CANTERBURY DHB BOARD. Thursday 15 December am. Board Room Level 1 32 Oxford Terrace Christchurch

Transcription

1 CANTERBURY DHB BOARD Thursday 15 December am Board Room Level 1 32 Oxford Terrace Christchurch

2 AGENDA PUBLIC CANTERBURY DISTRICT HEALTH BOARD MEETING To be held in the Board Room, Level 1, 32 Oxford Terrace, Christchurch Thursday 15 December 2016 commencing at 9.00am MIHI ADMINISTRATION Apologies 1. Conflict of Interest Register Update Board Conflict of Interest Register and Declaration of Interest on items to be covered during the meeting 2. Confirmation of the Minutes of Previous Meetings Ordinary Meeting 17 November Carried Forward/Action List Items 4. Patient Story REPORTS 5. Chair s Update (Verbal) Murray Cleverley Chairman 6. Chief Executive s Update David Meates Chief Executive 7. Finance Report Justine White GM, Finance & Corporate Services 9.00am 9.10am 9.20am am am am 8. Schedule of Meetings 2017 Justine White am 9. Advice to Board HAC Draft Minutes 29 November 2016 Andrew Dickerson Chair HAC am 10. Resolution to Exclude the Public Justine White 10.15am INFORMATION ITEMS - Health Target Report Quarter 1. ESTIMATED FINISH TIME PUBLIC OPEN MEETING 10.15am MORNING TEA am NEXT MEETING: Thursday, 16 February 2017 Board-15dec16-agenda 15/12/2016

3 ATTENDANCE CANTERBURY DISTRICT HEALTH BOARD MEMBERS Murray Cleverley (Chair) Sir Mark Solomon (Deputy Chair) Barry Bragg Sally Buck Tracey Chambers Anna Crighton Andrew Dickerson Jo Kane Aaron Keown Chris Mene David Morrell Executive Support David Meates (Chief Executive) Mary Gordon (Executive Director of Nursing) Sue Nightingale (Chief Medical Officer) Stella Ward (Executive Director Allied Health Scientific & Technical) Carolyn Gullery (General Manager Planning & Funding) Hector Matthews (Executive Director -Maori & Pacific Health) Michael Frampton (General Manager People & Capability) Justine White (General Manager Finance & Corporate Services) Kay Jenkins (Executive Assistant - Governance Support) Anna Craw (Board Secretary) Board-15dec16-attendance list Page 1 of 1 15/12/2016

4 CANTERBURY DISTRICT HEALTH BOARD MEMBERS CONFLICTS OF INTERESTS REGISTER (As disclosed on appointment to the Board and updated from time-to-time, as necessary) MURRAY CLEVERLEY (CHAIR) Trust Aoraki Limited Director Business Class Ltd Managing Director Opihi Vineyard Ltd - Chairman Sky Solar Holdings Ltd - Director South Canterbury DHB - Board Chairman South Canterbury Eye Clinic - Director New Zealand Health Partnerships Limited Director Silverfin Capital Limited - Director Waste 2 Energy Limited - Chairman SIR MARK SOLOMON (DEPUTY CHAIR) To be advised at meeting. BARRY BRAGG To be advised at meeting. SALLY BUCK Christchurch City Council (CCC) Community Board Member Member of the Central/Linwood/Heathcote Community Board which has delegated responsibilities from the CCC. Independence House Acting Manager Independence House is funded through the Ministry of Health to provide residential care for intellectually disabled youth and adults. TRACEY CHAMBERS To be advised at meeting. ANNA CRIGHTON Christchurch Heritage Trust Chair - Governance of Christchurch Heritage Christchurch Heritage Limited - Chair - Governance of Christchurch Heritage Heritage New Zealand Honorary Life Member Board 15dec16-interest register Page 1 of 4 15/12/2016

5 ANDREW DICKERSON Accuro (Health Service Welfare Society) - Director (from 9 December 2016) Is a not-for-profit, member owned co-operative society providing health insurance services to employees in the health sector and (more recently) members of the public. Accuro has many members who are employees of the CDHB. Maia Health Foundation - Trustee Is a charitable trust established to support health care in the CDHB area. Current projects include fundraising for a rooftop helipad and enhancements to the children s wards at Christchurch Hospital. Canterbury Health Care of the Elderly Education Trust - Chair Promotes and supports teaching and research in the care of older people. Recipients of financial assistance for research, education or training could include employees of the CDHB. Canterbury Medical Research Foundation - Member Provides financial assistance for medical research in Canterbury. Recipients of financial assistance for research, education or training could include employees of the CDHB. Heritage NZ - Member Heritage NZ s mission is to promote the identification, protection, preservation and conservation of the historical and cultural heritage of New Zealand. It identifies, records and acts in respect of significant ancestral sites and buildings. CDHB owns buildings that may be considered to have historical significance and Heritage NZ has already been involved with CDHB buildings. No Conflicts of Interest are envisaged for the following interest, but should a conflict arise this will be discussed at the time. NZ Association of Gerontology - Member Professional association that promotes the interests of older people and an understanding of ageing. JO KANE Latimer Community Housing Trust Project Manager Delivers social housing in Christchurch for the vulnerable and elderly in the community. Registered Resource Management Act (RMA) Commissioner From time to time sits on RMA panels throughout Canterbury. If any conflicts of interest arise from this they will be advised. NZ Royal Humane Society Director Provides an awards system for acts of bravery in New Zealand. It is not anticipated any conflicts of interest will arise. HurriKane Consulting Project Management Partner/Consultant A private consultancy in management, communication and project management. Any conflicts of interest that arise will be disclosed/advised. Key to Life Charitable Trust Undertakes consultancy work for this trust. Board-15dec16-interest register Page 2 of 4 15/12/2016

6 AARON KEOWN Christchurch City Council Councillor and Community Board Member Elected member and of the Fendalton/Waimairi/Harewood Community Board. Grouse Entertainment Ltd Director and Shareholder Grouse Films Ltd Director O3 Productions Writer/Director No conflicts of interest are anticipated from these roles but will be discussed at the appropriate time should they arise. CHRIS MENE Canterbury Clinical Network Child & Youth Workstream Member Core Education Director Has an interest in the interface between education and health. Wayne Francis Charitable Trust - Board Member The Wayne Francis Charitable Trust is a philanthropic family organisation committed to making a positive and lasting contribution to the community. The Youth focussed Trust funds cancer research which embodies some of the Trust s fundamental objectives prevention, long-term change, and actions that strive to benefit the lives of many. Regenerate Christchurch General Manager, Partnerships and Engagement Regenerate Christchurch (RC) is a new entity, established to lead regeneration activities across Greater Christchurch. RC will work with strategic partners, including the Canterbury DHB, the community, iwi and other stakeholders to plan and drive development in key areas of the city. DAVID MORRELL British Honorary Consul Interest relates to supporting British nationals and relatives who may be hospitalised arising from injury related accidents, or use other services of CDHB, including Mental Health Services. In addition a conflict of interest may arise from time to time in respect to Coroners Inquest hearings involving British nationals. Nurses Memorial Chapel Trust Chair (CDHB Appointee) Trust responsible for Memorial Chapel on the Christchurch Hospital site. Note the chapel is now owned by the Christchurch City Council. Heritage NZ Subscribing Member Heritage NZ s mission is to promote the identification, protection, preservation and conservation of the historical and cultural heritage of New Zealand. It identifies, records and acts in respect of significant ancestral sites and buildings. CDHB owns buildings that may be considered to have historical significance. Canon Emeritus - Christchurch Cathedral The Cathedral congregation runs a food programme in association with CDHB staff. Board-15dec16-interest register Page 3 of 4 15/12/2016

7 Great Christchurch Buildings Trust Trustee The Trust seeks the restoration of key Christchurch heritage buildings, particularly Christchurch Cathedral, and is also involved in facilitating the building of social housing. Hospital Lady Visitors Association - Wife is a member of this, but no potential conflict of interest is expected. Should one arise it will be declared at the time. Board-15dec16-interest register Page 4 of 4 15/12/2016

8 MINUTES DRAFT MINUTES OF THE CANTERBURY DISTRICT HEALTH BOARD MEETING held at 32 Oxford Terrace, Christchurch on Thursday 17 November 2016 commencing at 9.00am BOARD MEMBERS Murray Cleverley (Chair); Steve Wakefield (Deputy Chair); Sally Buck; Anna Crighton; Andrew Dickerson; Aaron Keown; Chris Mene; Edie Moke; and David Morrell. APOLOGIES Apologies were received and accepted from Jo Kane & Susan Wallace. An apology for lateness was received and accepted from David Morrell (11:00am). EXECUTIVE SUPPORT David Meates (Chief Executive); Mary Gordon (Executive Director of Nursing); Hector Matthews (General Manager, Maori & Pacific Health); Justine White (General Manager, Finance & Corporate Services); Anna Craw (Board Secretary); and Kay Jenkins (Executive Assistant, Governance Support). Hector Matthews welcomed everyone to the meeting with a Karakia. 1. INTEREST REGISTER Additions/Alterations to the Interest Register There were no additions or alterations to the interest register. Declarations of Interest for Items on Today s Agenda There were no declarations of interest for items on today s agenda. Perceived Conflicts of Interest There were no perceived conflicts of interest. 2. CONFIRMATION OF MINUTES OF THE PREVIOUS MEETINGS Resolution (64/16) (Moved: Aaron Keown /seconded: Andrew Dickerson - carried) That the minutes of the meeting of the Canterbury District Health Board held on 20 October 2016 be confirmed as a true and correct record, with the addition of Dr Sue Nightingale as an attendee under Executive Support. 3. CARRIED FORWARD/ACTION LIST ITEMS The carried forward items were noted. Board-minutes-17nov16-draft Page 1 of 5 17/11/2016

9 4. PATIENT STORY The meeting commenced with a Patient Story. 5. CHAIR S UPDATE The Chair acknowledged those affected by the recent earthquakes particularly in North Canterbury and Kaikoura. He also acknowledged the work David & his teams are doing around the earthquakes in the Emergency Operations Centre that swung into action here in the Corporate Office and has been operating 24 hours per day since it was set up immediately following the earthquake, and also those who have travelled to Kaikoura to assist. He advised that since the last meeting, he had attended the following meetings/events: Partnership Group Meeting the next meeting is on 22 November NZ Health Partnerships meeting 27 October. He was able to attend some of the Quality Improvement & Innovation Awards on 31 October. He attended the Blessing of the Acute Assessment Unit and Day Procedure Theatre, Ashburton Hospital on 15 November. Discussion took place regarding the affect of the earthquakes and the significant challenges facing us going forward. Resolution (65/16) (Moved: Murray Cleverley/seconded: Anna Crighton carried) That the Board: i. notes the Chair s verbal update. 6. CHIEF EXECUTIVE S UPDATE David Meates, Chief Executive, spoke to this report which was taken as read. The Chief Executive highlighted in particular: The Emergency response which commenced at 12.02am after the severe earthquake and also the Tsunami warning, and the potential need to evacuate two Aged Residential Care facilities in parts of Christchurch. He advised that the Emergency Operations Centre (EOC) has been operating 24 hours per day since then and will continue for a yet to be determined time line. The EOC is closely connected with Civil Defence and other relevant agencies. The Board noted that teams with different skills have been flown into Kaikoura. Staff rosters have been put in place through to next week, with planning underway for the next six weeks. It was also noted that there is no damage to Kaikoura Hospital and management are in touch on a daily basis with other facilities in the area. We have a number of staff in Kaikoura who no longer have homes or have not been home since the event. Board-minutes-17nov16-draft Page 2 of 5 17/11/2016

10 The comment was made that the significance of what we have to do over the next few months should not be under estimated. The Chief Executive advised that facilities will continue to be assessed and a re-assessment of the frail elderly will take place to ensure that no-one is left without access to support. The Serious & Sentinel Events Report was released last week and is available on the Health Quality & Safety Commissions website. The Canterbury DHB Radiology Service underwent its International Accreditation of New Zealand review on September. The assessment team overwhelmingly agreed that to the credit of the team, a high level of quality had been maintained throughout recent considerable changes. The Chief Executive advised that he has a video link with the Kings Fund this evening. Resolution (66/16) (Moved Chris Mene/seconded Sally Buck carried) That the Board: i. notes the Chief Executive s update. 7. FINANCE REPORT Justine White, General Manager, Finance, presented the Finance Report which was taken as read. The consolidated Canterbury DHB financial result for the month of September 2016 was a deficit of $3.088m which was $0.069m favourable against the budgeted deficit of $3.157m. The year to date position is $0.164m unfavourable. It was noted that the internal budget is phased differently to the draft Annual Plan submitted to the Ministry of Health in March this was phased evenly over the year pending finalisation of the budget. Year-to-date the draft Annual Plan (unphased) as submitted has a deficit of $9.471m. Both the internal budget and the draft Annual Plan are subject to finalisation. A question was raised regarding the cost of the recent earthquakes and the Chief Executive commented that the DHBs prime responsibility is to ensure the safety and wellness of our community and not let contracts or dollars get in the way of this. It was noted that it is a really complex journey that the DHB is on and this is a total system response, so there is not an area of the DHB that is not affected. It was also noted that ESPI compliance will be under extreme pressure as we continue to look at how we achieve the balance in the system. Resolution (67/16) (Moved Aaron Keown/seconded Steve Wakefield carried) That the Board: i. notes the financial result for the period ended 31 September Board-minutes-17nov16-draft Page 3 of 5 17/11/2016

11 8. ADVICE TO BOARD Community & Public Health Advisory Committee Anna Crighton, Chair, Community & Public Health Advisory Committee, provided an update on the Committee meeting held on 3 November The Board noted in particular: Canterbury has achieved the immunisation health target for the fifth quarter in a row - this quarter by vaccinating 95% children who turned eight months old. We had strong results achieving the target for all population groups: Asian (97%), New Zealand European (96%) Pacific (98%) and 96% of eligible Māori children. The good discussions on Chatham Islands and the services there, and the travel and accommodation support by the DHB of private services to the Islands. The whole of government forum. The Rural Health Update. Disability Support Advisory Committee Chris Mene, Chair, Disability Support Advisory Committee, provided an update on the Committee meeting held on 3 November The Board noted in particular: The Burwood Spinal Unit presentation detailing the engagement process and model of care. The Disability Action Plan. The update received around the National Disability Strategy. The updates were noted. 9. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (68/16) (Moved: Anna Crighton/Seconded: Edie Moke carried) That the Board: i ii. resolves that the public be excluded from the following part of the proceedings of this meeting, namely items 1, 2, 3, 4, 5, 6, 7, 8, 9 and the information items contained in the report; notes that the general subject of each matter to be considered while the public is excluded and the reason for passing this resolution in relation to each matter and the specific grounds under Schedule 3, Clause 32 of the Act in respect to these items are as follows: GENERAL SUBJECT OF EACH MATTER TO BE CONSIDERED 1. Confirmation of minutes of the public excluded meeting of 20 October Chair and Chief Executive - Update on Emerging Issues GROUND(S) FOR THE PASSING OF THIS RESOLUTION For the reasons set out in the previous Board agenda. Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 3. Legal Report Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including REFERENCE OFFICIAL INFORMATION ACT 1982 (Section 9) S9(2)(a) s9(2)(j) S9(2)(a) s9(2)(j) Board-minutes-17nov16-draft Page 4 of 5 17/11/2016

12 commercial and industrial negotiations). Maintain legal professional privilege 4. Wellbeing Health & Safety Report Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 5. Trust Report To carry on, without prejudice or disadvantage, negotiations (including 6. Earthquake Repairs Programme of Works Reprioritisation Update 7. Chatham Islands Health Facilities Repairs and Upgrades 8. Facilities Project Director s Update 9. Advice to Board: Facilities Committee Draft Minutes 1 November 2016 QFARC Draft Minutes 1 November 2016 commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). For the reasons set out in the previous Committee agendas. s9(2)(h) S9(2)(a) s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) iii notes that this resolution is made in reliance on the Act, Schedule 3, Clause 32 and that the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i)) of the Official Information Act The Public meeting concluded at 10.00am. Murray Cleverley, Chairman Date Board-minutes-17nov16-draft Page 5 of 5 17/11/2016

13 CARRIED FORWARD/ACTION ITEMS PUBLIC CANTERBURY DISTRICT HEALTH BOARD CARRIED FORWARD ITEMS AS AT 15 DECEMBER 2016 DATE ISSUE COMMENTARY REFERRED TO STATUS Jul 16 Bowel Screening Programme Update to HAC on planned rollout of Bowel Screening Programme GM Planning & Funding Presentation was provided to HAC on 29 November 2016, as minuted in Item 9. Board-15dec16-carried forward action list Page 1 of 1 15/12/2016

14 CHIEF EXECUTIVE S UPDATE TO: SOURCE: Chair and Members Canterbury District Health Board Chief Executive DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT This report is a standing agenda item, providing the latest update and overview of key organisational activities and progress from the Chief Executive to the Board of the Canterbury DHB. 2. RECOMMENDATION That the Board: i. notes the Chief Executive s update. 3. DISCUSSION PUTTING THE PATIENT FIRST PATIENT SAFETY Health and Disability Services Certification Surveillance Audit: The next CDHB Surveillance audit is confirmed to take place between 13 and 16 March The CDHB Quality Managers Group are managing the Certification Programme and will be consulting with the different divisional clinical groups on the detail. The Surveillance Audit will consist of: 4 System Tracer Audits: Deteriorating patient, Medication Management, Fall Prevention and Infection Control. 8 individual tracers Audits following the patient journey will be conducted: Acute Mental Health, Forensic, Medical, Surgical, Rest home/dementia, Child Health and Maternity. Incidental sampling Several meetings have been requested to audit the following standards such as Quality and Risk Management, Human Resource, Service Provider availability, Facility Management and Fire and Emergency, and Restraint. The reported improvements following the Corrective actions raised at the previous audit (2015) will be verified. The Chatham Island facilities will be visited. National Reportable Event Policy: Consultation on this national policy is currently taking place. Consumers/patients and families/whānau, individuals and organisations in the health sector, and others interested in the reporting of adverse events and health improvement are invited to feedback from now until 1 February For more information see Board-15dec16-chief executive s update Page 1 of 39 15/12/2016

