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

Public Capital & Coast and Hutt Valley District Health Boards Community and Public Health Advisory Committees Meeting 21 November 2011

CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS Community Public Health Advisory Committees Public Agenda Board Room, Pilmuir House, Hutt Valley District Health Board, Lower Hutt Monday 21 November at 9.00 am * Paper Item Action Presenter Min Time Page 1. Procedural Business 5 9.00 9.05 1.1 Continuous Disclosure * To Consider # 1.2 Minutes of a Meeting held on To Approve # 25 October 2011 * 1.3 Schedule of Matters Arising * To Note # 2. HVDHB Improving Equity To Consider 35 9.05 9.40 2.1 Report* To Note Nicholette Pomana 3. Regional Public Health To Consider 45 9.40 10.25 3.1 RPH Update* To Note Peter Gush/Barry Gall 3.2 Keeping Well 10/11 Report Update for the First Few Months of 11/12* 4. GM report Including Te Haika and Bicillin Action Points 5. ARC Capacity Planning Report presentation (action point) To Note To Note Peter Gush/Barry Gall Sandra Williams/Bridget Allan 15 10.25 10.40 To Note Wayne Skipage 15 10.40 10.55 # # # 6. Other/General Business To Consider 5 10.55 11.00 7. Resolution to Exclude the Public * 8. Date of Next Meeting tba To Approve 5 11.05 11.10 # Close 11.10

CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS Conflicts & Declarations of Interest Register 21 NOVEMBER 2011 Name Mr Wayne Guppy Chair Dr Judith Aitken Deputy Chair Interest Upper Hutt City Council - Mayor Orongomai Marae Trustee Wife employed by various community pharmacies in the Hutt Valley Director, Medic Alert NZ Member, Capital & Coast District Health Board Deputy Chair, Community & Public Health Advisory Committee Member, Disability Support Advisory Committee, Capital & Coast District Health Board Member, Greater Wellington Regional Council Chair, Audit, Risk & Assurance Committee, Greater Wellington Regional Council Member, Social & Cultural Committee, Greater Wellington Regional Council Member, Te Upoko Taiao & Environmental Committee Chair, Speakers Assurance Committee Trustee, Carter Observatory Trust Ms Katy Austin Fergusson Home (Upper Hutt) Voluntary Input Mr David Choat Member, Capital & Coast District Health Board Manager, Policy Development, Leader of the Opposition s Office Director & Shareholder, Policy Progress Limited Partner, Ms Fleur Fitzsimons, employed as Solicitor, New Zealand Public Service Association Ms Kayleen Katene Maori Partnership Board Ms Muriel Tunoho Maori Partnership Board Ms Iris Pahau AWE Consultants Limited Director Community Sector Taskforce National Development Manager NZ Coalition to End Homelessness Co-Chair Maori Women s Welfare League Member Co-Chair of the Hutt Housing Forum Ms Helene Ritchie Member, Capital & Coast District Health Board Member, Disability Support Advisory Committee, Capital & Coast District Health Board Councillor, Wellington City Council Registered Psychologist, Private Practice Capital & Coast and Hutt Valley District Health Boards

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

CPHAC Pub Min PUBLIC MINUTES OF THE COMMITTEE MEETING OF THE CAPITAL & COAST AND HUTT VALLEY DISTRICT HEALTH BOARDS COMMUNITY PUBLIC HEALTH ADVISORY COMMITTEE HELD AT BOARD ROOM, LEVEL 11, GRACE NEILL BLOCK, WELLINGTON REGIONAL HOSPITAL, NEWTOWN, ON TUESDAY 25 OCTOBER 2011, AT 9.00 AM PRESENT Wayne Guppy Judith Aitken Katy Austin David Choat Peter Glensor Virginia Hope Iris Pahau Chair Member, Deputy Chair Member Member (from 9.15am) Member Board Chair (from 9.20am) Member IN ATTENDANCE: Margaret Faulkner Mary Bonner Bridget Allan Taima Fagaloa Alison Hannah Riki Nia Nia Jim Wiki Justine Mecchia Sandra Williams Tricia Caughley Jack Rikihana Justine Thorpe Cathy O Malley Board Member CEO, C&CDHB Director Planning, Funding and Public Health, HV Director Pacific Health, C&C Senior Manager, Primary Care & HHS Services, P&F, C&C Director Maori Health C&C Senior Manager Maori Health, C&C Relationships and Contracts Maori Health, C&C Director, Planning & Funding, C&C Minute Secretary Maori Partnership Board CEO, Well Health PHO CEO, Compass Health PHO APOLOGIES Debbie Chin, Crown Monitor (ex officio), Darrin Sykes, Muriel Tunoho, Richard Schmidt, Wayne Skipage. The Chair welcomed everyone to the meeting, including Jack Rikihana of the Maori Partnership Board. 1. PROCEDURAL BUSINESS 1.1 CONTINUOUS DISCLOSURE Iris Pahau advised changes to the Conflicts of Interest Register details. CONFIRMED: The Committees confirmed that it was not aware of any other matters (including matters reported to, and decisions made, by the Committee at this meeting) which would require disclosure. 1

1.2 Minutes of Meeting held on 19 September 2011. CPHAC Pub Min RESOLVED: The Committees resolved to approve the minutes of the Members (Public) meeting held on 19 September 2011. Moved: Peter Glensor Seconded: Katy Austin CARRIED 1.3 Schedule of Matters Arising All October items are covered in the agenda for the meeting. The Rheumatic Fever update relating to Bicillin is still under investigation. NOTED: The Committee noted the Schedule of Matters Arising. 2. MAORI HEALTH AT C&C DHB 2.1 Maori Health Indicators Report The Director Maori Health, C&C advised that development of the Annual Maori Health Plan was beginning to enable alignment with the Annual Plan for 2012-13. Committee members were invited to contribute to the Plan. Jim Wiki gave a presentation (tabled at the meeting). The recent CCDHB Maori Partnership Board Hui made it clear, while there was a range of views, that whanau must be in the centre of planning activities. Discussion covered: The Director identified 3 key success factors for past successful initiatives: resource, clear direction and capability. What are the barriers to Maori enrolling in PHOs? Statistics in the report identified 82% of CCDHB Maori population are enrolled with CCDHB PHOs. Whilst the statistics indicate Maori health improvement there is still an underlying disparity with Maori dying 9 years earlier than non-maori. Focus needs to be on how well the system is serving Maori. A Member suggested an approach for 12/13 could be to track how Maori are receiving services and the improvements in health. Pick one area and monitor it over 12 months is it providing the level of care needed? A question was raised about how Disability was being covered as it was not mentioned in the report specifically. Vulnerable Children it was suggested the team consider how the plan would address children and their needs. Another focus area discussed was improving PHO enrolments. Disparities still have to be addressed. Make the words real. Bring attention to the key issues. Tackle four key objectives: Suggestions were made about the indicators used to track success. It was noted that they should which give a whole-of-system focus. Better comparisons could be gained through the use of rates rather than numbers. Have a small number of targets keep them realistically ambitious. Have a strong action plan related to chosen targets. NOTED: The Committee noted the Maori Health Indicator Report. 2

