Health and Safety Guide: Good Governance for Directors

Health and Safety Guide: Good Governance for Directors March 2016 142

About IoD The Institute of Directors in New Zealand (Inc) (IoD) is the leading professional membership organisation for directors with more than 7,000 individuals representing the spectrum of New Zealand enterprise, from the commercial, not-for-profit and public sectors. The IoD aims to raise the standard of governance in all areas of New Zealand business and society. It promotes excellence in corporate governance, represents directors interests and facilitates professional development through education, governance training and resources. About WorkSafe WorkSafe New Zealand is New Zealand s workplace health and safety regulator. New Zealand has unacceptably high rates of workplace fatalities, serious harm injuries and work-related disease and illness. We are working collaboratively to achieve a 25 percent reduction by 2020 of the workplace death and injury toll. Work is also underway to establish occupational health reduction targets. Our focus is to embed and promote good workplace health and safety practices. We are also the regulator for electricity and gas safety in the workplace and home. WorkSafe's approximately 550 staff are located in 20 offices across New Zealand. We work closely with employers, employees and others to: educate them about their workplace health and safety responsibilities engage them in making changes that reduce the chances of harm enforce workplace health and safety legislation. 143

CONTENTS Foreword 2 Introduction 4 WHY EFFECTIVE GOVERNANCE IS IMPORTANT 6 The need to improve 7 The benefits of good health and safety 7 ESSENTIAL ELEMENTS OF HEALTH AND SAFETY GOVERNANCE 9 Leadership 10 Legislation 10 Worker engagement and participation 12 THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE 14 1. Policy and Planning 15 2. Delivery 18 3. Monitoring 23 4. Review 25 CONCLUSION 27 APPENDICES 29 Appendix A: Directors Health and Safety Checklist 30 Appendix B: The Safety Governance Pathway How is your organisation tracking? 31 Appendix C: Sample Terms of Reference Board Health and Safety Committee 34 Appendix D: Glossary 36 144

FOREWORD The Institute of Directors in New Zealand (Inc) (IoD) is pleased to release the next edition of the Health and Safety Guide: Good Governance for Directors in partnership with WorkSafe New Zealand. The IoD is committed to raising awareness of the importance of health and safety in New Zealand businesses and educating directors about their roles and responsibilities. The Health and Safety at Work Act 2015 requires directors to take ultimate responsibility for the health and safety of their business. Directors must have knowledge of and commitment to health and safety, but contrary to some beliefs, are not expected to be experts to meet the expectations of the Act. The principles underpinning health and safety governance are no different than any other aspect of a governance role. Good health and safety governance is about having a demonstrable plan and a pro-active approach to making the workplace as safe as it can be. Directorship in health and safety is not about responsibility for the day-to-day granular operations of the entity. It is about ensuring appropriate systems and processes are in place to support health and safety and, critically, that there is proper resourcing and verification of health and safety at the board table. We are grateful to Dr Kirstin Ferguson for sharing the Safety Governance Pathway to help boards determine their vision of safety governance. In recent time we have seen many positive steps by companies to entrench a strong health and safety culture. It s encouraging to see many of our members making a commitment beyond basic compliance to changing the safety culture of the entity. Put simply, valued workers make for a better business. The health and safety guideline helps directors focus on the new Act and supports them with practical guidance and thought leadership in health and safety governance. I commend this guide to you on behalf of the IoD. Simon Arcus Chief Executive Institute of Directors 145

As Chief Executive of WorkSafe New Zealand I am pleased to introduce the revised version of the Health and Safety Guide: Good Governance for Directors in partnership with the Institute of Directors in New Zealand. The first version of this guide was produced in May 2013 to assist directors to lead workplace health and safety. This edition complements the Health and Safety at Work Act 2015 which came into force on 4 April 2016. The Act sets expectations and defines duties clearly. One of these duties is that senior officers of businesses, such as CEOs and board directors, must exercise due diligence on health and safety. This means that the top of the shop must have a good understanding of the risk profile of its operations, the key controls in place and a system of providing information on whether these controls are working. These are essential but not sufficient for exercising really effective health and safety leadership. In addition, leaders need to demonstrate to their staff and to their suppliers, customers and contractors that they mean it. This takes health and safety off the page of process and systems, and into the area of behaviour summarised in the old cliché, walking the talk. A key component of effective health and safety leadership is engagement with workers. The identification of risk and the implementation and maintenance of effective controls requires input from those at the sharp end. After all, it is the workers who often have the best understanding of how systems, processes and policies are working out in practice. There are also opportunities here that go beyond health and safety. It is well understood that an engaged workforce delivers better morale and productivity. So, what better subject than health and safety to start the engagement journey with staff? Myself and WorkSafe encourage and support all leaders to foster a health and safety culture in their operations, from one end of the supply chain to the other. Our messages are simple everyone needs to do more and do it better to make sure we all come home from work healthy and safe each day. Not only is good health and safety the right thing to do, it also makes good business sense. Gordon MacDonald Chief Executive WorkSafe New Zealand 146

INTRODUCTION The governance of an organisation involves a framework of values, processes and practices. Through this framework, directors and boards exercise their governing authority and make decisions to achieve the organisation s purpose and goals. Directors ensure the organisation operates ethically and complies with all laws and regulations. It is important to distinguish between governance and management practices. Directors should focus on determining the organisation s purpose, developing an effective governance culture, holding management to account and ensuring effective compliance. Directors work with management to develop strategy and business plans which are then implemented by management. Health and safety governance is as important as any other aspect of governance. It is a fundamental part of an organisation s overall risk management function, which is a key responsibility of directors. Directors and other officers have a duty to exercise due diligence to ensure that the organisation complies with health and safety duties and obligations. Failure to manage health and safety risk effectively has both human and business costs. The price of failure can be the damaged lives of workers, their families and friends, as well as direct financial costs, damaged reputations and the risk of prosecution. It is important to remember that an organisation s primary duty to ensure so far as is reasonably practicable the health and safety of workers extends beyond it s own workers to all workers whose activities they influence or direct (including subcontractors and volunteers). Legislation in New Zealand also extends an organisation s health and safety duties to all those who could be put at risk by the activities of the organisation, such as visitors, customers and the public. Organisations that learn to manage health and safety well learn that the capability that drives success in this area is the same capability that drives success in other areas of the business. Organisations with a good health and safety culture and reputation are valued by workers, investors and stakeholders. Because of their position in the organisation, directors have a unique opportunity and an obligation to make a difference by providing leadership in this critical area of governance. It is also important to ensure that when an organisation achieves success, it is celebrated. PURPOSE AND SCOPE OF THIS GUIDELINE The purpose of this guideline is to provide advice to directors on how to meet their health and safety obligations and to: demonstrate how directors can influence health and safety performance provide a framework for how directors can lead, plan, review and improve health and safety assist directors to identify whether their health and safety management systems are effective in minimising risk encourage directors to create strong, objective lines of reporting and communication to and from the board 1. 1 This document does not provide industry-specific advice. It is recommended that you seek such advice as a regular part of best practice. Ideally, you will have somebody with industry knowledge on your board who can provide this advice. 147

This guideline has been drafted by WorkSafe New Zealand in association with the Institute of Directors in New Zealand. Its focus is on the due diligence duty that directors have under the Health and Safety at Work Act 2015 (HSWA). The duty to exercise due diligence is in fact owed by all officers as defined in HSWA, not just directors. Therefore, this guideline can be referred to by all officers to assist them in meeting their due diligence duty. This guideline is also intended to have particular application to directors of medium-to-large sized organisations (20 or more employees). A separate guideline is available for officers of smaller organisations. This document is a good practice guideline, intended to explain how an officer (including a director) may comply with their legal obligations under HSWA. While a court may take this document into account, there is no compulsion for it to do so. Where the word must is used in the document, this is intended to convey a legal requirement. The word should is used to convey a good practice requirement. This guideline updates the 2013 Good Governance Practices Guideline, to reflect HSWA. 148

Why effective governance is important 6 149

WHY EFFECTIVE GOVERNANCE IS IMPORTANT THE NEED TO IMPROVE We know that many New Zealand organisations can and should improve their health and safety record. Each week one to two New Zealanders are killed while at work. It is estimated that annually 600 to 900 people die prematurely from occupational diseases such as asbestosis. The financial cost of work-related injuries and death is estimated to be $3.5 billion or more each year. When looking at our performance in comparison to other developed countries we have much room for improvement. The statistics do not begin to describe the impact on those who have been harmed, their families, friends and colleagues. The need to address this human cost is in itself sufficient reason to improve our record of harm prevention. THE BENEFITS OF GOOD HEALTH AND SAFETY A positive and robust health and safety culture that begins at the board table and spreads throughout the organisation adds significant value, including: Enhanced standing among potential workers, customers, suppliers, partners and investors as a result of a good reputation for a commitment to health and safety. Workers participating positively in other aspects of the organisation. A good organisational culture spreads wider than health and safety. Decreased worker absence and turnover. Engaged workers are more productive workers. Reduced business costs, for example, a reduction in ACC levies as a result of improved health and safety performance and outcomes. Potentially increased economic returns. A report from the International Social Security association found a return on prevention ratio of 2.2 2. The Pike River Mine case provides a sobering example of how ineffective governance can contribute to catastrophic results. 2 The Return on Prevention: Calculating the costs and benefits of investments in occupational safety and health in companies; International Social Security Association (ISSA), Geneva, 2011. 7 150

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS Case Study Pike River Coal Mine Tragedy An explosion at the Pike River Mine on Friday 19 November 2010 caused the deaths of 29 men. The mine was new and the health and safety systems of its owner, Pike River Coal Ltd (Pike River) were inadequate for safe coal production. There were numerous warnings of a potential catastrophe at Pike River including multiple reports made by the underground deputies and workers. The warnings were not heeded. In the view of the Royal Commission after the disaster, the directors and executive managers paid insufficient attention to health and safety and exposed workers to unacceptable risks. The final report reached the following conclusions: The board needed to satisfy itself that executive managers were ensuring workers were being protected. The board needed to have a company-wide risk framework and to keep its eye firmly on health and safety risks. It should have ensured that good risk assessment processes were operating throughout the company. An alert board would have ensured that these things had been done properly. It would have familiarised itself with good health and safety management systems. It would have regularly commissioned independent audits and advice. It would have held management strictly and continuously to account. The board s focus on meeting production targets set the tone for executive managers and their subordinates. The Chairman s general attitude was that things were under control unless told otherwise. Coupled with the approach taken by executive managers this attitude exposed the workers to health and safety risks. This last point is critical; the board s approach was not in line with good governance responsibilities. The board must establish an effective health and safety governance culture that encourages the disclosure of health and safety risks, to enable warnings to be heard and acted upon. 8 151

Essential elements of health and safety governance 9 152

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS LEADERSHIP It is the role of directors to provide leadership by driving policy, including setting the direction for health and safety management and performance. Directors create expectations and exercise due diligence by holding management to account for meeting them. Directors should: Ensure there is an active commitment and consistent behaviour from the board that is aligned with the organisation s values, goals and beliefs. This will encourage a positive workplace culture. Ensure leadership is informed leadership. Directors need to be aware of the organisation s risks. They should have an understanding of control methods and systems so they can identify whether their organisation s systems are appropriate. They should understand how to measure health and safety performance so they can understand whether systems are being implemented effectively. Be prepared to seek advice from industry and health and safety experts as required. Set an example and engage with managers and workers. This could include visiting work sites. This provides leadership, and improves knowledge of health and safety matters. The Safety Governance Pathway (Appendix B) is a tool to help identify what stage of safety governance maturity an organisation may currently be experiencing. LEGISLATION The core piece of legislation governing health and safety practice in New Zealand is HSWA. HSWA places a primary duty on a person conducting a business or undertaking (PCBU) to ensure, so far as reasonably practicable, the health and safety of its workers, and other workers whose activities they influence or direct. This primary duty extends to ensuring, so far as reasonably practicable, that the health and safety of other persons is not put at risk by the work of the PCBU, including visitors and other people in the vicinity of the workplace 3. A PCBU will usually be a business entity, such as a company. However, an individual can be a PCBU, such as a sole trader or self-employed person. Specific volunteer associations without paid employees are not PCBUs 4. DIRECTORS DUTIES AND LIABILITIES The legislation places a positive duty on directors as officers of a PCBU to exercise due diligence to ensure that the organisation complies with its health and safety duties and obligations. The term officers includes those who hold positions that enable them to significantly influence the management of the organisation. This means that certain senior leaders in an organisation (such as CEOs) are also officers and have a due diligence duty. 3 Health and Safety at Work Act, section 36. 4 Health and Safety at Work Act, section 17(2). 10 153

ESSENTIAL ELEMENTS OF HEALTH AND SAFETY GOVERNANCE Officers are: company directors partners in a partnership and general partners in a limited partnership a person who holds a position comparable to a director in a body corporate or unincorporated body (eg members of Boards of Crown entities, members of school trustees, Board or Committee members for community or not-for-profit organisations) people who hold positions that enable them to significantly influence the management of the business or undertaking (eg CEOs). An elected member of a governing body of a territorial authority or regional council does not have a duty of due diligence to ensure that a council-controlled organisation complies with it duties or obligations under HSWA, unless they are also an officer of that councilcontrolled organisation. While this guideline focuses on directors, it is important to note that all officers have the same duty under HSWA to exercise due diligence. DIRECTORS DUE DILIGENCE Due diligence requires directors (as officers) to take reasonable steps to understand the PCBU s operations and health and safety risks, and to ensure that they are managed so that the organisation meets its legal obligations. Due diligence is defined in section 44(4) of HSWA as taking reasonable steps to: acquire and update knowledge of health and safety matters gain an understanding of the operations carried out by the organisation, and the hazards and risks generally associated with those operations ensure the PCBU has, and uses, appropriate resources and processes to eliminate or minimise those risks ensure the PCBU has appropriate processes for receiving and considering information about incidents, hazards and risks, and for responding to that information in a timely way ensure there are processes for complying with any duty, and that these are implemented verify that these resources and processes are in place and being used. Directors (and other officers) must exercise the care, diligence, and skill that a reasonable director (or officer) would exercise in the same circumstances. What is considered reasonable will depend on the particular circumstances, including the nature of the business or undertaking, and the director or officer s role and responsibilities. All officers, including directors, may seek health and safety advice from experts or others within their organisation, such as managers. Where they choose to rely on this advice, the reliance must be reasonable. Directors (and other officers) should obtain enough health and safety knowledge to ask the right questions of the right people and to obtain credible information. 11 154

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS DIRECTORS LIABILITY Directors and other officers will be personally liable if they breach their due diligence duty. The maximum penalty for a serious breach of the due diligence duty is imprisonment for up to 5 years and/or a fine of up to $600,000 5. Insurance cannot be used to pay fines under HSWA 6. Certain officers are exempt from being prosecuted for a failure to meet the due diligence duty. Exempt officers include: elected members of local authorities (councillors) under the Local Electoral Act 2001 members of local or community boards elected or appointed under the Local Electoral Act 2001 members of school boards of trustees appointed or elected under the Education Act 1989 volunteer officers 7. The due diligence duty supports the primary duty of care. It places a duty on individuals whose decisions significantly influence the activities of a PCBU, therefore influencing whether or not the PCBU meets its duties. However, the PCBU s duties and the officer s due diligence duty operate independently. If a PCBU fails to meet any of its duties it does not necessarily mean that the directors or other officers have failed to exercise due diligence. Conversely, a director or other officer may be found guilty of an offence for failing to discharge their due diligence duty whether or not the PCBU has been found liable 8. WORKER ENGAGEMENT AND PARTICIPATION Worker engagement is an important part of growing a positive workplace culture. Research has shown that worker participation (and union participation) leads to better health and safety outcomes 9. All workers should be encouraged to contribute to continuous improvement by raising issues, generating ideas, and participating in system development, implementation, monitoring and review. It is a legal requirement for all PCBUs to have worker engagement and participation practices, regardless of their size, level of risk or the type of work they carry out. PCBUs must: engage with workers on matters which will or are likely to affect their health and safety have worker participation practices that provide workers with reasonable opportunities to participate effectively in improving health and safety. Participation practices can be flexible an organisation and its workers should choose a worker participation model that works for them. What is appropriate will depend on the nature of the risks, the size of the organisation and the views and needs of the workers. Our vision is that worker participation is a valued part of the workplace health and safety system, and management is interested in and open and responsive to workers health and safety concerns. The Report of the Independent Taskforce on Workplace Health & Safety: He Korowai Whakaruruhau (2013) 5 Health and Safety at Work Act 2015, section 47. 6 Health and Safety at Work Act 2015, section 29. 7 Health and Safety at Work Act 2015, section 51. 8 Health and Safety at Work Act 2015, section 50. 9 The role and effectiveness of safety representatives in influencing workplace health and safety, Walters, D.R. Theo Nichols, 12 Judith Connor, Ali C. Tasiran and Surhan Cam, (2005), HSE Research Report 363, Sudbury, HSE Books. 155

ESSENTIAL ELEMENTS OF HEALTH AND SAFETY GOVERNANCE Worker participation practices can be direct or through representation. Representation means that workers choose one or more people to speak or act on their behalf. Workers can then share questions, concerns and suggestions with health and safety representatives, health and safety committees, unions or other worker representatives who can raise health and safety matters with the PCBU. Directors should set the overall tone for engagement by holding management to account to ensure workers are involved. Questions as simple as what are our workers saying about this issue? or how do our workers feel about it? can bring a new dimension to the discussion. Asking what systems or processes are used in finding this information can provide assurance of authentic engagement for example, some boards may find it useful for directors to make site visits. Case Study Easy Rider When the Easy Rider sunk in Foveaux Strait in 2012, eight people died, including the skipper. In March 2014, Gloria Davis, the owner of the fishing vessel and sole director of AZ1 Enterprises Ltd was found by the court to be responsible for failing to take all reasonable steps to ensure no contractor or subcontractor was harmed while on board the vessel. The Court found that Davis failed to ask the relevant questions and consciously ignored safety issues as the vessel: had not passed a safety audit contained insufficient life-jackets was carrying passengers, not permitted for a commercial vessel had a skipper with no certification. In this case, while AZ1 Enterprises Ltd was the principal under the Health and Safety in Employment Act 1992 (HSE), the court found that the company could only discharge its responsibilities through its agents; the skipper, Mr. Karetai (who died in the accident) and Ms. Davis. The individuals actions could be attributed to the company and the company s liability was therefore the result of the shortcomings of its authorised agents. AZ1 was fined just over $200,000 and Davis was sentenced to 350 hours of community service and a fine of $3000. While brought under HSE, this case provides an example of how some elements of the due diligence requirements may be interpreted under HSWA. 13 156