15 CDHB Patient Experience Quarterly Results July Sept 2016 Every Quarter 400 patients are invited to participate in the national survey via or text. Canterbury DHB surveys an additional 400 per two weeks. The current response rate for the national survey is 34%, we are 7 % above. We consistently get a higher response rate from patients invited to participate in the survey via . Prior to the implementation of the electronic patient experience survey in August 2014 the CDHB had not been recording addresses. From the 1st of March 2015 we began recording the number of addresses collected in the Patient Management System for patients discharged. We started at 3.8% and have increased that to 21.8 % of patients having addresses recorded on discharge. The latest Quarterly public Patient Experience Reports has been published on the internet Surveys.aspx. Internally a Patient Experience Tableau dashboard has been developed. It s available to view via the Canterbury Health Information Portal on the intranet. Services can see their own patient experience results under the four domains above aligned with the activity data and coding data for hospital acquired injuries: falls, pressure injuries, medicine errors and urinary tract infections. Deteriorating Patient Programme: Canterbury DHB is a pilot site for the Health Quality and Safety Commission s programme to standardise all early warning of deterioration systems used in hospitals in New Zealand. Which includes increasing staff working with consumers to engage them in their care. Our use of an electronic observation system (PatienTrak) means we have real time data to assess the performance of the early warning system. Board-15dec16-chief executive s update Page 2 of 39 15/12/2016

16 Year Workstream 1 Pilot then implement the new NZ early warning system (recognition and response) 2 Patient, family and whanau escalation 3 Goals of Treatment 4 Measurement Pressure Injuries: The Pressure Injury Survey across the CDHB has been completed and presented to the Hospital Pressure Injury Group. Terms of Reference for the Hospital Acquired Pressure Injury Review and the associated Assessment Tool and Serious Event Documents are being trialled. Hand Hygiene: Below is how the Canterbury DHB measures up nationally. The CDHB Hand Hygiene Governance Group continues to support quality improvement initiatives to increase compliance. Board-15dec16-chief executive s update Page 3 of 39 15/12/2016

17 Community Supply of Continuous Positive Airway Pressure (CPAP) Model of Care: We have seen a 20% increase in the number of CPAP patients in the last 5 years and this increase is expected to continue. CPAP trials are provided by the Sleep Service at Christchurch Hospital for people with obstructive sleep apnoea (OSA). The trial involves assessment and provision of CPAP over a one year trial period. Those people who are shown to gain benefit with an improvement in outcomes and adhere to compliance criteria are ready to be discharged from the Sleep Service. In order to ensure that we can provide this treatment to the people that require it we are establishing a community CPAP service. The community service will provide follow up for stable, self-managing patients discharged from the Sleep Service (currently approximately 3,500 people). It will provide a structured responsive service to enable them to access equipment, information and assistance with replacement in a timely manner. This will remove the non-clinical patient interactions from the Sleep Service freeing clinicians for tasks that only they can provide. RT2C Acute Care Discharge Planning: The Admissions/Discharges Releasing Time 2 Care module was run successfully for Child Health at the beginning of this year with a number of key changes implemented such as criteria based discharge and a daily huddle of the Child Health Coordinators and Nurses in charge of each child health area, at 2100 hours to streamline admissions and enhance teamwork. We are considering the use of the RT2C Admissions/Discharges module to support the work of the Adult Acute SLA on discharge planning with focus on criteria based discharge and assertive board rounds. We are exploring ways of using this module to foster collaboration across the continuum of care. For example, if such a module was run for the Orthopaedic Service, it would involve primary, tertiary, rehab and community care. Changes to tongue tie pathway: Tongue tie, or ankyloglossia is when the piece of skin under your tongue is too short or dense and limits the range of tongue movements. If this impairs feeding in a newborn baby, surgery to divide the frenulum may help both mother and baby. International evidence shows that between 0.2% and 10% of babies have ankyloglossia and that only 25-50% of this group will have feeding problems related to their tongue. Within Canterbury we have had a high rate of surgical intervention rate for babies and until 2015 this rate was increasing annually reaching 15% that year. Despite the high intervention rate breastfeeding rates in Canterbury have been static, which suggests tongue-tie release surgery has made little difference in increasing the number of women breastfeeding. In order to reduce the number of unnecessary procedures a Canterbury Initiative Working Group involving several clinicians has been developing a system that enables us to take a consistent and evidence based approach to tongue-tie assessment at Christchurch Women s Hospital. This led to a reduction in the intervention level to 8% by mid Further changes will be put in place in early 2017 to ensure that newborn babies do not receive any potentially unnecessary surgery while ensuring access for a procedure that has been shown to improve breastfeeding comfort when clinically indicated and that other more relevant support for breastfeeding can be focussed on. Ongoing audit of the intervention rate and outcome for mothers and babies is planned. Paediatric burns calculator: Paediatric burns patients who receive appropriate nutritional supplements early in their journey have the best outcomes as proper nutrition significantly aids wound healing. Currently nutritional care requirements for inpatient paediatric burn patients are calculated manually. The potential risk here is human error in calculation, and the time taken to complete these tasks. A Paediatric Burns Calculator has been created by Dietitians at Christchurch Hospital that facilitates the calculation of the nutritional supplement requirements of an inpatient burns patient faster. This means that treatment starts sooner, leading to better outcomes. It also eliminates the risk of calculation errors. Cool sense pain numbing applicator: On a daily basis in our facilities children experience a number of potentially painful procedures including the placement of intravenous (IV) needles. Naturally many children are deeply fearful of these procedures. Commonly, topical anaesthetic Board-15dec16-chief executive s update Page 4 of 39 15/12/2016

18 creams are used to numb the site of injection. However use of this method has its own complications and associated anxieties which can lead to ineffective numbing of the skin resulting in a painful experience for the child. Within the Children s Haematology and Oncology Centre (CHOC) we have been trialling another approach. The CoolSense Pain Numbing Applicator is a hand-held device that acts to cool and numb the site of injection. Once this has been used it takes only ten seconds to work before the injection can then be administered. It is simple, allergen free and immediate. The introduction of the CoolSense product has produced a better experience for CHOC patients and families by reducing pain associated with treatment, which is vital in preventing future issues related to needle placement. In addition to these advantages this system is less expensive than the use of numbing creams. Baby Friendly Hospital Initiative (BFHI) Christchurch Women s Hospital: Christchurch Women s Hospital has recently obtained the Baby Friendly Hospital Initiative (BFHI) accreditation for the 5th time receiving the best results to date. The BFHI is a global effort by UNICEF and the World Health Organization to implement practices that protect, promote and support breastfeeding. It aims to ensure that all maternity and neonatal facilities become centres of breastfeeding support. Hospitals and maternity units set a powerful example for new mothers. The "Ten Steps to Successful Breastfeeding" are the foundation of BFHI and summarize the maternity and neonatal practices necessary to support breastfeeding. A maternity or neonatal facility can be designated 'baby-friendly' when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented the ten specific steps to support successful breastfeeding. Due to the education of LMC Midwives, and women through the antenatal breastfeeding classes there are increasing numbers of women choosing donor breastmilk over infant formula. The Human milk bank in the neonatal unit which currently provides pasteurised donor milk for sick and preterm infants admitted to NICU has also raised the awareness of the importance of human milk and subsequent increased request by parents to use donor milk over infant formula. Antenatal classes continue to attract large numbers of women and their partners or support team/whanau. Numbers have grown over the past four years and the additional classes offered on a Saturday every second month have proven very popular. Successful hospital pharmacy conference: Canterbury DHB s Pharmacy Service hosted the annual New Zealand Hospital Pharmacists Association conference in Christchurch from 4-7 November. The conference was opened by Executive Director of Allied Health, Stella Ward, and Executive Director of Māori and Pacific Health, Hector Matthews, on behalf of CDHB. About 180 delegates from hospital, community pharmacy and academia took part, including 26 CDHB pharmacy staff and several of our clinicians. Several of the Canterbury team presented at the conference with three of them picking up awards for their presentations. Two of the presentations are highlighted below: Making Medicines Education Memorable focussed on work done with Children with Cystic Fibrosis, who take a range of regular medicines that varies both in number and type depending on diagnosis and symptoms. A game has been created in order to actively engage these children in education provided about their medicines by pharmacists. This game is a modified version of a well known children s board game and is customised for each child. Children are excited by the fact that they get to take their game home with them. We ve shown that all children s knowledge of their medicines was improved following playing the game with one improved from knowing the name and purpose of three out of 11 of their medicines to ten out of 11. Another presentations described the experience over the past five years of pharmacist involvement in nephrology outpatient clinics. The pharmacists attends to help provide care to this group of people s who have particularly complex needs. This involves taking medicine histories, clinical reviews, answering medicine enquiries, providing medicine counselling and medication cards. We ve found that this has meant that doctors have access Board-15dec16-chief executive s update Page 5 of 39 15/12/2016

19 to clearer medication lists, patients leave clinic with appropriate counselling and clear information. They receive this information without delay and pharmacist time is used more efficiently due to issues being dealt with immediately rather than retrospectively. FRAIL OLDER PERSONS PATHWAY The Frail Older Persons Pathway currently consists of eight initiatives working across all divisions with the aim of getting frail older people home safely as soon as possible and minimising the amount of time spent in our facilities. The initiatives all have identified measures to track improvement and identify new opportunities for improvement. Flow pathways are in place for medicine, surgery and Older Persons Health and Rehabilitation (OPH&R) service and key measures identified that will enable the Board to track over-all performance. ED use how do we compare with the rest of NZ?: Rates of presentation at the emergency department in Canterbury are lower than those experienced in all other large DHBs, sitting at 75% of the New Zealand average ED attendance per 1000 (DHB of domicile, standardised) / / / / / /16 Canterbury Total If we narrow our view to consider only people older than 65 years the pattern is similar. Over 65 ED attendance per 1000 (DHB of domicile, standardised) / / / / / /16 Canterbury Total Board-15dec16-chief executive s update Page 6 of 39 15/12/2016

20 A significant contributor to this is that more people are being supported to stay well in their own homes and that services are being provided in the community. This reserves hospital services for those people that cannot receive care in other settings. General Medicine Activity: Average daily winter admissions to general medicine is now 40 patients - up from an average of 32 in previous years. A number of initiatives have made this manageable, including increasing the frequency of on-call for each team and increasing the availability of on-call senior and junior staff to align with times of peak demand, such as in the evenings, overnight and at weekends. This has been done with minimal increase in resources, rather relying on the team working together to improve systems. Almost every day starts with a review of the hospital bed state and a request to focus on discharging, in order to enable the new admissions waiting to flow through to access the care they need promptly and efficiently. Interruptions to flow of patients from ED have been uncommon in the last two years. Occupancy levels between May and August have been higher than seen before. This level of occupancy was caused by increased length of stay and resulted in a high number of general medical patients that were overflowed into non-general medicine beds (and in many cases, to surgical beds). This may have compounded the increase in length of stay over this period, we still have more work to do to understand the causes. And despite this period of extension General Medicine has comparatively short age standardised length of stay which has reduced substantially since 2012 and sits well below national average. General Medicine and use of technology to manage the patient journey: General medicine has now rolled out FloView to cover all of the designated general medical beds (AMAU, Wards 23, 24, 27 & 14) at the Christchurch campus. The original aim of FloView was to improve patient flow through the Acute Medical Assessment Unit, but it has now become the key mechanism through which the entire inpatient journey is managed. It allows visibility of the patient s status, the criteria for discharge and the anticipated discharge date. It is a centralised record of each step in the multidisciplinary journey for the patient. Duty Managers overseeing bed capacity within the whole hospital can now see at a glance and in real time the bed situation in general medicine. It will be progressively rolled out to surgical wards and other medical sub specialities. Both electronic prescribing (MedChart) and the recording of patient observations (PatientTrack) have gone live within General Medicine. This is part of the move towards a largely electronic patient record and interface for the management of patient care. Applications such as these are expected to improve patient safety, but there have been challenges during the roll out. Clinical data is now less visible and with input and output being slower than the systems they have replaced, the new systems are having a significant impact on work flow. Supplying the clinical teams with reliable devices to access the electronic information when they need it has been problematic. These issues are currently being examined as we work on making the most of the opportunities the software brings. General Medicine Model of Care: General medicine continues to operate with the focus on continuity of care within a multidisciplinary ward based clinical team. This approach is Board-15dec16-chief executive s update Page 7 of 39 15/12/2016

21 internationally recognised as providing the best care for this patient group. The patient under a single team for their entire episode of care minimises risks associated with multiple handovers and benefits from a close-knit team approach, which is well informed about the multiple complexities that our patients typically present. We have been able to manage the increase in demand facing the team by continuously reviewing and refining our model of care and will continue to work on improving the way that we work as time goes on. Previously the high number of patients being seen during winter months has resulted in large patient lists with lengthy post-acute rounds. These volumes have presented both safety and efficiency risks. In order to address this we have implemented a third on roster prior to the winter bulge, which allowed distribution of patients to a third post-acute team on those days when admission numbers were excessive. This has ensured that teams usually had no more than 14 new patients to see, which is safer and more effective. The service has also extended the daily discharge team (GM AMAU) from a five day to a six day roster. This team now supports the post-acute teams on Saturdays, discharging those patients who are less complex. A complete review of House Officer, Registrar and Senior Registrar job descriptions and job sizing has been completed. With their agreement, this has enabled us to flex staffing within the Department to cover fluctuations in workflow between teams and to bolster support for the acute and post-acute teams without increasing current staffing levels. General Medicine together with members of the Internal Medicine Cluster, have developed a Short Notice Relief RMO position to cover unplanned sick leave over the winter period. This has transformed the security of out-of-hours RMO cover. Prior to this there were frequent gaps, providing cover for which was a constant struggle. This is a new concept and expected to be close to cost neutral. All patients referred from General Practice not requiring resuscitation are now being admitted directly to AMAU. This has reduced the workload passing through the Emergency Department. Currently, the service is debating whether a significant change to the roster or staffing levels is necessary to sustain a safe, effective service with increasing volumes.. As a demand driven service we should have more medical teams for the winter months but for a range of reasons no general medicine service does this, as far as we are aware. It is one of the options we are considering alongside increasing the community capacity in winter. General Medicine teaching programme: General Medicine provides core training throughout the year to University of Otago medical students with 5th year and Trainee Interns rotating through the general medicine teams. The Department has won the annual award for best teaching for several years. We have developed a Scenario lunchtime teaching programme for our RMOs, organised and run by our Senior Registrars. This covers common clinical emergency situations and uses equipment such as manikins to make this as real as possible. We also provide postgraduate teaching for FRACP candidates. The pass rate for the FRACP examination at this hospital is outstanding. Our reputation for teaching helps us attract top calibre RMO staff, ensuring that we can continue an improving quality and level of care for the people that require it. Long term dedication to improving care for people with acute coronary syndrome: People with chest pain or other symptoms of a heart attack are encouraged to seek medical attention urgently around 6,500 present to Christchurch ED annually. The traditional process to rule-out heart attack, also called Acute Myocardial Infarction (AMI), has required admission for up to 90% of these patients. Of these only about 10-15% are ultimately diagnosed with AMI. This means that many people are exposed to invasive testing and represents a large burden to the health system. Over the past seven years the ICARE-ACS team recognised this problem could be solved using an accelerated diagnostic pathway (ADP) that enabled the decision to rule-out AMI to be made much earlier (in the ED) rather than - usually the next day- in a ward. This has involved the team in extensive work over several years including three observational studies and two randomised controlled trials (RCTs) run within the Christchurch ED. Each study has involved multiple CDHB services including the ED, Cardiology, General Medicine, Board-15dec16-chief executive s update Page 8 of 39 15/12/2016

22 Canterbury Health Laboratories, Planning and Funding, Decision Support and, more recently, General Practice, The 24 hour Surgery, Acute Demand and Health Connect South. The observational studies provided data to change the practice of performing many different blood tests for detecting AMI and replace this with a blood test for a single biomarker (cardiac troponin). The data also informed the development and predicted the likely efficacy of a future ADP. The first RCT provided the evidence to enable immediate implementation of an ADP within the ED which nearly doubled the proportion of chest pain patients who could be sent home from the ED within 6 hours. Christchurch became the first ED within New Zealand and possibly the world to make a chest pain ADP standard practice. A second RCT then demonstrated improved the identification of low risk patients. Early rule out of AMI is now possible in approximately four times more patients than before the project began. Ultimately, the project has resulted in safe and earlier discharge back to primary care for many more patients, reduced patient anxiety, mitigated ED overcrowding, and reduced unnecessary admissions and healthcare spending. The success of the Christchurch experience led to a Ministry of Health (MoH) initiative to implement an ADP for suspected ischemic heart disease into the Regional Service Frameworks. The ICARE-ACS team has been involved supporting and monitoring ADP implementation throughout the country and is currently planning the next iteration of the ADP within Christchurch and four regional hospitals. Flow pathways are in place for medicine, surgery and Older Persons Health and Rehabilitation (OPH&R). During recent months, we have seen a slight increase in admission of elderly people (although not as high as 2015) with an adjustment to its model of care. OPH&R are working through the benefits of an electronic Journey Board (FloView) on some wards with plans for each patient including establishing expected day of discharge (EDD) and Clinical Criteria for Discharge. (CCD). This has proved successful making visible the patients hospital journey. The process of introducing the Assertive Board Round process which has resulted in patients having an EDD set with input from the interdisciplinary team within 48 hours of their admission. By being able to make daily decisions regarding the patient s needs, the interdisciplinary teams are more responsive resulting in appropriate patient discharges. The success of the assertive board rounds has also resulted in more concise weekly interdisciplinary meetings which provide opportunity for greater in-depth discussion and problem solving of our more complex patients. A new Medical Registrar role has been established for the surgical wards, to support the management of elderly surgical inpatients from a medical perspective. Surgical house officers, registrars, nursing staff and allied health teams have all reported improvement in their medical knowledge and patient care planning since the role commenced. ENHANCED RECOVERY AFTER SURGERY Working across the system the team has identified additional opportunities in the patient pathway. New work has started to look at the pathway for patients who are unable to stand on their own i.e. non-weight bearing to ensure they are managed at the right place, at the right time by the right person. Total Hip and Knee replacement (Elective surgery): The key objectives the team set on this ERAS pathway were to reduce the time a patient spent as an inpatient post-surgery and to improve the patient experience by making the patient a partner in care. Result we significantly reduced the patient time in hospital by revising the expectation of patients. Where clinically safe to do so, we simply advised that the patient would be able to return home after a hospital stay of three nights/four days. The change in language, behaviour and expectations around length of stay for joint replacements is now embedded. Other pathway changes have included: pre-operative education; pre-operative carbohydrate drinks which help improve the patients nutritional status to achieve best possible outcome and support their recovery from surgery; Board-15dec16-chief executive s update Page 9 of 39 15/12/2016