CPHAC Pub Min 3. PACIFIC HEALTH AT C&C DHB 3.1 PHO/Pacific Update The Director Pacific Health, C&C reminded the Committee of the presentation given in April 2010 which related to the options for the Pacific Primary Care fund and resulted in the Board endorsing the PHO based model with PHOs enhancing the Services they deliver to their enrolled Pacific population. A subsequent report in April 2011 outlined the proposed reconfiguration of the services provided by PHOs and By Pacific For Pacific (BPFP) providers to provide connected and integrated Pacific services. This provides an opportunity to work with all PHOs who serve the Pacific population. The DHB needs to stay focused on the Pacific Population, regardless of the structure of Pacific providers. The Chief Executives of Well Health (Wellington) and Compass Health (Porirua) respectively contributed to the discussion. Discussion covered: New Whanau Ora provider collectives: The Director confirmed that Te Puni Kokiri had been informed of the direction that C&C DHB was taking. The 2 PHOs are working collaboratively and are interested in contracting on a joint basis. The discussion was halted at this point and resumed in the Public Excluded section. NOTED: The Committee noted the report to this point. 4. IMPROVING INEQUALITY IN 2010/2011 4.1 Hutt Valley DHB report Deferred to the November Meeting. The Committee requested that Disability be addressed in this paper, when presenting at the November meeting. 5. PLANNING AND FUNDING REPORT 5.1 Hutt Valley District Health Board Action Point updates NOTED: The Committee noted the contents of the report. 6. OTHER/GENERAL BUSINESS There was no other business. 3

CPHAC Pub Min 7. RESOLUTION TO EXCLUDE THE PUBLIC 7.1 Recommendation It is recommended that the Committees: (a) Agree that as provided by clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons: Subject Reason Reference* Public excluded Minutes For the reasons set out in the 2 September 2011 Board Agenda Annual Planning Would prejudice or disadvantage Section 9(2)(i) commercial activities CPHAC Work Programme 2012 Would prejudice or disadvantage commercial activities Section 9(2)(i) *Official Information Act 1982. Moved Judith Aitken Seconded: Katy Austin CARRIED A Refreshment break took place at 10.23am. The Committee entered the Public Excluded section of the meeting at 10.33am. DATE OF THE NEXT MEETING The next meeting will be Monday 21 November 2011, at 9.00am, Board Room, Pilmuir House, Hutt Valley District Health Board, Lower Hutt. The meeting closed at 12.00 noon. CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting. DATED this day of 2011 WAYNE GUPPY CHAIR COMMUNITY PUBLIC HEALTH ADVISORY COMMITTEE 4

MEMORANDUM FOR CPHAC COMMITTEES MEETING CPHAC Pub Min SCHEDULE OF MATTERS ARISING Minutes Matters Arising DHB Comments 25/10/2011 The Director Pacific Health C&C to ensure Kuini Puketapu, Maori Health Advisor, HVDHB was in the information loop with changes taking place in the Pacific Health area. CCDHB 19/09/2011 Rheumatic Fever Update: Further investigation by Management about a process where Bicillin can be provided free of charge to patients. 22/08/2011 Management to a. Use relevant accountability measures in future mental health reports to the Committee and Board. b. Arrange a presentation to the Committee on HoNOS and (appropriate for governance) KPIs c. Include the results of client satisfaction surveys of Te Haika in future reports. 18/07/2011 Aged Residential Care Capacity Planning report to come to CPHAC. 20/06/2011 Report back to CPHAC on the progress and discussion with Hutt Valley DHB on Te Haika Services. CCDHB/HVDHB When available CCDHB/HVDHB Next report on Mental Health to CPHAC CCDHB/HVDHB November 2011 CCDHB/HVDHB November 2011 5

Public Section Action: For Feedback and Noting Memorandum to: Author Community and Public Health Advisory Committee Elizabeth Lucie-Smith, Nicholette Pomana and Bridget Allan Date November 2011 Subject 2010/11 Improving Equity Report Recommendation It is recommended the committee: a) Note the contents of this report on progress against the Improving Equity Framework for the year to 30 June 2011. b) Note that good progress in improving equity has been made, particularly in relation to smoking cessation, breast and cervical screening, diabetes and cardiovascular screening and management, immunisation, Before School Checks and mental health access rates and crisis prevention/resiliency plans. c) Note that in some areas where equity has been improved, there are still significant disparities so the focus in these areas needs to continue. These include breastfeeding, oral health (especially for Pacific children), cervical screening, diabetes and cardiovascular screening and management, mental health access rates for Pacific people of all ages and for Maori aged 0 to 19 years, elective admissions for Pacific people, and avoidable hospital admissions (especially for 0 to 4 year olds and people 55 years and over). Background In September 2009, CPHAC approved a framework for reporting progress on improving equity at an operational level as well as for reporting overall progress annually. It was agreed that the progress reports would draw on data sources used for regular reporting. We reported on progress in 2009/10 in a report to CPHAC late in 2010, and this paper reports on progress in 2010/11. Strategic Context The Hutt Valley DHB s health profile which informed the development of the Statement of Intent was gained through a comprehensive Health Needs Assessment 1 prepared in 2008, drawing on data captured in the 2006 census and from health sources at a similar time. Work is now underway to update the Health Needs Assessment, although it will be limited by the deferral of the 2011 census until 2013. 1 Ministry of Health Public Health Intelligence, September 2008 and Central Technical Advisory Services, June 2008 as published on our website www.huttvalleydhb.org.nz 1