The role of directors in health and safety governance 14 157

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE This part explains how directors can exercise due diligence in relation to health and safety through their governance role. Due diligence is defined in section 44(4) of the HSWA as including particular actions (as is set out earlier in this guideline). This part of the guideline sets out a suggested approach to due diligence which incorporates the legal requirement in section 44(4) of HSWA. The role of directors is outlined in the following pages in terms of four key elements: 1. Policy and Planning 2. Delivery 3. Monitoring 4. Review The discussion of each element begins with a table that outlines suggested director and manager responsibilities. At the end of each section you will find a series of diagnostic questions and director actions. The diagnostic questions are designed to be used by directors as a tool to determine whether the organisation s practices are consistent with the board s beliefs, values, goals and approved systems. They can also be used as a basis for identifying areas that could be improved. They will not all be relevant to every organisation, but are intended to assist directors in asking probative questions. The actions for directors are divided into two categories baseline actions and recommended practice. Baseline actions are a suggested minimum requirement while recommended practice reflects taking the next step towards best practice. 1. POLICY AND PLANNING DIRECTOR RESPONSIBILITIES > To determine the board s charter and structure for leading health and safety. > To determine high level health and safety strategy and policy, including providing a statement of vision, beliefs and policy. > To hold management to account for implementing strategy. > To specify targets that will enable the board to track the organisation s performance in implementing strategy and policy. > To manage the health and safety performance of the CEO, including specifying expectations and providing feedback. MANAGER RESPONSIBILITIES > To determine and implement business and action plans to give effect to board strategy. > To determine targets that will enable management to track their performance. > To implement performance review processes for workers that specify health and safety expectations, and provide feedback on performance. BOARD CHARTER AND STRUCTURE The board should have its own charter setting out its role in leading health and safety in the organisation, as well as the role of individual directors. The board may consider assigning a lead role in health and safety to an individual (if you have someone on the board with the necessary expertise) or a committee (with its own Terms of Reference) clearly describing how it supports the board in fulfilling its roles under HSWA and the Board Charter. Where specialist expertise is required, consideration should be given to the engagement of an expert advisor. However, remember that while tasks can be assigned and external knowledge sought, overall responsibility and liability cannot be delegated. 15 158

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS HEALTH AND SAFETY GOVERNANCE POLICY A health and safety governance policy will be the formal mode of communication that demonstrates the board s commitment to the management of health and safety. This represents a long-term view that will set the tone for how everyone in the organisation will behave. The health and safety governance policy is robust when management and workers are involved in its preparation and reality-testing, and it is a legal requirement to engage workers in its development. However, this policy should ultimately be approved and owned by the board. Health and safety policies should reflect the organisation s responsibility to ensure so far as is reasonably practicable the safety and health of all workers (employees, contractors, subcontractors) and of anyone whose health and safety may be at risk by the work carried out by the organisation. SETTING TARGETS Directors should set targets that provide clear direction, focus and clarity of expectation. They should: be measurable be challenging but realistic contain a mix of lead and lag indicators, with a greater weighting on lead indicators which focus on prevention. A good discussion of the use of indicators is included in the publication How Health and Safety Makes Good Business Sense a summary of research findings. Lead indicators measure activities designed to prevent harm and manage and reduce risk, whereas lag indicators measure performance results. Care should be taken with the use of lag indicators because of their potential to encourage perverse outcomes such as the non-reporting of incidents, near misses and injuries. RELATIONSHIP WITH FINANCIAL TARGETS It is important that directors set health and safety and financial targets that are complementary. Directors should ensure their organisation does not have a culture where financial targets are prioritised at the expense of health and safety. ZERO HARM Zero harm is often used as an aspirational target, however this should be done with caution. Before applying this target, consider the strength of the organisation s risk and reporting culture. If it is weak, there may be a risk of cover-ups and non-reporting. Always remember, the key is to know what is happening in the organisation so that the board can make the right decisions. 16 159

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE MANAGEMENT STRUCTURE AND PERFORMANCE The board should ensure that there is an effective link between their health and safety goals and the actions and priorities of senior management. The board achieves this through the CEO. The CEO and managers allocate health and safety responsibilities and accountabilities throughout the organisation, by including them in role descriptions and performance review processes. It is also good practice for knowledge of, and commitment to health and safety to be assessed during the recruitment of senior managers. DIAGNOSTIC QUESTIONS The following diagnostic questions are examples that can be used by directors and boards as prompts to determine whether they are effectively meeting their responsibilities and accountabilities. They can also be useful in determining whether the organisation s practices are consistent with the board s strategies, beliefs, values, goals and approved systems. 1. How do you ensure that the targets you establish for the organisation are aligned with the health and safety strategies and goals in both the long and short-term, are challenging but realistic, and have no unintended perverse consequences? 2. How is the board structured to deliver its commitment to health and safety? Where and how is this structure described? 3. What are the key health and safety responsibilities and accountabilities of operational managers? How are these different from support staff? 4. How do you ensure that the CEO understands and meets the board s expectations with regard to health and safety management? 5. What process do you use to assess the CEO s health and safety performance? How does this process recognise good and bad performance? 6. What processes are in place for ensuring that managers clearly understand their health and safety responsibilities and are held accountable for carrying them out? 7. How are the organisation s workers involved in the establishment of the organisation s vision, beliefs and policy? ACTIONS FOR DIRECTORS BASELINE ACTIONS RECOMMENDED PRACTICE Organisational Beliefs, Vision, Policy Develop, approve and publish a health and safety policy statement that expresses the organisation s commitment to health and safety. Ensure that the PCBU involves workers and their representatives in the development of the policy statement. This will help to ensure that it is owned by the whole organisation and is also a legal requirement on the organisation as a PCBU. Targets Establish targets for tracking the organisation s effectiveness in implementing the board s health and safety strategy and goals. Include both lead and lag indicators in targets and ensure they do not create perverse incentives. 17 160

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS BASELINE ACTIONS RECOMMENDED PRACTICE Board Policy, Structure, Process Decide how to structure the board so that health and safety has appropriate focus and expertise. Develop a board charter that will describe the board s own role and that of individual directors in leading health and safety in the organisation. Consider nominating a non-executive director as a health and safety champion, or establishing a committee that can focus on this area. Ensure the board charter describes detailed structures and processes to be used to plan, deliver, monitor and review leadership of health and safety. Management Structure and Performance Provide the CEO with a role description that includes health and safety responsibilities and accountabilities. Ensure that management operates with a structure that appropriately recognises the respective health and safety responsibilities and accountabilities of operating and support staff. Apply a performance review process to the CEO role and ensure that a similar process applies to other management roles. Ensure that performance review and reward systems do not encourage cover ups and other unwanted behaviours that are inconsistent with the board s charter and health and safety policy. 2. DELIVERY DIRECTOR RESPONSIBILITIES > To set a clear expectation that the organisation has a fit-for-purpose health and safety management system. > To exercise due diligence to ensure that the system is fit-for-purpose, effectively implemented, regularly reviewed and continuously improved. > To be sufficiently informed about the generic requirements of a modern, best practice health and safety management system and about their organisation and its risks to know whether its system is fit-for-purpose, and being effectively implemented. > To ensure sufficient resources are available for the development, implementation and maintenance of the system. MANAGER RESPONSIBILITIES > To lead the implementation of health and safety management systems. > To identify resource requirements for the development, implementation and maintenance of the health and safety system, obtain approval for their provision, and secure and allocate resources accordingly. > To allocate responsibility and accountability to managers and workers for implementing the system. > To monitor the effectiveness of the system and implement continuous improvements. HEALTH AND SAFETY MANAGEMENT SYSTEM Organisations should have a fit-for-purpose health and safety management system that is integrated with other management systems. The size, sophistication and detail of the system will reflect the organisation s risk profile. For example high hazard organisations require more substantial systems. 18 161

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE Merely having a good system will not achieve good health and safety. Systems need to be implemented with rigour and consistency. Directors should hold management to account for effective implementation. The main aim of a health and safety management system is effective hazard and risk management. This is the process by which hazards that have the potential to cause harm are identified and controlled to eliminate or minimise the risk of harm. Harm refers to illness, injury or both. It includes physical or mental harm caused by work-related stress. RISK PROFILE Boards need to understand the nature of the health and safety risks their organisation and workers face. Risk assessment requires a judgement about the probability of an incident happening and the potential seriousness if it does happen. Attention needs to be paid to the full spectrum of risks: Critical risks are low probability events that could seriously harm or kill someone. Boards should ensure the organisation has identified its critical risks and that sufficient resources are available to control them. Boards should establish indicators and receive regular reports on management of critical risks. High probability risks are the risks that are more likely to occur but generally have less serious acute consequences or chronic effects where there is longterm exposure. Boards need to ensure that these risks are managed as they affect workers health and safety more often. Reviewing lag indicators such as incidents reports can enable boards to understand their high probability risks. Reviewing lead indicators can help the board gain assurance that these risks are being actively managed. Directors must ensure that the organisation (a PCBU) has available for use, and uses, appropriate resources and processes to eliminate or minimise risks to health and safety. Once boards understand their critical and high probability risks their risk profile, they can ensure that they allocate appropriate resources so the organisation, as a PCBU, can eliminate or minimise the risks, as appropriate. Key Aspects of a Health and Safety Management System Hazard and Risk management Incident management Emergency management Injury management Worker engagement Organisations must identify and assess work-related health and safety risks. During organisational change, risk assessments should be undertaken so that the health and safety impacts can be understood and managed. There must be processes to eliminate or minimise risks to health and safety caused by the work. Organisations should have well-defined processes for reporting and investigating incidents to identify root causes and then to respond to these in a timely way. The aim of incident management is to identify and implement remedial actions to prevent the incident happening again. Organisations should develop plans for managing potential emergencies that may arise in the workplace. These plans should be communicated to all persons working on site. Plans should be regularly tested by simulation. Organisations must have processes for ensuring that injured persons are properly cared for. In the case of serious injuries and fatalities this care should extend to families and work-mates. Organisations must have processes for engaging with their workers on health and safety matters. These processes should cover engagement generally and the specific circumstances when an organisation is legally required to engage with its workers. 19 162

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS Worker Participation Worker participation practices should be put in place so that workers can effectively participate in improving health and safety on an ongoing basis. Participation practices should provide workers ongoing ways to raise health and safety concerns, get and share information about health and safety issues, offer suggestions for improving health and safety, contribute to decisions which affect work health and safety, and be kept informed about health and safety decisions. Organisations must have appropriate processes for receiving and considering information regarding incidents, hazards and risks and for responding in a timely way to that information. Worker representation is one form of participation. Health and Safety Representatives and Health and Safety Committees are two well established methods of worker representation. Working with other organisations Continuous improvement Organisations must have processes in place to consult and co-ordinate with other organisations where they also have duties under HSWA in relation to the same task or activity. Continuous improvement is a fundamental part of any management system. Continuous improvement also includes the audit and review process. Two functions that overlay the system are resourcing and leadership. The organisation must be provided with the resources required for it to operate safely. This includes people, plant and equipment, systems and budget. Leadership should be shown at all levels throughout the organisation. Management must define its commitment to health and safety, establish objectives, targets and plans for giving effect to this commitment, and lead the organisation in their achievement. DIAGNOSTIC QUESTIONS Directors and boards can use the following questions as prompts to determine whether they are meeting their responsibilities and accountabilities. 1. How do you know that the organisation s health and safety management system is fit-for-purpose and represents best practice? 2. What systems are in place to ensure that hazards and risks (including risks to worker health) are identified, assessed and effectively managed? 3. Have you thought about potential incidents that are less likely to occur, but with critical consequences if they do? 4. Where there is significant organisational change that has implications for health and safety how do you ensure that this is reported to the board? 5. How good is the organisation s emergency management plan and state of readiness that will ensure an effective response to any potential emergency? When was it last tested? 6. How does the organisation ensure that it has the right people, with the right skills and motivation to manage health and safety? 20 163

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE 7. How does the organisation ensure that it engages with workers and their representatives on health and safety matters (including listening to their response and involving them in the decision making process)? 8. How does the organisation ensure that it has provided genuine opportunities for workers to participate in the ongoing improvement of health and safety? 9. How does the organisation ensure that all plant and equipment used on site meets an acceptable standard? 10. How does the organisation ensure that other organisations they work with have satisfactory health and safety standards? 11. How does the organisation ensure it works with other organisations to manage matters when both have health and safety duties as PCBUs? 12. How does the organisation ensure that the goods and services it supplies to other organisations meet satisfactory health and safety standards? 13. Does the organisation have an adequate budget for its health and safety programme? ACTIONS FOR DIRECTORS BASELINE ACTIONS RECOMMENDED PRACTICE Health and Safety Management Systems Ensure that the organisation (through management) develops, implements, audits and regularly reviews and updates an effective health and safety management system consistent with accepted standards. Verify the provision and use of resources and processes by requiring and then reviewing management reports on the health and safety management system. This should include reviews and audits of systems and control plans. Become personally aware of the organisation s risks and control systems. Ensure the organisation has processes in place to identify hazards and risks and control them. Ensure that management implements procedures for the selection of contractors and monitoring their activities so that the organisation is assured of their health and safety. Undertake training to ensure a good understanding of the requirements of the health and safety management system and particularly of hazard and risk management practices. Commission periodic external audits and reviews of the system. Ensure that workers and representatives participate in audits and system reviews. Ensure you have a detailed knowledge of the organisation s risks and control systems. Refresh this regularly by engaging with managers and workers, and where appropriate go on site visits. Periodically (at least every two years) obtain/ review independent advice on the adequacy of risk control plans and the effectiveness of their implementation. Ensure that management insists on contractors having health and safety standards that match the organisation s. Management should ensure that contractors management processes do not encourge under-reporting. 21 164

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS BASELINE ACTIONS RECOMMENDED PRACTICE Ensure that the organisation (a PCBU) implements procedures to consult and coordinate activities with other organisations (other PCBUs) that have overlapping health and safety responsibilities. Ensure management has processes to check that all organisations with overlapping duties are meeting their obligations as agreed. Resources People Ensure that management provides the organisation with personnel with the right skills, supported by specialists as required to operate the business safely. Ensure management implements a worker engagement system that enables workers and their representatives to participate in decision-making, implementation and monitoring of workplace health and safety management systems. Encourage a culture where reporting of incidents, hazards, and risks is expected and reports are followed up in a timely way. Ensure that the PCBU has appropriate processes for receiving this information and responding to it. Ensure that the organisation has effective processes in place for recruitment, training and direction of managers so that they are skilled and motivated to reinforce a positive health and safety culture and ensure the health and safety of their people and teams. Ensure that the organisation implements a just culture whereby there is an atmosphere of trust in which people are encouraged to provide safetyrelated information, without fear of retribution or blame for honest mistakes, but are still held accountable for wilful violations and gross negligence. Monitor the overall workplace health and safety culture using appropriate techniques, such as surveys. Resources Plant and Equipment Ensure that the organisation has processes in place so it can ensure plant and equipment is fit-for-purpose and well maintained, that workers using it are properly trained, and that there are safe operating procedures in place for work done on the plant and equipment. Ensure the organisation has processes to ensure that a contractor s plant and equipment meets the organisation s health and safety standards before it is allowed on site. Ensure the organisation includes both health and safety requirements in its procurement process for plant and equipment. Resources Budget Provide sufficient funds for the effective implementation and maintenance of the health and safety management system, health and safety training for managers and workers and for improvement programmes. Ensure there is a policy of dealing with health and safety on the basis of need rather than budget limits 22 165

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE 3. MONITORING DIRECTOR RESPONSIBILITIES > To monitor the health and safety performance of the organisation. > To outline clear expectations on what should be reported to the board and in what timeframes. > To review reports to determine whether intervention is required to achieve, or support organisational improvements. > To make themselves familiar with processes such as audit, risk assessment, incident investigation, sufficient to enable them to properly evaluate the information before them. > To seek independent expert advice when required to gain the necessary assurance. MANAGER RESPONSIBILITIES > To give effect to board direction by implementing a health and safety management system using the plan, do, check, act cycle. > To provide the board with reports on health and safety management system implementation, and performance as required. > To implement further actions following board review of reports. > To ensure root cause investigations are carried out using independent investigators in the case of serious incidents. Implementing long-term health and safety goals and strategy through business planning is the responsibility of the organisation (as a PCBU). The board needs to ensure, through appropriate monitoring, that these strategies are being effectively implemented. Boards should create a strong reporting culture that welcomes bad news and responds to it appropriately. Directors must never turn a blind eye to undesirable information. They should, instead, always seek out complete and accurate information that will enable them to know whether the organisation is meeting all of its health and safety obligations and goals. Directors must always act decisively whenever that information suggests that it is not. Boards need to undertake a critical assessment of the data and reports they receive. They should ensure that they have sufficient understanding of their organisation's risk profile to be able to stress test the information provided and decide whether their intervention or further investigation is required. ROUTINE REPORTS TO THE BOARD The following information should be on the board s agenda and reviewed on a regular basis: Data on all incidents, including near misses, work-related ill-health, compliance with health monitoring programmes and ACC claims. Effective monitoring of these statistics can alert the board to underlying problems before any serious incidents occur. Data on absence rates due to sickness. This can be an indicator of issues such as stress and fatigue. Data on trends including routine exposure to risks that are potentially harmful to health such as high noise levels, toxic chemicals and bullying. Progress towards implementing formal improvement plans and meeting policy goals, including number of actions closed-out on time. Actions in place aimed at preventing harm, such as training, and maintenance programmes. The health and safety performance and actions of contractors. Reports on internal and external audits and system reviews. Data on proactive safety visits such as safety tours and workplace inspections. Directors should be alert to the possibility that there is reluctance to report this information and should satisfy themselves that any obstacles have been addressed. 23 166

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS INCIDENTS Incident investigations should identify root causes, and measures to put in place to prevent the incident happening again. Investigations should not be about apportioning blame. When looking for root causes there should be consideration of human factors that can contribute to incidents and the possibility of systemic failure such as culture, workload or lack of training. Directors should review reports following serious incidents. They need to be satisfied with the integrity of the process, and that the incident investigation has correctly identified root causes. An effective action plan should be put in place to address the issues identified. Directors should require further reports on the completion of actions so that they can be satisfied that the implementation of actions arising from incidents is both effective and timely. DIAGNOSTIC QUESTIONS The following diagnostic questions are examples that can be used by directors and boards as prompts to verify that the information they receive is appropriate, accurate and comprehensive. 1. Are you asking the right questions? Do you determine what information you receive or does management? 2. How do you know that the information you are receiving is supported by a strong and honest reporting culture? 3. How does the organisation s performance compare with other comparable organisations, how do you know? 4. Does the organisation have the capability to carry out root cause investigations? 5. How do you know that actions identified in incident investigations are effectively implemented? 6. How much of the information that you receive is also shared with workers and their representatives? 7. Are you receiving sufficient information about health as well as safety? ACTIONS FOR DIRECTORS BASELINE ACTIONS RECOMMENDED PRACTICE Health and Safety Management Systems In the board s charter specify clear requirements regarding reporting and timeframes for addressing significant health and safety events. Ensure that in the case of serious incidents, management have sought external input or review to provide independence and avoid potential vested interests. Review serious incidents including serious noncompliance by the organisation and near misses, and be personally satisfied with the adequacy of management actions in response. Directors should receive basic training in incident investigation methodology sufficient to ensure that they are able to distinguish between adequate and inadequate investigations. In the case of serious health and safety incidents, obtain independent advice on the adequacy of the investigation and remedial actions. 24 167