23 non-opioid analgesia which has fewer side-effects and faster recovery for patients and getting patients up and moving on the day of surgery. Changes made have resulted in an increase of 26% (from 52% pre to 78% post introduction of ERAS) in the number of patients returning home earlier and being cared for in the community. A patient information and work book was developed to help keep patients informed throughout their journey and manage expectations. Patients are actively participating in their recovery. This is supported by the further drop in our balancing measure of readmission rates, which shows that our focus and clinical practice is on track. REDUCING THE TIME PEOPLE SPEND WAITING Medical & Surgical and Women s & Children s Services Faster Cancer Treatment - 62 Day target: Canterbury DHB submitted 99 records to the MoH during July, August and September During this period 75% of our eligible patients were treated within 62 days, an increase of 3% compared to the 3 months June to August. 31 Day Performance Measure Canterbury DHB submitted 390 records during July, August and September. This figure includes patients also eligible for the 62 days target which is consistent with the MoH definition. During this period 87% of our eligible patients met the 31 day measure, up from 85% for the 3 months of June to August and therefore we again met the target of 85% compliance set by the MoH. Head and neck pathway (joint project with Nelson Marlborough DHB): The patient pathway for head and neck patients which was developed in Canterbury has been reviewed by NMDHB who have comprehensively mapped their own processes. We have agreed that we will now together review both maps to clarify how the pathways differ and then look for Best Practice. Particular attention will be targeted on patients treated out of their DHB of domicile; treatment for this group of patients can pose extra challenges as the distances involved mean they are often separated from their families and friends while having treatment. We ll work on this together before the end of Elective Services Target Outcomes: Preliminary reports from the Ministry of Health show that: At the end of September we are red status for ESPI 2. This is the first month in red after a run of yellow months. We had 65 patients waiting for longer than the MoH target that no patient will wait for longer than 120 days for an FSA. At the end of October we are red status for ESPI 5, for the third month in a row. We had 135 patients waiting for longer than the MoH target that no patient will wait for longer than 120 days for surgery. We have put in place a range of measures both within our own services and through outsourcing to return to yellow for ESPI 5 at the end of November. The 100 days team has been providing support for services to reach compliance with 100 days wait limits, this work is moving from sitting with a project team into business as usual. We have set the challenge that all services will move to be green at 100 days by May Many services are regularly successful at achieving this goal already and so this is the right time to see this as our usual maximum waiting time. We are putting in place opportunities for services to seek support from EMT, ensuring that as a system we are accountable for achieving this goal. Board-15dec16-chief executive s update Page 10 of 39 15/12/2016

24 Virtual reality and MRI managing patient anxiety: Recently Radiology, with the help of the Human Interface Technology Laboratory New Zealand (HIT Lab NZ) and the University of Canterbury have been validating the use of Virtual Reality (VR) in MRI. A VR MRI service was created to determine the patient s anxiety associated with upcoming MRI and to better prepare the patient before they leave the ward or their home. The key benefits associated with this are being able to detect anxiety that will require intervention. Some patients who indicated that they would experience significant anxiety change their mind following the VR experience. Other patients that are not bothered by the loud noises and enclosed space can be caught offguard in the early stages of the scan which leads to patient s movement and non-diagnostic quality images. Preparation via VR can avoid this. A recent US study estimates that motion artefacts lead to about $115,000 USD of lost potential revenue per scanner per year which in NZ would translate to wasted resource. VR providing significant benefit in MRI and we are working to share these benefits to patients in other areas of the hospital: Pain relief Immersion in VR has been proven to provide effective analgesia. Distraction Immersion has the ability to transform patients to new surroundings helping them to be fully distracted from their current situation. VR is a new experience for many and we have been able to make people laugh and smile while they are in very dark stages of their treatment. Nurse prescribing set to change the way that we provide some outpatient services: From September 2016 registered nurses with specified post graduate qualifications and experience are legally able to prescribe a designated range of medicines. Most nurse prescribers will work in inter-disciplinary teams. We have identified criteria to prioritise areas for nurse prescribing. One priority is to address settings where patients wait a long time for a doctor to prescribe. The breast service is one such area where women can wait up to an hour for an RMO to complete the prescriptions assessed as necessary by the nurse-led service. A plan is in place to support nurse prescribing training in this service over the next two years. Other areas have been identified as priorities and further exploration is required. We expect to be able to provide care in a way that reserves Medical capacity for tasks that only doctors can carry out, thus improving the time that patients spend waiting both while at clinic, and while waiting for a clinic appointment. General Medicine Outpatients: A refined triage system has been developed to ensure compliance with the 100 day initiative. For those patients not needing to be seen, detailed management advice is provided as a virtual consultation. In addition to General Clinics a number of speciality clinics have been created within General Medicine to support targeted services to people with a range of conditions. These are: Heart failure is the commonest trigger for medical readmissions, irrespective of the original admission diagnosis. Together with Cardiology/University of Otago we are researching and developing integrated inpatient and community care packages to reduce this. As part of this we have a dedicated Heart Failure clinic with particular expertise at managing heart failure in the setting of complex medical problems. Hypertension is a very common condition without a clear pathway for those who cannot be easily managed in the community. Setting up a Hypertension Clinic, has quickly become an important and busy part of our department s outpatient service. Rapid Response Clinics offer an alternative to admission for acutely unwell patients who need to be seen urgently but might not need admission, avoiding what might otherwise be an overnight stay. The Funny Turns Clinic provide a diagnostic service for a common problem which can turn out to be anything from a simple faint through to (transient) cardiac arrest. Cardiology Department transcription turnaround times: The Cardiology administration team has shown consistent efficiency in their transcription times over the last 6 months. A Board-15dec16-chief executive s update Page 11 of 39 15/12/2016

25 standout performance was the month of October when average transcription completion time was less than one day Average Days to Completion of Transcription 0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Cardiology CDHB The key to this performance is team work. The admin team sees its role as a vital part of an integrated health system. Rapid turnaround times for transcriptions improves communication between the multidisciplinary cardiology team, other specialist services and primary care. Members work together as a team, continuously keeping an eye on workload and how they can support one another to manage the daily variation in workload. The benefit to the service is improved response times, reduced uncertainty and decreased stress. This plays a direct role in delivering a high quality cardiology service. This is achieved in one of the busiest specialist services delivering over outpatient appointments and 6000 inpatient admissions per year. The Electives Health Target report from the Ministry of Health shows that at the end of September CDHB was running slightly behind its agreed target. Internal reports are showing that, as at the end of week 19 (4th November), this deficit has not been corrected. All outsourcing contracts are in place and have begun to deliver. Internally, services are providing an updated indication of their expected elective discharges over the coming months so that we can assess whether further planning is required. Integrated Respiratory Nursing Service (IRNS): In May 2016, following extensive cross sectoral discussion, we have started work on developing the Integrated Respiratory Nursing Board-15dec16-chief executive s update Page 12 of 39 15/12/2016

26 Service. There are currently three separate services providing specialist community based respiratory nursing. There is the potential for duplication of services within this model, which is confusing for both patients and refers. The development of clear pathways will prevent this and ensure timely appropriate care is provided. The IRNS will provide Respiratory Nursing care for patients within the Canterbury region, including as far north as Kaikoura and South to the Rakia River. The services involved are, CanBreathe, Community Respiratory Nursing and Cardio Respiratory Integrated Specialist Services (CRISS). The working group is made up of members from these three services. The working group reports to Integrated Respiratory Services Development Group (part of the Canterbury Clinical Network), ensuring that their recommendations for service innovation are endorsed by this group. The development of this new integrated service will ensure seamless care for this group of patients, with clarity as to who is best suited to see the patient. The IRNS will provide a short term intervention, engaging with general practice to ensure ongoing care is in place when the patient is discharged from IRNS care. The nurses from IRNS will provide education to Practices and Residential care to enhance their knowledge and skills in regard to caring for patients with a respiratory diagnosis. Women s Health Consumer Engagement: Canterbury has a changing population and we are becoming more diverse. Noticeably we have a growing Maori and Asian population, and the aftermath of the Canterbury earthquakes has meant we now have a large migrant population due to the Canterbury rebuild. Ensuring we have active consumer representation to mirror our changing population will be one of a key priorities for maternity services this year. We will also focus on our at risk women, for example, young mothers and women with mental health issues, who have historically not been well represented. Our strategies will include use of community groups, social media and development of apps (applications) to make information more mobile friendly and therefore accessible, easier to download and view for women. Our changing population means that we also need to review the information available to women that are not English speaking. Strategies will involve engaging with community groups and primary health, i.e. LMC s and GP s to further develop and enhance paper-based and on-line information. We will look at smarter ways to gain feedback from consumers that will help to drive our quality improvements. Improving our Information for Women: We welcome the birth of the Canterbury Maternity Community (CMC) Facebook page which launched on 25 October 2016 as one of the initiatives around improving consumer engagement for the maternity services. It is a project led by Sam Burke the MQSP coordinator, administered by Maternity consumer representatives and endorsed by the CDHB communication team, who also hold administration rights. An ideal platform to share what is going on in Maternity across the sector and an opportunity to receive feedback from our community. ED Adult Acute Pain Guidelines: The ED Pharmacy Committee met with representatives from SARA and the Opioid Collaborative Team to discuss the transfer of patients with appropriate analgesia charted. Doses used in ED are higher than that advocated by the Dosing Guide for Acute Pain used in the surgical division. This resulted in the development of a guideline to standardise opioid dosing in ED and what should be charted to help facilitate the transfer of patients to the wards. Prescribing in ED for patients transferring to SARA is aided by the provision of stamps which follow the pain guidelines used in the surgical division. This ensures patients are receiving optimal and safe pain relief. College of Intensive Care Medicine Accreditation Inspection: Christchurch Hospital recently received a visit, reviewing our accreditation to participate as a facility in the training scheme for intensive care specialists. The overall comments from the College were favourable and we will retain accreditation for training. The auditors were positive about the team leadership and training environment, supervision of training and future planning including the current expansion and the ASB. Some concerns were also raised that require addressing. Our participation in this scheme is key to the sustainability of our SMO workforce in intensive care. Board-15dec16-chief executive s update Page 13 of 39 15/12/2016

27 The ability to access high quality trainees that understand the local environment is a key component to providing good care to our sickest patients. Specialist Mental Health Services (SMHS) Occupancy of the adult acute inpatient service decreased from 94% in October 2016 to 91% in November There were 15 sleepovers required in November 2016, of which five were for patients waiting to be formally admitted to the Tupuna unit. Demand for Crisis Resolution remains steady. There was an increase from 224 new crisis case starts in October 2016 to 249 in November New crisis case starts require an assessment and response within a day of referral. Recruitment into Crisis Resolution is currently challenging putting additional pressure on an already busy team. We are also experiencing challenges recruiting SMOs into mental health. There are a number of vacancies and locums across the services, we expect this situation to remain challenging until mid by which time it is anticipated a number of permanent appointments of overseas psychiatrists will be in post. The service is exceeding national targets with respect to wait times for adult SMHS. The targets are 80% of people seen within 21 days and 95% within 56 days. In November 97.7% of people referred to the Adult Community Service were seen within 21 days, and 99.9% were seen within 56 days. The percentages were 94.0% and 98.7% respectively when other adult services i.e. Specialty, Rehabilitation and Forensic are included. Our focus on reduction of seclusion in Te Awakura (Acute Inpatient Service) continues. Three consumers experienced seclusion during November 2016 for a total of 34.9 hours. This is a positive result considering the high acuity and occupancy challenges Total Te Awakura seclusion hours (Te Awakura patients only) 800 hours Jan-11 May-11 Sep-11 Jan-12 May-12 Sep-12 Jan-13 May-13 Sep-13 Jan-14 May-14 Sep-14 Jan-15 May-15 Sep-15 Jan-16 May-16 Sep-16 Board-15dec16-chief executive s update Page 14 of 39 15/12/2016

28 25 Total Te Awakura patients secluded Jan- May Sep- Jan- May Sep- Jan- May Sep- Jan- May Sep- Jan- May Sep- Jan- May Sep- Child, Adolescent and Family (CAF): Reducing wait times has been a key focus for CAF services. National targets require 80% of young people to be seen within 21 days and 95% within 56 days. Our results for November 2016 show that 57.9% of people were seen within 21 days and 92.7% within 56 days. The number of CAF new case starts for November 2016 was 212 compared to 160 for October Our wait time management and service delivery model are heavily influenced by an initiative called CAPA (Choice and Partnership Approach). CAPA was designed in the UK and has been progressively implemented across NZ over the last 10 years. CAPA had been used differently across our CAF teams. Currently 68.4% of Child and Adolescent North (CAN) clients waited longer than 8 weeks between Choice and Partnership appointments and 77.8% of Child and Adolescent South (CAS) clients waited longer than 8 weeks. The recent reorganisation of services across CAF marked a huge step forward in the CAF service plan to improve the way we are working to ensure children and young people have access to the care they need. The service has undergone significant growth over the past 15 years, which accelerated after the quakes. In recent years, it has become apparent that the individual components of the service that developed, somewhat independently of each other, need to be drawn closer together to ensure smooth clinical and administrative processes and efficient use of resources. The changes have been designed to complement and support the full range of services provided by CAFs and are intended to ensure an integrated, flexible, accessible and efficient service delivered sooner and more conveniently to the young people of Canterbury and their families. It includes the full implementation of CAPA along with a range of other initiatives such as development of a kids in care pathway for young people in CYFs custody and an under 5 s pathway. Regular updates will be provided in this report over the next 12 months. Board-15dec16-chief executive s update Page 15 of 39 15/12/2016

29 Average Waiting time (days) Jan-10 Average Time (days) from Referral to Case Start for Child, Adolescent & Family Mental Health Service Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Child & Youth Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Linear (Child & Youth) Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 Demand for Specialist Mental Health Services: The SMHS divisional leadership team and Planning & Funding continue to closely monitor demand for SMHS. New case starts for adult services appears to have stabilised, albeit at a higher level. Demand for Child & Youth Services however continues to increase. We are proactively planning to ensure services continue to be available with ongoing service improvements required to ensure our mental health system continues to flex and adapt to the changing needs of our community. We are working closely with other government agencies with the aim of ensuring complementary programmes are well coordinated and information and learning is shared. High demand and capacity constraints are however impacting our ability to participate in some initiatives. The School Based Mental Health Team: The Team continues to engage with a large number of schools across Canterbury and at end November 2016 are working with 112 schools. The ongoing focus is to help schools identify the mental health support needed for their population and meet these needs through workshops, pastoral care meetings, learning and development activities for staff, and liaison and engagement with other agencies. In response to the additional mental health funding received from the Ministry earlier this year, three new staff have joined the team and are orienting to their roles. Two planning days have been held and the team are now operationalising the direct service delivery component. The Team has also been busy providing support to North Canterbury and Kaikoura schools in the wake of the Culverden earthquake and this assistance has been highly valued by all schools they are supporting. Accommodation and Housing: The number of consumers in our four acute wards who require accommodation continues to fluctuate. The situation is monitored on a monthly basis and data from the last 12 months indicates a range 12% to 34% of inpatients requiring accommodation at any one time. The year to date average for 2016 is 22.5% of inpatients requiring accommodation in the community at any one time. The majority of those waiting for supported accommodation in the adult inpatient service during 2016 will have been undergoing and extended period of care and rehabilitation at Seager Clinic in preparation for discharge. Seager Clinic, Tupuna Villa and the 2 intellectual disability wards provide care for many consumers with high and complex needs for whom securing suitable accommodation is a pivotal part of discharge planning. Plans for discharge are at various stages of development for all consumers in these units based on need and complexity. Watch House Mental Health Nursing Role recognised. Two mental health nurses (Neil McNulty and Steve Howie) were awarded District Commander s Commendations at the annual Police awards last week. The Commendation is awarded to Police sworn staff, Police employees and members of the public who have made significant contributions to the New Zealand Police and/or the community or who have exhibited acts of bravery or selflessness that the Police District Commander wishes to acknowledge. The nurses received the award as founding Board-15dec16-chief executive s update Page 16 of 39 15/12/2016

30 members of an initiative between Canterbury Police and Canterbury DHB in which dedicated mental health nurses work alongside Police in the custodial area of the watch-house. Men's Health for a Staff Wellbeing Forum for Christchurch Police. Bryan Geer, Clinical Nurse Specialist, gave a presentation to Christchurch Police and attended by Canterbury District Commander, Superintendent John Price on the importance of taking care of ourselves and those we work with. Bryan provided a broad range of strategies to achieve this. This is a great example of inter-agency collaboration and support. Older Persons Health & Rehabilitation Adult Rehab review: To enhance the adult rehabilitation journey through the CDHB by: improving service pathways and transfer of care points to and from services that interface with Older Persons Health and Rehabilitation (OPH&R) division. The primary focus for this work will be services for those aged years or close in age and interest (noting some services have varying age parameters). We will develop a strategic plan and governance structure for ongoing service management for Adult Rehabilitation patients in the CDHB. We have a number of aspirations in this piece of work: Define an overarching model of care for adult rehabilitation services within the CDHB. Agree and implement outcome measures across the pathway. Have a single referral point for adult rehabilitation needs. Have an enhanced/ optimal journey for all adult rehabilitation patients in the CDHB. Have an agreed overflow pathway for adult rehabilitation patients in the CDHB. Enhance working relationships at transfer of care points for rehabilitation providers in Canterbury. Enhance the patient experience strategy within rehabilitation services in the CDHB. Review in-reach models of care related to rehabilitation services. Work to date includes: OPH&R have released its final consultation document for their leadership framework, introducing revised clusters of services, nursing leadership, allied health leadership and organisational response to embedding the models of care in Burwood. Feedback closes on the 15th December with a decision being finalised this year to implement in the New Year. Focus continues on the community team hub and spoke model with focus on identifying the location for a central hub to bring together the service delivery model of care closer to home principles in partnership with those community provider and primary health. Board-15dec16-chief executive s update Page 17 of 39 15/12/2016

