Healthy Skin in Greater Wellington Hui - 26 May 2011 Totara Lodge, Trentham, pm

Transcription

1 Healthy Skin in Greater Wellington Hui - 26 May 2011 Totara Lodge, Trentham, pm Present: Adrian Gilliland (Clinical Advisor Primary and Integrated Care, Capital & Coast DHB) Api Poutasi (Public Health Analyst, Keeping Well) Barry Gall (Senior Public Health Advisor, Keeping Well) Berni Marra (Manager Capital & Tumai, Compass PHO) Cathy Nichols (City Medical Centre) Christine Roseveare (Senior Public Health Advisor, Regional Public Health) Debbie Rickard (Child Health Services, Capital & Coast DHB) Joanne Reid (Group Manager, Preventive Health & Chronic Disease, Regional Public Health) Kathie McCarten (Communications Co-ordinator, Keeping Well) Mary Strang (Public Health Advisor, Regional Public Health) Robyn Kelly (Team Leader, School Based Services, Regional Public Health) Ruth Richards (Public Health Physician, Regional Public Health) Sarah Dewes (Public Health Advisor, Wairarapa Population Health Unit) Stephanie Chapman (Project Manager, Clinical Leadership Group) Taima Fagaloa (Director Pacific Health, Capital & Coast DHB) Theresa Fowler (Primary Health Nurse Consultant, Hutt Valley DHB) Tessa-Jane Dennes (Team Leader, Population Health, Wairarapa Population Health Unit) Vicky Noble (Director of Nursing, Primary Health Care & Integrated Care, Capital & Coast DHB) Apologies: Anne Mitchell (Clinical Head of Paediatrics, Hutt Valley DHB) Jenny Allan (Group Manager, School Health & Immunisation) Lisa Burch (Portfolio Manager, Wairarapa DHB) Lyn Taylor (Portfolio Manager, Hutt Valley DHB) Nicholette Pomana (Population Health Manager, Hutt Valley DHB) Nikki.Blair (General & Community Paediatrician, Capital & Coast DHB) Tess Geard (Paediatrics Team Leader, Wairarapa DHB) Facilitators: Barry Gall and Ruth Richards Overview of Keeping Well Barry Gall gave an overview of the Keeping Well (KW) Strategy and Implementation Plan. KW has chosen Children & Young peoples as a priority population group and canvassed the sub-regional DHB s regarding population health projects to initiate or support. The DHB s identified the following child health issues to address: Capital & Coast DHB rheumatic fever, skin infection and respiratory conditions with particular support of the Porirua Kids Project Hutt Valley DHB - respiratory conditions, skin infection and rheumatic fever with a focus on high needs areas Wairarapa DHB skin infection with a focus on school and early childhood settings The commonality of skin infection allowed for a sub-regional approach to the issue whilst supporting the local projects. Cognisant of other initiatives regarding skin infection, KW undertook to bring key players together to explore a joined up approach and reduce the risk 1

2 of duplication. While the initial focus is on skin infection, the project has the potential to change the way we work across the continuum of health sector practice. If successful, it could be a prototype for dealing with other conditions across districts and disciplines e.g rheumatic fever, respiratory conditions Overview of Regionalisation Dr Ruth Richard presented a diagram that mapped current activity on skin infection within the sub-region. Some additions were recommended and are included in version 2 (Appendix 1). Overview of Ambulatory Sensitive Hospitalisation (ASH) project Stephanie Chapman provided background and progress on the sub-regional ASH project which is a work stream of the Sub-Regional Clinical Leadership Group (CLG). The CLG was formed in 2010 to progress regional collaboration and identified four key priority areas to focus on. Child Health is one of these priorities and the ASH project is a work stream of the Child Health focus area. The ASH project report to the CLG included the following recommendations: 1. That an agreed approach to skin infections in the community be adopted by the three DHBs in conjunction with Keeping Well, Porirua Kids and other projects. 2. That adequate data is collected and information gained as to the effectiveness of programmes is obtained so that those initiatives that are most effective and deliver best value for money are promulgated across the sub-region. 3. That the learnings from the skin infection project refine the general principles which are then applied to the other ASH conditions (asthma, viral respiratory infections and gastroenteritis). Roadmap to Healthy Skin in Greater Wellington Ruth Richards gave an overview of a proposed road map to achieving the goal of Healthy Skin in Greater Wellington. Using DoView, the roadmap was amended to incorporate suggested changes and activities (Appendix 2). Discussion on the outcomes and action areas are summarised below. Outcomes There was general agreement that the proposed nine Outcomes captured the necessary outcomes to achieve the goal of healthy skin in greater Wellington. It was noted that addressing other skin conditions (e.g eczema) was important and this would fall under the outcome of more prevalent prevention and management of other skin conditions. Action Areas The group discussed the proposed Action Areas and provided the following comments and activities that would support each Action Area: 1. Income - access to resources through Work & Income It was suggested that this simply be access to resources of which Work and Income would be one source of assistance. PHO s are another sources of assistance for the cost of scripts and access to kits (e.g dressings). There are local examples where access is determined via assessments by social workers and we need to build on these. 2. Housing Environment pest control, linen, care of pets Housing environment was stressed as being important and interventions need to be accompanied by prevention messages to households. 2