THE ROLE OF DIRECTORS IN HEALTH AND SAFETY GOVERNANCE BASELINE ACTIONS Ensure that improvement goals are developed annually by management and that regular progress reports are received by the board. RECOMMENDED PRACTICE Separate organisations and work sites will have their own goals. Visible tracking of these by directors will demonstrate commitment and leadership and encourage commitment from line management to take these goals seriously. For example, a site manager may be invited to a board meeting to report on progress with an annual improvement plan or this may be the subject of discussion during a site visit. Specify clear requirements for the regular reporting of health and safety performance results, and review these reports at meetings for indications of trends, system breakdowns and improvement needs. Ensure you have a sound understanding of, and focus on, risks that would have a significant impact on health and safety. Ensure reports allow tracking of both lag and lead indicators. Directors should satisfy themselves that there are no obstacles to free and frank reporting. Boards should develop their own reports on health and safety performance for shareholders and other stakeholders. Health and safety performance should be included in external reports. 4. REVIEW DIRECTOR RESPONSIBILITIES > To ensure the board conducts a periodic (eg annual) formal review of health and safety to determine the effectiveness of the system and whether any changes are required. > To ensure the board considers whether an external review is required for an independent opinion. MANAGER RESPONSIBILITIES > To organise regular audits and reviews of the health and safety management system (internal and external) and its implementation. > To take remedial actions as required arising from any audit or review. > To report to the board on the outcomes of audits and reviews. > To assist the board with the formal health and safety review by providing information and other input as required. The board should conduct a formal review of the organisation s health and safety performance on a periodic basis. This enables the board to establish whether their health and safety principles have been embedded in the organisation s culture. Similarly, the review will consider whether the policy and system are being effectively implemented and whether they are still fit-for-purpose. AUDITS AND SYSTEM REVIEWS Audits and system reviews arranged by management will inform the board s formal review. Directors should ensure that reviews are undertaken on a regular basis. The objective of an audit is to assess the quality of system implementation. The objective of a system review is to assess whether the system is fit-for-purpose and representative of best practice. It is normal for audits and system reviews to recommend actions for improvement. Directors should ensure that these recommendations are properly considered by management, and effectively implemented where agreed. 25 168

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS It is desirable that an internal audit or review team comprises a cross section of managers and worker representatives so that a range of perspectives, knowledge and skill is brought to the table. This approach also supports the message that health and safety is everybody s responsibility. Directors should consider if the appropriate people were involved in the review or audit. It is also good practice for the organisation to periodically seek independent and objective assurance from an external audit and/or system review. An external opinion can bring a fresh pair of eyes and new ways of thinking. Involving worker representatives in the selection of external auditors and reviewers is good practice that will help ensure the required objectivity. FORMAL REVIEW OUTCOMES The formal review will identify strengths and weaknesses in the system and its implementation. It is just as important that good performance is recognised and celebrated as it is that opportunities for improvement are identified. Improvement action plans arising from the formal review should be tracked by directors at regular board meetings. DIAGNOSTIC QUESTIONS The following diagnostic questions are examples that can be used by directors and boards as prompts to verify that they are conducting adequate formal reviews of health and safety. 1. What do you do to ensure an appropriate and thorough board level review of health and safety? 2. What information do you use for the review and who do you involve? 3. How do you ensure that the review uses best practice as a benchmark? 4. How do you ensure that workers contribute to this review? 5. How do you ensure maximum independence and objectivity of reviews and audits? 6. How do you recognise and celebrate success? 7. How do you ensure that actions identified in the review are communicated and effectively implemented? ACTIONS FOR DIRECTORS BASELINE ACTIONS In the board s charter specify arrangements for the formal review of health and safety including frequency, who is involved and how, what input is required etc. RECOMMENDED PRACTICE Provide opportunities for worker representatives and workers with relevant skills and knowledge to participate in internal audits and reviews and in the selection of external auditors and reviewers. If workers are likely to be directly affected by the matter being reviewed, the PCBU must engage with them. Ensure that inputs to the formal reviews include audits (internal and external), system reviews, performance results, significant incidents, organisational changes and benchmark data. Periodically commission a culture survey to assist the review. As an outcome from the review ensure that the organisation determines an action plan and tracks its progress. 26 169

Conclusion 27 170

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS As a director, the organisation s health and safety risk is just as important as it s financial performance and reputational risk and it should receive the same focus. Boards must ensure that the organisation (as a PCBU) has processes for risk management and receiving and considering information about incidents, hazards and risks. The board must make sure these processes are appropriate. The board must also ensure that the organisation has processes to comply with all of its duties as a PCBU. To manage this, boards should determine high level health and safety strategy and policy which managers are required to implement. This strategy and policy should take into consideration all those affected by the organisation s activities, not just workers. A board s responsibility, however, does not stop with the issuing of strategy and policy. The board should also ensure that it is implemented effectively. They do this by holding management to account through processes of policy and planning, delivery, monitoring and review. This includes recognising when the organisation is doing well and celebrating success. Through these processes the board should ensure that they have created an environment in which a commitment to health and safety is part of everyday business. Having a positive health and safety culture and an integrated, embedded and effective health and safety management system in which managers and workers take individual ownership will have significant benefits for the organisation. RESOURCES KEY LEGISLATION All available online at www.legislation.govt.nz Health and Safety at Work Act 2015 Accident Compensation Act 2001 Hazardous Substances and New Organisms Act 1996 Employment Relations Act 2000 GUIDANCE A wide range of health and safety guidance including Approved Codes of Practice can be found on the WorkSafe website: www.worksafe.govt.nz Further resources on health and safety governance are available on the IoD's website: www.iod.org.nz PUBLICATIONS AND WEBSITES Ministry of Business, Innovation and Employment: www.mbie.govt.nz ACC: www.acc.govt.nz/publications 28 171

Appendices 29 172

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS APPENDIX A: DIRECTORS HEALTH AND SAFETY CHECKLIST DIRECTOR HEALTH AND SAFETY CHECKLIST How do the board and all directors demonstrate their commitment to health and safety? How do you ensure that the organisation s risks are assessed and appropriate mitigation measures put in place? How does the organisation involve its workers in health and safety? How do you ensure that the organisation s health and safety targets are challenging, realistic and aren t creating unintended consequences? What data is the board receiving on both health and safety? Is this sufficient? How does the organisation ensure all workers are competent and adequately trained in their health and safety responsibilities and accountabilities? Does the organisation have sufficient resources (people, equipment, systems and budget) for its health and safety programme? How connected are you to what happens at the organisation s work sites? What measures are in place to inform you? Does the organisation have a schedule of audits and reviews to ensure the health and safety management system is fit-for-purpose? How do you ensure that actions identified in incident reports, audits and reviews are communicated to the appropriate level within the organisation and effectively addressed by the organisation? Does the organisation have policies and processes in place to ensure contractors used by the organisation have satisfactory health and safety standards? How does the organisation s performance compare with other comparable organisations and how do you know? How do you recognise and celebrate success? 30 173

APPENDICES APPENDIX B: THE SAFETY GOVERNANCE PATHWAY HOW IS YOUR ORGANISATION TRACKING? The Safety Governance Pathway developed by Dr Kirstin Ferguson is a tool to help identify what stage of safety governance maturity an organisation may currently be experiencing. Safety governance is the relationship between board members and senior executives in the safety leadership of an organisation. It provides the structure through which the vision and commitment to safety is set; agreement on how safety objectives are to be attained; the framework for how monitoring performance is to be established; and a means for ensuring compliance with relevant safety legislation 10. Understanding where an organisation currently sits on the Safety Governance Pathway is essential for understanding where senior executives and boards are starting from in their approach to safety governance and determining a vision for where an organisation might like to move to. TRANSACTIONAL COMPLIANT FOCUSED PROACTIVE INTEGRATED Figure 1: Safety Governance Pathway Every organisation will identify themselves at a different point on the pathway and may find themselves moving forwards or backwards depending on the commitment to safety of the leaders in place, the emphasis and initiatives to drive safety improvements, or serious incidents that may have occurred. Below are some indicators which can help identify where a particular organisation is placed. TRANSACTIONAL Does the board tend to see safety as a management responsibility? Does the board become engaged in safety only after an incident has occurred? Is the culture of the organisation that production is the most important driver of the business success? A transactional approach to safety is the least effective stage of safety governance; and organisations at this stage are likely to have areas of legal non-compliance. There is no clear health and safety vision across the organisation and no clear understanding that good safety means good business. Health and safety is seen as the responsibility of management or the health and safety professional (where one is engaged although often they are part-time or consultants). Health and safety performance is not prioritised and is not disclosed in annual reports. Line managers do not take responsibility for safety outcomes but rather all responsibility for safety is directed to the health and safety function. 10 Ferguson, K. (2015). A study of safety leadership and safety governance for board members and senior executives. PhD thesis. QUT. 31 174

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS COMPLIANT Is compliance with relevant workplace health and safety legislation the main driver of reporting to the board? Is the board focused primarily on ensuring the minimum legislation standards are met? During the compliant stage, the board are aware of their legal responsibilities and compliance is the main driver for establishing a health and safety governance framework. Health and safety data is reported; yet the focus of reporting is ensuring compliance and concentrates primarily on lag indicators. Basic (often generic) safety policies and procedures are in place but the board and senior management are not aware of the importance of their own safety leadership. A brief mention of health and safety may be made in annual reports. FOCUSED Do board members ask detailed safety questions, often drilling down into the causes of incidents? Does your board consider site visits an important part of their safety leadership role? After realising that mere compliance with legislation will not necessarily ensure everyone returns home safely every day and a plateau in safety performance is reached, senior executives often drive a more focused approach to safety governance. During this stage, the specific role of the board in health and safety may be included in the board charter. A health and safety vision is introduced and safety performance reporting includes lead indicators. A health and safety management system is in place and processes are disclosed in annual reports. There may also be focus on the resourcing of the health and safety function as well as consideration on where the function is included in the organisational chart so there is visibility to the executive team. PROACTIVE Is there a sense that most board members get health and safety? That is, they understand that a strong safety culture is much more than simply compliance but requires safety leadership inside and outside of the boardroom? The proactive stage is often driven by the board who have become more involved in their safety leadership role and seek to take a proactive approach to safety governance. The board may establish a subcommittee to focus on health and safety. The Chairman often includes a personal commitment to health and safety performance in their annual reports or at annual general meetings. Safety performance referencing both lag and lead indicators is disclosed in annual reports. In most cases, the lead health and safety professional will report to the CEO and report on health and safety directly to the board. INTEGRATED Does the board seek to understand the safety impacts of every decision made in the boardroom? Does the concept of safe production set the tone for board discussions? The most effective stage of safety governance occurs when health and safety is completely integrated into business operations. The board and senior executives understand that a high level of health and safety performance is linked to business excellence. The board s commitment to health and safety is stated clearly in annual reports and safety disclosures are transparent. 32 175

APPENDICES Safety committees will cascade throughout the organisation so that safety information can be readily shared and obtained from the board sub-committee through to employee safety committees. The senior health and safety professional understands their role is not just a technical position but has a significant strategic focus for the business. Line managers acknowledge and accept their own responsibility for safety rather than seeing it as falling to the health and safety function. There is transparent sharing of safety data and learnings with other organisations in the industry and beyond. Kirstin Ferguson is a professional company director sitting on ASX100 and ASX200 boards, private company and government boards. She has a PhD in Business focused on safety leadership and safety governance for board members and senior executives, and was awarded the QUT Colin Brain Corporate Governance Fellowship and Safety Institute of Australia Dr Eric Wigglesworth Award for her research contributions to the fields of corporate governance and health and safety respectively. 33 176

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS APPENDIX C: SAMPLE TERMS OF REFERENCE BOARD HEALTH AND SAFETY COMMITTEE 1. CONSTITUTION The Board Health and Safety Committee shall be a committee of the board established by the board. 2. OBJECTIVE The role of the committee is to assist the board to provide leadership and policy in discharging its health and safety management responsibilities within the organisation. 3. SECRETARIAL AND MEETINGS 3.1. The secretary of the committee shall be appointed by the board. 3.2. A quorum of members of the committee shall be two. 3.3. The committee may have in attendance such members of management, including the Chief Executive Officer (CEO), and such other persons as it considers necessary to provide appropriate information and explanations. 3.4. All directors shall be entitled to attend meetings of the committee. 3.5. Reasonable notice of meetings and the business to be conducted shall be given to the members of the committee, all other members of the board and the CEO. 3.6. Meetings shall not be held fewer than four times a year. Further meetings will be arranged on an as-needed basis. 3.7. Minutes of all meetings shall be kept. 3.8. After each meeting the chair will report the committee s recommendations, key issues and findings to the board. 4. RESPONSIBILITIES 4.1. Review, monitor and make recommendations to the board on the organisations health and safety risk management framework and policies to ensure that the organisation has clearly set out its commitments to manage health and safety matters effectively. 4.2. Review and make recommendations for board approval on strategies for achieving health and safety objectives. 4.3. Review and recommend for board approval targets for health and safety performance and assess performance against those targets. 4.4. Monitor the organisations compliance with health and safety policies and relevant applicable law. 4.5. Ensure that the systems used to identify and manage health and safety risks are fit-forpurpose, being effectively implemented, regularly reviewed and continuously improved. This includes ensuring that the board is properly and regularly informed and updated on matters relating to health and safety risks. 34 177

APPENDICES 4.6. Seek assurance that the organisation is effectively structured to manage health and safety risks, including having competent workers, adequate communication procedures and proper documentation. 4.7. Review health and safety related incidents and consider appropriate actions to minimise the risk of recurrence 4.8. Make recommendations to the board regarding the appropriateness of resources available for operating the health and safety management systems and programmes 4.9. Any other duties and responsibilities which have been assigned to it from time to time by the Board 5. AUTHORITY 5.1. The committee has complete access to the organisations senior executive team through the chairman, chief executive or company secretary at any time. 5.2. The committee has the authority of the board to obtain any information and to investigate any matter within its terms of reference 5.3. The chairman of the committee has the authority of the board to obtain independent legal or other professional advice and research and generally to engage such advisors and involve such consultants (at the expense of the organisation) as the committee considers necessary to carry out its responsibilities. 5.4. The committee does not have the authority to make a decision in the board s name or on its behalf. The committee will make recommendations to the Board on all matters requiring a decision. 6. REVIEW The committee shall: 6.1. Ensure that processes are in place to develop, implement, audit, regularly review and update the health and safety management framework to be consistent with accepted standards. 6.2. Formally review the health and safety performance of the organisation including review of audits (internal and external), system reviews, performance results, significant incidents and investigations, the impact of organisational changes and benchmark data. The CEO will be responsible for producing sufficient information for this review to occur, with input from the rest of the executive/senior management team. 6.3. Receive and consider independent reviews and or audits of health and safety within the business. 7. REVIEW OF THE COMMITTEE The committee shall undertake annual self-review of its objectives and responsibilities and of these terms of reference and report back to the board. The committee may at any time initiate a review of the committee and make appropriate recommendations for its alteration to the board. Terms of reference adopted by the committee on XX/XX/201X. 35 178

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS APPENDIX D: GLOSSARY TERM Best practice Board Health and Safety Committee Engagement DEFINITION A method or technique that in like circumstances has consistently shown superior results in comparison to results achieved using other means used as a benchmark. The board health and safety committee is a sub-committee of the board. The purpose of the committee is to assist the board in its role in providing leadership and policy, and to fulfill its responsibilities to ensure compliance with health and safety legislation. A PCBU (person conducting a business or undertaking see below) has to engage with its workers on health and safety matters. A PCBU engages by: > sharing information about health and safety matters so that workers are wellinformed, know what is going on and can a say in decision-making > encouraging workers to have a say > listening to and considering what workers have to say > giving workers opportunities to contribute to the decision-making process relating to a health and safety matter. Due diligence The due diligence duty requires directors and other officers under HSWA to take reasonable steps to: > know about work health and safety matters and keep that knowledge up-to-date > gain an understanding of the operations of the organisation and the hazards and risks generally associated with those operations > ensure the PCBU has appropriate resources and processes to eliminate or minimise those risks and uses them > ensure the PCBU has appropriate processes for receiving information about incidents, hazards and risks, and for responding to that information > ensure there are processes for complying with any duty, and that these are implemented > verify that these resources and processes are in place and being used. Officers must exercise the care, diligence and skill a reasonable officer would exercise in the same circumstances, taking into account matters including the nature of the business or undertaking, and officer s position and nature of their responsibilities. Harm Hazard Illness, injury or both. This includes physical or mental harm caused by workrelated stress. Physical hazards Things that can cause physical harm, like moving machinery, falls from heights or lifting heavy objects. Some of these hazards may cause injury very slowly like equipment with poor ergonomics. Environmental hazards Things in the environment that could cause injury or illness, like hot or cold temperatures, poor lighting, or uneven ground. Hazardous substances Things such as asbestos or chemicals that could cause health issues such as cancer, fertility problems and even death. Social hazards Such as work-related stress, overwork, long hours, inadequate breaks, or bullying. 36 179

APPENDICES TERM Health and Safety Committee DEFINITION A Health and Safety Committee (HSC) supports the ongoing improvement of health and safety at work. An HSC enables PCBU representatives, workers and other committee HSC members to meet regularly and work co-operatively to ensure workers health and safety. One of the HSC s main functions is to assist in developing standards, rules, and policies or procedures relating to workplace health and safety. An HSC can also perform other functions that are agreed between the PCBU and the HSC, or specified by the WEPR Regulations. Health and Safety Representative Lag indicators Lead indicators Officer A worker elected as a health and safety representative in accordance with subpart 2 of Part 3 of HSWA. Lag indicators are reactive measure of performance; they measure events where there has been a health and safety failure such as injuries and occupational ill health. Lead indicators are proactive measures of performance, such as the number of training sessions or risk assessments completed. They aim to prevent incidents occurring. An officer is a person who has the ability to significantly influence the management of a PCBU. This includes, for example, company directors and chief executives. Officers must exercise due diligence to ensure the PCBU meets its health and safety obligations. Other person at workplace Organisational Culture Participation PCBU Examples of other persons at workplaces include workplace visitors and casual volunteers at workplaces. The collective set of values and beliefs held and exercised within an organisation or workplace. Worker participation practices are what the PCBU puts in place so that workers can help to improve workplace health and safety on an ongoing basis. These practices make it possible for workers to share ideas and information, raise issues, and contribute to decision-making on an ongoing basis. A PCBU is a person conducting a business or undertaking. A PCBU may be an individual person or an organisation. It does not include workers or officers of PCBUs, volunteer associations with no employees, or home occupiers that employ or engage a tradesperson to carryout residential work. A PCBU must ensure, so far as is reasonably practicable, the health and safety of workers, and that other persons are not put at risk by its work. This is called the primary duty of care. So far as is reasonably practicable Core health and safety duties require PCBUs to ensure health and safety so far as is reasonably practicable. When used in relation to these core duties, something is reasonably practicable if it is reasonably able to be done to ensure health and safety, having weighed up and considered all relevant matters, including: > How likely are the hazards and risks to occur? > How severe could the harm that might result from the hazard or risk be? > What a person knows or ought to reasonably know about the hazard or risk and the ways of eliminating or minimising it. > What measures exist to eliminate or minimise the risk (control measures)? > How available and suitable is the control measure(s)? Then weigh up the cost: > What is the cost of eliminating or minimising the risk? > Is the cost grossly disproportionate to the risk? 37 180