The following information from the Needs Assessment is still relevant to this report: The ethnic composition of the overall population is similar to overall NZ figures, although there is a higher proportion of Pacific people (7.2% compared with 5.6% nationally). The population of the Hutt Valley is changing and over time there will be more people who are older and more Maori and Pacific people. The population of Maori will increase by around 27% by 2026 and Pacific people by 30%. Areas of relatively high deprivation within the Hutt Valley district include Naenae, Taita, Moera, Timberlea, and parts of Petone, Stokes Valley, Wainuiomata, Waiwhetu and central Upper Hutt. Nearly half of the Pacific people living in the Hutt Valley fall into the two most deprived groups (Deciles 9 and 10). The Maori and Pacific populations are generally younger than the rest of the population and experience higher levels of deprivation than non Maori. Maori and Pacific people are over-represented in the most deprived areas. When compared with the rest of the population, Maori and Pacific people experience: o Lower consumption of vegetables and fruit o Lower rates of breastfeeding o Higher prevalence of obesity. In addition, Maori also experience o Higher rates of hazardous drinking o Higher prevalence of smoking. Maori and Pacific people experience higher rates of death from cancer, cardiovascular disease and stroke, and much higher prevalence of diabetes, asthma and depression. Maori also experience higher rates of death from lung cancer in particular and suicide. When compared with the rest of the population, Maori and Pacific people experience: o Higher rates of avoidable hospital admissions o Greater rates of hospitalisation of children for dental conditions and asthma o Greater unmet need for a GP o Poorer access to oral health checks, diabetes checks, breast and cervical screening. The DHB response to the health profile Given the health profile outlined above, the DHB has recognised that the challenge of improving equity applies to a wide range of services, from preventative through early intervention to treatment and followup. DHB strategies and frameworks are expected to improve outcomes for high needs groups, including Maori and Pacific and high needs geographical areas. Specific examples include implementation of the Keeping Well Strategy implementation of the Long Term Conditions Framework implementation of the Ambulatory Sensitive Hospitalisations (ASH) Action Plan. The Keeping Well Strategy 2008-2012 is a Wellington region strategic plan for population health for the Hutt, Wellington and Wairarapa regions. It is designed to inform those DHBs and the Ministry of Health in their collaborative leadership for population health and improving outcomes for high needs groups, including Maori and Pacific and high needs geographical areas. During 2010/11, it was agreed that the Keeping Well programme would 2

focus on improving health for children and youth, with an initial project to reduce skin infections. The Long Term Conditions Framework includes strategies to prevent long-term conditions occurring as well as improved management of existing conditions. Following the long term conditions inter-disciplinary think tank with consumers, clinicians and other stakeholders in 2009, specific projects are now underway under the long term conditions banner, relating to diabetes, heart failure and respiratory conditions. The Ambulatory Sensitive Hospitalisations (ASH) Action Plan aims to address the high rates of avoidable hospitalisations in the Hutt Valley, particularly for children aged 0 to 4 years. It is now (in 2011/12) being linked to DHB-wide efforts to reduce hospital unplanned stays under the 30 A Day programme, with an initial focus on reducing admissions for skin infections. Analysis This section of the report provides information on progress in areas linked to the health profile above, and related areas. In analysing the information, the report attempts to show not just improvements for the target population groups, but also increasing or decreasing equity. The more detailed information which underpins the conclusions in this section can be found in Appendix 1. It should be noted that whilst this report is designed to focus on Maori, Pacific and high deprivation populations, in many areas, deprivation information is not available. Smoking 91% of hospitalised smokers were provided with advice and help to quit in 2010/11, a significant increase on the 83% achieved by the end of 2009/10, and more than achieving the National Health Target of 90% by July 2010. There is little difference between population groups, with all ethnicities being provided with similar levels of advice and assistance. Hutt Hospital has continued to distribute Nicotine Replacement Therapy and training of hospital based and primary care providers in smoking cessation during the year. Reducing obesity The DHB has continued to promote increased consumption of vegetables and fruit, and increased physical activity, through community action projects for Maori and Pacific populations. Early in 2010/11, the Healthy Eating, Healthy Action programme documented the success of many school and early childhood projects (e.g. vegetable gardens, improved canteens and physical activity programmes) in a widely distributed booklet. Hutt Valley DHB is also currently supporting 20 primary, 4 intermediate and 3 secondary schools as part of the Health Promoting Schools programme which targets high deprivation schools. Breastfeeding In 2010/11, Hutt Valley birth rates decreased for all ethnicities, when compared to the previous three years. The percentage of births to teenage mothers has also decreased for all ethnicities, but remains significantly higher for Maori births. 3 Data from Plunket indicates that in 2010, Hutt Valley breastfeeding rates remained below the national averages and Ministry set targets at 59% (6 weeks), 47% (3 months), and 19% (6 months). The data indicates that breastfeeding rates for Maori and Pacific babies are still significantly below those of non-maori non-pacific babies and below the national targets, at three months and six months. There is an improvement, though, at six weeks with rates for Maori rising significantly (from 46% to 57%) and for Pacific (from 47% to 51%).

It needs to be noted that the information above about breastfeeding only relates to babies that are enrolled with Plunket. Information from other DHB funded WellChild/Tamariki Ora providers (Maori and Pacific providers) will be included in 2011 reporting. Given that these numbers will be relatively small, the overall conclusion that Maori and Pacific breastfeeding rates are lower than the rest of the population is still valid and improving breastfeeding rates for Maori and Pacific babies must remain an area for focus. There has been progress in driving actions to improve breastfeeding in the Hutt Valley. Our whanau ora engagement and facilitation programme is already making an impact in facilitating women to programmes and supporting individual women to breastfeed. The Hutt Valley Breastfeeding Network is well established and several more programmes are being arranged that will promote breastfeeding. Immunisation for children and young people Key areas of achievement in child and youth services in 2010/11 were the success of the screening and immunisation programmes, particularly the success of primary health care in achieving 91% immunisation coverage for children aged 2 years (against a target of 90%). In relation to immunisation the Ministry of Health noted that the Hutt Valley DHB is an outstanding performer; of particular importance is the DHB s reduction in ethnic disparity. The DHB immunisation teams have also continued to deliver the Human Papilloma Virus Immunisation (HPV) programme for older girls, alongside the School Year 8 immunisation programme. The DHB has not performed at the same level as the New Zealand average, partly due to parental reluctance to immunise 12 and 13 year old girls, but has reached the target for Pacific girls. Screening for children The Before School Checks programme is on track. This is a universal, comprehensive screening and heath education opportunity for children turning four and their parents or guardian. In 2010/11 the programme exceeded the total target (for the whole population) and met the target for the high deprivation (Quintile 5) population. The public health nursing School Health Team focuses on schools with high numbers of Maori and Pacific peoples, and monitors children to ensure that they have received their Before School Check. They also screen for family violence, provide year 7 immunisations and link with the dental service. Oral health The School Dental Service has improved the rates of child oral health screening over the past few years, finishing the 2010 calendar year with an arrears rate of 12%. The service is expected to have a zero arrears rate, so further work is required to achieve this under the new community model of oral health delivery. 4 It is important for children to engage early with oral health services, so that their caregivers are well informed about good oral health practices and any problems can be addressed in a timely way. The number of preschool children enrolled with the oral health service increased from 29% to 40% in 2010. Other children have better oral health at age 5 years and at Year 8 (12 years) than Maori or Pacific children, although there has been a significant improvement in the oral health of Maori children seen in 2010. The oral health of Pacific children is poorer, as shown by both the lower caries free score and the higher decayed/missing/filled teeth (DMFT) rate at age 5 years and Year 8. This will continue to be a focus of the School Dental Service as they implement the new community model of oral health delivery. In 2010/11, the DHB expected to have 6,796 adolescents enrolled and examined in oral health services, but was only able to deliver to 5,666 adolescents. The variance is a result of lower than expected availability of private providers. During 2010, a full stocktake