3 3. Engagement with preventive, primary, secondary and tertiary services It was agreed that and wider sector be added to reflect the necessity of intersectoral action to address key determinants. Relevant agencies should be identified and strategic relationships developed on many levels e.g management to management, CEO to CEO. Sharing of information and activities will strengthen what is already working and reduce duplication. 4. Settings educational, work, sport, cultural These need to be locally responsive and successful initiatives to be identified and shared across the region. 5. Access to health care community, primary, secondary, tertiary services Community includes pharmacy and community health workers who can engage with whanau and link to services which also improves access. 6. Focus resources where the problem is greatest This approach is to include particular populations or geographic communities and can be informed by local Needs Analysis. Any approach should be strength based and include a Strengths Analysis which also identifies local leaders. 7. Whanau/Community Engagement As above, the approach needs to be strength based with an emphasis on empowering whanau/community. While there is an emphasis on children, a whanau ora approach would embrace the whole family. Community engagement should include iwi and churches. 8. Workforce development This should be broad based and appropriate to the level of activity. The target workforce needs to be identified (e.g nurses, GP s, teachers, community workers, pharmacists) as well as champions. Some training would need to be delivered outside 9-5 work hours to included evenings and weekends. 9. Guidelines, protocols and common messages A common problem is the lack of consistent messages. There are many guidelines and protocols in use and we need to agree on a consistent set of messages to be reflected in all key messages, especially for the community. These messages can also be adapted for certain audiences, especially for our target communities. A group of clinicians may want to establish best practice guidelines. 10. Data Collection It was agreed that evaluation be added to this action area. It is important to capture success at an earlier stage than hospital admission as ASH data alone does not provide the full picture. Any action here should link in with RPH s Data Collection project. Key ideas from the day Engagement and communication with communities need to be strengths based. Health literacy can be empowering and target communities should be involved in the design of interventions and especially communication methods which can include the use of metaphor. Ensure that our understanding of causation includes the multiple issues and layers. 3

4 Have a good appreciation of what is happening in the community. The regionalisation overview could be used to capture current activity and identify which initiatives to build on and/or apply elsewhere. Next steps: Notes from the Hui and background information to be disseminated to the group. The roadmap to include an introduction and instructions on how to read it. The group to identify others to be involved and seek feedback on the roadmap from their networks. Meet again with a wider group that includes others to be involved and work out how to efficiently keep all players engaged at sub-regional and local levels. The next hui to develop a plan of action that identifies resources and approaches that can be developed and applied sub-regionally. 4

5 Appendix 1 Regionalisation in Health Minister Public Health Population Health National Public Health Leaders Group Ministry of Health incl National Health Board Regional Public Health Group 6 DHB Plus Tairawhiti and Taranaki (new) Regional District Health Boards Planning Group (6 DHB: Whanganui, Mid-Central, Hawkes Bay, Wairarapa, Hutt Valley, Capital and Coast) Regional Public Health covering Greater Wellington DHBs Programmes RPH Skin Programme School Health Public Health Nurses Primary Health Organisation Services to Improve Access/Health Promotion Primary Care Wairarapa Skin Project Sub-regional Clinical Leadership Group Four Campus Planning (3 DHBs) Clinical Project Groups Child Health Mental Health ENT Older Persons Health ASH* Greater Wellington DHBs: Hutt Valley, Capital & Coast and Wairarapa *= Ambulatory Sensitive Hospitalisations Others Ear Van RPH 5 Secondary and Tertiary Care Plans to Improve Child Health Outcomes Keeping Well Strategy- WDHB, HVDHB, C&C DHB, MoH Link community, prevention, primary and secondary care. Focus on children. Exemplar Projects WDHB HVDHB C&C DHB Wairarapa Skin Project Hutt Primary Care Nurses Skin Project Porirua Kids- Rheumatic fever and skin

6 Appendix 2 A Roadmap for achieving Healthy Skin in Greater Wellington Interpretation The roadmap below is a visual tool for illustrating how we want to achieve the Goal (top yellow box) of Healthy Skin in Greater Wellington The Outcomes (green boxes) are the results of our activities that are necessary to achieve the goal. The Action Areas (blue boxes) are the building blocks that lead to the outcomes that we want. Each of the Action Area boxes can drill down to another box or page that identifies specific activities. These activities will identify who does what and the resources and activities that can be shared. 6

7 7