HEALTH AND SAFETY GUIDE: GOOD GOVERNANCE FOR DIRECTORS TERM Volunteer officer Worker Workplace DEFINITION An officer who is acting on a voluntary basis (whether or not that person receives out of pocket expenses). A worker is an individual who carries out work in any capacity for a PCBU. This includes an employee, a contractor or sub-contractor, an apprentice or trainee, a person on work experience or a work trial, or a volunteer worker. A workplace is a place where a worker goes or is likely to be while at work, or where work is being carried out or is customarily carried out. It includes a vehicle, vessel, aircraft, ship or other mobile structure and any waters and any installation on land, on the bed of any waters, or floating on any waters. So certain locations will only be classed as workplaces while work is being carried out at those locations. Most duties under HSWA relate to the conduct of work. However, some duties are linked to workplaces. WorkSafe New Zealand Zero harm WorkSafe is the government agency that is the work health and safety regulator. WorkSafe collaborates with PCBUs, workers and other duty holders to embed and promote good workplace health and safety practices, and enforce health and safety law. An expression used by many organisations to describe an aspirational target of no harm of any sort to workers. 38 181

DISCLAIMER WorkSafe New Zealand and the Institute of Directors in New Zealand have made every effort to ensure the information contained in this publication is reliable, but makes no guarantee of its completeness. WorkSafe and the IoD may change the contents of this guide at any time without notice. This document is a guideline only. It should not be used as a substitute for legislation or legal advice. WorkSafe and the IoD are not responsible for the results of any action taken on the basis of information in this document, or for any errors or omissions. ISBN: 978-0-908336-22-7 (print) ISBN: 978-0-908336-21-0 (online) Published: March 2016 PO Box 165, Wellington 6140, New Zealand www.worksafe.govt.nz Except for the logos of WorkSafe and the IoD, this copyright work is licensed under a Creative Commons Attribution-Non-commercial 3.0 NZ licence. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/3.0/nz/ In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to WorkSafe and the IoD and abide by the other licence terms. WSNZ_2181_MARCH 2016 182

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Page 2 of 11 Balanced Score Card Inpatient Units, Community Teams and Indicator Definitions The MHAID Service 3DHB is comprises two main parts: The local/sub-regional mental health and addiction services. Te Korowai- h ri i which consists of adult rehabilitation and forensic (mental health and addiction) and intellectual disability services. A range of age specific community and inpatient services are delivered to meet population needs. Eleven inpatient units provide service and age specific assessment and treatment for the most severely unwell consumers. Services are either local, sub-regional regional or national (see table 1). The balanced score card inpatient measures are divided by DHB for the local/sub-regional services. For Te Korowai- h ri i the inpatient measures split is by Forensic & Inpatient Rehabilitation and Intellectual Disability. There is additional split by age-based facilities for forensic and intellectual disability services. Table 1. MHAID Service 3DHB Inpatient Units MHAIDS 3DHB Group Provision* Service & Age Focus** Hutt Valley DHB Capital and Coast DHB Te Whare o Matairangi Sub-regional Mental Health - Adult Te Whare Ahuru Managed Withdrawal Service beds Intensive Recovery Central region Mental Health - Adolescent Regional Rangatahi Acute Inpatient Unit Sector Sub-regional Mental Health - Psychogeriatric Te Whare Ra Uta Local / Sub-Regional Te Korowai- ri i Younger Persons Community & Addictions Forensic & Inpatient Rehabilitation Intellectual Disability Services Central region Eating Disorders - Mixed Central Region Eating Disorder Service Central region Central region Regional Rehabilitation - Adult Forensic - Adult Tawhirmatea Tane Mahuta Puraehuraehu Rangipapa National Forensic - Youth Nga Taiohi Build in progress Central and South Island Intellectual Disability - Adult Haumietiketike National Intellectual Disability - Youth Hikitia Te Wairua * Sub-Regional Wairarapa, Hutt Valley, Capital and Coast DHBs; Central Sub-Regional DHBs plus Mid-Central, Hawkes Bay, Wanganui DHBs plus Tairawhiti DHB; National All DHBs ** Youth Population aged 12 18 years; Adult Population aged 18 65 years; Psychogeriatric Population aged 18 65 years; Mixed Population aged 16 plus years MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 187

Page 3 of 11 There are 61 community based provider arm teams (see table 2). The majority are local or sub-regional services providing primarily assessment and treatment. Some teams also provide consultation liaison and education services. The balance score card community indicators report performance for these teams. Given varying indicator definitions not all teams are reported in all the measures (MHAID Service 3DHB, 2015). Table 2. MHAID Service 3DHB Community Provider Arm Services MHAIDS Group WDHB HVDHB CCDHB 3DHB Local / Sub-Regional Younger Persons Community & Addictions CAMHS a CAMHS teams: Child Speciality Service and Youth Speciality Service a Intensive Clinical Service Team b Central Region Eating Disorder Service Community C CAMHS teams: Kapiti, Porirua, Wellington, Primary Liaison Service, Pasifika and Maori a Early Intervention Service b Specialist Maternal Mental Health Service C Adult CMHT a CMHTs: 1, 2, 3 and 4 a CMHTs: Kapiti, Porirua, South and Wellington, Adult Maori, Adult Pasifika a Detox a Co-Existing Disorder Service b Older Persons Mental Health Community Alcohol and Drug Service a Service a GP Liaison: Kapiti, Porirua a Adult GP Opioid Service b Community & ECT a Addictions Managed Withdrawal Service b Psychogeriatric team a Opioid Treatment Service Regional Personality Disorder Service C Acute Day Service a CATT a CATT a Consultation Liaison a Intensive Consultation Liaison a Home-based Treatment a Recovery Sector Rangatahi Day Service a Rangatuhi Day Service a TACT a Operations Intake Team a Te Haika a Centre MH NASC a Service Coordination a Forensic & Adult Forensic Community Service C Inpatient Regional Adult Forensic Community Service C Rehabilitation Youth Forensic Community Service C Intellectual Co-existing Mental Health & Intellectual Disability Service b Disability Behavioural Support Service b Services National Intellectual Disability Care Agency d a Local: Primarily delivered to respective DHB population. b Sub-Regional Wairarapa, Hutt Valley, Capital and Coast DHBs (some services only contract delivery to Hutt Valley and Capital and Coast DHBs); c Central Sub-Regional DHBs and Mid-Central, Hawkes Bay, Wanganui DHBs (some contracts also include Tairawhiti DHB); d National All DHBs Te Korowai- Wh ri i MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 188

Page 4 of 11 Table 3. MHAID Service 3DHB Balanced Score Card Indicator Definitions No. Measure Target Definition Purpose and utility of indicator Reporting capability 1.1 28 day readmission rate (Adult IP units only) Target - 10% Alert - 20% Total number of in-scope overnight referral closures by the participant s acute mental health and addiction services inpatient unit during the reference period that are followed by a readmission within 28 days to the organisation s acute mental health and addiction services inpatient unit. Excludes transfers, deaths & readmissions from same day event (Northern DHB Support Agency, 2010). Unplanned readmission to an inpatient service following a recent discharge may indicate that inpatient treatment was either incomplete or ineffective or that follow-up care was inadequate to maintain the person out of hospital. WDHB: N/A as no IP unit. 1.2 Long-term consumers with current wellness plan (%) 95% The percentage of long-term consumers with a wellness plan. Long-term consumers are adults and older people (20 years plus) whose episode of care is two or more years, and children and youth whose episode of care is for one or more years. The episode of care is measured from the inpatient admission or primary community referral start date (Ministry of Health, 2014a). A proxy measure for quality of care. Wellness plan (relapse prevention plans) identify early relapse warning signs of clients. The plan identifies the support required by the tangata whaiora/consumer to promote resilience and recovery when early warning signs are present. Each client will know of (and ideally have a copy of) their plan. WDHB: manual quality audit HVDHB: Report on current electronic risk plans CCDHB: Report on electronic wellness plans 1.3 Held for indicator under development 1.4 Better help for inpatient smokers to quit 95% The percentage of hospitalised patients who smoke and are seen by a health practitioner in public hospitals and percentage of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking (Ministry of Health, 2014b). There is strong evidence that brief advice is effective at prompting quit attempts and long-term quit success. The quit rate is improved further by the provision of effective cessation therapies pharmaceuticals, in particular nicotine replacement therapy (NRT), and telephone or face-to-face support. WDHB: N/A as no IP unit. 1.5 HoNOS compliant inpatient discharges - matched pairs 80% The percentage of in scope discharges that have both an admission and discharge HoNOS. In scope discharges: LOS >3 days and the consumer was discharged routinely or to another healthcare facility OR to other service within the same facility. The consumer was not discharged to another psychiatric inpatient unit or an accident and emergency service (Northern DHB Support Agency, 2010; Te Pou, 2012). Provides information about the effectiveness of inpatient treatment in aiding recovery by measuring if change occurs between the admission and discharge HoNOS. WDHB: N/A as no IP unit. HVDHB: Snapshot CCDHB: New measure covers the reference period. Data validation still required. MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 189

Page 5 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability 1.6 HoNOS collection compliance - community 1.7 Consumer death by suspected suicide (community and inpatient) 1.8 Severity 1 & 2 (Confirmed SAC 1&2) 1.9 All reportable events 1.10 Medication errors (n) 80% N/A N/A N/A Number of community consumers with a current HoNOS collection. In-scope collections are within the current episode of care. For new referrals the collection must be within 14 days of the first face-to-face appointment. Thereafter a 91 day review is required. The 91 day reviews are required to be completed within 14 days either side of the review date (Te Pou, 2012). Count of suspected community suicides by current mental health consumer within 28 days of contact with service and all suspected suicides as inpatient (Health Quality and Safety Commission New Zealand, 2012). Count of the number of SAC 1&2 events that have been reviewed and reported by the CCDHB Patient Safety Office per month (Health Quality and Safety Commission New Zealand, 2012). Count of the number of all reported events reported in the reportable events database prior to any review. Count of the number of all medication errors reported in the Reportable Events system. Provides information about the effectiveness of community treatment in aiding recovery by measuring if change occurs overtime. Serious Adverse Events are events which have generally resulted in harm to patients. When adverse incidents occur, it s important these events are reported, investigated and reviewed so we can learn from them and improve the way we do things. Systematic review of and learning from adverse events should see a reduction in serious adverse events over time, reflecting improved safety for people using services (Mental Health Commission, 2014). WDHB/HVDHB: Snapshot CCDHB: New measure covers the reference period. Data validation still required. 1.11 Complaints (n) Count of the number of complaints received and recorded per week by the Quality & Risk team and reported in the reportable events database. 1.12 Complaints resolved/closed within 30 days (%) 100% complaints resolved within 30 days The percentage of all complaints that were received in the reference period and resolved in 30days. This excludes HDC complaints or where the complainants have been notified within 10 working days that an extension is required by the DHB which received the MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 190

Page 6 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability complaint (HDC Code of Health and Disability Services Consumers Rights Regulation 1996, n.d). 1.13 Health & Disability Commissioner Complaints Count of all HDC complaints in the reference period and year to date 1.14 Compliments (n) Count of the number of compliments received and recorded per month by the Quality & Risk team in the reportable events database. 1.15 Restraints (n) Count of the number of all restraints reported in the Reportable Events system. 1.16 Consumers required to undergo MH Act assessment 1.17 Consumers subject to compulsory treatment order 1.18 Number of seclusion hours Count unique consumers required undergo assessment subject to sections 11 or section 13 or section 14(4) of the Mental Health Act during the reference period. Consumers transferred between sections in the reference period are only counted once. If section 11 has occurred more than once in the reference period, the person is counted twice. Count of unique consumers subject to an inpatient or community compulsory treatment order during the reference period. This includes extensions and indefinite orders. Consumers transferred between sections in the reference period are only counted once. For example an inpatient treatment order transferred to an outpatient treatment order or when an order is extended or made indefinite. Per the national health target and DHB Maori Health Plans, this indicator also reports the number of Maori subject to section 29 community treatment orders (Capital and Coast District Health Board, 2014; Hutt Valley District Health Board, 2014; Wairarapa District Health Board, 2014). Count of the hours that are attributed to seclusion activity in the reference period. This measure excludes WDHB: Manual data All DHBs: Data quality issues that each DHB is working on may impact numbers. Data quality project underway. As above MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 191

Page 7 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability per 100000 pop. the hours attributed to events that occur before or after the reference period. The divisor is DHB catchment projected population divided by 100,000. The Maori and Pacific projected populations are the divisor for the supplementary measures. 2.1 Access rate The average total number of people domiciled in the DHB region, seen per year rolling every three months being reported (the period is lagged by three months) for the projected population of the DHB region (Ministry of Health, 2014c). This indicator will provide a means of monitoring rates of access to assessment and treatment services and to compare these with what is known about the distribution of mental disorders and what is aimed for in policy and in funding agreements. It is known that there are significant levels of unmet need in mental health and addiction. A measure Is required to monitor population treatment rates and assess these against what is known about the distribution of mental disorders in the community (Mental Health Commission, 2014). Ministry of Health data, incudes NGOs. Rolling year, 3 month lag (PP6). 2.2 Average length of acute inpatient stay (days) 14-21 days Alert - 30 days. Total number of inpatient bed nights for discharges that occurred in the reference period excludes transfer, deaths and leave days (Northern DHB Support Agency, 2010). Mental health & addiction services aim to provide care in the least restrictive environment. This KPI provides some information about the extent to which this is being achieved and promotes a more complete picture of an organisation s overall model of care (Northern DHB Support Agency, 2012). 2.3 Inpatient occupancy 85% Average level of occupancy in acute inpatient units managed by the mental health and addiction service over the reference period (Northern DHB Support Agency, 2010). Most acute inpatient units run at or close to 100%. Experience suggests that acute inpatient units operating above 90% occupancy on an ongoing basis are stressed, compromising the provision of optimal care during the inpatient period including discharge planning. Benchmarking will help to understand variations between DHBs, the drivers of high occupancy, and may support movement toward lower occupancy rates (Mental Health Commission, 2014; Northern DHB Support Agency, 2010). 2.4 Pre-admission 75% Number of in-scope acute inpatient referrals to the Provides a measure of the quality of care, efficiency of HVDHB/CCDHB: New MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 192

Page 8 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability community care mental health and addiction service organisation s acute inpatient team, occurring during the reference period for which a face-to-face community mental health contact was recorded in the seven days immediately preceding that admission by community care services managed by the organisation (Northern DHB Support Agency, 2010). resource use and the extent to which a service has engaged with consumers and attempted to support them within their natural environment (Northern DHB Support Agency, 2012). measure. Data validation still required 2.5 Post-discharge community care 90% Number of overnight referral closures from acute inpatient units to the organisation s community catchment during the reference period for which a community mental health contact with client participation was recorded in the seven days immediately following that discharge (Mental Health Commission, 2014; Northern DHB Support Agency, 2010). A responsive community support system for people who have experienced an acute psychiatric episode requiring hospitalisation is essential to maintain clinical and functional stability and to minimise the need for hospital readmission (Northern DHB Support Agency, 2012). Refer to comment 2.4. 2.6 Consumer related time 30-40% The percentage of recorded community clinical activity that is attributed to paid direct-care clinical FTE in the reference period. The numerator is the total recorded clinical activity for both consumer participation time (telephone & face-to-face) and non-consumer participation time (liaison/care coordination with other agency or family contact without the consumer present). The denominator 'paid direct-care clinical FTE' is all paid hours for staff (excludes support and management/administration staff) minus any recorded leave (Northern DHB Support Agency, 2010). Number of contact hours with service user participation plus the number of contact hours without service user participation (Northern DHB Support Agency, 2012). WDHB/HVDHB: Indicator under development. 2.7 Community treatment days per quarter 10-12 days Total number of community treatment days provided by the mental health and addiction service organisation s community mental health and addictions services within a three month reference period. (A treatment day is a day on which a service user received some clinical input; it could be one contact or many). This is a three monthly average (Northern DHB Support Agency, 2010). Provides a measure of the intensity of treatment within the community (Northern DHB Support Agency, 2012). WDHB/HVDHB: Indicator under development. 2.8 Wait-time to first face-to-face 80% < 3 weeks Measures Wait-time from the referral received date to the first face-to-face appointment. Provides a measure of service efficiency (Ministry of Health, 2014c). Ministry of Health data, Rolling year, 3 month lag MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 193

Page 9 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability contact 95% < 8 weeks The MHAID 3DHB calculation differs slightly to the MoH PP8 measure as we measure the wait-time for all referrals. The MoH calculation measures wait times for those consumers who have not access MH&AS in the past year. (PP8). 2.9 Community DNA rate 2.10 Caseload with consumer participation in the last 90 days (%) 3.1 Staff turnover annualised (%) Count of DNA activity. The count divided by all DNA activity plus all face-to-face activity in the reference period provides the DNA rate. Note: In MHAID mental health & addiction services did not attend activity (DNA) is mainly collected as an activity, rather than an appointment as used by the 3- DHB general outpatients measure This means that the general out patients and MHAID measure is not comparable. All unique community consumers at month end, with an episode of care 90 days or over, that have had a service user participation contact recorded during the previous 90 days. 8-10% Number of employed staff who voluntarily resign from mental health and addiction services within the reference period (Northern DHB Support Agency, 2010). Provides a measure of the quality of care (safety and risk for consumers who do not attend) and efficient use of community FTE resource. An indicator of service delivery timeliness and proxy measure to consider if active treatment is being delivered to consumers accessing community teams (Mental Health Commission, 2014). Provides an indicator of the effectiveness of staff recruitment, orientation, engagement and support. Overall it is generally seen as an indicator of the health of the organisation (Northern DHB Support Agency, 2012). HVDHB/CCDHB: New indicator. Annualised indicator from October 2015 3.2 Sick leave (%) 2-4% Total number of sick leave hours claimed by all employed mental health and addiction staff during the reference period (Northern DHB Support Agency, 2010). Provides an indicator of a healthy, sustainable workforce (Northern DHB Support Agency, 2012). 3.3 Number of staff with annual leave > 200 hours (n) 0 (Coop, 2006) Total number of MHAID staff who have annual leave owing greater than 200 hours during the reference period (Coop, 2006). Provides measure and control on annual leave liability. Staff are encouraged to take leave for their better wellbeing, in turn this reduces the liability carried by the organisation (Coop, 2006). 3.4 Physical assaults Count of assaults. MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 194