31 Laboratory Services Efficiencies through reorganisation of logistics: The Canterbury Health Laboratories Customer Services team have modified their process for supply of pathology consumables. CHL support many health providers and commercial clients for a variety of testing protocols. Historically this has involved collecting supplies from individual locations and packaging them ready for the courier at the main lab site. Post the earthquakes this team was moved further away from the main lab site, creating inefficiencies with the process. A space was identified at their new location where stocks could be held, creating better visibility and reducing time spent in motion to collect items. Arrangements have been made for the courier company to pick up from their new site as well, meaning the system is now contained all within one location. Vitamin D in dried blood spots: Vitamin D is crucial for calcium metabolism and bone health, and assists the normal functioning of the immune system. A new mass spectrometry based assay has been developed to quantify 25-OH-Vitamin D3 and 25-OH-Vitamin D2 in dried blood spots, such as those obtained from neonatal blood spots. The assay has been validated in two pilot studies and applied to a large subgroup of samples from the Growing Up in New Zealand (GUiNZ) study in Auckland. This assay has brought in external funding to CDHB in and further studies are planned with Massey University as well as analysis of the full GUiNZ cohort. The method is currently being written up for publication. This work represents the innovative approach CHL is providing to support to clinical research around NZ. Bone Marrow reporting system live in October: Canterbury Health Laboratories has introduced a new electronic module for bone marrow and trephine reporting. The Haematology Department routinely performs approximately 500 bone marrow and trephine biopsies per annum for Christchurch Hospital and Greymouth providing a full diagnostic and staging service. These are reported by Clinical Haematologists and Haematology Registrars. The new Sysmex Delphic Anatomical Pathology reporting module replaces the previous paper based system. This permits the Haematologists and Registrars to directly input and authorise results electronically, reducing potential for transcription error and improving bone marrow and trephine reporting efficiency. Pathologist Appointments: Dr Wendy McBurnie has officially accepted her offer of employment as a Consultant Anatomical Pathologist and will start in her new position on the 19 December. Dr Burnie has been a Registrar at the CDHB, and we look forward to her making the move up to Consultant. Dr Frederica Loghides has now also commenced with the department as well. Direct Acting Antiviral Therapy for Hepatits C: The introduction of DAA (Direct Acting Antiviral) therapy for the treatment of Hepatitis C will have an impact on laboratory services. Increasing requests for anti-hcv screening (HCV Ab), Hepatitis C viral load (HCV VL) and in particular Hepatitis C genotyping are already occurring with a 250% increase in genotyping in the first 4 months of this financial year. The current Pharmac funded DAA is only suitable for Hepatitis C genotype 1, with no funded treatment available at present for the other genotypes. Both the Hepatitis C viral load and Hepatitis C genotyping required for diagnosis, are molecular assays requiring specialised equipment and scientists. Correct laboratory identification of treatable individuals is paramount to the success of the treatment regime and the laboratory needs to be included in all decision making in the roll of out of new treatment regimes. Requests for data from the Ministry of Health are both on going and retrospective. Board-15dec16-chief executive s update Page 18 of 39 15/12/2016

32 Hepatitis C volume per test HCV genotype HCV VL HCV Ab 14/15 15/16 16/17 (corrected) Laboratory clinical Involvement strategy: Microbiology has introduced a new strategy promoting clinical interaction between both the clinical teams and the laboratory. Microbiology registrars are now stationed in each of the two main areas of Microbiology, Bacteriology and Virology/Serology enabling laboratory scientist s rapid access to any queries regarding patient testing. This link to clinicians via the registrars provides faster information regarding the most appropriate testing for our patients already resulting in a decrease of inappropriate testing and ensuring that the testing provided adds value to the patient journey. Robert Michel, Dark Daily: CHL hosted Robert Michele, Editor for the Dark Daily, international commentator on Pathology and Laboratories and diagnostics. The focus of this forum was around the future of diagnostics within the Canterbury Health System, incorporating informal discussion and sharing of perspectives for both Radiology and Laboratories and what is happening locally and the identified trends internationally (Robert Michel). The forum highlighted some commonality in some areas of which Radiology and Labs could work closer together and we will pursue that further in the New Year. Leadership Appointments: Three long awaited appointments have been made to the CHL Leadership Team: Bronwyn Marshall joins the Patient & Client Services Team as the Customer Relationships Facilitator. Greg Devane has been appointed to the Service Manager Anatomical Pathology and Genetics. Greg has been covering this role for the past 11 months. Jill Westgarth has accepted the position of CHL Operations Facilitator. This role will see Jill focus on a number of lab wide key projects and operating support functions for the CHL Leadership group. Ashburton Health Services Ashburton Hospital is on track for the move into the new Acute Assessment Unit and Day Procedure Theatre on the 7th December. During November we have completed the blessing and were well supported by the community with more than 430 people attending our community open day on the Sunday 27th November. The unit was open between and 2.00 where the local leadership team took groups of approximately 20 people at a time on a tour of the facility. Staff who will work in the unit volunteered their time to talk about their station on the tours, with the additional fun of all visitors required to wear surgical booties to protect the floor as we were still considered a building site. The staff felt much supported by the CDHB with the presence of David Meates, who joined in our effort engaging with the queues of people lined up down the hall, waiting for their turn to look at the unit. The community feedback was Board-15dec16-chief executive s update Page 19 of 39 15/12/2016

33 very positive, with many comments about how lucky Ashburton is to have such a well-equipped modern unit available for their community. Throughout the community open day we took the opportunity to share the key messages of care around the clock and call your GP first. This was a great opportunity to have the discussion and clarify any confusion and support a message of confidence that a clinical person is available to provide advice on when to come into the Acute Assessment Unit or when to wait and contact your General Practice the next day. We also took the opportunity to communicate some key messages regarding visiting hours for inpatients. The hospital has had a number of mixed messages about visiting hours and we have streamlined these to support a more secure approach to who has access to the hospital overnight. Visitors are encouraged to complete their visit by 8.00pm, supporting patients to have time for rest. We anticipate it will take until 9.00pm for the visitors to leave the hospital and will continue to have reception staff in place until this time to support the Duty Nurse Manager and clinical teams. We welcome close family /whanau to visit anytime but have asked that they check with staff first. With the new unit we are able to provide a controlled access to the hospital after hours, providing a much more secure environment for patients and staff. The front door of the hospital will closed from 8.00pm, with clear signage directing all presenting patients or visitors to enter the hospital via the Acute Assessment Unit. This ensures that the Duty Nurse Manager and AAU team are able to support access into the hospital that is appropriate, staff are able to see presenting patients and family as they present, but can control access into the unit itself. To ensure the security of all patients and staff we may limit friends/support people from coming in to the hospital after hours particularly if they are under the influence of alcohol or drugs. We also have cameras on the front entrance of the hospital and will be monitoring to make sure no one has been dropped off at this entrance by mistake The Acute Assessment team will move on the 7th, the theatre staff and service delivery will move in on the 21st December, with the first list delivered in the new facility on the 23rd January. This will give time for teams to embed working together in a new environment. The DON and CD will co-facilitate a weekly huddle with the combined team from the 7th December, reviewing what is working well, what are the current challenges and proposed solutions. With the completion of the new unit, our focus remains on the refurbishment work underway for Ward 1, Medical Day Stay and Ward 6. Our projected date of completion for all refurbishment and relocation remains May 2017 Improving the acute flow within the hospital continues, utilising the quality improvement and learnings that we uncover through Releasing Time to Care. Specific work is underway on improving our recording of the patient journey to ensure we accurately reflect this the PMS. To support we are piloting a clerical officer role based in the acute assessment unit between 7.30am and 8.30pm daily. The pilot will enable us to identify the opportunities to reduce the administration burden on clinical staff, in particular nursing. The roles are designed to support patient flow and provide the administration for the patient journey throughout the hospital and are not limited to AAU component only. Releasing Time to Care continues to provide a strong platform for quality improvement and reducing waste in our system. On November 16th we held our third workshop, Patient Status at a Glance with representation from across the hospital. This will enable us to build on the initial work in acute flow, adding in specific tools such as the Assertive Board Round. Board-15dec16-chief executive s update Page 20 of 39 15/12/2016

34 INTEGRATING THE CANTERBURY HEALTH SYSTEM Acute Demand Management There continues to be strong demand for the Acute Demand Management Service, with total referrals in October up 11% on the same month last year. While referrals are up, the program remains within budget indicating smaller average size of each package of care. We are working to better understand this. We are continuing to work with the Acute Demand service to develop standardised reporting practises, and have been making good progress in this area. Pegasus and the DHB have agreed that these reporting issues will be given priority to ensure they are substantively resolved by early This will help us to better understand the needs of the patient cohort and enable us to better target the services provided. It will allow evaluation of pathway and cohort effectiveness in terms of hospital avoidance. Integrated Diabetes Service This quarter, the Integrated Diabetes Service received the six-monthly amalgamated data from all three Canterbury PHOs, laboratory and retinal screening. This report provides the service with a picture of diabetes prevalence across the region. The service also evaluated agestandardised data reflecting the Māori, Pacific and Indian populations and their diabetes prevalence. It is clear that these populations experience poorer diabetes self-management and access. Summaries were provided to General Practice teams comparing their patient data with the region, along with a summary of the Diabetes Care Improvement Package (DCIP) funding utilisation across all practices. The Integrated Diabetes Services continues to support strengthened links across specialist, primary care and community providers. Activities continue to focus on improvement opportunities and development of services closely aligned to the national 20 Quality Standards for Diabetes Care. Activities underway include: Education to be delivered by a variety of clinicians in a variety of settings, increasing clinician and patient understanding. A reinstated working group overseeing the High Risk Diabetic Foot (podiatry) programme is supporting the PHOs in service design and delivery. The group has revised the contracts with community podiatry providers to align with national standards, whilst ensuring service delivery is within finite PHO resources for high risk diabetic foot assessments and treatment. The retinal screening working group is progressing planning for the relocation of the hub, as there is no capacity in the new Outpatients building. The IDSDG continues to develop the dataset to provide insight into the diabetes population. The team is working with business analysts and the Māori Health team to ensure data collected is relevant and useful to support planning. The aim is to improve service delivery to Maori and Pacific populations in particular, with other cultural groups also being supported. Pharmacists in the Community Stakeholders from across the Canterbury health system have completed work on designing more integrated pharmacist care for the priority populations of frail elderly, people with mental health issues, vulnerable children and those with chronic conditions. They recognised that pharmacists in the community are well placed to help people improve their health literacy and thereby their capability to better self-manage their health. Most groups recommended offering people the Board-15dec16-chief executive s update Page 21 of 39 15/12/2016

35 option of registering with their preferred community pharmacy, supporting greater continuity of care and better recognition of their pharmacist s role in their wider care team. These and other recommendations will influence the development of future shared care and pharmacist service funding arrangements from Local general practices and pharmacies now have access to the New Zealand Electronic Prescription Service (NZePS). This service enables the electronic transmission of prescription information from general practices to pharmacies aided by paper prescriptions with unique barcodes. The benefits of this service include reducing the chance of pharmacist transcription error, allowing prescribers to easily communicate the clinical reasons for a medication change and lets prescribers monitor fulfilment of the prescription. It will also in time make controlled drug triplicate prescription forms redundant. A small number of Canterbury practices and pharmacies are now beginning to use NZePS. Others are expected to adopt NZePS over the next two years. SUPPORTING OUR VULNERABLE POPULATIONS Older Persons Health National Health of Older People Strategy - Canterbury Community Services Redesign: The Community Services Redesign proposal has been socialised to a range of DHB committees and groups. We are now working on a prioritisation programme to identify and improve functional processes required to support implementation of the service redesign. Mental Health Mental health services are responding to current demand and are participating in new cross sector initiatives, such as Children s Teams and Integrated Family Safety Response. The capacity due to the additional funding is supporting the system to cope and the priority remains on children and families. Following the 14 November Earthquakes, distress in the affected populations in apparent, we have seen a rise in calls to the 0800 earthquake support line. The Mental Health Line, Depression Line, Healthline have also reported an increase in calls not only from Canterbury but also across the upper South Island and lower North Island. The rural community mental health team is active in Kaikoura, seeing existing mental health patients and those identified as vulnerable or at risk. Our services are also providing additional support to the North Canterbury communities following the earthquakes. Additional supports include psychologists at Waiau and Kaikoura. Primary Care Free Care for Under 13 s: Historically, in-hours General Practice utilisation in Canterbury has been lower than national averages. This has continued following the change to zero fees for under 13s, however there has still been an increase in visits to General Practice by this age group, during opening hours, which is in line with a national increase. All General Practices in Canterbury continue to offer zero fees for under 13s for their enrolled patients. While there was a higher uptake of the free after hours initiative for 6-12 year olds than anticipated in response to the winter illness peak, this steadied through the remaining 3 quarters of and has not been repeated in quarter one There has been a slight reduction in presentation volumes in the 0-5year old age group at the three large after hours providers (24 Hour Surgery, Riccarton Clinic and Moorhouse Medical Centre) consistent with a service that has been in place for several years. Board-15dec16-chief executive s update Page 22 of 39 15/12/2016

36 Enhanced Capitation: The Enhanced Capitation initiative provides flexible funding to general practice to enable improved coordination of the care of patients with complex health and social needs. For the patients, coordination of care translates to support in navigating the health system with a better understanding of how to manage their own health. A transition group including the PHO s, CDHB and Canterbury Clinical Network, is monitoring the implementation for the first months and will address any unexpected issues that arise. System Level Measures Framework: From 1 July 2016, a shift from the Integrated Performance and Incentive Framework (IPIF) to a value and performance framework has been implemented. For 2016/17, the Canterbury Clinical Network (CCN) Alliance developed an Improvement Plan that included locally agreed milestones and a set of contributory measures for the following four system level measures: number of acute hospital bed days per capita; ambulatory sensitive hospitalisation rates for 0 to 4 year olds; patient experience of care; and amenable mortality rates. This Improvement Plan for has been approved by the Ministry who have asked for it to be provided to other DHBs as an exemplar. Work is continuing on the communication of the System Level Measures with the relevant work groups, service level alliances, and specialist groups to enable their support of actions that contribute to progress against the current measures. We are in the process of considering our response to the two new measures for ; the Babies in Smokefree Homes and Access and Utilisation of Youth-Appropriate Health Services. Primary Care Health Targets Canterbury s quarter one result against the Better Help for Smokers to Quit primary care target, improved 1% from the previous quarter to 89%. Activities that support this target include: Christchurch and Rural Canterbury PHOs are funding health checks for newly enrolled patients; these include delivery of health target activity, as required. Pegasus s outreach team provides additional assistance to practices for the delivery of brief advice and/or cessation support. PHOs continue to provide practices with their results benchmarked against the PHO results and support to actively recall and engage their hard to reach patients. The More Hearts and Diabetes Checks target has been replaced as a national health target in 2016/17 with the Raising Healthy Kids health target. Performance will continue to be monitored and we remain focused on reaching the national performance target. Maori and Pacific Health The Māori Health educator has had a busy period delivering training across the CDHB. In addition to Tikanga Best Practice workshops, training on the Treaty of Waitangi to 31 staff as well as supporting family violence workshops with 95 social work and nursing students exploring Māori perspectives when dealing with whānau violence. The Māori health team at Christchurch Hospital, Ngā Ratonga Hauora Māori along with staff from Te Korowai Atawhai (Specialist Mental Health Services) were able to come together recently to support the blessing and the turning of the soil ceremony for the new HREF building site. Board-15dec16-chief executive s update Page 23 of 39 15/12/2016

37 The Christchurch Hospital supported whānau accommodation facility, Te Whare Mahana, has now settled in at its new location, at 384 Selwyn Street. The original facility had to be relocated to accommodate the ASB construction and moved to leased rooms at the YMCA. Moving to Selwyn Street has meant a significant saving in lease costs. Māori Health staff have been developing an information brochure for the Te Whare Mahana facility at 384 Selwyn Street which will be sent to all DHBs/National Travel Assistance offices who may need to send patients to Christchurch hospital for care. The Māori Health staff are now operational in Health Connect South; training has just been completed and patient notes can now be entered into the system electronically by Māori health staff. Until the CDHB goes completely paperless there will remain a requirement to write interactions in the patient notes. Ongoing review will be conducted to ensure consistent and accurate notes are maintained. Te Komiti Whakarite, which supports research applications at Christchurch Hospital, has processed 13 applications for Māori consultation in the past quarter. This assistance to research applications ismurray c very much appreciated by colleagues, given the mandatory requirements to have Māori consultation for all health research. Tamariki Ora service: The Tamariki Ora service that we fund through our kaupapa Māori provider, Te Pūāwaitanga, have just appointed a new registered nurse who has begun her Well Child training. This role has been partly supported by the CDHB Māori workforce development funding and will contribute to the sustainability of the Māori Tamariki Ora workforce. Referrals at the end of October for the Tamariki Ora service are higher than in any previous year. At 422 new people as at the end of October. The service is currently 120% over the contracted volumes of 350, with two months of the year still to go. The majority of clients in this service, 80%, are needs assessed as high need long term, meaning Te Pūāwaitanga are required to deliver the seven core Well Child/Tamariki Ora visits plus as many as 10 additional contacts. With an oversubscribed service Te Pūāwaitanga acknowledges this creates safety concerns for client and staff as the presenting issues of the high need client requires more time per client to be addressed. The remaining 20% of clients are assessed as high need short term, a cohort that also requires additional visits beyond the seven core visits. Early Start Programme: Early Start is an intensive home visiting service for whānau/families with new-born babies where difficult situations have the potential to negatively impact on the life chances of children in their care. The programme encourages and supports whānau/families to provide each of their children with a positive and enjoyable childhood experience. Early Start uses a planned, focused and systematic approach to intervention to enable enrolled whānau/families to: To learn and apply nurturing parenting practices To discover personal strengths and abilities To develop new skills and practices To support healthy lifestyle change Te Pūāwaitanga are being supported by the Early Start Project to become an Early Start provider. They now have a team of five working in this service and will gradually be building their capability over the next three years. Wahakura Wānanga: The wahakura is the first kaupapa Māori safe-sleeping device developed by the Nukutere Weavers Collective in Gisborne in The wahakura has a traditional forbear in the pōrakaraka, a similar pre-european structure slung from the rafters of the whare. Research shows that whānau Māori like and embrace the wahakura as a cultural device to keep baby safe. It is also an effective vessel around which to pass on a range of ante-natal messages. Te Pūāwaitanga have been running wānanga (traditional study events) for whānau to make Board-15dec16-chief executive s update Page 24 of 39 15/12/2016