of adolescent utilisation was completed. The three areas of concern were Wainuiomata, Naenae and Taita. A private provider has initiated a mobile service in Wainuiomata with a view to a similar service for Taita. To improve the Naenae situation, the hospital dental department is trialling an initiative where they provide services from the new Naenae hub. Breast and cervical screening. Good progress is being made, with breast screening and cervical screening rates continuing to increase for all women and for Maori and Pacific women in particular. The progress in breast screening has been pleasing, with Pacific women showing a 4% increase in breast screening over the last year and a 39% increase over the past six years. This compares with a 2% increase of the rest of the population in the last year and a 25% increase over the last six years. Maori women too had increased rates of breast screening with a 2% increase over the last year and a 31% increase over the last six years. With cervical screening rates, there has been a slight improvement for all groups over the past few years, but there remains a significant gap with Maori and Pacific women having rates of just over 60% while the total population is at 80%. Although the disparity is reducing (especially in breast screening) and good progress is being made, Maori and Pacific women continue to have lower screening rates than the rest of the population, so the focus in these areas needs to continue. Cancer Lung cancer is a major cause of death for Maori. A significant initiative during 2009/10 was the mapping of lung cancer pathways. This highlighted the complex and intricate pathways, and that for Maori in particular there is little understanding of the services available and how best to access and move between them. During 2010/11, Hutt Valley DHB has been involved in two inequalities projects funded through the Central Cancer Network: the Cancer Services Directory for providers and patients and translation of service information in a range of languages and a series of workshops with Maori across the wider Wellington region called Demystifying Cancer. Ambulatory Sensitive Hospitalisations Ambulatory Sensitive Hospitalisations (ASH) provides a measure of admissions that might be prevented if appropriate health services are delivered in community settings. This includes access to effective primary health care. If there is good access to effective primary health care for all population groups, then it is reasonable to expect that there will be lower levels of ASH admissions. ASH rates can highlight service areas where a new focus could reduce the need for people to be hospitalised. ASH rates for all ethnic groups are highest in the very young and very old. In the Hutt Valley, Maori and Pacific people have higher rates throughout life than those of Other ethnic groups, with the disparities being greatest for children aged 0 to 4 years, and for people aged 55 years and over. Children aged 0 to 4 years of Other ethnic groups who live in a deprived area (Quintile 5) also have high ASH rates. For the 0 to 74 population within the Hutt Valley, the ASH rate continues to be high. Over the last two years, ASH rates for 0 to 4 year old children appear to have decreased slightly for Pacific children but have increased for Maori children and for children of Other ethnic groups, driven by higher rates in deprived (Quintile 5) areas. Although there have been decreases in the ASH rates for people aged 45 to 64, these are not statistically significant. 5

CPHAC is already aware of the 30 A Day programme (incorporating the 2011/12 ASH Action Plan) which contains a range of projects and interventions aiming to reduce the ASH rates, including those for skin infections, gastroenteritis and dental conditions. Over the next year, there will be further analysis to identify specific projects addressing other ASH conditions (which may include heart conditions, respiratory conditions and the complications of diabetes). The DHB is continuing to facilitate access to GP practices for the unenrolled Hutt Valley population. A letter advising patients who present to ED without a GP about practices which are currently enrolling patients is updated on a regular basis. The new practice, which opened in 2010 is continuing to enrol patients, and a number of other practices are taking on new patients. Cardiovascular disease Cardiovascular (CVD) risk assessment in primary care will lead to earlier identification of people with cardiac problems and potentially reduce ambulatory sensitive admissions for myocardial infarction, angina, congestive heart failure, stroke and hypertensive disease. Practices now use electronic clinical support tools for cardiovascular risk assessments and provide follow up risk management. Patients are encouraged to use complementary programmes on offer through the PHO, many targeted at high needs populations. Cardiovascular (CVD) risk assessment in primary care has been measured indirectly by the number of lipid tests. Through our primary care partners, the DHB has achieved the target in 2010/11, reaching 77% against a 76% target. While there have been improvements in earlier years for Maori and Pacific rates, these now appear to have stabilised at just over 70% while rates for the rest of the population are closer to 80%. The measure for Cardiovascular (CVD) risk assessment will be changing in future, as primary care will be expected to record and report on actual risk assessments done. As part of this change, we will be encouraging primary care to address the disparities for the different ethnic groups. Diabetes Hutt Valley DHB has been working with primary care to improve access to diabetes checks for people with diabetes in the Valley. In 2010/11, the DHB exceeded the diabetes annual check target, reaching 75% coverage. There was a 5% increase in the number of checks provided (with a 7% increase for Maori). The increase for Maori is pleasing as over earlier years, the rate of increase for Maori had been lower than for Pacific and Other ethnicities. However, the number of checks for Pacific people has not increased, and there are still much lower rates for Maori and Pacific people than for Others. Looking now at the management of diabetes (as shown by HbA1c of 8 or less) among those receiving annual checks, the DHB did not reach this target, achieving 74.1% against a target of 75%. There are still much lower rates for Maori (62%) and Pacific (55%) people than for Others. Greater focus on this target is expected to follow as our new PHO beds in its approach and activities. Asthma Asthma continues to be one of the top three causes of ambulatory sensitive hospitalisations in 2010/11. For combined ages, asthma hospital admissions for Maori and Pacific have increased over the last two years while remaining similar for Other populations. For children aged 0 to 4 years, a similar increase in asthma admissions was 6

seen for both Maori and Pacific children but there was also an increase for Other children in deprived (Quintile 5) areas. The DHB is continuing to support intersectoral work to prevent respiratory conditions such as asthma, by improving housing in the Hutt Valley. In 2010/11, the DHB met its target of completing 100 Healthy Housing Programme s Health and Social Assessments for homes for the year, and we expect to complete a similar number in 2011/12. Alongside this, though, it will be important to bring respiratory conditions under the 30 A Day programme to get a comprehensive sector-wide response to reducing the impact of respiratory diseases. Mental Health and Alcohol and Drug The Hutt Valley access rates for people using mental health services have improved in 2010/11, achieving the overall access rate target of 3%. The prevalence of mental illness and addiction in Maori and Pacific populations is higher than in the general population 2 and this is reflected in Hutt Valley DHB Maori access rates to services (4.4%) being higher than the general population (3.1%). Pacific people however still have the lowest access rates to specialist services (2.1%) in spite of the high prevalence. The overall access rate for 0 to 19 year olds of 2.3% has been achieved. However, Maori child and youth access rates need to be improved. The Infant Child Adolescent and Family Service (ICAFS) is currently connecting with local Marae to increase the profile of the service that they offer and to discuss how this service can be utilised to support the Maori population. The service is also working with the Marae to look at alternative options to engage Maori children and youth in their service in a timely manner. The ICAFS team has recently had their Maori Liaison worker return from Maternity Leave. It is expected that the return of this role will enhance access opportunities for the Maori child and youth population. Relapse prevention planning has been shown to be a key component of service delivery that allows the medium to long term impacts of a serious mental illness to be minimised to service users. The target for the percentage of long term mental health service users having crisis prevention/resiliency plans is 95%. The DHB has moved from a 2009/10 result of 65% to a 2010/11 result of 92%. Even more significant is the improvement for Maori and Pacific clients, moving from 26% to 90%, and 38% to 99%, respectively. Hospital specific information. Consistent with the burden of disease, Maori and Pacific people, and Other high deprivation populations (Quintile 4 and 5) have higher rates of ED attendances, inpatient discharges and surgical admissions than the rest of the population. There is a different picture with First Specialist Assessments (FSA) and elective services, where Maori and Pacific people have lower rates than the rest of the population. Over the past four years, the disparity for Maori and Pacific populations has decreased with Maori and Pacific populations experiencing the greatest increases in elective operations. Pacific people however continue to have a significantly lower rate of FSAs and elective admissions than the rest of the population. There has been an overall decrease in cardiac procedures as referrals have dropped due to less invasive procedures being carried out in cardiology. Maori and Pacific people also have lower rates of intervention for cardiac procedures, while the non-maori, non-pacific 2 Te Rau Hinengaro, The New Zealand Mental Health Survey 2006. 7