Page 10 of 11 No. Measure Target Definition Purpose and utility of indicator Reporting capability on staff 3.5 Percentage of performance appraisals completed 100% (Coop, 2006) Percentage of performance appraisals completed in the last year excluding causal, fixed term, medical. This indicator signals the significance of staff career development and progress towards high quality service delivery (Coop, 2006). CCDHB: Under development 4.1 Operating (actual) costs ($'000) Total MHAID costs including personnel, outsourced, clinical costs, infrastructure costs and recharging during the reference period (Coop, 2006). Provides measure on total cost over total revenue. In general a good indicator to have some controlled measures by percentages etc. 4.2 Personnel including outsourced ($'000) 4.3 Overtime (total hours versus overtime hours) Total MHAID personnel and outsourced costs during the reference period (Coop, 2006). Total overtime hours costs over total hours of personnel costs (Coop, 2006). Provides an indicator of personnel costs and outsourced costs percentages to total revenue. Good indicator to measure performance on budget. An indicator of total overtime hours spent compared to total personnel hours costs. This gives a good picture on the use of overtime hours and puts control measures as percentage to total hours. In general a good tool to control overtime costs over budget. 4.4 FTEs - actual Total MHAID personnel and outsourced FTE s (contracted), excluding vacancies during the reference period (Coop, 2006). Measure the performance vs budget. 4.5 FTEs - vacancies Manual count of vacancies provided on a monthly basis, one month lag. MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 195

Page 11 of 11 References Capital and Coast District Health Board. (2014). Capital & Coast District Health Board Maori Health Action Plan 2014/15. Retrieved from http://www.ccdhb.org.nz/planning/maori_health/ccdhb Maori Health Plan 2014_15_FINAL.PDF Coop, C. F. (2006). Balancing the balanced scorecard for a New Zealand mental health service. Australian Health Review : A Publication of the Australian Hospital Association, 30(2), 174 80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16646766 Health Quality and Safety Commission New Zealand. (2012). Serious Incidents involving users of Mental Health services. Retrieved February 02, 2015, from http://www.hqsc.govt.nz/assets/reportable- Events/Publications/Reporting-reviewing-adverse-events-MH-Dec-2012.pdf Hutt Valley District Health Board. (2014). Hutt Valley District Health Board Maori Health Plan 2014/15. Retrieved July 15, 2015, from http://www.huttvalleydhb.org.nz/content/3e4af01f-de2c-426a-80a5-dc0ffbcf43a7.cmr Mental Health Commission. (2014). MHC (Rising to the Challenge) Outcomes Framework - Outcomes Framework Indicators Definition Draft V3.0 (20th June 2014). MHAID Service 3DHB. (2015). Mental Health, Addictions & Intellectual Disability Service 3DHB: Balanced Score Card - Technical Specifications (in draft). Ministry of Health. (2014a). 2013/14 DHB non-financial monitoring framework and performance measures. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/508 Ministry of Health. (2014b). 2014/15 DHB Health Targets. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/menumh/accountability+documents Ministry of Health. (2014c). 2014/15 DHB non-financial monitoring framework and performance measures. Retrieved February 02, 2015, from http://www.nsfl.health.govt.nz/apps/nsfl.nsf/menumh/accountability+documents Northern DHB Support Agency. (2010). Key Performance Indicator Framework for New Zealand Mental Health and Addiction Services Phase III: Implementation of the Framework Benchmarking Participation Manual Part 3. Technical Specifications for participating organisations July 2010. Retrieved February 02, 2015, from http://www.ndsa.co.nz/linkclick.aspx?fileticket=obs7tai8s_q=&tabid=95 Northern DHB Support Agency. (2012). KPI Framework for New Zealand Mental Health And Addiction Services. Phase III - Implementation of the framework in adult mental health services. June 2012. Retrieved December 11, 2014, from http://www.ndsa.co.nz/ourserviceswhatwedo/mentalhealth/kpiframework.aspx Te Pou. (2012). Mental Health Outcomes Information Collection Protocol - HoNOS Family (Version 2.1). Retrieved February 02, 2015, from http://www.tepou.co.nz/library/tepou/mental-health-outcomes---informationcollection-protocol Wairarapa District Health Board. (2014). Wairarapa District Health Board Maori Health Action Plan 2014/15. Retrieved from http://www.huttvalleydhb.org.nz/content/df930e87-ed92-404d-a0d0-dc2d30a31d34.cmr MHAID Service 3DHB 2015/16 FY Balanced Score Card - Feburary 196

Finance Report February 2016 Dr Ashley Bloomfield Chief Executive Judith Parkinson Chief Financial Officer HVDHB Monthly Operating Report Page 1 ` 11 March 2016 197

FINANCIAL PERFORMANCE OVERVIEW The month of February has a favourable variance to budget of $477K and year to date (YTD) favourable $409K. Key results YTD were: Funder favourable by $549K Governance favourable by $201K Provider unfavourable by ($340K) The forecast year-end position is a deficit of ($8,103K). Material Variances New sub-regional Laboratory contract from 1 November 2015 The new Laboratory agreement changed how the costs are shown in the accounts with Hutt Valley DHB holding the outsourced labs contract for all 3DHBs. Both Wairarapa and Capital and Coast DHBs pay their proportion of the contract via the IDF mechanism. $ 000 Labs contract, variance to budget YTD Revenue IDF inflow 5,912 Other revenue 198 Expenditure Other external provider costs, sub-regional Labs contract (6,084) NET SAVING 26 Personnel and outsourced Personnel unfavourable by ($1104K) YTD: Medical is favourable by $317K, SMO s under by $1,089K offset by outsourced. Registrars over by ($916K). Nursing 26 full time equivalents (FTEs) favourable for the month due to budgeting for Nursing Entry to Practice (NETP) graduate nurses (22 FTEs) not appointed. YTD, 29 FTE over budget and unfavourable by ($912K). The Care Capacity Demand Management (CCDM) governance group has been established. FTE levels are reducing each month and have dropped 51FTEs between August 2015 and February 2016. Shift patterns have been reviewed and any surplus staff are being used to cover annual leave and sickness across the hospital. Annual leave balance has fallen substantially ($1.17M) since December 2015 but compared to January 2016 has marginally increased by $132K. Sickness levels for February 2016 are slightly down on the same time last year. IDF Outflow Unfavourable ($1,171K) including ($739K) for acute and elective inpatient Haematology, General Surgery, Cardiothoracic, and Neurosurgery. Hospital activity was high this month in surgical services both acute and elective. YTD Mental Health and Maternity have high activity levels. Ophthalmology and additional plastic surgery elective sessions started this month. Emergency Department attendances continue to be high. Cash position averaged $19.8M during February 2016 ($21.6M in January) and was $3.84M at the end of February. We are anticipating a balance of $1.3M by year-end dependant on the capital programme and operating costs staying within the current forecast. The DHB has an overdraft facility with the NZHP sweep arrangement of $18M so we are not anticipating an equity injection being required. HVDHB Monthly Operating Report Page 2 ` 11 March 2016 198

Year-end Forecast The updated year-end forecast is a deficit of ($8,103K) which is adverse to budget by ($1,378K). We have included a contingency in the forecast for potential increases in inter-district flow (IDF) outflow towards the end of the financial year, which is a common pattern. The following table provides a summary of the financial performance of the DHB at the end of February 2016. Financial performance Month Hutt Valley DHB Year to Date Annual Actual Budget Variance Last Year Variance Operating Report YTD February 2016 ($000s) Actual Budget Variance Last Year Variance Forecast Budget Variance Last Year Variance Revenue 31,841 31,732 109 31,105 736 Devolved MoH Revenue 254,749 253,531 1,218 249,344 5,405 382,240 380,665 1,574 374,327 7,913 1,476 1,434 42 1,612 (137) Non Devolved MoH Revenue 14,036 13,721 315 13,933 103 20,693 20,323 370 21,234 (541) 422 481 (59) 382 41 ACC Revenue 3,356 3,846 (489) 2,825 532 5,291 5,769 (477) 4,702 590 682 741 (59) 520 162 Other Revenue 5,179 5,989 (810) 5,034 145 8,152 8,953 (801) 7,968 185 7,328 5,962 1,366 5,406 1,922 IDF Inflow 53,708 47,701 6,007 44,831 8,877 83,395 71,549 11,847 67,594 15,801 537 244 293 270 267 Inter DHB Provider Revenue 2,988 1,967 1,021 1,665 1,323 4,113 2,942 1,171 3,148 965 42,285 40,593 1,692 39,295 2,990 Total Revenue 334,016 326,755 7,261 317,631 16,385 503,883 490,199 13,684 478,972 24,911 1 Expenditure Employee Expenses 3,979 3,961 (19) 4,001 22 Medical Employees 32,954 33,271 317 30,825 (2,129) 49,344 49,936 592 47,367 (1,977) 4,903 4,786 (117) 4,704 (200) Nursing Employees 40,250 39,338 (912) 38,993 (1,257) 60,280 59,300 (980) 59,604 (677) 2,160 2,269 109 2,511 351 Allied Health Employees 19,083 19,821 739 20,098 1,016 28,616 29,387 772 30,983 2,367 471 529 58 511 40 Support Employees 4,513 4,369 (144) 4,582 69 6,759 6,586 (173) 6,898 139 1,648 1,680 31 1,668 20 Management and Admin Employees 13,272 14,010 737 12,856 (416) 20,300 21,061 761 19,907 (392) 13,161 13,225 63 13,395 233 Total Employee Expenses 110,071 110,809 738 107,354 (2,717) 165,300 166,270 971 164,759 (540) 2 Outsourced Personnel Expenses 177 90 (87) 149 (27) Medical Personnel 1,959 729 (1,230) 2,057 98 2,946 1,088 (1,859) 3,344 398 6 6 0 38 33 Nursing Personnel 67 48 (19) 272 205 91 72 (19) 331 241 19 22 3 31 12 Allied Health Personnel 174 195 22 197 23 261 283 22 282 21 9 9 (0) 12 3 Support Personnel 120 94 (25) 132 12 158 132 (25) 184 26 147 64 (84) 95 (52) Management and Admin Personnel 1,106 517 (589) 675 (431) 1,495 771 (724) 1,163 (332) 358 190 (168) 326 (32) Total Outsourced Personnel Expenses 3,425 1,583 (1,842) 3,333 (92) 4,950 2,346 (2,605) 5,305 354 2 1,431 1,496 66 698 (733) Outsourced Other Expenses 9,337 9,497 159 5,968 (3,370) 15,276 15,528 252 9,292 (5,984) 1,966 1,865 (101) 1,873 (93) Treatment Related Costs 16,536 16,209 (326) 16,860 324 25,628 24,548 (1,080) 27,224 1,596 3 1,257 1,622 365 1,332 74 Non Treatment Related Costs 11,107 11,694 587 10,833 (274) 17,059 17,459 399 15,947 (1,112) 4 7,102 7,171 70 6,514 (588) IDF Outflow 58,542 57,371 (1,171) 55,679 (2,862) 87,851 86,056 (1,795) 83,454 (4,398) 5 13,935 12,405 (1,530) 12,198 (1,738) Other External Provider Costs 111,338 106,113 (5,225) 104,886 (6,452) 171,151 159,824 (11,327) 156,943 (14,209) 6 2,043 2,064 21 1,855 (187) Interest, Depreciation & Capital Charge 16,451 16,678 228 15,426 (1,025) 24,770 24,892 122 23,593 (1,177) 7 41,253 40,038 (1,216) 38,190 (3,063) Total Expenditure 336,807 329,955 (6,852) 320,340 (16,467) 511,986 496,924 (15,063) 486,517 (25,470) 1,031 555 477 1,105 (73) Net Result (2,791) (3,200) 409 (2,709) (82) (8,103) (6,725) (1,378) (7,545) (558) Result by Output Class 3,209 2,925 284 2,828 380 Funder 9,436 8,887 549 6,316 3,120 12,075 12,055 20 9,284 2,791 10 (137) 147 18 (8) Governance 165 (35) 201 144 22 224 23 201 93 130 (2,187) (2,233) 46 (1,741) (446) Provider (12,393) (12,052) (340) (9,169) (3,224) (20,402) (18,802) (1,599) (16,922) (3,479) 1,031 555 477 1,105 (73) Net Result (2,791) (3,200) 409 (2,709) (82) (8,103) (6,725) (1,378) (7,545) (558) HVDHB Monthly Operating Report Page 3 ` 11 March 2016 199

The key variances to budget for the month and YTD are detailed below: 1. Revenue: Ministry of Health (the Ministry) revenue is $151K favourable for the month and $1,533 YTD. This includes additional funding for free under 13s $736K YTD (offset by expenditure), and Breast screening $86K for the month and $385K YTD for additional volume. ACC revenue is unfavourable ($489K) YTD as the ACC revenue initiative has achieved $394K of $800K planned YTD. Other Revenue is unfavourable ($810K) YTD. For additional Plastic Surgery, these sessions started in February and the result will be seen as increased IDF inflow. IDF inflow is favourable by $1,366k for the month including $1,460K for the new Laboratory Contract and higher inpatient inflows $243K YTD, mostly acute services. 2. Personnel including outsourced is unfavourable by ($105K) for the month and ($1,104K) YTD. Personnel (excluding outsourced) favourable by $738K YTD and the largest impact was the reduction in the annual leave accrual of $1,297K during January. Medical Unfavourable ($19K) for the month SMOs $191K offset by Registrars ($181K) made up from an additional FTE in General Medical, Mental Health, Orthopaedics, and Emergency. This is offset by ($168K) for the month and ($1,583K) YTD of outsourced costs for Anaesthesia ($299K) and Medical ($149K) including backfilling SMO s on sabbatical and locums in Children s Health ($127K), Mental Health ($158K) and Dental ($58K). There are vacancies in Mental Health (5.0 FTE) of which 2 FTEs have been filled by Capital & Coast DHB, efforts are being made to fill the remaining positions on a permanent basis. Anaesthetics is now fully staffed Registrars over by ($916K) with 11 FTE s over this includes additional FTE approved to improve cover in ED and support additional plastic surgery. Nursing ($117K) unfavourable for the month due to the increase in annual leave and overtime. Nursing FTE been re-evaluated as a result of the CCDM review down 51 FTE since August. Nursing FTE are now close to budget. Use of HCA for minding has also reduced with a new process in place. YTD unfavourable by ($912K). Allied $109K for the month, $739K YTD and FTE s are below budget mental health (5 FTE YTD) and child oral health (7 FTE). Support favourable by $58K and 3 FTEs under for the month due to the new cleaning rosters implemented in February. YTD ($144K) and 4 FTE over budget YTD, primarily in cleaners, orderlies, laundry staff and sterile supply assistants. New rosters for orderlies continue to result in reduced costs. Management & Admin is favourable $31K for the month and $737K YTD offset by outsourced. Outsourced is adverse ($84K) for the month and ($589K) YTD, for interim CEO, COO, CIO and the 3DHB mental health management team. 3. Treatment related costs are unfavourable by ($101K) for the month and ($326K) YTD driven by Blood Supplies ($451K) YTD not in the Labs contract. 4. Non Treatment Related costs are favourable $365K for the month and $587K YTD. Corporate compliance costs are favourable $305K YTD. IT software licence fees remain overspent by ($271K) YTD. 5. IDF Outflows are $81K favourable for the month and ($1,082K) adverse YTD. Inpatient wash-ups $107K month but ($739K) YTD. The YTD ($65K) outpatient wash-ups, ($141K) pharmaceuticals wash-ups and $107K favourable wash-up for PCTS. 6. Other External Provider costs unfavourable ($1,530K) for the month including the new Laboratory Contract ($1,510K) not included in the budget (offset by increased IDF revenue). Capitation expenditure ($75K) for the month and ($377K) YTD for under 13s offset by additional revenue from MOH. Health of Older People (HOP) costs for residential care remain favourable $34K month and $642K YTD. Pharmaceuticals is favourable $33K for the and $875K YTD due to additional PHARMAC rebates received based on latest PHARMAC forecast including lower claims and a GST adjustment $189K. 7. Interest, Depreciation and Capital charge costs are favourable $21K for the month and $228K YTD including building revaluation. HVDHB Monthly Operating Report Page 4 ` 11 March 2016 200