38 wahakura. The wānanga cover all aspects of wahakura making from harvesting the harakeke, preparation through to weaving and construction. It doubles as a tremendous opportunity to develop whānau ora. These wānanga have now become a highly successful initiative which have been supported over the past two years by the Red Cross and have enabled Te Pūāwaitanga to support safe sleeping, particularly for Māori and those with high needs that don t wish to access Well Child or Plunket services. Ten wahakura were flown into Kaikōura last week, where they will be useful in overcrowded situations and a Hawkes Bay provider also donated eight for babies in Kaikōura post-earthquake. The Ministry of Health has acknowledged that wahakura are a powerful and effective safe-sleep tool that also supports whānau ora and they are exploring ways to support such initiatives which are being run by Māori providers all over NZ, hitherto not supported by MoH. Providers are waiting to see if MoH rhetoric will manifest in financial support. Canterbury Clinical Network: Te Pūāwaitanga are also part of two CCN initiatives. They have trained and accredited facilitators for the Triple P Healthy Lifestyle Group programme, which is part of the Healthy Weight in Childhood work. In addition to this, they have a newly recruited Stop Smoking Practitioner who brings experience having done similar work in Auckland. The kaupapa Māori provider asserts that being part of the CCN steering groups for these initiatives enhances relationships with other primary and community providers and supports understanding of the various contributions that kaupapa Māori providers are making to improving access of Māori whānau to our health system and improving equity. Promotion of Healthy Environments & Lifestyles All Right? social marketing campaign update: Emergency Response: All Right? has created some new resources during the response phase following the Kaikoura Earthquake. These messages fit into the psychological first aid category and are very much focused on mental wellbeing support in the immediate aftermath of the disaster. Psychological first aid recognises that people possess coping skills and exist within a social and cultural framework from which they draw their most valuable support. In other words it s about acknowledging and linking to the individual and collective, family/whanau and community strengths. Resources produced during this response phase include postcards with advice and tips to those in the affected areas from the people of Greater Christchurch, a resource for parents and a general resource about coping after a disaster. These have been informed by experts in psychosocial response and people on the ground in the Kaikoura and Hurunui districts. Kaikoura Earthquake: Public Health Emergency Response: As part of the Canterbury DHB response Community and Public Health established an Emergency Operations Centre on Monday 14 November in the aftermath of the Kaikoura Earthquake (and tsunami threat) which remains operational as at 1 December The emergency response has had significant impact on business as usual as staff have worked to support the emergency response in the Hurunui and Kaikoura Districts. Community and Public Health staff have been in the field in both the Hurunui and Kaikoura Districts (Kaikoura Township) providing public health support including the provision of key public health messages, and professional advice and support (incl. advice regarding drinking water safety, water testing, addressing sanitation issues, highlighting food safety challenges, establishing enhanced gastrointestinal illness surveillance, liaising with Civil Defence and other agencies, and the provision of psychosocial resources). Situation Reports have been produced daily and now twice-weekly (as of 28 November) to inform other agencies of our situation assessment, actions taken, and planned actions for the next hours. Board-15dec16-chief executive s update Page 25 of 39 15/12/2016

39 Weekly Incident Action Plans are developed which ensure that planned actions relate to the priorities identified in each action area. Psychosocial support and Recovery are increasingly the focus of this work (as at 28 November). Fresh Air Project update: Following the successful launch of the Fresh Air Project on 1 November, 20 participating cafés have been promoting their smokefree outdoor dining areas. Customers have been invited to provide anonymous feedback via in situ feedback/suggestion boxes placed at each venue. To date the feedback has been collected from only four venues. Of this initial feedback 95% of the 230 responses received are supportive of the smokefree outdoor dining areas. Sixty-one percent of respondents report that they would be more likely to visit the venue concerned again because of its smokefree outdoor dining area. SUPPORTING OUR TRANSFORMATION Integrated Family Health Services (IFHS) and Community Health Hubs The principles of integration are guiding discussions on health service delivery in rural areas where locally led service reconfiguration is being implemented. Akaroa: The concept design for the new facility has been signed off and the detailed design is underway. A model of care for the integrated service will be presented to the community in the early part of We are meeting with the community group to work out the service delivery and establishment of the community service provider. Kaikoura: Due to the recent earthquake, it was agreed to delay the decision document release. Hurunui: Work continues on a model of care and best use of the limited health staffing resources in Hurunui. It is expected that the work will progress more quickly in the New Year. Oxford: The Oxford Group is now engaged with developing a model of care for the Oxford community. Effective Information Systems Health Connect South Electronic Clinical Patient Record: The Health Connect South (HCS) computer software solution provides two key things. One is a way that clinicians can log into one computer system to get access to many others, which is called a portal. The second is special computer software that is part of the HCS overall solution, with Electronic Referrals being one example. One big benefit of this portal is it works very much like an Internet site which allows clinical people from more than one District Health Board (DHB) to access the same electronic patient record, as long as that clinician is involved in the care of that patient. HCS is currently available in four DHBs (Canterbury, West Coast, Southern and South Canterbury) covering some 800,000 South Islanders. There is a HCS project currently running to provide hospital based clinicians the ability to access the portal from Nelson Marlborough District Health Board (NMDHB). Go-live is expected in February Once this project is completed, all of the South Island DHBs will be able to use this single portal. This will mean the South Island will be the first Region in New Zealand to achieve this. This will also mean Board-15dec16-chief executive s update Page 26 of 39 15/12/2016

40 that all of the South Island will be able to access HealthONE and we will have a system-wide shared health record. Medical Images (Wabalogic): A project named Wabalogic has commenced to manage all of the activities needed to upload medical photographs to a new secure computer system. This new area will then be used to link these images to the electronic clinical record, which is accessed via Health Connect South. The contract between the CDHB and the supplier (UK firm, Wilde and Betts Agency (WABA)) has been signed. The CDHB Information Services Group technical team have finished building the computer system and have provided the ability for the UK WABA team to access this system securely. The UK WABA team are now in the process of making their changes to the computer system so that both parties can start testing. Work is ongoing with the Medical Illustrations team who are assisting with the setup of the system and liaison with clinicians as to how the system will look. There is potential to take this system throughout the South Island Productivity Improvement: To support the paperlite project which involves progressing to convert paper forms to digital and to improve security rights on who can populate some forms, ISG have started moving forms into the Cherwell portal. The first form converted has been the MedChart User Request Form. Rather than the previous process where requestors completed a paper form and faxed it to ISG, the form is now provided on-line. This form now authenticates the customer, auto populates many of the form fields and prompts the customer to accept the MedChart terms and agreement. Once submitted, the form is archived for auditing and a copy is sent to the customer. The system then updates the training database for the User Support and Training team (UST). UST have reported that a conservative estimate is that this new process saves, on average, 20min per form. So far since go live the system has logged 3000 requests. Facilities ICT programme: For ASB and Christchurch the budget and associated detail continues to be developed by the project team as capabilities and requirements are refined and confirmed. The team are devising a plan of engagement with operational staff to confirm requirements and key operational contacts have been identified. Project plans are in development and procurement activities are underway. The programme is working across other departments to understand the timescales and potential resourcing impacts of complementary projects, which will compete from a similar pool of resources such as HREF. Key risks remain around availability of key technical and project management resources. Detailed resource profiling, along with lessons learned from Burwood has been completed. Next steps involve detailed scoping and confirming budget details for each deliverable. Windows 10: With Microsoft withdrawing support for the current version of Windows 7 in January 2020, ISG has commenced a project to upgrade to Windows 10. This process is expected to take more than two years, and currently workshops are being arranged with Microsoft to review Windows 10, its features and benefits. Once this is completed, a business case will be prepared with work starting in the 17/18 financial year. Electronic Medicines Management (emed): The emeds project aim is to provide an electronic medication system that will give all health care providers access to a person s medication information and will enable them to manage their medicines more effectively. This includes prescribing, administering, reconciling, dispensing and tracking medicines. The project has several workstreams which are currently being worked on: MedChart: Electronic Medication Prescribing & Administration (epa) allows medication to be prescribed and administration to be recorded electronically in hospitals aided by decision support, during a hospital admission. Board-15dec16-chief executive s update Page 27 of 39 15/12/2016

41 MedRec: Electronic Medication Reconciliation (emr) an electronic system for hospitals that ensures a patient s medication information is accurate on admission, transfer and discharge. Migration to NZULM New Zealand Universal List of Medicines (Drug library so that all solutions speak the same language this will be migrated from the current drug library: Monthly Index of Medical Specialties (MIMS). epharm (or epharmacy) electronic Pharmacy inventory management (Hospital pharmacy inventory management) Currently, MedChart has been rolled out to Ashburton, Hillmorton and Burwood and has been migrated to NZULM (NZ Unified List of Medicines). Rollout to Christchurch Hospital commenced early November and will mostly will be completed by 2 December. Due to complexity, Emergency Dept. and ICU are the two remaining areas to be rolled out and this is expected to be complete by the end February Computer network equipment upgrade: This project is to replace key IT equipment that enables sharing of information on the CDHB computer network such as phone data, and patient information. The upgrade will provide CDHB staff with a more resilient and robust computer environment and be able to cope better with future demands. New Switch equipment received and being installed into computer rooms. Design documents are now complete and the Vendor Implementation Plan is being drawn up for review and sign-off. Due to delays in resolving Architecture and subsequent ordering of new hardware, along with the annual IT Change freeze period over Xmas and New Year (preventing changes to the IT environment in a period of lower levels of staffing due to leave) the Project rollout is now scheduled for a January start. COMMUNICATION AND STAKEHOLDER ENGAGEMENT Communications on Quality Improvements Kaikoura and Hurunui earthquake communications: The Communications team has been working as part of the Emergency Operations Centre in response to the Culverden Quakes. The first update to all Canterbury DHB staff was issued a couple of hours after the first quake, and the team has been providing communications advice and support 24/7 as part of the health system response. Health messages for the quake-affected areas are focused on making sure: all water consumed is safe people practice good hand hygiene people have access to relevant public health information people know to ask for help if they need it people know General Practice is their first point of call for all non-urgent care. The following methods have been used to communicate health and wellbeing information: Media releases and media interviews Creation and distribution of resources with relevant health and wellbeing information. Resources created and/or distributed by the CDHB include: o Health Information for Hurunui (CDHB) o Health Information for Kaikoura (CDHB) o SKIP Earthquakes and other scary events Board-15dec16-chief executive s update Page 28 of 39 15/12/2016

42 o All Right? Practical tips for coping with a disaster o Mental Health Foundation Take care of your children but don t forget yourself o Mental Health Foundation Tips for coping after an earthquake o The Worry Bug 6 ways to help children worried about the earthquakes Providing material to be included in communications by other responding agencies Advertisements in the Kaikoura Star, North Canterbury News, Northern Outlook and Facebook Posters to display on the 12 noticeboards around Kaikoura Targeted Texting Canterbury worked with all telcos, who agreed to send geographically targeted text messages containing key health information. These were sent free of charge we are grateful to Spark, Vodafone and 2Degrees for their assistance and follow-up service getting these messages out to affected communities. DHB Communication managers two day meeting: Canterbury hosted Comms managers from around the country on 14 and 15 November. The timing meant many were in Christchurch to feel the 7.8M quake which hit just after midnight. While some of the speakers were not able to attend due to quake-related work pressures, feedback from attendees was that the forum provided excellent presentations and practical, relevant, take-away knowledge. Highlights included a visit to the Design Lab, a session on making videos on your iphone, social media, reporting on suicide and case studies from other DHBs, including the Havelock North water crisis and patient privacy issues. Media: It s been a busy month on the media front with more than 130 queries during November, the majority have been in relation to the quakes. Online activity: Normal online activity has altered to focus on timely health advice for the general public affected by the recent earthquakes. Website activity: Since the earthquake there has been significant increase in visits to Kaikoura service information (at its peak a 10,000% increase on traffic for the same period last year) with Kaikoura Health information becoming more read than other larger Christchurch Hospital service information. Health alerts and media releases have been published since the morning following the quake. Notices confirming Canterbury DHB services availability were posted and have been regularly updated. Updates to Kaikoura Health service information have been regularly updated, including information about subsidised and free healthcare. A new website section has been created to be used as a hub online health advice for residents in Kaikoura and Hurunui. Supporting health advice from many organisations has been posted to this new section. Board-15dec16-chief executive s update Page 29 of 39 15/12/2016

43 Social media activity Facebook engagement (likes) are up 272% on same period last year, showing a high level of interaction with the CDHB Facebook page over the past month due in most part to the provision of regular updates and information about the earthquakes As a result of higher levels of interaction and membership our social media reach (the number of people reading our stories) has also increased significantly over the past month. A Facebook advertising campaign has been initiated provide targeted health advice to those using Facebook in Kaikoura and Hurunui There were nearly 11,000 likes, comments and shares over this period, a 129% increase in engagement with the stories and information on our Facebook page. Board-15dec16-chief executive s update Page 30 of 39 15/12/2016

44 Screenshots showing selected activity Facilities Redevelopment our regular communications channels have been kept up to date. At Burwood: Burwood communications requirements are increasingly business as usual rather than facilities-specific. Additional signage and map requirements continue to be provided, including updates to staff parking and site maps. At Christchurch: Parking issues: Communications has worked to increase awareness among staff of other ways to reach work and other parking options available. Working with ECAN to promote bus use, and currently scoping having real-time bus information displayed on screens. Other activities: Ongoing work with CPB staff to communicate changes and forthcoming works on the Acute Services Building site, including concrete pours, painting, glazing and steel erection. Board-15dec16-chief executive s update Page 31 of 39 15/12/2016

45 Ongoing work/meetings/updates with hospital ops staff and project teams to communicate changes across all current Christchurch campus site works. Regular site photography. New update video created for hospital screens. Outpatients building: Ongoing work with Leighs staff to communicate changes and forthcoming works on the Outpatients site. Ashburton Hospital Acute Assessment Unit: A site blessing ceremony was organised on 15 November. The ceremony was led by Upoko Arowhenua Rūnaka, Te Wera King. A guided walkthrough was also offered on the day for members of the community funding groups. There was a positive write-up of the event in the local media. A public open day for the Acute Assessment Unit was then organised on 27 November. Around 600 people attended this successful event. CEO Update stories The importance of kindness in healthcare: How kindness can influence culture was the subject of Tim Keogh s talk at the Grand Round on 18 November. A partner at UK Consulting firm, April Strategy, Tim was a key note speaker at the Asia Pacific (APAC) Forum on Quality Improvement in Healthcare and was visiting New Zealand doing work for the Blood Service and Southern DHB on culture. National safe practice launch: The Safe Practice Effective Communication National Programme was launched at a forum at Canterbury DHB on 21 and 22 November. The forum is a combined effort of the directors of mental health nursing and Te Pou, working together to bring a national training to fruition. This forum is a first for mental health in that all DHBs will provide the same training to their staff, making it transportable across the country and safer for patients and staff. Nurses Memorial Chapel restoration: The historic earthquake damaged Nurses Memorial Chapel at Christchurch Hospital will be restored and strengthened in time for its reopening as part of New Zealand s WWI centenary commemorations. The announcement was made on November 23 by the Mayor of Christchurch, Lianne Dalziel, at a gathering on the lawn of the chapel s memorial garden. Successful hospital pharmacy conference: Canterbury DHB s Pharmacy Service hosted the annual New Zealand Hospital Pharmacists Association conference in Christchurch from 4-7 November. 180 delegates from hospital, community pharmacy and academia took part. Three CDHB presenters won awards. Emergency preparedness course on the Chathams: A Coordinated Incident Management System (CIMS) course was held in the Chatham Islands on Saturday 5 November. The course was run by CDHB Emergency Planning Manager, Jenny Ewing, and Ministry of Health s Manager, Emergency Management Capability, Murray Halbert. Challenging mental health nursing role recognised: Two CDHB mental health nurses have been honoured with a special Police award. Steve Howie and Neil McNulty, who work at the Police watch-house at the Christchurch Central Police Station were given District Commander s Commendations at the annual Police awards. Steve and Neil and received the award as founding members of an initiative between Canterbury Police and Canterbury DHB in which dedicated mental health nurses work alongside Police in the custodial area of the watch-house. Christchurch has the only police watch house in the country with a 24-hour programme of this sort which takes pressure off police and the justice system and is credited with stopping suicides in the cells and improving outcomes for detainees. Board-15dec16-chief executive s update Page 32 of 39 15/12/2016

