should go live as of the 1 January Implications for current Pacific providers For PHSW, the Governance Board will discuss the implications and make decisions around workforce and service closure. PHSW holds a Smoking Cessation contract with MOH which has been extended for two more years. Furthermore, PHSW and Taeaomanino Trust have entered into a collaborative agreement to form one Trust, the Pacific Care Trust under Whanau Ora. This places some complexity in relation to their current contracts however it was made clear to TPK and MSD during the due diligence process of Whanau Ora that the Pacific reconfiguration programme may have implications for the PHSW contract. For PHSP, similarly they Governance Board will discuss the implications on service delivery. PHSP also hold a Smoking Cessation contract with MOH. PHSP are working collectively with Compass Health to identify opportunities for ongoing service delivery. The outcome of this new model will have implications for PHSP staffing. The PHOs and Pacific providers continue to discuss how the model will work across the sector. It is envisaged that current staff will have the opportunity to apply for new roles that result in the current Pacific reconfiguration programme. Recommendation: 1. That the Board note the contents of this report. 3

48 Appendix 1 BACKGROUND PAPER 5 April 2011 TO: Community and Public Health Advisory Committee FROM: Taima Fagaloa, Director Pacific Health Directorate DATE: April 2011 SUBJECT: Programme Pacific Stocktake Project and Pacific Reconfiguration Purpose This paper provides an update for CPHAC on the progress to date of the Pacific reconfiguration project. The intent of this paper is to provide background information to complement the CPHAC presentation. Reconfiguration of Pacific Primary Care investment Currently CCDHB Pacific Directorate invests about $880,000 in two By Pacific For Pacific (BPFP) providers to provide primary care facilitation services. The services were established in 2000 (prior to the establishment of PHOs) to provide wraparound care that supported Pacific people to access primary care services. The number of Pacific people accessing BPFP services is approximately 2,000, out of a total of 22,000, or less than 10%. The majority of people accessing BPFP services are clients of the GP services run by Pacific providers. In 2009 a Stocktake of Pacific primary health care services was undertaken. The Stocktake was a qualitative examination of the health needs of Pacific people and health services targeted to Pacific people, with interviews conducted with Pacific providers, mainstream providers (particularly PHOs) and funders. The Stocktake took into account an examination of past and current audit reports and utilisation data. The Stocktake identified key strengths and weaknesses of both BPFP and mainstream providers. BPFP strengths lie with a passionate workforce, skills in delivering culturally appropriate services, and links with Pacific communities. 4