Funder Financial Statement of Performance Actual Budget Last year Month Hutt Valley DHB Year to Date Annual Variance Funder Result Variance Variance Actual vs Budget Actual vs Last year Feb-16 Actual Budget Last year 28,525 28,525 29,545 (0) (1,020) Base Funding 241,163 241,163 236,365 (0) 4,798 363,453 363,453 354,545 0 8,908 3,315 3,206 1,560 109 1,755 Other MOH Revenue 13,585 12,367 13,025 1,218 560 18,786 17,212 19,829 1,574 (1,043) 228 10 15 218 213 Other Revenue 444 80 448 363 (4) 483 120 624 363 (140) 5,868 5,962 5,406 (94) 461 IDF Inflows 47,796 47,701 44,831 94 2,965 71,643 71,549 67,594 94 4,048 1,460 0 0 1,460 0 - Lab Contract Change 5,912 0 0 5,912 0 11,753 0 0 11,753 0 39,397 37,704 36,526 1,693 1,410 Total Revenue 308,900 301,312 294,669 7,588 8,319 466,117 452,334 442,592 13,784 11,773 263 263 263 0 0 DHB Governance & Administration 2,101 2,101 2,101 0 0 3,151 3,151 3,151 0 0 14,888 14,939 14,724 51 (165) DHB Provider Arm 127,482 126,840 125,686 (642) (1,795) 191,890 191,248 189,760 (642) (2,130) External Provider Payments: 2,631 2,664 2,650 33 19 - Pharmaceuticals 23,212 24,087 24,291 875 1,079 35,145 36,067 35,464 922 319 3,732 2,222 2,189 (1,510) (1,543) - Laboratory 23,858 17,774 17,557 (6,084) (6,301) 38,817 26,660 26,666 (12,157) (12,151) 1,889 1,814 1,754 (75) (135) - Capitation 15,236 14,859 14,664 (377) (572) 22,874 22,492 22,119 (382) (755) 973 836 826 (137) (148) - ARC-Rest Home Level 7,829 7,257 7,025 (572) (804) 11,825 10,901 10,629 (924) (1,196) 1,408 1,579 1,481 171 73 - ARC-Hospital Level 12,490 13,704 13,717 1,214 1,228 18,789 20,584 20,338 1,795 1,549 966 789 838 (178) (128) - Other HoP 7,531 7,016 7,105 (516) (427) 11,278 10,722 10,787 (556) (491) 807 928 834 121 27 - Mental Health 7,526 7,768 6,919 242 (606) 11,237 11,479 10,104 242 (1,133) 690 697 656 7 (34) - Palliative Care / Fertility / Comm Radiology 5,603 5,575 5,307 (28) (296) 8,363 8,363 7,933 0 (430) 0 (147) 0 (147) 0 - Savings Plan 0 (1,178) 0 (1,178) 0 0 (1,767) 0 (1,767) 0 838 925 959 87 122 - Other 7,895 8,455 8,191 560 296 12,529 13,127 12,902 598 373 0 0 0 0 0 - IDF Wash-ups - Prior Year 160 0 0 (160) (160) 160 0 0 (160) (160) 7,102 7,182 6,514 81 (588) IDF Outflows 58,542 57,371 55,679 (1,171) (2,862) 86,435 86,190 83,454 (245) (2,981) 0 89 0 89 0 - Provision for IDF Wash-ups 0 709 0 709 0 1,550 1,063 0 (487) (1,550) 0 11 0 11 0 - Provision for National IDFs 0 89 0 89 0 1,550 133 0 (1,417) (1,550) 36,188 34,789 33,688 (1,399) (2,500) Total Expenditure 299,464 292,425 288,243 (7,039) (11,220) 455,593 440,412 433,307 (15,181) (22,286) 3,209 2,914 2,838 295 (371) Net Result 9,436 8,887 6,425 549 (3,011) 10,524 11,922 9,284 (1,397) 1,240 Overall the funder result for the month of February is $284k and $549k favourable YTD. The main reasons for the variances are: Revenue Other MOH revenue is $109K favourable for the month and $1,218K YTD. This variance for the month is made up of $24K additional electives revenue for the month, $191K YTD and $65K month and $736K YTD for under 13s services. Other YTD variances $115K new MOH revenue contract relating to youth health services, $70K national patient flow project, $54K for the Maternity Quality and Safety programme, $40K 2014/15 additional electives funding. Other revenue variance of $218K for the month relates to the PHO contribution for overnight primary care provided by Emergency Department ($122K last financial year and $96K for the current year) these amounts were not budgeted or accrued. The $363K YTD variance included $145K related to recoveries from the Starship Foundation. IDF Inflows are $1,366K favourable in the month which includes a movement of ($67K) in the month for wash-ups with the Provider Arm, $1,460K relating to the change in lab contracts and ($27K) relating to other changes. YTD IDF Inflows are $6,007K favourable which includes $243K for wash-ups Actual vs Budget Actual vs Last year Year End Forecast Annual Budget Last Year Actual Forecast vs Annual Budget Forecast vs Last year HVDHB Monthly Operating Report Page 5 ` 11 March 2016 201

recognised with the Provider Arm, $5,912K relating to the change in lab contracts and ($149K) relating to other changes. Please refer to separate table below. Expenditure Provider Arm payments are $51K favourable for the month and ($642K) YTD. This includes $67K favourable for the month and ($243K) YTD from IDF Inflows wash-ups recognised. A monthly adjustment of $8K with Wairarapa DHB for general surgery CWDs bringing the YTD total to $63K. A monthly adjustment of ($24K) for additional electives funding bringing the YTD total to ($191K). In previous months there have been one-off adjustments of: ($54K) relating to the Maternity Quality and Safety programme, ($70K) national patient flow funding, ($64K) for cancer related multi disciplinary meetings, ($83K) for mental health services. External Provider Payments: Pharmaceuticals expenses are $33K favourable in the month because of higher PHARMAC rebates. YTD pharmaceuticals expenses are $875K favourable with $651K from higher PHARMAC rebates recognised, $189K relating to GST claimed on deductions from the PHARMAC rebates, and $35K from lower claiming of demand driven costs. Laboratory costs are ($1,510K) adverse for the month and ($6,084K) YTD which reflects the new contact for lab services. A separate table below shows the financial impact of this contract. Capitation costs are ($75K) adverse for the month and ($377K) YTD which is in relation to the MOH funding for services for under 13s and other Ministry funded programmes. Aged residential care costs are $34K favourable (rest home & hospital level) for the month and $642K YTD because of lower overall volumes. While there are higher volumes of clients receiving dementia and rest home level care this has been offset by a greater decrease in clients receiving hospital level care. Other HOP costs are ($178K) adverse for the month and ($516K) YTD with higher residential care for under 65s due to an increase in clients accessing this service and higher than expected respite care and day programme costs. The month result also includes a correction to the accrual for home based support services where a review shows no invoice has been processed for the fortnight ending 6 December 2015. Mental Health is $121K favourable for the month and $242K YTD with lower residential care costs offset by lower IDF inflows, the transfer to the Provider Arm of $68K of costs. Palliative Care / Fertility / Comm Radiology is ($28K) adverse for the YTD because of the phasing of the contract payments to Fertility Associates. The Savings line shows ($147K) adverse for the month and ($1,178K) YTD because savings are recognised elsewhere. Other expenses are $87K favourable for the month and $560K for the YTD. This month savings of $63K were recognised in child and youth costs where the Ministry is now funding some costs that we were paying for. Other reasons for the YTD variances are because of lower travel and accommodation costs, lower rheumatic fever costs which is offset by lower revenue, the release of an accrual for PET scans which is no longer required as costs are now reflected in IDFs, recovery of screening costs and recovery of funds from our PHO. IDF Wash-ups - Prior Year - the net wash-up for 2014/15 was ($160K) adverse mainly as a result of the wash-up for outpatients being much higher than expected. HVDHB Monthly Operating Report Page 6 ` 11 March 2016 202

IDF Outflows are $81K favourable for the month and ($1,082K) adverse YTD. The result for the month includes $107K lower outflow wash-ups and ($27K) from agreed service changes. The YTD result includes ($739K) inpatient outflow wash-ups, ($65K) outpatient wash-ups, ($141K) pharmaceuticals wash-ups and $107K favourable wash-up for PCTS. Please refer to separate table below showing the IDF variances. The Provision for IDF Wash-ups includes a monthly amount of $89K, which comprises $17K per month for additional outpatient volumes and $72K per month for cardiothoracic volumes to meet the required target. The annual budget included $200K for additional outpatient volumes and a further $863K which was budgeted from the electives funding for cardiothoracic volumes to meet the required target. Year-End Forecast The funder is forecasting a surplus of $12,075K, which is $20K favourable to the budgeted surplus of $12,055K. Forecast Revenue: The Ministry revenue is $1,574K favourable which is made up of the current YTD position of $1,218K plus a further $356K which is $65K per month for under 13 services and $24K per month additional electives revenue. Other revenue of $363K remains unchanged from the YTD position. IDF inflows are favourable by a total of $11,847K, the vast majority of which, $11,753K, is a result of the new lab contract. Forecast Expenditure: Provider Arm variance of ($642K) remains unchanged from the YTD position. Pharmaceuticals are $922K favourable based on the latest PHARMAC forecast (October 2015) and includes the adjustment recognised in December for GST claimed on deductions from the rebates. Laboratory costs are forecast to be ($12,157K) adverse which relates to the new lab contract less $605K per month of costs recharged to the Provider Arm. Capitation costs are ($382K) adverse based on a forecast of costs for the remainder of the year. ARC demand driven costs are forecast to be $871K favourable at year-end which is the current YTD variance plus a further $50K per month for hospital level volumes. Other HOP costs are forecast to be ($556K), which is the YTD position plus a further ($10K) per month for unbudgeted TAS costs. Mental Health costs are forecast to be $242K favourable, which is the YTD position. Other costs are $598K favourable, which is based on the YTD position plus $38K savings in PET scan costs as these are now included in IDF outflows as part of the outpatient wash-ups. IDF Outflows - the wash-ups are forecast to be ($1,550K), which is ($487K) adverse to budget. This includes ($800K) for inpatient volumes, ($450K) for outpatient volumes and ($300K) for pharmaceuticals costs. This also includes an adjustment of $320K for elective ophthalmology volumes which are now being done at Hutt, based on the IDF service change which has been processed. HVDHB Monthly Operating Report Page 7 ` 11 March 2016 203

Pharmaceutical Costs The following graph shows the expenditure on community pharmaceutical costs including the actuals for 2014/15 and 2015/16 and the budget for 2015/16. The budget for 2015/16 has been phased based on the information provided in the PHARMAC forecast which was used as the basis for the budgets. The net amount reported as pharmaceutical costs in the accounts includes community pharmaceutical costs, PHARMAC rebates, payments for National Haemophilia services and any transactions relating to the Discretionary Pharmaceutical Fund (DPF). The graph shows pharmacy drug costs and fees only and excludes the impact of the PHARMAC rebate, NHMG services and DPF transactions. Community Pharmaceuticals accruals are calculated on a consistent methodology across the 3 DHBs which takes into account the seasonality of the expenditure, and timing delays between the month of service and the month of payment. In 2014/15 financial year, on average, 30.62 percent of the costs were paid in the month of service, 65.60 percent in the month following, and the remaining 3.78 percent spread across the three months following. HVDHB Monthly Operating Report Page 8 ` 11 March 2016 204

The amounts included in the graph above therefore include some accruals, as detailed in the following table: Month of Service Cash Transactions Accrual Total Reported Jun-15 $ 3,589,611 $ 60,000 $ 3,649,611 Jul-15 $ 3,579,496 $ 0 $ 3,579,496 Aug-15 $ 3,407,131 $ 0 $ 3,407,131 Sep-15 $ 3,449,813 $ 0 $ 3,449,813 Oct-15 $ 3,512,428 $ 0 $ 3,512,428 Nov-15 $ 3,520,900 $ 0 $ 3,520,900 Dec-15 $ 3,807,019 $ 5,500 $ 3,812,519 Jan-16 $ 3,093,403 $ 95,500 $ 3,188,903 Feb-16 $ 1,026,939 $ 2,200,500 $ 3,227,439 Total Accrual $ 2,361,500 Note the accruals for December are higher than usual but is consistent with previous years where claims are high in this month. HVDHB Monthly Operating Report Page 9 ` 11 March 2016 205

Aged Residential Care The following tables show the $, volume and price variances for the different aged residential care levels. Overall ARC costs are $643K favourable YTD with $589K from lower volumes and $54K attributable to lower prices. Reduced Hospital Level Care bed usage ($1,209K favourable) is offset by more use of dementia and rest home level beds ($719k adverse). Hutt Valley DHB Aged Residential Care to 29 February 2016 Month Year to Date Full Year Volume Price $000 Actual Budget Variance Actual Budget Variance Var as % Budget Variance Variance Expenditure Dementia Care 297 248 (49) 2,455 2,156 (298) -13.8% 3,239 (377) 79 Rest Home Level Care 676 588 (89) 5,374 5,101 (273) -5.4% 7,662 (342) 69 Hospital Level Care 1,196 1,361 165 10,739 11,813 1,073 9.1% 17,743 1,209 (136) Psychogeriatric Care 212 218 6 1,750 1,891 142 7.5% 2,841 99 43 Total Expenditure 2,381 2,415 34 20,318 20,961 643 3.1% 31,485 589 54 Month Year to Date Full Year Activity Actual Budget Variance Actual Budget Variance Var as % Budget Dementia Care 3,363 2,719 (644) 27,727 23,601 (4,126) -17.5% 35,450 47,071 Rest Home Level Care 9,056 7,902 (1,154) 73,179 68,580 (4,599) -6.7% 103,011 124,234 Hospital Level Care 9,711 11,111 1,400 86,561 96,429 9,868 10.2% 144,842 146,952 Psychogeriatric Care 1,280 1,251 (29) 10,290 10,857 567 5.2% 16,308 17,469 Total Subsidised Beddays 23,410 22,984 (426) 197,757 199,467 1,710 0.9% 299,611 Year to Date Last Year Price Increase Per Unit Cost Actual Budget Variance Actual over Last Year Dementia Care 88.72 91.37 2.65 92.27-3.85% 40,232 Rest Home Level Care 73.42 74.38 0.96 71.95 2.05% 105,583 Hospital Level Care 123.92 122.50 (1.42) 123.33 0.48% 133,978 Psychogeriatric Care 170.56 174.19 3.63 172.38-1.05% 15,758 HVDHB Monthly Operating Report Page 10 ` 11 March 2016 206

ARC Costs for Hutt DHB $ 3,500,000 $ 3,000,000 Total Cost $ 2,500,000 Actual 2015/16 Actual 2013/14 Actual 2014/15 2015/16 Budget $ 2,000,000 $ 1,500,000 $ 1,000,000 $ 500,000 $- Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month HVDHB Monthly Operating Report Page 11 ` 11 March 2016 207

Personnel Month FTE Report YTD February 2016 Year to Date Annual Actual Budget Variance Last Year Variance FTE Actual Budget Variance Last Year Variance Budget Last Year FTE 256 249 (7) 254 (1) Medical 251 252 1 241 (10) 239 231 736 762 26 754 18 Nursing 765 736 (29) 740 (25) 738 701 383 402 19 439 56 Allied Health 411 425 14 432 21 415 444 129 133 3 137 8 Support 137 133 (4) 137 0 128 123 311 317 6 313 2 Management & Administration 307 319 11 309 2 318 304 1,815 1,863 48 1,896 81 Total FTE 1,871 1,865 (6) 1,860 (11) 1,838 1,803 $ per FTE ($000) 15,574 15,917 343 15,750 176 Medical 131,466 132,071 606 127,990 (3,476) 209,034 205,052 6,659 6,278 (381) 6,239 (420) Nursing 52,620 53,464 844 52,666 46 80,301 85,027 5,644 5,651 7 5,725 81 Allied Health 46,394 46,593 199 46,471 77 70,774 69,781 3,637 3,983 346 3,730 92 Support 33,033 32,883 (150) 33,508 475 51,574 56,082 5,296 5,290 (6) 5,334 37 Management & Administration 43,165 43,959 794 41,542 (1,623) 66,305 65,485 7,250 7,098 (152) 7,064 (187) Cost per FTE all Staff 58,831 59,425 595 57,720 (1,111) 90,466 91,381 FTE Commentary Medical FTE are above budget for the month especially RMOs in General Medical, Orthopaedics to cover gaps in rosters and to avoid using high cost locums, Emergency for improved patient flow and Mental Health partly due to overtime to cover gaps in rosters. SMOs are favourable. During the month SMO vacancies have been backfilled by outsourced SMOs primarily in Mental Health, Imaging and Rheumatology. The anaesthetic roster is now filled and use of locums has reduced. Nursing FTE under budget by 26 FTEs for the month as NETP graduate nurses (22 FTEs) were budgeted but not recruited (these are budgeted as supernumerary in their first 6 weeks so impacts February and part of March). Nursing FTE establishments are back to previous levels whilst maintaining patient safety. This has seen a reduction of 51 FTE since August. The new process to improve the use of minders has reduced Health Care Assistants by 6.0 FTEs since November. Nursing FTEs (excluding the 22 NETP) are adverse (4); medical directorate was over by (6) FTEs and Surgical (10). Allied FTEs are under by 19 FTE for the month due to; Dental Therapists 4, Therapist Aids 7, (Child oral health), Social workers 6 (mostly mental health), Occupational Therapists 4 (Therapies and Mental Health), Health Promotion Officers 3. 10 Allied staff recruited in February mostly in Dental and Mental health. Support FTEs are under budget by 3 FTEs as a result of the new rosters that have been implemented in cleaning and orderlies to manage the staffing levels effectively. Management & Administration favourable primarily due to changes in 2-3 DHB services and staff capitalisation in Information Services. Some of these positions are now shown as outsourced with managers employed by Capital Coast or Wairarapa. HVDHB Monthly Operating Report Page 12 ` 11 March 2016 208

FTE Trend Actual Total Jun 12 Jun 13 Jun 14 Feb 15 Mar 15 Apr 15 May 15 June 15 July 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Medical 238 224 228 254 248 249 250 252 248 247 246 247 243 259 260 256 Nursing 707 690 733 754 749 779 769 785 779 788 787 782 761 748 737 736 Allied Health 437 428 435 439 441 448 444 452 444 441 439 427 400 384 373 383 Non Health Support 145 133 135 137 138 139 141 142 145 142 137 138 134 135 132 129 Managemt/Admin 342 272 305 313 318 318 318 317 308 308 309 305 307 304 310 311 Actual FTE 1,869 1,748 1,836 1,896 1,894 1,932 1,922 1,948 1,924 1,926 1,918 1,898 1,845 1,830 1,812 1,815 Budget 1,862 1,824 1,785 1,808 1,807 1,814 1,805 1,804 1,891 1,882 1,887 1,887 1,837 1,836 1,836 1,863 HVDHB Monthly Operating Report Page 13 ` 11 March 2016 209

Annual Leave The following graph shows the historical trends in annual leave for the last two years. The accrued leave increased $132k in February 2016 compared to January 2016. 17,000 16,500 16,000 15,500 15,000 14,500 14,000 13,500 13,000 12,500 Accrued Annual Leave $000 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - Annual Leave - Days outstanding Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2015-16 2013-14 2014-15 2015-16 2014-15 2013-14 Category Total staff with Annual leave days Less than 20 20-30 30-40 Greater than 40 % of staff >40 Total Staff Total Leave Less LSL $ Medical - Senior 71 18 18 38 26% 145 4,043,224 Medical - Junior 96 16 8 6 5% 126 1,022,822 Nursing 500 171 94 90 11% 855 6,788,924 Allied Health 384 48 21 15 3% 468 1,508,122 Support 61 32 18 13 10% 124 674,749 Mgmt/Admin 246 51 32 12 4% 341 1,288,304 Total* 1,358 336 191 174 8% 2,059 15,326,145 HVDHB Monthly Operating Report Page 14 ` 11 March 2016 210

Sick Leave The following graph shows the historical trends in sick leave for the last two years. 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% % Sick Leave Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2015/16 2013/14 2014/15 2013-14 Jul-14 Aug-14 Sep-14 Nov-14 Dec-14 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Medical 1.1% 1.2% 1.9% 0.7% 1.0% 2.1% 0.5% 0.9% 1.1% 1.2% 1.3% 1.5% 2.6% 1.6% 2.6% 2.1% 1.6% 0.6% 1.0% Nursing 3.1% 5.4% 4.3% 3.7% 2.6% 3.6% 2.6% 3.1% 2.7% 3.1% 2.6% 4.4% 5.1% 4.2% 3.5% 3.3% 3.1% 2.3% 2.8% Allied Health 2.7% 2.6% 4.5% 3.0% 3.2% 3.0% 2.6% 2.6% 2.6% 2.6% 3.5% 3.2% 5.3% 3.3% 3.2% 2.5% 2.3% 0.8% 1.8% Support 3.1% 6.4% 2.2% 4.5% 2.0% 3.6% 2.8% 3.2% 1.9% 1.7% 3.7% 5.1% 2.8% 2.7% 3.7% 3.0% 2.5% 2.0% 1.9% Admin 2.8% 4.0% 5.8% 2.2% 3.0% 1.8% 3.0% 3.5% 2.6% 2.3% 2.6% 3.2% 5.0% 4.1% 2.9% 3.1% 3.0% 1.2% 2.2% Total 2.7% 3.9% 4.2% 3.0% 2.5% 2.9% 2.4% 2.8% 2.4% 2.5% 2.7% 3.6% 4.6% 3.6% 3.2% 2.9% 2.7% 1.5% 2.2% HVDHB Monthly Operating Report Page 15 ` 11 March 2016 211