46 Physiotherapist named Cricket president: Former White Ferns captain and Canterbury DHB Physiotherapist, Debbie Hockley, has been elected the first female president in New Zealand Cricket s 122-year history STAFFING, TRAINING, EMPLOYEE ENGAGEMENT AND PERFORMANCE MANAGEMENT People and Capability Services The People and Capability team is focused on ensuring people are at the very heart of our health system. Our programme of work [below] supports this goal and ensures we continue: Doing the basics brilliantly. Growing individual and team capability. Enabling the wellbeing of our people. Supporting the delivery of care. Performance Key Performing to plan At risk but not an issue Needs immediate attention Not scheduled to commence Complete Wellbeing, Health and Safety Key initiatives Due Status Enhance our Health and Safety system 2017: Q4 Deploy a Wellbeing Survey 2016: Q4 Develop a Wellbeing Strategy 2017: Q1 Enhance Occupational Health services 2017: Q1 The key themes from the survey have been worked up in further detail via a number of focus groups. This work is critical for informing the subsequent development of a comprehensive Wellbeing Strategy, which is on track to be released in Quarter [January March]. As part of enhancing our Health and Safety system, the development of a policy and procedure framework has commenced, with the next step focused on contractor management. Planning is underway to run multi-disciplinary teams through scenarios to inform the roles and responsibilities with respect to who owns the risk and controls. The Terms of Reference for Occupational Health service review have been drafted, with current state mapping commenced. People and Capability Services Key initiatives Due Status Refresh Remuneration Strategy: IEA 2016: Q4 Redesign the employee lifecycle 2017: Q2 A shortlist of consultancy services to partner with the People and Capability team to redesign the employee lifecycle has been identified. As part of the procurement process, these consultancy services will present to the evaluation panel on 6 December. Board-15dec16-chief executive s update Page 33 of 39 15/12/2016

47 It is anticipated that a consultancy service will be appointed before year-end, and phase one of the redesign will commence in Quarter People and Capability Operations Key initiatives Due Status Standardise advisory processes Streamline change processes Renew People and Capability policies 2016: Q4 2016: Q4 2017: Q2 The toolkit of standardised change processes and templates continues to be enhanced. This includes standardised processes and documentation for planning, consultation, decision making and implementation of People and Capability operational changes. Organisational Development [OD] Work has commenced to re-focus the approach of the Organisational Development team. This includes a re-energised focus on five key areas of OD: Leadership Capability development System and process optimisation Production planning Design, innovation and culture. A programme of work within these five areas is under development. FACILITIES REPAIR AND REDEVELOPMENT General EQ repairs within Christchurch campus: Injection grouting of floors and walls ongoing. Other Parkside panels to be reviewed in conjunction with panel hierarchy. Planning underway. Awaiting on decision of MOH master planning exercise. Ongoing repairs of seismic joints throughout the Christchurch site. Other Parkside stair repairs: Stair 1, 2, 3, 6 & 7 completed. Stair 5 commenced. Stair 4 planned to start in New Year. Clinical Service Block roof strengthening above Nuclear Medicine: Currently pending confirmation on the new SPECT/CT scanner business case. Clinical Service Block: Ground floor Fire Wall to corridor outside Pharmacy from north end to south. Fire wall complete and hoardings down. Work to protect ducting on Bone Shop side commenced. Repairs continue to progress on a number of fronts with heavy ceiling tile replacement now 95% complete to Parkside. Consents have been granted for heavy ceiling tile replacement for Clinical Services Block which commenced in February This involves the need to add in new fire barriers above the ceiling. The ability to complete such work continues to be Board-15dec16-chief executive s update Page 34 of 39 15/12/2016

48 constrained by the access to clinical spaces. Some clinical areas in Riverside had been postponed due to heavy patient demand. Work has now recommenced. Laboratory panel replacements at north-west corner of the laboratories building complete. Works to replacing panels on north east side started (part of stairs 2) Design and planning underway for Labs stair 3 (south-west corner) and stair 4 Concept Design underway for strengthening of Parkside link to CSB. Christchurch Women s Hospital Stair repairs: Closing one stairway at a time starting with stair 1. Completion dates to be advised as more information around extent of damage is confirmed. Lower ground to the 3rd floor steel has been completed. Concrete cutting is underway. Gib work and stopping and painting underway. Level 5 essential slab repair completed. Work to corridor constrained due to high level of acute patients that will be affected in NICU. Other essential slab repairs, to be programmed. A more detailed survey of windows is about to commence to determine risks around movement in situ and repair requirements. Damaged sewer stacks, Christchurch Women s Hospital. Currently adopting a watch and wait process. Other Works 33 St Asaph St: Building structure demolition completed. Floor slab foundation work started. Demolition of the Blue Car Park: Completed and ground levelled. Area will be temporarily fenced. Endo Labs: Minor internal work underway. Main Campus Fire Engineering: Stage 1 report received and in review. Further meeting with Board / CEO required prior to Stage 2 works commencing. Christchurch Hospital campus Energy Centre: This is managed by the Ministry of Health (MoH)). Tunnel project to provide services route from Energy Centre to ASB and existing buildings and pedestrian route from Public carpark to new Outpatient building and to main Hospital site (managed by MoH). 235 Antigua St and Boiler House: No work to be undertaken until boiler requirements have been resolved for the new energy centre. Parkside renovation project to accommodate clinical services, post ASB (managed by MoH): Health planners appointed and planning underway. This project is being managed by the MOH with close stakeholder involvement from the Canterbury DHB. New Outpatient project (managed by MoH): Contract awarded to Leighs Construction. Piling commenced. Paediatric Outpatients: Work underway. Hydro pool area 70% complete; CWH area 80% complete. Started work on some spaces within POPD. Additional MRI scanner for Radiology: Handover to service 10 October. Final commissioning complete. Board-15dec16-chief executive s update Page 35 of 39 15/12/2016

49 Christchurch Hospital campus flood mitigation and lateral spread requirements: New retaining walls, kerbs and channels are being constructed. Additional enabling works for VIE tank, HV cable enabling and the temporary boilers will be completed on behalf of MoH. 3rd feeder on campus works complete. Orion working on street works to free up cable required to connect to hospital. Burwood Hospital Campus Burwood New Build: Handover from MoH to Site Redevelopment to manage defects liability period has commenced. Formal start of this process will not occur until practical completion is achieved, which is now forecast for the end of Burwood boiler house: Construction nearing completion, managed by MoH. Practical completion has not been achieved to date, but the facility is operational. Site services etc: being managed by the MoH and the main contractor. Burwood Admin main entrance block: Spatial planning and consultation with user groups complete. Tapper Units: Tender process closed 21st October. Review process started. Contract award December. To start on site January 17th Drainage repairs: 90% complete with work on-going. Completion expected by end of Currently on budget. Spinal Unit: RFP process completed for Consultancy Services. Reviewing options if relocating to ORU. Full business case will be submitted after firming up concept and cost plans. Spinal Trust: Continuing planning as part of Mini Health Precinct. Space planning work on reuse of current Administration building complete. Burwood Birthing/Brain Injury: Enabling works complete. Asbestos survey complete. Tender documents to be completed once methodology agreed. 2nd MRI Installation: Development of business case to relocate MRI scanner from Merivale to the 2nd scanner room in Radiology in the Burwood new build, underway. Pharmacy Area: Work completed pharmacy operational from the 23 of August 2016 currently operating under a CPU while works in other areas are being completed. Hairdresser Area: Agreement to Lease has been executed. Fit out work has commenced and is forecasted to be completed in December Hillmorton Hospital Campus Earthquake works: No EQ works currently taking place. This will be reviewed once the outcome of the TPMH mental health business case has been advised. Food Services building. On hold at present. Cotter Trust on-going occupation being resolved as part of overall site plan requirements. Te Whare Manaaki: Review of all works complete. Awaiting decision on windows. The Princess Margaret Hospital Campus West Spoke for OPH community team relocation options being investigated. Mental Health Services relocation in December 2015, CIC has informed Canterbury DHB that a two stage business case process is required. The Long list options for permanent relocation has been identified and the Mental Health service relocation from TPMH Indicative Board-15dec16-chief executive s update Page 36 of 39 15/12/2016

50 Business Case has been approved by the CDHB Board and submitted to HRPG 31st March 2016 meeting, pending decision. Canterbury DHB are continuing to refine the options and rereview the IBC. Ashburton Hospital & Rural Campus Stage 2: Works will progress upon the completion of the new building. Work is ongoing to finalise the Fire upgrade solution and submit a Building Consent amendment. Completion will be late in the first quarter of Stage 1: The new building is in the final stages of completion. Internal finishes and CDHB fit out is progressing well and consultants are working through final sign off. The formal blessing will take place in mid-november and the AAU will move in the first week of December. The Project team is closely monitoring the ongoing issues with consultant performance and budget concerns. Other Sites/Work Akaroa Health Hub. Concept design formally signed off. Kaikoura Integrated Family Health Centre: Code compliance inspection occurred 19th Sept gathering final documentation to allow Kaikoura District Council to issue code compliance certificate. Rangiora Health Hub: Work completed. Awaiting availability of Hagley Outpatients building to continue with project. Montreal House. Main building work completed December Additional work of full roof replacement to be completed later in 2016, to avoid the winter period. Former Christchurch Women s Site: Evaluation of Park and Ride suitability currently underway. Corporate Office Fitout: Completing minor additional works. Board-15dec16-chief executive s update Page 37 of 39 15/12/2016

51 DELIVERY AGAINST THE NATIONAL HEALTH TARGETS Canterbury achieved the Shorter Stays in ED health target the month of October, with 95.2% of patients admitted, transferred and discharged from our emergency departments within six hours. The slower start mentioned last month continues. This month (October) due to the Resident Doctor strike 95 elective surgeries were postponed. Planning is being undertaken to ensure we deliver to target by end of fiscal year. Results against the Immunisation health target show Canterbury meeting the national target with 95% of eight-month-olds being fully immunised 96% of Māori children. Quarter one results for the Better Help for Smokers to Quit Primary Care health target suggest that performance has increased to 88.6%. The Faster Cancer Treatment results for the last 3 months (August, September and October) show a marked improvement against the national targets. 83% of eligible patients received their first cancer treatment within 62 days of being referred with a high suspicion of cancer. The target of 85% was met in October with preliminary results suggesting that over 90% of eligible patients were treated within 62 days of referral. 87% of eligible patients received their first cancer treatment within 31 days of agreeing a treatment plan with their clinician, which again meets the MoH target of 85%. 46% of four year olds identified as in or above the 98 th percentile for their weight were referred for healthy lifestyle advice/ intervention. Raising Healthy Kids is a new target for the 2016/17 year, Canterbury are taking an alliancing approach to the target and people are engaged across the sector. The Healthy Lifestyle Coordination programme, which will coordinate referrals and provide the families with options of Healthy Lifestyle intervention, is currently being established. The full service will be up and running in early Board-15dec16-chief executive s update Page 38 of 39 15/12/2016

52 LIVING WITHIN OUR FINANCIAL MEANS The consolidated Canterbury DHB financial result for the month of October 2016 was a deficit of $4.443m which was $0.262m favourable against the budgeted deficit of $4.705m. The year to date position is $0.098m favourable. 4. APPENDICES Appendix 1: Psychosocial FAQ Report prepared by: David Meates, Chief Executive Board-15dec16-chief executive s update Page 39 of 39 15/12/2016

53 Psychosocial FAQ What we mean by psychosocial What are psychosocial effects? Psychosocial effects include: Environmental effects, with social, political and physical environments impacting people s wellbeing (social determinants of health) e.g., insurance stress, job losses Social effects, impacting how people relate to each other e.g., parental stress impacting on children Individual psychological effects, impacting how people feel and function e.g., anxiety about aftershocks What are psychosocial supports? Psychosocial supports are psychological and social interventions that: repair and support the social fabric of the community e.g., community events and celebrations ease physical, psychological & social difficulties for individuals, families, whānau & communities e.g., temporary accommodation and earthquake support coordination enhance mental wellbeing e.g., wellbeing campaigns What psychosocial outcomes do we want to achieve? The desired outcome of these supports is psychosocial recovery and adaptation, where people and communities are able to achieve wellbeing and lead lives they have reason to value. The concept of wellbeing is understood holistically in the Te Whare Tapu Wha model, consistent with a psychosocial approach: Taha Tinana Physical wellbeing Individuals, populations and communities have the resources and capability they need to develop and maintain healthy physical lifestyles. Taha Hinengaro Mental and emotional wellbeing Individuals, populations and communities can openly communicate thoughts and feelings, make decisions and solve problems. Taha Whānau Social wellbeing Individuals, populations and communities feel a sense of belonging and have the interpersonal support they need from relationships with friends, family, whānau and the wider community. Taha Wairua Spiritual wellbeing Individuals, populations and communities can make sense of life events, take comfort in a sense of meaning and live their lives with a sense of purpose, true to themselves and their cultural values. Effective psychosocial supports must also ensure that other aspects of recovery do not result in further harm to individuals and communities.

54 CDHB roles in psychosocial Recovery Who is responsible for planning for psychosocial recovery? Civil Defence guidelines define Psychosocial Support as, focusing on the psychosocial and social interventions that will support community recovery. Psychosocial support during an emergency and throughout the recovery period is about easing the physical, psychosocial and social difficulties for individuals, families/whanau, and communities, as well as enhancing wellbeing. Effective psychosocial recovery ensures that other aspects of the recovery process (e.g., rebuilding) do not result in further harm to individuals or their communities. Civil Defence guidelines state the role of District Health Boards. District Health Boards are responsible for coordinating the provision of psychosocial support services. The guidelines also outline the requirement for a Psychosocial Support Team responsible for planning, relationship building and establishment of operational arrangements. CDHB-CPH has already convened an informal Psychosocial Support Team to fulfill this role. It is critical that the team foster strong and productive cross-agency links, for instance, with MSD, Iwi, TPK, Red Cross, Salvation Army, Primary Care, etc. Internally, strong links will also be vital with Planning & Funding and with the Vulnerable People s teams. How are CPH staff supporting psychosocial recovery planning? During the transition from response to recovery, CPH staff have already been playing key roles in fulfilling psychosocial requirements. Planning. Working with the CDEM Group Recovery Manager to develop broader recovery planning processes. Relationship building. Health promoters on the ground in affected areas have been building relationships with local people, including across agencies and organisations, to support the immediate well-being of the community and more coordinated work later on. Operational arrangements. Staff are working with other agencies to coordinate psychosocial response that is locally-led, regionally supported, and nationally funded. CDHB-CPH staff have been undertaking this work with a collaborative, interagency approach and with respect and recognition for spontaneous community-led initiatives.

55 A Psychosocial Recovery Programme What would a psychosocial recovery programme do? A comprehensive & effective psychosocial recovery programme needs to: support the majority of the population who need some psychosocial support within the community to allow their innate psychological resilience/coping mechanisms to come to the fore address the most severely affected minority through efficient referral systems & specialised care What kinds of supports will the CDHB and its recovery partners need to organise? One prominent model presents four layers of support, moving from the provision of basic needs for all through to intensifying interventions for smaller & smaller numbers of people with more focused needs. Intervention Pyramid Universal Supports Community & Family Supports Targeted Supports Specialist Supports Example supports: CDHB 0800 Earthquake Support Line All Right? messages Example supports: Recovery partners Range of spontaneous community-led initiatives (e.g., people checking on their neighbours, churches reopening, etc.) Free GP visits Earthquake Support Coordination Service & Rū Whenua Kaitoko whanau Residential Advisory Service MSD support packages Community events Vulnerable People s work Triage services targeting elderly vulnerable Workforce wellbeing initiatives (public sector) EQC & insurance case-management Specialist mental health services Specialist education

56 A Psychosocial Recovery Programme What are the key elements of psychosocial recovery planning? Planning for psychosocial recovery requires organising a programme that responds to the needs identified and activates the principles of an effective psychosocial response. The principles are critical how psychosocial recovery is undertaken is equally if not more important than the array of interventions. One key principle is for recovery to be community-led. Therefore, the most effective plan outlines a way of working without prescribing particular services and interventions (although these may be proposed). Our planning role at this stage is to ensure that three inter-related streams of psychosocial recovery planning are operational. Monitoring Administrative data Service data Qualitative observations Other agreed sources Governance Local committees of local leaders Agencies, oganisations, networks, iwi, etc. Able to share information, adapt operations Services Support for increased capacity in existing organisations Shared Programme identifying collaborative responses and other supports What kind of local governance structures are in place to psychosocial recovery planning? Local Psychosocial Committees are being established to provide governance for recovery work. The Committees will identify and review monitoring sources and make collective decisions about how services should be adapted in light of current need. What kind of monitoring and data will the Committee use to inform its decisions? The Committees will need to ensure they have a suitable array of monitoring sources to inform their decisions. No new forms of monitoring are recommended at this point, and it will be the Committee s responsibility to decide what sources of information will be the most valuable to them. Sources of information may extend beyond data in a strict sense and should include the qualified observations of Committee members (e.g., local knowledge). How can the Committee be supported to coordinate services? A tool that has supported collaborative service delivery in greater Christchurch is the Shared Programme of Action. The existing Programme could highlight for the group the array of service options that have been developed and proven in greater Christchurch. The Programme may also act as a template for capturing cross-agency work contributing the shared psychosocial recovery goals. The CDHB can play a role at a more strategic level to ensure there is buy-in for a collaborative approach to realignment of local services.