high deprivation (Quintile 4 and 5) population has the highest rate of intervention for cardiac procedures. The regional Cardiac Network has recognised this pattern of disparity and is working with the Eru Pomare Centre to identify the reasons and remedial actions. Conclusion Good progress in improving equity has been made in relation to smoking cessation, breast and cervical screening, diabetes and cardiovascular screening and management, immunisation, Before School Checks and mental health access rates and crisis prevention/resiliency plans. In some areas where equity has been improved, there are still significant disparities so the focus in these areas needs to continue. These include breastfeeding, oral health (especially for Pacific children), breast and cervical screening, diabetes and cardiovascular screening and management, mental health access rates for Pacific people of all ages and for Maori aged 0 to 19 years, elective admissions for Pacific people, and avoidable hospital admissions (especially for 0 to 4 year olds and people 55 years and over). The 2011/12 AP contains a number of key actions which relate to improving equity, including the areas identified above. The next Improving Equity report, which will be provided to CPHAC in October 2012, will report on performance in 2011/12 against these key actions. Elizabeth Lucie-Smith Planning and Funding Nicholette Pomana Planning and Funding Bridget Allan Director Planning, Funding and Public Health Attached: Appendix 1: Graphs and Tables 8

Appendix 1: Graphs and Tables Ambulatory Sensitive Hospital Admissions Ambulatory Sensitive Hospitalisations (ASH) provides a measure of admissions that might be prevented if appropriate health services are delivered in community settings. This includes access to effective primary health care. If there is good access to effective primary health care for all population groups, then it is reasonable to expect that there will be lower levels of ASH admissions. ASH rates can highlight service areas where a new focus could reduce the need for people to be hospitalised. ASH admission rate (per 1,000 population) to Hutt Hospital 2010/11 160 140 120 100 80 60 40 20-0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Maori Other Pacific Other Q5 ASH rates for all ethnic groups are highest in the very young and very old. Maori and Pacific people have higher rates throughout life than those of Other ethnic groups, with the disparities being greatest for children aged 0 to 4 years, and for people aged 55 years and over. Children aged 0 to 4 years of Other ethnic groups who live in a deprived area (Quntile 5) also have high ASH rates. The Ministry of Health prepares indirectly standardised ASH rates so that DHBs can compare their situation with that of other DHBs. The national rate is set at 100, and other rates are compared against that. For the 0 to 74 population within the Hutt Valley, the ASH rate continues to be high i.e. 20 to 30% higher than the national rate and has increased for Maori over the last two years (see the graph below). Over the last two years, ASH rates for 0 to 4 year old children appear to have decreased slightly for Pacific children but have increased for Maori children and for children of Other ethnic groups (driven by higher rates in deprived (Quintile 5) areas. Although there have been decreases in the ASH rates for people aged 45 to 64, these are not statistically significant. 9

Indirectly Standardised ASH Trends Hutt Valley DHB population groups YE Sep 09 YE Mar 10 YE Sep 10 YE Mar 11 180 160 ISDR ASH (National = 100) 140 120 100 80 60 40 20 0 Maori Pacific Other Maori Pacific Other Maori Pacific Other People 0-74 years Children 0-4years Adults 45-64 years Diabetes and Cardiovascular Disease Management Hutt Valley DHB number of Diabetes Annual Reviews (Get Checked) Maori Pacific Other 5000 4000 3000 2000 1000 0 2008/09 2009/10 2010/11 Other 2967 3247 3447 Pacific 467 486 480 Maori 445 500 534 Between 2009/10 and 2010/11, the number of diabetes annual reviews has increased by 7% for Maori and 5% overall, while the number of reviews for Pacific people has not increased. 10

% of Hutt Valley DHB diabetics checked with HbA1c of 8 or less 90% 2008/09 2009/10 2010/11 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Other Total The percentage of Maori and Other people with well managed diabetes has been relatively unchanged over the past to years, but there has been a considerable reduction in the percentage of Pacific people whose diabetes is well managed. Hutt Valley DHB people receiving a cardiovascular risk assessment in the last 5 years 90% 2008/09 2009/10 2010/11 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Other Total Over the past two years, the percentage of eligible people receiving a cardiovascular risk assessment has been estimated by analysing laboratory lipid testing data. On this basis, Hutt Valley has been doing reasonably well, although Maori and Pacific people are less likely (with rates just over 70%) whereas Other people have rates closer to 80%. Diabetes & CVD Health Target result 2010/11 Maori Pacific Total Diabetes free checks 62% 59% 75% Diabetes management 62% 55% 74% Cardiovascular disease (CVD) 71% 71% 77% Final reported value 65% 62% 75% 11

Asthma admissions 7.00 6.00 5.00 4.00 3.00 2.00 1.00 - Hutt Valley Residents admitted for Asthma at Hutt Hospital per 1,000 population Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 Number of Admissions 70 60 50 40 30 20 10 0 Hutt residents aged 0-4 years admitted for Asthma at Hutt Hospital Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 2009/2010 2010/2011 2009/2010 2010/2011 Asthma continues to be one of the top three causes of ambulatory sensitive hospitalisations in 2010/11. For combined ages, asthma hospital admissions for Maori and Pacific have increased over the last two years while remaining similar for Other populations. For children aged 0 to 4 years, a similar increase in asthma admissions was seen for both Maori and Pacific children but there was also an increase for Other children in deprived (Quntile 5) areas. Better help for smokers to quit (hospital) The 2006 Census show that 22.9% of Hutt Valley residents aged 15 years and over were regular smokers, slightly higher than the national average of 20.7%. Hutt Valley males had a slightly higher smoking prevalence to females (23.4% compared to 22.5%) and Māori and Pacific smoking rates were significantly higher than other ethnic groups, at 44.1% and 32.5% respectively. The highest rates of smoking in the Hutt Valley were among Māori females (49.0%). 91% of hospitalised smokers were provided with advice and help to quit in 2010/11. This exceeded the National Health Target of 90%. There is little difference between population groups with all ethnicities being provided with similar levels of advice and assistance. 100% % of Hospitalised smokers offered advice to quit % of smokers admitted to hospital 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Other 2008/2009 2009/2010 2010/2011 12