IDF Analysis Month Inter District Flows (IDF) Feb 2016 Year to Date Actual Budget Variance Last Year Variance $000s Actual Budget Variance Last Year Variance Budget Last Year IDF Inflows 891 874 17 664 227 Acute 7,498 6,995 503 5,347 2,151 10,493 10,476 580 938 (358) 555 25 Elective 7,244 7,503 (259) 5,917 1,327 11,255 11,199 5,857 4,150 1,707 3,989 1,868 Other Services 38,966 33,201 5,765 23,932 15,034 49,801 47,864 7,328 5,962 1,365 5,208 2,120 Total IDF inflows 53,708 47,699 6,009 35,196 18,512 71,549 69,538 IDF Outflows 2,236 2,236 0 2,210 (26) Acute 18,743 17,891 (852) 16,168 (2,575) 26,836 23,962 812 1,163 351 908 96 Elective 9,154 9,303 149 9,574 420 13,954 14,234 1,877 1,771 (106) 1,574 (303) Outpatient 14,101 14,166 65 9,443 (4,658) 21,249 18,886 277 245 (32) 255 (21) Pharmaceutical Cancer Treatment 2,064 1,957 (107) 1,532 (532) 2,936 3,064 1,900 1,757 (144) 1,737 (164) Other Services 14,479 14,054 (425) 10,421 (4,059) 21,081 20,841 7,102 7,171 70 6,684 (418) Total IDF Outflows 58,542 57,371 (1,171) 47,137 (11,404) 86,056 80,988 100 100 Funder IDF provision 797 797 2,250 1,196 1,500 7,102 7,271 169 6,684 (418) Total IDF Net of provision 58,542 58,168 (373) 49,387 (11,404) 87,252 82,488 Note: Timing differences when reporting on IDFs will have a bearing on year to date figures reported above IDF inflow (revenue): IDF inflow for other services is over budget by $5,765K YTD due to a service change for the new Laboratory contract DHBs which was not in the budget and some mental health services and a favourable wash-up for PHO s (which is completed quarterly). Inpatient inflows are over budget which is phased evenly over 12 months, however activity is above last year s actual. Acute: major variances are in Plastics - $360K, General Medicine $47K, Paediatric $50K, Gynaecology $40K, Dental $58K, Gynaecology $40K, offset by Maternity ($126K). Electives: major variance is in Rheumatology $218K, offset by Plastics ($304K), Gynaecology ($39K), Orthopaedics ($73K), ENT ($38K). Elective plastic surgery is below expected volumes by (64) caseweights however they are over by 40 cases. For Capital and Coast DHB residents favourable Electives in Plastics 26 caseweights $125K, Rheumatology 42 caseweights $197K. Electives Plastics have dropped for Nelson Marlborough by (56) caseweights ($266K) and Whanganui (42) caseweights ($196k). IDF Outflow (expense): Acute IDF outflows Caseweights are over budget in General Surgery ($531K), Neurosurgery ($414K), Haematology ($208K), ENT ($164K), General Medicine ($107K), Cardiothoracic ($418K). Acute outflows to Capital Coast is (159) caseweights over budget resulting in an unfavourable variance of ($754K). Elective Caseweights are over budget in Cardiothoracic ($251k), Gynaecology ($163K), Neurosurgery ($100K), and offset by reduced volumes in Vascular surgery $323K, Specialist Paediatric Cardiac $114K, General Surgery $106K. Overall, elective outflows to Capital & Coast District Health Board is (10) caseweights over budget resulting in an unfavourable variance of ($47K). HVDHB Monthly Operating Report Page 16 ` 11 March 2016 Annual 212

The graphs below show actual IDF CWD flows by month IDF CWD Acute Outflow IDF CWD Elective Outflow 700 350 600 300 500 250 400 200 300 150 200 100 100 50 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2015/2016 2014/2015 2013/2014 2015/16 Budget 2015/2016 2014/2015 2013/2014 2015/16 Budget IDF CWD Acute Inflow IDF CWD Elective Inflow 300 300 250 250 200 200 150 150 100 100 50 50 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2015/2016 2014/2015 2013/2014 2015/16 Budget 2015/2016 2014/2015 2013/2014 2015/16 Budget HVDHB Monthly Operating Report Page 17 ` 11 March 2016 213

Hospital throughput Month Hutt Valley DHB Year to Date Annual Variance Variance Hospital Throughput Variance Variance Actual Actual vs Budget Note: Other inpatient includes mental health and maternity Actual vs Last year YTD February 2016 Actual vs Budget Actual vs Last year Annual Budget Budget Last year Actual Budget Last year Last year Discharges 1,081 925 (156) 936 (145) Surgical 8,132 7,908 (224) 8,025 (107) 11,804 12,686 1,414 1,342 (72) 1,284 (130) Medical 12,070 11,471 (599) 11,980 (90) 17,123 13,592 453 380 (73) 463 10 Other 3,964 3,246 (718) 3,612 (352) 4,846 5,602 2,948 2,646 (302) 2,683 (265) Total 24,166 22,625 (1,541) 23,617 (549) 33,774 31,880 CWD 1,118 995 (122) 887 (230) Surgical 8,477 8,509 33 8,485 9 12,703 12,686 876 833 (42) 818 (58) Medical 7,936 7,124 (812) 7,698 (238) 10,634 9,573 333 346 13 340 7 Other 3,441 2,958 (483) 3,030 (411) 4,416 5,019 2,326 2,174 (152) 2,045 (281) Total 19,853 18,591 (1,262) 19,213 (640) 27,753 27,278 Other 3,889 3,771 (118) 3,656 (233) ED Attendances 31,965 31,307 (658) 31,639 (326) 47,106 37,703 957 767 (190) 767 (190) ED Admissions 7,865 7,177 (688) 7,177 (688) 10,699 10,804 825 736 (89) 715 (110) Theatre Visits 6,271 6,294 23 6,186 (85) 9,396 9,213 6,820 6,485 (334) 6,259 (560) Bed Days 58,524 55,454 (3,070) 58,038 (486) 82,780 66,153 4.19 4.59 0.40 4.54 0.35 ALOS Inpatient 4.46 4.59 0.13 4.62 0.16 2.43 3.39 2.17 2.43 0.26 2.33 0.16 ALOS Total 2.43 2.43 0.00 2.44 0.01 4.59 2.55 All surgical areas had a higher number of cases this month particularly acute general surgery. This meant there was also an increased occupancy in the surgical wards for the month. Patients were also more complex leading to higher case weighted discharges (CWD). Medical is over budget by 599 discharges YTD with a higher average CWD. Admissions for other services particularly Mental Health and maternity were below budget for the month but remains high YTD. ED volumes continue to be higher than budget and last year. A higher proportion of patients are now admitted 25percent against 23 percent last year. Ward occupancy was higher than planned during the month especially General Surgery 94 percent and Te Whare Ahuru 101 percent. YTD Medical, Maternity and Te Whare Ahuru continue to have high occupancy. Overall average length of stay (ALOS) remains below budget for inpatients and the total ALOS is below budget and last year s actual. HVDHB Monthly Operating Report Page 18 ` 11 March 2016 214

Statement of Financial Position as at 29 February 2016 Hutt Valley DHB Balance Sheet February 2016 $000 As at 29 February 2016 Actual Budget 30 June 15 Actual vs Budget Variance Crown Equity 45,728 45,797 44,727 (69) 1,001 Reserves 91,342 91,341 91,254 1 88 Retained earnings (38,670) (38,994) (31,128) 324 (7,542) Net Surplus/deficit (2,787) (3,200) (7,539) 413 4,752 Total Equity 95,613 94,944 97,314 669 (1,701) *NHMG National Haemophilia Management Group *NZULM NZ Universal List of Medicines *NHITB National Health IT Board Actual vs 30 June 15 Explanation between actual and budget. Bank 3,851 13,141 8,928 (9,290) (5,077) Average bank account in February was $19.85m, closing NZHP $3,837k. Includes Petty cash $12k. Bank - Non-Hutt DHB funds 2,956 3,471 4,275 (515) (1,319) Accounts receivable 16,658 15,763 14,600 895 2,058 Debtors balances are higher than expected due to higher receivables and accrued debtors Stock 1,408 1,391 1,391 17 17 Prepayments 1,396 833 527 563 869 Prepayments peak in month one of each quarter. New RPH contract not included in budget Total current assets 26,269 34,600 29,721 (8,331) (3,452) Fixed assets 203,774 199,733 204,287 4,041 (513) Large capitalisation undertaken as part or Oracle WIP implementation Work in progress 10,329 10,280 11,480 49 (1,151) Total fixed assets 214,103 210,013 215,767 4,090 (1,664) Investments in associates 300 0 0 300 300 Investment in Allied Laundry Services shares Trust funds invested 1,466 1,288 1,288 178 178 Restricted trusts made up of $1m term deposit and remainder in high interest savings account Total Investments 1,766 1,288 1,288 478 478 Total Assets 242,138 245,901 246,776 (3,763) (4,638) Accounts payable and accruals 33,315 34,772 37,273 1,457 3,958 Crown loans and other loans 14,770 9,488 15,402 (5,282) 632 Loan matured in December 2015 remains in current assets for YTD actuals - to be moved in March Capital charge payable 1,245 1,298 0 53 (1,245) Capital charge paid 6 monthly in December and June. $3.7m forecast to pay in June. Current employee provisions 20,384 22,085 19,120 1,701 (1,264) Actuarial Valuation completed 30 June 2015 Total current liabilities 69,714 67,643 71,795 (2,071) 2,081 Crown loans 64,550 70,000 64,550 5,450 0 Loan matured in December 2015 remains in current assets for YTD actuals - to be moved in March Other loans 1,072 1,072 1,072 0 0 Non-Hutt DHB liabilities 3,241 4,472 4,275 1,231 1,034 Non DHB funds liabilities, note these are held in NZHP account, term deposits and separate bank accounts Long term employee provisions 6,482 6,482 6,482 0 0 Actuarial Valuation completed 30 June 2015 Trust funds invested 1,466 1,288 1,288 (178) (178) Total non-current liabilities 76,811 83,314 77,667 6,503 856 Total Liabilities 146,525 150,957 149,462 4,432 2,937 Net Assets 95,613 94,944 97,314 669 (1,701) HVDHB Monthly Operating Report Page 19 ` 11 March 2016 215

Statement of Cash Flow February 2016 Cash Flow Summary by Month Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast OPERATING ACTIVITIES PBF / MOH Devolved Funding 35,409 35,400 35,530 39,218 35,400 73,161-35,402 37,830 35,400 35,400 35,400 MOH Non-Devolved Contracts 1,865 1,878 4,197 3,751 4,792 1,820 2,086 1,527 3,586 3,086 3,086 3,686 Other Govt and DHB revenue 1,504 1,026 1,202 809 1,121 827 967 887 1,065 1,016 1,114 1,065 IDF Inflow 7,653 7,202 7,337 5,150 7,090 7,491 10,069 9,553 9,258 9,258 9,258 9,258 Pharmac Rebate - 996 - - 1,532 1,079 432 962 - - 1,500 - Total Receipts 46,431 46,502 48,266 48,928 49,936 84,378 13,554 48,331 51,739 48,760 50,358 49,409 Payments to Employees (14,189) (13,227) (15,282) (13,606) (12,409) (14,202) (13,559) (12,398) (14,970) (12,520) (12,420) (14,130) Payments to Suppliers (excluding Capital Expenditure) (7,975) (8,052) (6,345) (8,827) (7,165) (8,352) (7,719) (5,894) (7,946) (7,486) (6,918) (7,651) Capital Charge - - - - - (3,891) - - - - - (3,734) GST Paid (1,863) (1,368) (1,879) (2,290) (1,778) - (3,638) (2,276) (1,819) (1,819) (1,819) (1,819) Payments to Providers (16,846) (15,359) (14,930) (15,336) (15,552) (17,002) (14,757) (18,182) (17,300) (17,300) (17,300) (17,300) IDF Outflow (8,291) (8,293) (8,311) (10,482) (8,311) (8,291) (8,291) (8,291) (8,291) (8,291) (8,291) (8,291) Total Payments (49,164) (46,299) (46,746) (50,541) (45,215) (51,738) (47,964) (47,041) (50,326) (47,416) (46,748) (52,925) Net Cash Inflow/(Outflow) from Operating Activities (2,732) 204 1,520 (1,612) 4,721 32,640 (34,410) 1,290 1,413 1,344 3,610 (3,515) INVESTING ACTIVITIES Interest Income 88 122 31 52 137 44 90 40 60 60 60 60 Capital Expenditure (442) (447) (605) (870) (796) (1,108) (662) (1,769) (1,189) (1,292) (1,011) (1,015) Net Cash Inflow/(Outflow) from Investing Activities (354) (325) (574) (818) (659) (1,064) (572) (1,729) (1,129) (1,232) (951) (955) FINANCING ACTIVITIES Interest Paid on Crown Loans - - (287) (312) (89) (1,236) 0 - (186) (311) (87) (1,235) Equity Injection (Oral Health) - - - - - - - 1,000 - - - - Net Cash Inflow/(Outflow) from Financing Activities - - (287) (312) (89) (1,236) 0 1,000 (186) (311) (87) (1,235) Net Increase/(Decrease) in cash held (3,086) (121) 659 (2,742) 3,973 30,340 (34,982) 561 98 (199) 2,572 (5,705) Add Opening Cash 9,912 6,826 6,705 7,364 4,622 8,595 38,936 3,954 4,515 4,613 4,415 6,987 Closing Cash NZHP account 6,826 6,705 7,364 4,622 8,595 38,936 3,954 4,515 4,613 4,415 6,987 1,282 Petty Cash Balance 12 12 12 12 12 12 12 12 12 12 12 12 Closing Cash balance 6,838 6,717 7,376 4,634 8,607 38,948 3,966 4,527 4,625 4,427 6,999 1,294 1 - HVDHB has an available overdraft facility of $18m Non-DHB Funds* Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Opening Balance 4,477 4,499 4,445 2,533 4,692 4,684 3,612 5,407 Net Movement 22 (54) (1,912) 2,159 (8) (1,072) 1,795 (2,165) Closing Balance 4,499 4,445 2,533 4,692 4,684 3,612 5,407 3,242 *Non-DHB funds include NHMG, NHITB a nd NZULM held i n NZHP a ccount ($0.29M), Term Deposits ($0) and s pecifi c bank accounts ($2.956M) HVDHB Monthly Operating Report Page 20 ` 11 March 2016 216

Weekly Actual Cash Flow Up to 24 February 2016 50 Weekly cash balance 40 30 20 $m 10 - (10) (20) (30) 7/1/2015 7/8/2015 7/15/2015 7/22/2015 7/29/2015 8/5/2015 8/12/2015 8/19/2015 8/26/2015 9/2/2015 9/9/2015 9/16/2015 9/23/2015 9/30/2015 10/7/2015 10/14/2015 10/21/2015 10/28/2015 11/4/2015 11/11/2015 11/18/2015 11/25/2015 12/2/2015 12/9/2015 12/16/2015 12/23/2015 12/30/2015 1/6/2016 1/13/2016 1/20/2016 1/27/2016 2/3/2016 2/10/2016 2/17/2016 2/24/2016 Note the overdraft facility shown in red at $18M The cash balance of 3 February 2016 was at its lowest for this financial year as an invoice of $1M was paid to the DHB three months late and capital expenditure relating to the new Ophthalmology service was purchased ready for the new service starting in February 2016. We also had high planned capital costs in the period relating to the replacement of the clock tower roof which needed to be completed during the summer period. HVDHB Monthly Operating Report Page 21 ` 11 March 2016 217

Capital Expenditure Summary 2015/16 As at February 2016 Project description 2014-15 Brought forward (Approved but unspent) Budget* Current year 2015-16 Total Capital Budget Current year spend Total Actual Costs to Date Estimated Costs 2016 Estimated Costs Post 2016 Total Forecasted Project Costs at Completion Variance Total Forecasted Project Costs vs Budget ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) ($000) STRATEGIC CAPEX e-pharmacy - 500 500 - - 500-500 - 2015-16 projects yet to be initiated COE 465-465 263 470 - - 470 (5) Project capitalised in January 2016 MRI Scanner 400-400 5 453 - - 453 (53) Project Completed Digital Mammography 841-841 8 164 677-841 - In progress - desktop integration to be completed mid calendar year 2DHB Web PAS 150 790 940-182 758-940 - Timing of future spending will be based on Board decisions Local CRISP implementation (RIS) - 300 300 - - - 300 300 - Project will not be started in 2015-16 Regional Clinical Portal (CTAS) - 780 780 - - 780-780 - 2015-16 projects yet to be initiated Regional Clinical Portal (Local Implementation) - 600 600 - - 600-600 - 2015-16 projects yet to be initiated FPSC (Financial Procurement Supply Chain) ex FMIS 198 735 933 332 717 216-933 - Phase 2 completed in July, FA in December, projects to be in March Gynaecology Plus Software - 100 100 31 31 69-100 - Project started in November Fluoroscopy Room - 800 800 - - 800-800 - 2015-16 projects yet to be initiated Echo Machine - 438 438 - - 434-434 4 Business case at review stage - Capital approved in March Central Monitoring System - 300 300 - - 441-441 (141) Capital approved in January Migration to Integrated Lab Provider LIS - 193 193 - - - 193 193 - Project will not be started in 2015-16 Hospital eordering - 285 285 - - - 285 285 - Project will not be started in 2015-16 Integration into Clinical Record - 250 250 - - - 250 250 - Project will not be started in 2015-16 Inpatient Notes (paperless ward) - 70 70 - - - 70 70 - Project will not be started in 2015-16 VOIP Upgrade - 150 150 - - 150-150 - Project capex approved in December ProVation Software - 220 220 72 72 148-220 - Project started in November Child Oral Health Service 2,872-2,872 2,028 2,506 366-2,872 - On-going project, school-based. To be completed in March Other Software - 130 130 - - - 130 130 - Budget will not be spent in 2015-16 TOTAL STRATEGIC PROJECTS 4,926 6,641 11,567 2,739 4,595 5,939 1,228 11,762 (195) BASELINE CAPEX Buildings & Plant 1,814 3,000 4,814 899 1,288 2,526-3,814 1,000 A number of building related projects are at work-in-progress stage Clinical Equipment 1,097 2,000 3,097 1,829 2,145 811-2,956 To be fully allocated - contingency funds also allocated to top up Central 141 Monitoring System Other Equipment 888 100 988 133 542 446-988 - Expected to be fully allocated, including any under spend in 2014/15. Information Technology 748 850 1,598 385 635 963-1,598 - Expected to be fully allocated, including any under spend in 2014/15. Intangible Assets (Software) 296 1,000 1,296 72 590 706-1,296 - A number of projects are currently at work-in-progress stage TOTAL BASELINE PROJECTS 4,843 6,950 11,793 3,318 5,200 5,452-10,652 1,141 National Patient Flow X53083 (funded by MOH) 100 50 150 35 88 62-150 - TOTAL CAPEX 9,869 13,641 23,510 6,092 9,883 11,453 1,228 22,564 946 Status HVDHB Monthly Operating Report Page 22 ` 11 March 2016 218