57 FINANCE REPORT AS AT 31 OCTOBER 2016 TO: SOURCE: Chair and Members Canterbury District Health Board Finance DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT This is a regular report and standing agenda item providing an update on the latest financial results and other relevant financial matters to the Board of the Canterbury DHB. A more detailed report is presented to and reviewed by the Quality, Finance, Audit and Risk Committee (QFARC) monthly, prior to this report being prepared. 2. RECOMMENDATION That the Board: i. notes the financial result for the period ended 31 October DISCUSSION Overview of October 2016 Financial Result The consolidated Canterbury DHB financial result for the month of October 2016 was a deficit of $4.443m which was $0.262m favourable against the budgeted deficit of $4.705m. The year to date position is $0.098m favourable. The table below provides the breakdown of October s result. Note that our internal budget is phased differently to the draft Annual Plan submitted to the Ministry of Health in March this was phased evenly over the year pending finalisation of the budget. Year-to-date the draft Annual Plan (unphased) as submitted has a deficit of $12.628m. Both the internal budget and the draft Annual Plan are subject to finalisation. Board-15dec16-finance report Page 1 of 11 15/12/2016

58 4. APPENDICES Appendix 1: Financial Result - October 2016 Appendix 2: Statement of Comprehensive Revenue & Expense October 2016 Appendix 3: Statement of Financial Position October 2016 Appendix 4: Cashflow and Bank October 2016 Report prepared by: Justine White, General Manager Finance & Corporate Services Board-15dec16-finance report Page 2 of 11 15/12/2016

59 APPENDIX 1: FINANCIAL RESULT FINANCIAL PERFORMANCE OVERVIEW YTD OCTOBER 2016 The internal budget we are reporting against is a deficit of $37.517m for the year (compared to the draft annual plan deficit of $41.987m). It is important to note that the Annual Plan includes earthquake repair related expenses and revenues, although there is expected to be variability between the expected and the actual timing of these costs. The year to date earthquake related costs included in the results are $10.333m, offset by insurance revenue drawdown from the Ministry of Health of $4.359m. KEY RISKS AND ISSUES We continue to actively monitor expenditure trends, including earthquake related costs over the year, and expect to continue to incur earthquake related repair and maintenance expenditure and the depreciation impacts of quake related capital spend for a significant number of years into the future. Board-15dec16-finance report Page 3 of 11 15/12/2016

60 PERSONNEL COSTS/PERSONNEL ACCRUED FTE KEY RISKS AND ISSUES Board-15dec16-finance report Page 4 of 11 15/12/2016

61 TREATMENT & NON TREATMENT RELATED COSTS KEY RISKS AND ISSUES Repairs and maintenance costs linked to earthquake repairs will continue to be volatile, but are expected to remain favourable for the remainder of this financial year. Board-15dec16-finance report Page 5 of 11 15/12/2016

62 EXTERNAL PROVIDER COSTS Refer to the Planning and Funding section of the report for further information on the total external provider costs. KEY RISKS AND ISSUES Board-15dec16-finance report Page 6 of 11 15/12/2016

63 EARTHQUAKE KEY RISKS AND ISSUES The variability and uncertainty of these costs will continue to put pressure on meeting our monthly budgets in future periods. Please note that the 16/17 figures at this point do not include any impact of the November Kaikoura / Culverden earthquakes. Earthquake (EQ) operating costs include EQ repair works and other non-repair related costs such as additional security and building leases. EQ repairs (integral part of the DHB EQ Programme of Works) costs are offset by an equivalent amount of insurance revenue that will be progressively drawn down to minimise the impact of EQ repair costs on the net result. The insurance revenue relates to the portion of earthquake insurance settlement amount that was repaid to the Crown in 2013/14 for future draw down by the DHB as and when appropriate to fund the earthquake repairs and programme of works. Note: Quake costs associated with additional funder activity such as increased outsourced surgery are captured under external provider costs. Board-15dec16-finance report Page 7 of 11 15/12/2016

64 FINANCIAL POSITION The equity increase for June shown in the graph relates to the increase in the revaluation reserve of $91M as a result of the valuation done of Land and Buildings for 30 June. The new Burwood facility was transferred to CDHB in mid-august. We have reflected the debt and equity in September, and an estimate of the assets (we are working through a reconciliation of the assets with the MoH). Our net cash position includes $5.9m held with New Zealand Health Partnerships Ltd. To ensure that we minimise our capital charge expense, we are closely monitoring our overdraft expense to ensure it is less than the capital charge should we draw down further equity. We anticipate costs of earthquake repairs and related expenses to continue to impact our cash balances that were otherwise being accumulated for our facilities redevelopment. As previously noted, a significant portion of the repairs and maintenance that we are undertaking (and will continue to undertake in the future) to place our buildings and infrastructure back to a pre earthquake condition is being capitalised and depreciated, resulting in the amortisation of costs over a number of years. We continue to review and close off earthquake related projects, accounting for the increase in building asset cost, and, as noted above, facilities costs. Appendix 10 shows the breakdown of our funds exposure to different financial institutions, and appendix 11 shows our cashflow forecasts. KEY RISKS AND ISSUES Earthquake costs continue to be difficult to predict with certainty, including the impact on the valuation of our facilities. Board-15dec16-finance report Page 8 of 11 15/12/2016

65 APPENDIX 2: CANTERBURY DHB GROUP STATEMENT OF COMPREHENSIVE REVENUE AND EXPENSE Board-15dec16-finance report Page 9 of 11 15/12/2016

66 APPENDIX 3: CANTERBURY DHB GROUP STATEMENT OF FINANCIAL POSITION Board-15dec16-finance report Page 10 of 11 15/12/2016

67 APPENDIX 4: CASHFLOW & BANK At the end of October, the total exposure to our banking partners (including Brackenridge and our trust funds) for on call, term deposits, and bonds was: Current Month $M Previous Month $M NZ Health Partnerships shared treasury function Westpac BNZ Other Board-15dec16-finance report Page 11 of 11 15/12/2016

68 SCHEDULE OF MEETINGS TO: SOURCE: Chair and Members Canterbury District Health Board Corporate Services DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The purpose of this report is to seek the Board s confirmation and support to a schedule of meetings for the Board and its Committees, both statutory and non-statutory, for the 2017 calendar year as required by the NZ Health and Public Disability Act RECOMMENDATION That the Board: i. notes that in terms of the Canterbury DHB s Standing Orders (Clause 1.6.1) a formal resolution is required from the incoming Board to adopt a meeting schedule for 2017; ii. notes that at the Board meeting of 15 September 2016, the Board approved in principle the attached schedule of meetings for the 2017 year (Appendix 1); iii. reconfirms the delegation of authority to the Chief Executive, in consultation with the Chair of the Board and/or relevant Committee Chairperson, to alter the date, time or venue of a meeting, or cancel a meeting, should circumstances require this; and iv. formally confirms the adoption of the attached schedule of meetings for the 2017 year, as required by the NZ Health & Disability Act 2000 and the Board s Standing Orders. 3. SUMMARY The purpose of this report is to seek the Board s support for a schedule of meetings for the 2017 calendar year. The date for Committee and Board meetings are to a large extent determined by the reporting cycle required to produce information for the Quality, Finance, Audit and Risk Committee and the Hospital Advisory Committee in particular. The proposed meeting cycle for 2017 is: Board monthly meetings on a Thursday, starting at 9:00am. Facilities Committee monthly meetings on a Tuesday, starting at 10:00am. Quality, Finance, Audit and Risk Committee monthly meetings on a Tuesday, starting at 1:00pm. Hospital Advisory Committee bi-monthly meetings on a Thursday, starting at 9:00am. Community and Public Health Advisory Committee bi-monthly meetings on a Thursday, starting at 9:00am. Disability Support Advisory Committee bi-monthly meetings on a Thursday, starting at 1:00pm. Board-15dec16-schedule of meetings-2017 Page 1 of 2 15/12/2016

69 Background If a DHB does not adopt an annual schedule of meetings then, in terms of the New Zealand Public Health and Disability Act 2000 (the Act) and in accordance with Standing Orders (Clause ), members are instead required to be given written notice of the time and place of each individual meeting, not less than ten working days before each meeting. The adoption of a meeting schedule allows for more orderly planning for the forthcoming year for the Board, Committees and staff. The proposed schedule also serves as advice to members that the meetings set out on the schedule are to be held. The suggested meeting dates for 2017 are based on a similar cycle to 2016 meetings, with Committee meetings on Tuesdays and Thursdays, and Board meetings on the third Thursday of each month. In situations where additional meetings of the Board and its Committees are required, these will, in terms of the Act, be treated as special meetings. Notice of these meetings will be given to members in each case prior to the meeting. In addition, where workshops are required, which are not part of the regular meeting cycle, notice of these meetings will also be given to members prior to the workshop. On rare occasions it may be necessary to alter the date, time or venue of a meeting or to cancel a meeting. It is recommended that the authority to do this be delegated to the Chief Executive in consultation with the Chair of the Board or the Committee Chairperson. Meetings of the Board and its Statutory Committees will be publicly notified in accordance with Section 16 of Schedule 3 of the New Zealand Health and Disability Act APPENDICES Appendix 1: 2017 Schedule of Meetings Report prepared by: Report approved for release by: Anna Craw, Board Secretary Justine White, GM, Finance & Corporate Services Board-15dec16-schedule of meetings-2017 Page 2 of 2 15/12/2016

70 S/S Mon Tues Wed Thu Fri S/S Mon Tues Wed Thu Fri S/S Mon Tues Wed January NEW YEARS DAY OBSERVANCE PUBLIC HOLIDAY / / February HAC 9AM WAITANGI DAY March April May June July August September October November December 1/2 1/2 1 3 FACILITIES 10AM QFARC 1PM 4 FACILITIES 10AM CPHAC 9AM DSAC 1PM 2 CPHAC 9AM QFARC DSAC 1 1PM 2 3 1PM 4 5 6/ / FACILITIES 10AM QFARC 1PM 4 FACILITIES 10AM QFARC 1PM 1 FACILITIES 10AM QFARC 1 PM / CPHAC 9AM DSAC 1PM 6 CPHAC 9AM HAC 9AM DSAC 1PM / /6 4 HAC 9AM / HAC 9AM HAC 9AM /5 3/4 2/3 4/5 6 6 QUEEN'S BIRTHDAY OBSERVANCE FACILITIES 10AM QFARC 1 PM / CPHAC 9AM DSAC 1PM GOOD FRIDAY 10 11/ / / / / / / /12 13 EASTER MONDAY / / /

71 Thu Fri S/S Mon Tues Wed Thu Fri S/S Mon Tues Wed Thu Fri S/S CDHB BOARD MEETING 16 CDHB BOARD MEETING 16 CDHB BOARD MEETING 20 CDHB BOARD MEETING / / CDHB BOARD MEETING / /30 CDHB BOARD MEETING CDHB BOARD MEETING 19 CDHB BOARD MEETING /22 22/ /21 19/ /28 FACILITIES 10AM QFARC 1PM 31 FACILITIES 10AM QFARC 1PM 28 FACILITIES 10AM QFARC 29 1PM CDHB BOARD MEETING 15 16/ / CDHB CANTERBURY BOARD ANNIVERSARY MEETING DAY / /17 22 LABOUR DAY 18 ANZAC DAY CDHB BOARD MEETING / / / FACILITIES 10AM QFARC 1PM 31 FACILITIES 10AM QFARC / PM / /29 25/ / /30 24/25 23/ CHRISTMAS DAY BOXING DAY HAC 9AM /31 January 2017 February March April May June July August September October November December

72 HAC 29 NOVEMBER 2016 TO: SOURCE: Chair and Members Canterbury District Health Board Hospital Advisory Committee DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The purpose of this report is to provide the Board with an overview of the Hospital Advisory Committee s (HAC) public meeting held on 29 November RECOMMENDATION That the Board: i. notes the draft minutes from HAC s public meeting on 29 November 2016 (Appendix 1). 3. APPENDICES Appendix 1: HAC Draft Minutes 29 November 2016 Report prepared by: Report approved by: Anna Craw, Board Secretary Andrew Dickerson, Chair, Hospital Advisory Committee Board-15dec16-HAC 29nov16 Page 1 of 1 15/12/2016

73 MINUTES PUBLIC DRAFT MINUTES OF THE HOSPITAL ADVISORY COMMITTEE MEETING held in the Board Room, Level 1, 32 Oxford Terrace, Christchurch, on Tuesday, 29 November 2016, commencing at 9.00am PRESENT Andrew Dickerson (Chair); David Morrell (Deputy Chair); Sally Buck; Murray Cleverley; Anna Crighton; Jan Edwards; Aaron Keown; Trevor Read; and Steve Wakefield. APOLOGIES An apology was received and accepted from Ana Rolleston. An apology for lateness was received and accepted from Steve Wakefield (9:20am). Apologies for early departure were received and accepted from Trevor Read (10:45am); Sally Buck (11:30am); and David Morrell (11:45am). EXECUTIVE SUPPORT David Meates (Chief Executive); Sue Nightingale (Chief Medical Officer); Mary Gordon (Executive Director of Nursing); Greg Hamilton (Team Leader Service Transition, Planning & Funding); Jan van der Heyden (Business Manager); and Anna Craw (Board Secretary). IN ATTENDANCE Item 4 Peri Renison - Mental Health Services Marilyn Ollett/Heather Gray - Medical/Surgical and Women s & Children s Health Win McDonald/Berni Marra Rural Health Services Dan Coward - Older Persons, Orthopaedics & Rehabilitation Kirsten Beynon Hospital Laboratories Item 6 Michael Burt - Clinical Director, Gastroenterology Gill Fowler Service Development Manager Secondary Care, Planning & Funding Rob Hallinan Service Manager, Christchurch Hospital Janice Donaldson South Island Alliance 1. INTEREST REGISTER Additions/Alterations to the Interest Register There were no additions or alterations to the Interest Register. Declarations of Interest for Items on Today s Agenda There were no declarations of interest for items on today s agenda. Perceived Conflicts of Interest There were no perceived conflicts of interest. HAC 29nov16 minutes draft Page 1 of 7 29/11/2016

74 2. CONFIRMATION OF PREVIOUS MEETING MINUTES Resolution (16/16) (Moved: Aaron Keown/Seconded: Jan Edwards carried) That the minutes of the meeting of the Hospital Advisory Committee held on 27 September 2016 be confirmed as a true and correct record. 3. CARRIED FORWARD/ACTION ITEMS Peri Renison, Chief of Psychiatry, provided an update on the AT&R Unit. The following points were noted: A physical restructure of the Unit is in progress, with input being provided by Maintenance and Engineering, and Site Redevelopment Teams. Strengthening of the seclusion room door is complete and operational. Viewing panels are to be installed within the next week. A review of camera placements is underway. The Committee noted the carried forward items. 4. HOSPITAL AND SPECIALIST SERVICE (H&SS) MONITORING REPORT The Committee considered the Hospital Advisory Committee Monitoring Report for November The report was taken as read. General Managers spoke to their areas as follows: Older Persons, Orthopaedics & Rehabilitation Service Dan Coward, General Manager Continued success has been seen in the length of stay for total hip and knee replacement elective surgeries. Key objectives of the Enhanced Recovery after Surgery (ERAS) pathway are being met. A six month pilot project around theatre prioritisation is underway, with a focus on interactions and connectivity across both Christchurch Campus and Burwood. Connectivity with Christchurch Campus around winter planning continues, with planning underway for Spinal Unit. A paper will be submitted to the EMT s Facilities Subcommittee on 8 December 2016 recommending a preferred option. Timelines moving forward will be dependent on the outcomes of discussions and decisions at this meeting. There was discussion around the increased length of stay for over 75 year olds over the winter months. Whilst achieving a lot in the community and with various programmes, those admitted have displayed greater levels of frailty (as seen across all age groups). As a result, these patients have required a greater level of input. Overall, outcomes in such cases have been good, however, an increased length of stay has been required to achieve such results. Hospital Laboratories Kirsten Beynon, General Manager Canterbury Health Laboratories (CHL) have appointed another Anatomical Pathologist. As it can take 6-12months for an appointment to start if from overseas, it is important that CHL keeps ahead of the wave for recruitment in this area, especially with HAC 29nov16 minutes draft Page 2 of 7 29/11/2016

75 continuing demands on this workforce. Pathologists are a key workforce providing an integrated approach to care for patients that goes beyond testing. Any increase in SMOs in other disciplines can directly increase demand in Anatomical pathology. CHL recently hosted Robert Michele, Editor for the Dark Daily, international commentator on Pathology and Laboratories and diagnostics. The focus of this forum was around the future of diagnostics within the Canterbury Health System, incorporating informal discussion and sharing of perspectives for both Radiology and Laboratories. The forum highlighted commonality in some areas of which Radiology and Labs could work closer together and this will be pursued further in the New Year. Key Ministry initiatives that are in progress that will have impacts and changes for Labs are Bowel Cancer Screening, change to primary HPV screening, HCV initiative and the Forensic, Coronial, Mortuary Services. There is a need to keep across these initiatives and work with hospital services in relation to impact and implementation. Point of Care Testing (POCT). CHL provides the largest accredited POCT network in NZ, and is the only one to incorporate oversight of CPAMS and have them accredited. Connectivity includes Public Hospitals, Private Hospitals, Community & Chatham Islands (GPs, both rural and urban and Pharmacies currently). The key advantage is that results are connected to the patient management system and there is accreditation for all groups (under CHLs POCT, IANZ accreditation), which ensures high quality and reliable testing, delivered safely by competently trained personal. There was a discussion around laboratory facilities and the complex set of challenges faced. This is another facilities issue that the Board will need to address going forward. Equipment maintenance was also discussed, with Ms Beynon advising frequent maintenance is necessary, with recalibration of equipment occurring at least fortnightly. Medical/Surgical & Women s & Children s Health Marilyn Ollett, Service Manager; and Heather Gray, Director of Nursing General medicine has seen a move away from trends of previous years and at this point has not returned to normal. This is being closely monitored. Challenges are being faced with high occupancy levels. Whilst North Canterbury earthquakes have not significantly impacted on operations of Christchurch Hospital, staff resilience levels across the organisation have been impacted. There was further discussion around increased lengths of stay in general medicine. The Committee was advised that Ward 27, which normally has the quickest turnover, saw the biggest increase in length of stay. Rather than being attributable to a single cause, several factors are seen to be contributing to the increase, including age and frailty of patients, winter respiratory virus, presentation and admittance times. A number of options and initiatives are being discussed between hospitals, along with general practices, to address these issues. ESPIs ESPI 5 Treatment September and October returned a red result for ESPI 5. There was no leniency given by the MOH for strike action. 50 Vitreo-retinal surgeries have been outsourced to meet the November target and when the strike action was set to occur again in November, all long waits were moved ahead of the strike. Despite the strike action being deferred, there is still a real risk of receiving a fourth red in a row for November. Four reds theoretically triggers the ability for a financial penalty of up to $3.2M ($1.6M per month for two months) and would preclude the DHB from partaking in any other redistribution of funds during the fiscal year. A letter is being drafted to the Ministry of Health around Canterbury DHB s position with regards to ESPI compliance. A copy of this letter will be circulated to Committee members for their information. HAC 29nov16 minutes draft Page 3 of 7 29/11/2016