Breast Screening Breast screening coverage rates continue to increase for all women and for Maori and Pacific women in particular. Pacific women had a 4% increase in breast screening over the last year and a 39% increase over the past 6 years. This compares with a 2% increase of the rest of the population in the last year and a 25% increase over the last 6 years. Maori women have increased rates of breast screening with a 2% increase over the last year and a 31% increase over the last 6 years. 80% Breast Screening 24 month coverage for Hutt Valley DHB women aged 45-69 70% 60% 50% 40% 30% 20% 10% 0% 2005 2006 2007 2008 2009 2010 2011 Maori Pacific Total Target Cervical Screening There was an increase of 2% in cervical screening rates for Pacific women between January 2010 and December 2010 compared with an increase for all population groups of 1.7% in that same period. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Cervical screening: Percentage of HVDHB eligible women screened age 20-69 Maori Pacific Asian Total Ethnicity Sep-08 Jan-10 Dec-10 13

Birth Rates The Hutt Valley birth rate has dropped in 2010/11 after an increasing trend in the last four years as demonstrated in the table below. births per 1,000 population 22 20 18 16 14 12 10 8 6 4 2 - Births in Hutt Valley per 1,000 population by ethnicity 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 Maori Pacific Other The overall teenage birth rate has dropped slightly to 6% of all Hutt Valley births each year. Maori births for teenage mothers remain higher than for other groups. 25% Percentage of Births to Teenage mothers in Hutt Valley by ethnicity % of total mothers giving birth 20% 15% 10% 5% Maori Pacific Other Total 0% 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 14

Breast Feeding (Plunket data only) The table below contains nationally collected Plunket data only. In 2010, Hutt Valley breastfeeding rates remained below the national averages and Ministry set target at 59% (6 weeks), 47% (3 months), and 19% (6 months). The rates for babies enrolled with Plunket exclusively or fully breastfed at 6 weeks have remained relatively stable at 59% against a national rate of 69% (national target is 74%). Rates for Maori have risen significantly (from 46% to 57%) and for Pacific (from 47% to 51%) 4%. Rates for Other ethnicity have decreased slightly. Rates at 3 months have gone down for Pacific and Other but increased slightly for Maori. The rate of breastfeeding at 6 months has remained relatively steady and shown no real improvement. % of Hutt Valley DHB Breastfeeding Rates 70% 60% 50% 40% 30% 20% 10% 0% 2008 2009 2010 Maori Pacific Other All ethnicities Maori Pacific Other All ethnicities Maori Pacific Other All ethnicities Breast feeding Rates for 6 weeks Breast feeding Rates for 3 Months Breast feeding Rates for 6 Months 6 weeks Actual 2008 % Actual 2009 % Actual 2010 % Target 2010/11 % Breastfed at 6 weeks: 46 46 57 74 Maori Breastfed at 6 weeks: 47 47 51 74 Pacific Breastfed at 6 weeks: 61 64 61 74 Other Breastfed at 6 weeks: Total 56 58 59 74 15

3 months Actual 2008 % Actual 2009 % Actual 2010 % Target 2010/11 % Breastfed at 3 months: 35 36 38 57 Māori Breastfed at 3 months: 45 43 38 57 Pacific Breastfed at 3 months: 52 55 51 57 Other Breastfed at 3 month: Total 48 49 47 57 6 months Breastfed at 6 months: Māori Breastfed at 6 month: Pacific Breastfed at 6 months: Other Breastfed at 6 months: Total Actual 2008 % Actual 2009 % Actual 2010 % Target 2010/11 % 14 11 10 27 12 16 13 27 21 21 22 27 19 18 19 27 16

Immunisation Progress towards the national target of 95% of two year olds fully immunised is shown below. Coverage increased in 2010/11 over all ethnic groups and coverage of Pacific children reached the national target. Coverage reached 90% or higher in all deprivation quintiles. 100% 2 year olds fully immunised by ethnicity 90% 80% % of total population 70% 60% 50% 40% 30% 20% 10% 0% NZ European Maori Pacific Asian Other 2008/09 2009/10 2010/11 Target 10/11 The Ministry of Health recently acknowledged our success in reaching Maori and Pacific families of preschool children. The Ministry feedback for quarter 4 was that Hutt Valley DHB is an outstanding performer; of particular importance is the DHB s reduction in ethnic disparity. 100% 2 year olds fully immunised by deprivation 90% 80% % of total population 70% 60% 50% 40% 30% 20% 10% 0% Q1 Q2 Q3 Q4 Q5 2008/09 2009/10 2010/11 17

Human Papilloma Virus immunisation The Hutt Valley overall rates are similar to the national rates at al ages. For all ages, the rates for Pacific girls have met or exceeded the targets. The rates for Maori girls are below target. It should be noted that nurses are reporting that some parents of 12 and 13 year old girls consider them to be too young to commence the HPV, despite the evidence supporting earlier commencement of the vaccine for greater benefit. HPV vaccination coverage Girls Aged 13 years at Dec 2010 HPV vaccination coverage Girls Aged 14-18 years at Dec 2010 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Total 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Total Hutt NZ Target Hutt NZ Target HPV vaccination coverage Girls Aged 14-18 years at Dec 2010 80% 70% 60% 50% 40% 30% 20% 10% 0% Maori Pacific Total Hutt NZ Target 18

Before School Checks 1400 B4 School Checks: Children seen by ethnicity 1200 1000 Children seen 800 600 400 200 0 Maori Pacific Other 2009/10 2010/11 The number of Maori and Pacific children receiving a B4 school check increased in 2010/11. Checks for children living in highly deprived areas have also increased from 311 to 414 children, which is 80% of estimated eligible children in this group. 2009-10 2010-11 2010-11 Target Children seen 1,383 1,713 1,685 Quintile 5 Children seen 311 414 413 Oral Health It is important for children to engage early with oral health services, so that their caregivers are well informed about good oral health practices and any problems can be addressed in a timely way. The number of preschool children enrolled with the oral health service increased from 29% to 40% in 2010. There was a significant improvement in the percentage of children receiving their oral health check ups on time between 2007 and 2008, but progress has slowed since then. There was a slight improvement in 2010, with only 12% of children in arrears. 19