Treasury as at 29 February 2016 1) Short term funds / investment ($000) 3) Debt ($000) Term debt - Repayment Amount Interest rate NZHP banking activities for the month Core loan 15-Dec-17 $19,000 6.535% Current month Last month Loan 9 15-Apr-20 $5,450 2.980% Loan 4 15-Apr-16 $2,000 5.520% Average balance for the month $19,846 $21,574 Loan 5 15-Apr-16 $5,000 5.020% Lowest balance for the month ($38) $3,275 Loan 14 30-Jun-16 $2,000 2.750% Loan 2 15-Dec-18 $4,500 5.970% Average interest rate 3.25% 3.16% Loan 8 15-Dec-18 $5,450 5.090% Loan 10 15-Dec-18 $6,000 3.710% Net interest earned for the month $48 $55 Loan 6 15-Mar-19 $5,000 5.685% Loan 16 15-Mar-19 $6,500 4.420% Loan 17 15-Apr-20 $8,000 3.250% 2) Hedges Loan 12 15-Jun-20 $5,000 3.355% No hedging contracts have been entered into for the year to date. Loan 13 15-May-21 $5,100 3.450% Total $79,000 5) Foreign exchange transactions for the month ($) Weighted cost of funds 5.143% No. of transactions involving foreign currency 3 4) Debt repayment profile ($000) Total value of transactions $106,869 NZD Year Amount Largest transaction $87,093 NZD 2015/16 $14,450 No. of transactions Equivalent NZD 2017/18 $19,000 AUD 2 $103,393 2018/19 $27,450 GBP 1 $3,476 2019/20 $13,000 2020/21 $5,100 Total $79,000 Total 3 $106,869 HVDHB Monthly Operating Report Page 23 ` 11 March 2016 219

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Month Subject Media outlet Details Jan First baby for New Year Fairfax Media Media enquiry Theft of a patient s handbag Fairfax Media Media enquiry Hutt Hospital ED over Christmas and New Year Period Hutt News & Upper Hutt Leader Media enquiry Treatment of Te Whare Ahuru patients Hutt News Media enquiry Over 3,500 more children enrol in the free regional dental service Hutt News/Fairfax Media Pro-active media approach resulted in coverage Dental House Surgeons achievements Hutt News/Fairfax Media Pro-active media approach resulted in coverage Staff collaborate to improve patient experience Hutt News/Fairfax Media Pro-active media approach resulted in coverage Legionellosis in Wellington Hutt News/Fairfax Media Media enquiry to Regional Public Health Coroner s findings Liam Tawhara Dominion Post Media enquiry Feb Incident at Te Whare Ahuru Dominion Post Media enquiry Filming, photography and audio recording in hospital Dominion Post Media enquiry Page 1 of 54 220

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. PVC recycling for children s play mats The Australian New Zealand College of Anaesthetists (ANZCA) Bulletin Follows media interest from previous proactive media approach (still waiting on clipping) Woman in court Dominion Post Media enquiry Efficiency savings NZ Herald Stuff Newstalk ZB Hutt News/ Upper Hutt Leader Media enquiries Syrian refugees in Wellington region Dominion Post Hutt News Media enquiry Hydrotherapy Pool Stuff and Hutt News Mention in Hutt CC article March Laundry bill RNZ Media generated. Mention in story around NZ Health Partnerships Hydrotherapy Pool Stuff and Hutt News Media enquiry New stroke team Hutt News and Stuff Proactive media approach Health professionals are paid by Coca-Cola South Pacific over the last five years Fairfax Radio NZ Media generated Youths in Upper Hutt playing harmful game Hutt News Media enquiry Interest in the Orongomai Marae fruit and vegetable co-op (RPH). Radio LIve Media generated RPH Upper Hutt Leader HVDHB CE was mentioned positively NZ Doctor (subscription only) Parliament Q & A Page 2 of 54 221

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Hutt News Syrian refugees in Wellington region Dominion Post & Hutt News Board meeting Media enquiry Interest in the Orongomai Marae fruit and vegetable co-op (RPH). Radio Live Upper Hutt Leader Media generated RPH Communication key to better CPAMS service Pharmacy Today Media generated Press releases February 11: Final stage of Wellington, Kapiti and Hutt Valley modernised school dental service launches February 23: Latest Health Target results show Hutt Valley DHB treating cancers faster than ever before Pitched stories not picked up by media (Feb): Something to Smile About film now out; Combined Podiatry and Orthotics Combined Clinic better for patients Page 3 of 54 222

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. January First baby for New Year, Fairfax Media, (Dominion Post, Hutt News, Upper Hutt Leader) Media enquiry 7 January Page 4 of 54 223

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Theft of a patient s handbag, Fairfax Media, Media enquiry, Stuff, 3 January Page 5 of 54 224

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 6 of 54 225

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Hutt Hospital ED over Christmas and New Year Period, Hutt News & Upper Hutt Leader, Media enquiry 12 January Page 7 of 54 226

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Treatment of Te Whare Ahuru patients, Hutt News, Media enquiry, 19 January Page 8 of 54 227

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 9 of 54 228

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Over 3,500 more children enrol in the free regional dental service, Hutt News, Proactive media approach resulted in coverage, 26 January Page 10 of 54 229

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Dental house surgeon s achievements, Hutt News, Proactive media approach resulted in coverage, 26 January Page 11 of 54 230

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Staff collaborate to improve patient experience Hutt News, proactive media approach resulted in coverage, 26 January Page 12 of 54 231

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Legionellosis in Wellington, Media enquiry, Hutt News, Fairfax Stuff RPH, 26 January Page 13 of 54 232

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Coronor s findings Liam Tawhara, Dominion Post, Media enquiry 26 January Page 14 of 54 233

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 15 of 54 234

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. February 2016 Health funding, Media generated, Dominion Post Stuff, 1 Feb Page 16 of 54 235

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 17 of 54 236

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Incident at Te Whare Ahuru, Hutt News, Upper Hutt Leader, Media enquiry, 2/3 February Page 18 of 54 237

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Filming, photography and audio recording in hospital, Dominion Post, Media enquiry, 9 Feb Page 19 of 54 238

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 20 of 54 239

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Nurse in court, Dominion Post, Media enquiry, 12 February Page 21 of 54 240

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 22 of 54 241

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 23 of 54 242

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Efficiency savings, NZ Herald, 16 February Page 24 of 54 243

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 25 of 54 244

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 26 of 54 245

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 27 of 54 246

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Efficiency savings NewstalkZB, 16 February Page 28 of 54 247

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 29 of 54 248

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Efficiency savings Hutt News/ Upper Hutt Leader, Media enquires 23/24 Feb Page 30 of 54 249

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Syrian refugees in Wellington region, Dominion Post, Hutt News 18 Feb Page 31 of 54 250

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 32 of 54 251

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Refugee Care, Hutt News, 23 February Page 33 of 54 252

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Hydrotherapy Pool, Stuff and Hutt News, Mention in Hutt City Council article Page 34 of 54 253

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. March Syrian refugees, Hutt News, Media enquiry from board meeting, 2 March Government accused of setting refugees up to fail Page 35 of 54 254

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Laundry bill, Radio NZ, Media generated. Mention in story around NZ Health Partnerships, 4 March Page 36 of 54 255

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 37 of 54 256

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 38 of 54 257

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Hydrotherapy pool, Stuff and Hutt News, media enquiry 8 March Page 39 of 54 258

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. New stroke team, Hutt News and Stuff, Proactive media approach, 8 March Page 40 of 54 259

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Health professionals took money from Coca-Cola, Stuff, Media generated March 13 Page 41 of 54 260

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 42 of 54 261

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Q&A Parliament, health spending, NZ Doctor subscription only article, 14 March Page 43 of 54 262

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 44 of 54 263

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Youths in Upper Hutt playing harmful game, Hutt News and Upper Hutt Leader, Media enquiry Page 45 of 54 264

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 46 of 54 265

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Syrian refugees Hutt News, Upper Hutt Leader Stuff, Media enquiry, 29 March Page 47 of 54 266

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Page 48 of 54 267

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Interest in vegetable co-op Regional Public Health, Radio Live (interview) Stuff and Upper Hutt Leader 16 & 31 March Page 49 of 54 268

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. DHB staff s improvements to Community Pharmacy Anticoagulation Management Service (CPAMS), Pharmacy Today (subscriber only), March edition Communication key to better CPAMS service Hutt Hospital clinical pharmacist Rachael Cooke is doing her bit to help warfarin users, by boosting communication between primary and secondary healthcare providers in her area Jonathan Chilton-Towle Rachael Cook believes other areas could incorporate some of the CPAMS improvements implemented by Hutt Valley DHB Hutt Hospital clinical pharmacist Rachael Cooke is doing her bit to help warfarin users, by boosting communication between primary and secondary healthcare providers in her area. Mrs Cooke took action after she identified issues with the communication systems between the hospital and Community Pharmacy Anticoagulation Management Service (CPAMS) providers that potentially put patients at risk. Page 50 of 54 269

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. CPAMS is a programme allowing accredited community pharmacists to perform International Normalised Ratio (INR) testing on patients using anticoagulation medicine warfarin. Participating pharmacies may also make dose adjustments with the help of a decision support system. The goal is to provide a much faster and smoother process for warfarin management. There are around 140 participating pharmacies throughout New Zealand (Pharmacy Today, February 2015). But Mrs Cooke discovered Hutt Valley patients enrolled in CPAMS were not easily identifiable to hospital staff, and staff could not get patients test results while pharmacies were closed. As hospital staff could not access records of who was managing the anticoagulation, discharging doctors were often sending patient results to GPs rather than pharmacies. CPAMS pharmacists felt they were left unsupported and often did not know who to contact within secondary care if issues arose with discharge management. They were often unaware that the patient had been in hospital and could require closer monitoring after an admission. Mrs Cooke set out to facilitate changes that improved the exchange of patient information between pharmacies and the hospital. "The two weren't talking to each other," she says. A series of changes to the Hutt Valley DHB electronic records system Concerto were suggested and implemented, culminating in the CPAMS INR testing results being directly emailed to Concerto at the time of testing, enabling test results to be available 24 hours a day. Information identifying a patient as a CPAMS patient, the patient's pharmacy and its phone number have become part of the patient's individual record. Another change allows community pharmacists to easily identify CPAMS patients as current inpatients. Mrs Cooke also suggested an audit of the service provided by a CPAMS pharmacy could identify areas where systems and processes could be improved. An audit was carried out at one of the local pharmacies, resulting in several patient-specific improvements to service. In November 2014, Mrs Cooke established a regional peer review group, with quarterly meetings and an online chat group available for all CPAMS pharmacists in the greater Wellington region. She is the current chair of this group. Mrs Cooke believes other regions in New Zealand could incorporate some of these changes into their own areas to improve patient care. Clinical pharmacist Pam Duncan became involved in the effort to improve communications after working with Mrs Cooke on problem solving several issues. Mrs Duncan was working at Unichem Nae Nae, one of the first pharmacies to join the CPAMS programme in the country. She now works at the Pharmacy Council but still attends the peer group. "We thought there must be a better way to communicate between primary and secondary care," she says. The changes implemented have had amazing results, Mrs Duncan says. "It's just meant there was some cohesion around the patient treatment plan. "There has been a huge improvement in patient safety." Page 51 of 54 270

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. PRESS RELEASES February 11, 2016 Final stage of Wellington, Kapiti and Hutt Valley modernised school dental service launches The final stage of a multimillion makeover of the school dental service in Wellington, Kapiti and Hutt Valley launches today. Dr Virginia Hope who chairs both the Capital & Coast and Hutt Valley DHBs officially opened Selby House in Newtown today one of six fully refurbished, modern school dental clinics to open in 2016. These final six clinics are part of a plan that has seen more than $12 million spent on upgrading and running school dental services since 2010 in this region. In total 13 clinics have been refurbished and 11 dental vans visit schools that don t have a clinic. Today s launch has been the culmination of several years work to modernise the Bee Healthy Dental service which provides free school based dental services and make sure it is accessible and sustainable for many years to come. Dr Hope said this was another example of the two DHBs working together to provide the most efficient service and getting the best value for money for our communities. The six fully refurbished hubs have the latest in modern equipment, are child friendly and staffed by a talented team of dental nurses who provide an excellent service, free of charge to the community. Making sure children have good oral health is vital, no child can be expected to perform their best in school if their teeth hurt, Dr Hope Said. These six new dental that open during term one 2016 are located at: Petone Central School - Hutt Central School- Raumati Beach School Paraparaumu School Miramar Central School and Selby House in Newtown. Clinical Director of the CCDHB and HVDHB Oral Health Service (or The Bee Healthy Dental Service) Kathryn Fuge said throughout the country this new model of care with mobile vans visiting schools for yearly check-ups and centrally located hub clinics and means that most children will get their yearly dental check on site at their school and parents will have more involvement with all stages of their child s oral health care. Page 52 of 54 271

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. Any child that is seen in a dental van and who needs more extensive treatment such as fillings will be referred to one of the six dental hubs. Preschool children can also be seen for free at one of the dental hubs. The Bee Healthy Regional Dental Service provides free dental examinations and treatment for all children from birth until year 8 (around age 12), across the Wellington, Hutt Valley and Kapiti Coast regions. The launch of the new hubs does mean some of the older clinics at schools will close. But schools that no longer have a dental clinic will be visited by the dental van. These changes will not result in a reduction in service rather they mean people will be able to access more modern and sustainable services. We are really excited by these changes and we encourage every parent who is not sure if their child is enrolled in the service to get in touch, Dr Fuge said. The Bee Health Dental service is currently working to finalise the opening dates for the new clinics and in the meantime if parents have any concerns about their child s teeth or a child has dental pain, an appointment can be arranged by calling 0800 TALK TEETH (0800 825 583). Parents/caregiver can also call this number to update contact details. Media contact: Vikki Carter 027 2309571 MEDIA RELEASE FOR IMMEDIATE RELEASE: 23 February 2016 Latest Health Target results show Hutt Valley DHB treating cancers faster than ever before Hutt Valley DHB has made an 11% increase in the Faster Cancer Treatments Health Target. Quarter Two results released today show that Hutt Valley patients who have a high suspicion of cancer are being seen faster than ever before. Hutt Valley District Health Board Chief Executive Dr Ashley Bloomfield is impressed with the latest results. It s really important to me that people in the Hutt Valley get access to the care they need quickly. We re working alongside Capital & Coast District Health Board to ensure patients in this district see the specialists they need quickly, and as close to home as possible, says Dr Bloomfield. Page 53 of 54 272

HVDHB Media Coverage January to March 2016 Coverage does not include patient condition updates. The number of Hutt Valley people receiving treatment for cancers is increasing each year: 571 people received cancer services in 2011/12 and this increased to 755 in 2014/15. This represents a more than 30% increase in Hutt Valley people receiving cancer treatment at Wellington Regional Hospital over the period. These results also help to demystify some recent media that suggested we were trying to reduce oncology admissions. Because oncology services are provided by a limited number of hospitals, we need to ensure that the services we get from other DHBs are being charged back to Hutt Valley DHB correctly and appropriately. We are also doing some work to understand why the Hutt Valley population has a cancer incidence of slightly below the national average, but an above average hospitalisation rate. We think some of this care could be provided in the Hutt, so we are looking at how this could happen. Hutt Valley DHB is committed to our population receiving the care that they need, when they need it. The latest target results show we are on track to achieve this. Media contact: Izzi Brown, Communications Manager, Hutt Valley DHB. 027 469 8880 Pitched stories not picked up by media (Feb): Something to Smile About film now out; Combined Podiatry and Orthotics Combined Clinic better for patients Page 54 of 54 273

Summary of Primary Care activities to improve Pacific health BACKGROUND Hutt Valley DHB is one of the eight Pacific priority DHBs where over ninety per cent of Pacific peoples resides, (Census 2013 figures of 12,370 Pacific People in the Hutt Valley). The snapshot provided below from Te Awakairangi Health Network (TeAHN) details the progress we are making as a DHB in addressing the health of our Pacific population. This presentation and information was provided to the Pacific sub regional group in their meeting in February 2016. PRIMARY CARE IN THE HUTT VALLEY 1. ACCESS TO CARE More than 425,000 general practice consultations per annum More than 16,000 consultations for other TeAHN services (primarily for Maori, Pacific and Quintile 5 people) Since the 2012/13 year, Pacific people enrolled with TeAHN have increased their use of general practitioners and nurses from 3.1 to 3.3 visits annually. While the Pacific utilisation rate is lower than that of people who are non-maori and non-pacific, TeAHN is keen to work with the DHBs and the Ministry of Health (the Ministry) to remove barriers to access (policy settings) and within our community (appropriateness). Other TeAHN services: Pacific as % of total users Primary Mental Health 6% Community Health Worker 27% Outreach Nursing 21% Dietitian 31% Healthy Family coach 27% Transport 17% Pacific Healthy Lifestyle Sessions An average of 50 people attend each session. 274

2. PREVENTING ADMISSIONS PACC (person-centred acute community care) service assisting general practice to prevent admissions to hospital Addressing avoidable hospitalisations (ASH) for children cellulitis, gastroenteritis, dental conditions, respiratory conditions 3,300 more pre-schoolers enrolled for dental care Work underway regarding asthma and other respiratory conditions HealthPathways eg, impact of cellulitis pathway New and improved services eg, rheumatic fever prevention through sore throat clinics. 3. Reducing Avoidable Admissions 4. Primary Mental Health Aim to improve health outcomes for people with mild to moderate mental illness, or with addiction issues Run in Upper Hutt, Lower Hutt, Whai Oranga, and marae Active in suicide prevention and post-vention Low utilisation by Pacific people (6 percent compared with 9 percent of enrolled) - Of 196 youth, 11 Pacific (July December 2015) - Of 887 adults, 54 Pacific (Jul Dec 2015). 275

5. Child Health 5.1 Health Target Immunisation Among the best in New Zealand, achieving both the eight month and two year old target. 5.2 Children Oral Health Enrolment Whole-of-system approach to Child Health: Hutt Valley DHB has a multiple new born enrolment system where infants are enrolled at time of birth in all services. A data matching process has been completed with PHOs resulting in a large increase in enrolments this year. The 3,300 more pre-schoolers means that more than 90 percent of Hutt Valley pre-schoolers are enrolled and can now be followed up by the Bee Healthy service 276