76 The Committee discussed the use of retrospective data and the need going forward for incorporation of queue data. This is to be included in future reports. Rural Health Services - Win McDonald, Transition Programme Manager Kaikoura Currently, there are 13 inpatient long term care patients, one acute and one respite patient. No births are planned in Kaikoura until the end of January Kaikoura Hospital performed very well, with no damage. There has been an increase in demand for psychosocial services. Waikari Currently, there are three long term care patients, one end of life and one respite patient. Initial building assessments identified no issues apart from a loss of power and some water issues. These have since been rectified. Staff are being supported with psychosocial services. Akaroa A further patient journey workshop has been held, focusing on Akaroa s future model of care. Oxford Model of care structure is up and running. Currently focus is on demographic and impact issues. Hurunui Good work continues in Hurunui. Improved response times from MSD in relation to people going into care has been noted. Chatham Islands A cross government agency forum has been held. Focus has been on developing a strategic plan for working together and moving forward. There was general discussion around the North Canterbury earthquakes. Mary Gordon, Executive Director of Nursing provided the following update: The military will be pulling out today, with control of the inland road being handed to NZTA. The coastal road south of Kaikoura is expected to open within the next six months, possibly by Christmas. The road north of Kaikoura may take 18 months/2 years to reopen. Public health issues continue. 95% of Kaikoura is back on sewerage. Boil water signs are still in force. Primary schools are reopening this week. Psychosocial teams will be onsite. EQC staff are now on the ground in Kaikoura Canterbury DHB s Emergency Operation Centre (EOC) is expected to close at the end of this week as we move into the recovery phase. It is anticipated that a Recovery Manager for North Canterbury will be appointed for the next phase of the journey and what the new normal will be. Peri Renison, Chief of Psychiatry, advised that additional mental health services will likely be required in the region as the impact of the earthquakes, drought history, economic implications play out. In addition, there are a number of ex Christchurch residents who, having relocated following the Christchurch earthquakes, are now being impacted again. HAC 29nov16 minutes draft Page 4 of 7 29/11/2016

77 With respect to additional costs being incurred, the Committee was advised that a cross sector response has been provided to the Crown for an overall funding package. Rural Health Services Berni Marra, Manager Ashburton Health Services Work is on track for moving into the new Acute Assessment Unit (AAU) and Day Procedure Theatre on Wednesday, 7 December Refurbishment of other wards will continue with an anticipated end to all works being April/May A community open session was held on 27 November 2016, with positive response. Work continues on integrating primary/secondary services, with a focus on tangible processes and working collectively so benefits are gained by all. Mental Health Peri Renison, Chief of Psychiatry Whilst there has been a stabilisation in demand for adult community care, demand in child services continues to rise. Reducing wait times has been a key focus for Child, Adolescent and Family (CAF) Mental Health Services. Triage processes are working well and work is underway to change the model of care to address wait times for follow up appointments. The Committee was advised that errors had been identified in page 35 of the H&SS Monitoring Report. A replacement page was provided to Committee members. Resolution (17/16) (Moved: Andrew Dickerson/Seconded: Steve Wakefield - carried) That the Committee: i. notes the H&SS report. The Committee moved to Item NATIONAL BOWEL SCREENING PROGRAMME UPDATE - PRESENTATION Michael Burt, Clinical Director, Gastroenterology, presented to the Committee on the National Bowel Screening Programme proposed for rollout in Also in attendance were Gill Fowler, Service Development Manager Secondary Care, Planning & Funding; Rob Hallinan, Service Manager, Christchurch Hospital; and Janice Donaldson, South Island Alliance. The presentation included: Summary and findings of Waitemata Bowel Screening Pilot. The national roll-out has been modified to cover 60 to 74 year olds (initially 50-74), as well as adjusting the threshold for a positive test. DHBs will be responsible for colonoscopy delivery and histology, and subsequent treatment and investigation. DHB s access to funding will be contingent on meeting targets for patients accessing diagnostic, surveillance and screening colonoscopies. DHBs will be responsible for treatment costs. HAC 29nov16 minutes draft Page 5 of 7 29/11/2016

78 Concerns that there are not enough colonoscopists to do the work. A third colonoscopoist trainee has been taken on in Christchurch, with other solutions being investigated. The Bowel Cancer Screening Programme will be centrally funded, but possibly not fully. Non funded additional costs will include a 20% increase in symptomatic demand, and surveillance colonoscopies. The Committee was advised that whilst wary of funding and workforce issues, clinicians are enthusiastic about the programme and see huge benefits to be gained by the community. Challenges will be faced juggling screening, surveillance and symptomatic demands. Workforce planning will be critical and is currently being looked at from a regional perspective. The Committee moved to Item CLINICAL ADVISOR UPDATE Sue Nightingale, Chief Medical Officer (CMO), provided a verbal update. Whilst strike action and earthquakes have been forefront over the past couple of months, other areas of focus include: The roll out of a SMO professional development programme. Support training for Clinical Director s. Improving Canterbury DHB behaviour and culture within the workplace, with models of kindness being explored. Ensuring coordinated quality approaches across the organisation. Hospital HealthPathways is now fully operational, providing online, real time clinical pathway guidance predominantly for junior doctors. It is expected that the Blue Book will be turned off at the end of February Topical agenda items at a national CMO level include credentialing, and harassment and bullying programmes. An appointment has been made to the position of Chief of Service, Burwood Hospital with a start date of January The Committee moved to Item RESOLUTION TO EXCLUDE THE PUBLIC Resolution (18/16) (Moved: Jan Edwards/Seconded: Steve Wakefield - carried) That the Committee: i ii. resolves that the public be excluded from the following part of the proceedings of this meeting, namely items 1 and 2; notes that the general subject of each matter to be considered while the public is excluded and the reason for passing this resolution in relation to each matter and the specific grounds under Schedule 3, Clause 32 of the Act in respect to these items are as follows: HAC 29nov16 minutes draft Page 6 of 7 29/11/2016

79 GENERAL SUBJECT OF EACH MATTER TO BE CONSIDERED 1. Confirmation of the minutes of the public excluded meeting of 27 September CEO Update (If required) GROUND(S) FOR THE PASSING OF THIS RESOLUTION REFERENCE OFFICIAL INFORMATION ACT 1982 (Section 9) For the reasons set out in the previous Committee agenda. Protect information which is subject to an obligation of confidence. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). Maintain legal professional privilege s 9(2)(ba)(i) s 9(2)(j) s 9(2)(h) iii notes that this resolution is made in reliance on the Act, Schedule 3, Clause 32 and that the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i)) of the Official Information Act INFORMATION ITEMS Nil. There being no further business, the public section of the Hospital Advisory Committee meeting was closed at 11.45am. Confirmed as a true and correct record. Andrew Dickerson Chairperson Date HAC 29nov16 minutes draft Page 7 of 7 29/11/2016

80 RESOLUTION TO EXCLUDE THE PUBLIC TO: SOURCE: Chair and Members Canterbury District Health Board Corporate Services DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The following agenda items for the meeting are to be held with the public excluded. This section contains items for discussion that require the public to be excluded for the reasons set out below. The New Zealand Public Health and Disability Act 2000 (the Act), Schedule 3, Clauses 32 and 33, and the Canterbury DHB Standing Orders (which replicate the Act) set out the requirements for excluding the public. 2. RECOMMENDATIONS That the Board: i ii. resolves that the public be excluded from the following part of the proceedings of this meeting, namely items 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,12 and the information items contained in the report; notes that the general subject of each matter to be considered while the public is excluded and the reason for passing this resolution in relation to each matter and the specific grounds under Schedule 3, Clause 32 of the Act in respect to these items are as follows: GENERAL SUBJECT OF EACH MATTER TO BE CONSIDERED 1. Confirmation of minutes of the public excluded meeting of 17 November Chair and Chief Executive - Update on Emerging Issues GROUND(S) FOR THE PASSING OF THIS RESOLUTION For the reasons set out in the previous Board agenda. Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 3. Legal Report Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). Maintain legal professional privilege 4. Wellbeing Health & Safety Report Protect the privacy of natural persons. To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). REFERENCE OFFICIAL INFORMATION ACT 1982 (Section 9) S9(2)(a) s9(2)(j) S9(2)(a) s9(2)(j) s9(2)(h) S9(2)(a) s9(2)(j) Board-15dec16-resolution to exclude the public Page 1 of 3 15/12/2016

81 5. Quarterly Facilities/Earthquake POW Update 6. Home Dialysis Service Agreement to Lease 7. Christchurch Campus Tunnel Repair Temporary Infrastructure To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 8. Park and Ride Proposal To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) /18 Planning Expectations To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). 10. Facilities Project Director s Update - Verbal 11. Indicative Business Case for Specialist Mental Health Services 12. Advice to Board: Facilities Committee Draft Minutes 28 November 2016 HAC PX Draft Minutes 29 November 2016 QFARC Draft Minutes 29 November 2016 To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). To carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations). For the reasons set out in the previous Committee agendas. s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) s9(2)(j) iii notes that this resolution is made in reliance on the Act, Schedule 3, Clause 32 and that the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i)) of the Official Information Act SUMMARY The Act, Schedule 3, Clause 32 provides: A Board may by resolution exclude the public from the whole or any part of any meeting of the Board on the grounds that: (a) the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i) of the Official Information Act In addition Clauses (b) (c) (d) and (e) of Clause 32 provide further grounds on which a Board may exclude members of the public from a meeting, which are not considered relevant in this instance. Clause 33 of the Act also further provides: (1) Every resolution to exclude the public from any meeting of a Board must state: (a) the general subject of each matter to be considered while the public is excluded; and Board-15dec16-resolution to exclude the public Page 2 of 3 15/12/2016

82 (b) the reason for the passing of that resolution in relation to that matter, including, where that resolution is passed in reliance on Clause 32(a) the particular interest or interests protected by section 6 or 7 or section 9 of the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the meeting in public; and (c) the grounds on which that resolution is based(being one or more of the grounds stated in Clause 32) (2) Every resolution to exclude the public must be put at a time when the meeting is open to the public, and the text of that resolution must be available to any member of the public who is present and form part of the minutes of the Board. Approved for release by: Justine White, General Manager Finance Board-15dec16-resolution to exclude the public Page 3 of 3 15/12/2016

83 HEALTH TARGET REPORT QUARTER 1 TO: SOURCE: Chair and Members Canterbury District Health Board Planning and Funding DATE: 15 December 2016 Report Status For: Decision Noting Information 1. ORIGIN OF THE REPORT The purpose of this report is to present the Board with the Canterbury DHB s progress against the national health targets for the first quarter of the year (July September 2016). DHB performance against the health targets is published in newspapers and online on Ministry and DHB websites. The quarter one health target performance table is attached (Appendix 1). 2. SUMMARY In Quarter one, Canterbury has: Achieved the Immunisation health target with 95% of eight-month-olds fully immunised. This is the fifth consecutive quarter that we have achieved this target. Partially achieved the Shorter Stays in ED health target, with 92.8% of patients admitted, transferred and discharged from our emergency departments within six hours. Hospital flow provided a major barrier to target achievement throughout the winter months. Partially achieved the Improved Access to Elective Surgery health target, achieving 98.9% of the expected delivery, providing 4,936 elective surgeries. We have a recovery plan in place to make up performance over the coming quarters. Partially achieved the Faster Cancer Treatment target with 77.5% of patients receiving their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer. Work being done around the capture and quality of the data and improving patient pathways will improve DHB performance over the next few quarters. Partially achieved the Better Help for Smokers to Quit Primary Care health target, reaching 88.6% of patients who smoke, maintaining last quarter s performance. This is above the national average result and Canterbury now sits near the top of the league table (5 th ) for this target. Partially achieved the Raising Healthy Kids health target, with 46% of four-year-olds identified as above the 98th centile for their BMI (height and weight measurement) referred for clinical assessment and healthy lifestyle intervention. Canterbury is in the establishment phase of the Healthy Lifestyle Coordination Service. The service will coordinate referrals and provide the families with options of Healthy Lifestyle intervention. The full service will be up and running in early APPENDICES Appendix 1: Report prepared by: Report approved by: Health Target Report Quarter One Jessica Wise, Accountability Coordinator, Planning & Funding Greg Hamilton, Acting GM Planning & Funding Board-15dec16-health target report quarter one Page 1 of 1 15/12/2016

84 NATIONAL HEALTH TARGETS PERFORMANCE SUMMARY Quarter /2017 (July to September 2016) Target overview Target Q2 15/16 Q3 15/16 Q4 15/16 Q1 16/17 Target Status Page Shorter Stays in ED Patients admitted, discharged or transferred from an ED within 6 hours. 95% 95% 95% 93% 95% 2 Improved Access to Elective Surgery Canterbury s volume of elective surgeries. 10,338 YTD 15,082 YTD 21,039 YTD 4,936 YTD 20,982 3 Faster Cancer Treatment Percentage of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer. Increased Immunisation Percentage of eight-month-olds who have had their primary course of immunisations on time. Better Help for Smokers to Quit Percentage of PHO enrolled patients who smoke who have been offered help to quit smoking by a health care practitioner in the last 15 months. Raising Healthy Kids Percentage of obese children identified at B4SC offered a referral for clinical assessment and healthy lifestyle interventions 77% 73% 70% 78% 85% 3 96% 96% 96% 95% 95% % 85.2% 88% 89% 90% 4 New New New 46% 95% 5 Canterbury DHB Health Target Report Quarter

85 Shorter Stays in Emergency Departments Target: 95% of patients will be admitted, discharged or transferred from an ED within 6 hours Figure 1: Percentage of patients who were admitted, discharged or transferred from Christchurch or Ashburton ED within six hours. 98% 95% 92% 89% 86% 83% 80% 13/14 Q1 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 15/16 Q4 16/17 Q1 Canterbury result NZ result 2016/17 target Figure 2: Weekly ED Attendances since 2012 All Canterbury Despite a number of initiatives to support flow in the Emergency Department (ED), Canterbury DHB did not reach the health target in quarter one with 92.8% of patients admitted, discharged from ED within 6 hours. Hospital flow provided a major barrier through the winter months. The whole of system approach delivered a number of initiatives to cope with high expected August volumes. While we didn t achieve the target, a number of these investments will assist future performance; for example; work with general practice to increase planned care with new acute care plans in HealthOne. We are now reviewing performance and approaches to high demand with a focus on next winter as flow has now returned to usual with the arrival of spring. The supports in place in the community, such as the Acute Demand Management Service, have meant 33,000 people in Canterbury have been provided care in the community over the last year, rather than being admitted into hospital. Graph Interpretation: The blue line is the actual number of attendances. The green line is the average. The red lines are the upper and lower control limits. The dotted lines indicate the pre-quake trend. Canterbury DHB Health Target Report Quarter

86 Improved Access to Elective Surgery Target: 20,982 elective surgeries in 2016/17 Figure 3: Elective surgical discharges delivered by the Canterbury DHB 1 25,000 20,000 This quarter, Canterbury delivered 4,936 elective surgeries, 98.9% of our target delivery. There is a recovery plan in place to make up performance over the coming quarters. 15,000 10,000 5,000 0 Q1 Q2 Q3 Q4 Performance YTD Target 2015/16 Performance Faster Cancer Treatment Target: 85% of people receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer Figure 4: Percentage of Cantabrians receiving their first cancer treatment or other management within 62 days (rolling six month result) 2 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 15/16 Q4 16/17 Q1 Canterbury New Zealand 2016/17 target In quarter one, 77.5% of patients received their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer. This is an increase (7.5%) from the previous quarter. Our teams are continuously working to improve the capture and quality of the Fast Cancer Treatment data, and reviewing patient pathways to improve timeliness. We continue to achieve the secondary performance target with 100% of patients ready-for-treatment receiving their radiation or chemotherapy treatment within four weeks. 1 Excludes cardiology and dental procedures. Progress is graphed cumulatively. 2 This target was introduced in quarter two 2014/15. The previous Health Target 100% of people needing radiation or chemotherapy receive it within four weeks continues to be monitored as a DHB performance measure. Canterbury DHB Health Target Report Quarter

87 Increased Immunisation Target: 95% of eight-month-olds are fully immunised Figure 5: Percentage of Canterbury eight-month-olds who were fully immunised 100% 95% 90% 85% 80% 13/14 Q1 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 15/16 Q4 16/17 Q1 For the fifth quarter in a row, Canterbury has achieved the immunisation target, vaccinating 95% of eligible children in quarter one. We had strong coverage rates across all population groups meeting the health target for all ethnicities (except other) this quarter: Asian (97%), Pacific (98%), New Zealand European (96%) and Māori (96%). This is a significant achievement, showing the results of the ongoing commitment from immunisation teams right across our system. Opt-off and decline rates increased this quarter from 2.6% to 3.3% of the eligible population being unreachable due to parental choice. Total Māori Pacific National Target Better Help for Smokers to Quit Target: Percentage of PHO enrolled patients who smoke who have been offered help to quit smoking by a health care practitioner in the last 15 months Figure 7: Percentage of smokers expected to attend primary care who were offered advice and help to quit smoking 100% 80% 60% 40% 20% 0% 13/14 Q1 13/14 Q2 13/14 Q3 13/14 Q4 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 15/16 Q4 Canterbury result NZ result 2015/16 target 16/17 Q1 In quarter one, 88.6% of smokers attending primary care were offered advice and help to quit smoking. While this target has not be reached performance continues to improve and the DHB s results are in line with national performance. To support performance, all PHOs continue to engage with General Practices to support them to engage staff in the delivery of ABC and actively recall patients who have a current smoker status. Canterbury DHB Health Target Report Quarter

88 Raising Healthy Kids Target: 95% of obese children identified at B4SC offered a referral for clinical assessment and healthy lifestyle interventions. 100% 80% 60% 40% 20% 0% Q1 Q2 Q3 Q4 Referrals Sent & Acknowledged New Zealand result Target This quarter, 46% of four-year-olds identified as above the 98th centile for their BMI (height and weight measurement) were referred for clinical assessment and healthy lifestyle intervention. The establishment phase of the Healthy Lifestyle Coordination Service is underway. The service will coordinate referrals and provide the families with options of Healthy Lifestyle intervention. The full service will be up and running in early We anticipate the percentage of referrals sent and acknowledged to increase in the next quarterly reporting round. Canterbury DHB Health Target Report Quarter

89 National Health Target Results Q1