Exame Arrears 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2007 2008 2009 2010 Actual 2010 Target There are two outcome statistics for oral health: Caries free, where a higher score indicates a better result; Decayed/missing/filled teeth (DMFT), where a lower score indicates a better result. Looking first at the caries free data, Other children have better oral health at age 5 years than Maori or Pacific children, although there has been a is a significant improvement in the number of Maori children that are caries free at age 5 in 2010. The oral health of Pacific preschool children is poorer, as shown by the lower caries free score. Children Caries free at age 5 80% 70% 60% 50% 40% 30% 20% 10% 0% 2004 2005 2006 2007 2008 2009 2010 Maori Pacific Other The same picture is evident in the DMFT data for 5 year olds and Year 8 students (12 years), with Pacific children having high and increasing rates. This result for Pacific children is thought to result from improved screening picking up the poor oral health of Pacific children who were not previously screened (and therefore not included in the DMFT statistics). 20

4.0 Oral Health - Mean DMFT Score at Age 5 3.5 3.0 DMFT score 2.5 2.0 1.5 1.0 0.5 0.0 2008 2009 2010 calendar year Maori Pacific Other Mean DMFT Score at year 8 2.00 1.80 1.60 1.40 1.20 1.00 0.80 0.60 0.40 0.20-2004 2005 2006 2007 2008 2009 2010 Maori Pacific Other 21

Mental Health PP6 Percentage of population accessing Mental Health services 0-19 yrs 20-64 yrs 65 + yrs People seen in MH services as % of population 6% 5% 4% 3% 2% 1% 0% Sep-08 Mar-09 Sep-09 Mar-10 Sep-10 Mar-11 Year ending The prevalence of mental illness and addiction in Maori and Pacific populations is higher than in the general population 3 and this is reflected in Hutt Valley DHB with Maori access rates to services (4.35%) being higher than the general population (3.1%). Pacific people however still have the lowest access rates to specialist services (2.1%) in spite of the high prevalence. 4.5% People accessing Mental Health services by ethnicity 4.0% 3.5% % of total population 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 2008/09 2009/10 2010/11 Total Māori Clients Total Pacific Clients Total Other Clients 3 Te Rau Hinengaro, The New Zealand Mental Health Survey 2006. 22

The overall access rate for 0 to 19 year olds has been achieved. However, Maori and Pacific child and youth access rates need to be improved. PP6 Percentage of 0 19 years population accessing Mental Health services Maori Pacific Other Total Overall Target for age group 6% People seen in MH services as % of population 5% 4% 3% 2% 1% 0% Sep-08 Mar-09 Sep-09 Mar-10 Sep-10 Mar-11 Year ending The target for the percentage of long term mental health service users having crisis prevention/resiliency plans is 95%. The DHB has moved from a 2009/10 result of 65% to a 2010/11 result of 92%. Even more significant is the improvement for Maori and Pacific clients, moving from 26% to 90%, and 38% to 99%, respectively. PP7 % of long term MH clients with an up to date crisis prevention/resiliency plan Total % of long term MH clients (more than 2 years) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2008/09 Q4 2009/10 Q4 2010/11 Q4 Total 55% 92% Maori 26% 90% Pacific 38% 99% reporting period 23

Hospital Services Consistent with the burden of disease, Maori and Pacific people, and Other high deprivation populations (Quintile 4 and 5) have higher rates of ED attendances, inpatient discharges and surgical admissions. Rate of Emergency Department attendances The rate of ED attendances per 1,000 population has increased slightly for each of the last four years. Maori, Pacific and Other higher deprivation populations have higher rates of emergency department attendances than the Other low deprivation (Quintile 1, 2 and 3) population. This has remained relatively constant over the past four years. The ED attendance rates for Maori and Pacific have been increasing over the past four years. Rate of ED Attendances per 1,000 Population 450 400 350 300 250 200 150 100 50 - Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 Total 2007-08 2008-09 2009-10 2010-11 Inpatient discharges Consistent with the burden of disease, the Hutt Hospital discharge rate per 1,000 population is highest for Maori and Pacific people, and for Other high deprivation populations. 160 140 120 100 80 60 40 20 Hutt Hospital Inpatient Discharge per 1,000 Population 0 Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 2008-09 2009-10 2010-11 24

Surgery admission rates Surgery admission rates are higher for Maori and Pacific people, and for Other high deprivation populations than for the rest of the population. These have remained at a reasonably consistent level over the past 3 years. 160 Surgery Admission Rates per 1,000 Pop 140 120 100 80 60 40 20 0 Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 Total Pop Financial Year 2008-09 2009-10 2010-11 There is a different picture with First Specialist Assessments, elective services and cardiac procedures, where Maori and Pacific people have lower rates. First Specialist Assessments Both Maori and Pacific people have lower rates of first specialist assessments, but this is more marked for Pacific people. 1st Specialist Assessments per 1,000 population 140 120 100 80 60 40 20 - Maori Pacific Other Total Ethnicity 2007/2008 2008/2009 2009/2010 2010/2011 Elective services The non-maori, non-pacific high deprivation (Quintile 4 and 5) population has the highest rate of elective interventions per 1,000 population. However, over the past four years the disparity with the Maori and Pacific population has decreased with Maori and Pacific populations experiencing the greatest increases in electives. This shows better access to 25

planned care for these at risk populations. Pacific people however continue to have a significantly lower rate of elective admissions than the rest of the population. 60 Hutt Valley Resident Elective admissions per 1,000 Population - At Hutt, Wellington and Kenepuru Hospitals 50 40 30 20 10 - Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 Total Ethnicity 2007-08 2008-09 2009-10 2010-11 Cardiac procedures The non-maori, non-pacific high deprivation (Quintile 4 and 5) population has the highest rate of intervention for cardiac procedures. There has been an overall decrease in these procedures as referrals have dropped due to less invasive procedures being carried out in cardiology. Cardiac procedures per 1,000 population 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 - Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 Total Ethnicity 2007-08 2008-09 2009-10 2010-11 26

Stroke There has been little change in the rate of hospitalisation for stroke in the past two years. The small numbers involved make it difficult to draw conclusions about the overall rate of stroke in the community, with 17 Maori and 9 Pacific people admitted for strokes in 2010/11. 10.0 Rate of Stroke per 10,000 Population 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Maori Pacific Other Quintile 4 & 5 Other Quintile 1-3 2009/2010 2010/2011 27

The population health strategy for the Wellington region Keeping Well Annual Report 2010/2011

Keeping Well Annual Report 2010/11 Introduction Keeping Well is the overarching population health strategy for the greater Wellington region; Capital & Coast, Hutt Valley and Wairarapa District Health Boards. The strategy was developed in 2008 after widespread consultation and includes the views of over 150 stakeholders. The aim of the strategy is to lift population health by improving the performance of the population health sector. The sector includes agencies and organisation that have a stake in improving health outcomes for the region s population including; Ministry of Health, Capital & Coast DHB, Hutt Valley DHB, Wairarapa DHB, Regional Public Health (RPH), Maori Providers, Whanau Ora providers, Pacific providers, Primary Health Organisations, Non Government Organisations, Local Authorities and Central Government agencies. The strategy proposes a way for the population health sector to work together to provide collaborative leadership, planning and action. This will be achieved through: improving leadership and communication improving effectiveness and efficiency by avoiding duplication and applying what works focusing on Maori, Pacific peoples and high needs communities and reorienting resource to priority areas applying a whanau ora approach sharing learning opportunities and best practice Oversight of the implementation of Keeping Well is provided by the Wellington Region Public Health Steering Group and members include: General Managers, Funding and Planning from each DHB Population Health Portfolio Managers from each DHB representatives of the Public Health Group, Ministry of Health a nominee of DHB Maori GMs a nominee of DHB Pacific Advisors RPH Service Manager a Medical Officer of Health In July 2010, RPH was handed the contract to facilitate the implementation of the strategy. Two dedicated staff took up appointments in September 2010, and other appointments were made in January and July 2011 to fill the 3 FTE resource. RPH revised a draft Implementation Plan based on the Stage 1 Evaluation recommendation and proposed some new directions. This included focusing on children and young people as a population group in recognition of the poor health G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 1

Keeping Well Annual Report 2010/11 and wellbeing status that children have in New Zealand. Another approach was to actively support projects that would provide examples of the strategy in action. The 2010/11 Implementation Plan was based on enablers that would drive action and create a supportive infrastructure to improve the performance of the population health sector. This report describes progress against these enablers. Enabler 1: Improved Leadership and Communication Regional Public Health An RPH multidisciplinary Advisory Group was established to support implementation within the service, alongside a Champions Group with expertise in the following eight action areas: 1. Equal opportunity to good health 2. Smoke free living 3. Mental wellbeing 4. Healthy Eating Healthy Action 5. Lives free from harm due to drugs and alcohol 6. Control of infectious diseases 7. Living conditions that nurture human health 8. Families enjoying violence free lives An action planning tool was also developed for RPH staff to enhance alignment between their action plans and Keeping Well priorities. Hutt Valley DHB Keeping Well enabled Hutt Valley DHB to strengthen its population health based programmes and relationships with sub-regional neighbours and public health providers. Through strategic regional meetings, discussions, planning and exemplar projects a more collective approach is evident. The focus on child and youth health includes addressing skin conditions, respiratory conditions and rheumatic fever which feature as priorities within both the HVDHB Annual Plan 2011-12 and the Maori Health Action Plan. As we look forward Keeping Well will guide and steer HVDHB across other specific areas of Intersectoral work programmes and initiatives, in particular two localised initiatives which are influenced by national strategy and policy: G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 2

Keeping Well Annual Report 2010/11 Positive Pomare the impact of state housing, with a focus on inequalities, local leadership, building of local capability and knowledge within a community of high need and vulnerability Whanau Ora implementing the learning and outcomes frameworks, sharing of information and knowledge to enhance and support local approaches Redefining population programme planning and sustainability with the phased withdrawal of national funding to programmes such as HEHA Population Health Network A population health network was established to promote communication and provide a centralised point of contact for the sector. The network was used to disseminate newsletters and advise of shared training opportunities. A webpage has also been established to host shared resources and updates on activity. An engagement strategy led to face-to-face meetings with DHB portfolio managers, PHOs, Maori providers, Pacific providers, Whanau Ora providers and Maori Advisory groups. Enabler 2: Focus on inequalities and high needs areas In consultation with the three DHBs, Keeping Well identified projects with a child health focus to initiate or support: Capital & Coast DHB rheumatic fever, skin infection and respiratory conditions with particular support of the Porirua Kids Project Hutt Valley DHB - skin infection, respiratory conditions and rheumatic fever with a focus on high needs areas Wairarapa DHB skin infection with a focus on school and early childhood settings Capital and Coast DHB - Porirua Kids Project Keeping Well has provided the following support to this project: assisting with the communications plan coordinating community communications with Compass Health and Regional Public Health writing press releases and providing peer review for articles in local papers (Dominion Post, Kapi Mana, Northern Courier, Petone Herald) sourcing relevant resources and peer review of new resources arranging resource packs for PHOs, pharmacies, community clinics, schools G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 3

Keeping Well Annual Report 2010/11 The communications approach has resulted in media interest which has led to greater awareness of rheumatic fever in the local community as illustrated below: A mother reported that she took her son to Ora Toa Takapuwahia with a sore throat and fever. He was swabbed (which came back positive), and prescribed a 10 day course of antibiotics. As soon as he finished the medication he relapsed and was given penicillin intramuscularly. There was a dramatic improvement in his health within two hours. Second throat swabs come back positive and this was followed up with a third swab. At this stage, the mother requested her three other children be swabbed. The 15 month old came back with a positive swab and was put on a 10 day course of antibiotics. The mother says she was proactive because of the increased community awareness of rheumatic fever. Hutt Valley DHB - Primary Nurses Skin Project Keeping Well is supporting the Reducing the Burden of Skin Infections in the community project in the Hutt Valley. The aim of this primary nurse innovation is to improve skin infection management by educating health providers, patients and families. This is expected to have a positive impact on Ambulatory Sensitive Hospitalisations at Hutt Valley DHB. The project is linked with the regional skin initiative and we are providing support for aspects of the evaluation. Hutt Valley DHB - Positive Pomare Keeping Well is involved in the Positive Pomare Project with a initial focus on supporting the community as it deals with the impact of relocation and redevelopment. Wairarapa - Skin Project Keeping Well is supporting the Wairarapa Healthy Skin Project which is being lead by the Population Health Unit, under Tihei Wairarapa. A pilot project is being developed as an active learning experience to inform the larger project. Three or more whanau from across Wairarapa, identified as having multiple recurrent skin infections, will be invited to take part. This pilot will assist with defining the role of a key worker; a review of referral pathways, and intersectoral collaboration to identify and address social determinants where possible. Workforce development for all health providers will then commence in October. G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 4

Keeping Well Annual Report 2010/11 Regional Approach to Reducing Skin Infection The local exemplar projects are also linked together under the regional Healthy Skin in Greater Wellington initiative facilitated by Keeping Well. A hui bringing together people in the health sector known to be interested in reducing serious skin infection was held in May 2011. The group developed an agreed outcomes framework which included ten action areas. The group meets again in July 2011 to progress these action areas. A feature of this project is the way population health, community, primary, secondary and tertiary services have combined to create a whole of system approach. This approach will provide a way of working that can be used for other high priority child health issues (e.g. respiratory conditions and rheumatic fever). The project is also connected with the Sub-regional Child Health work stream of the Clinical Leadership Group. Evaluation Keeping Well is assisting with the design and scoping of an evaluation of three Aukati Kaipaipa (smoking cessation for Maori) providers in the sub-region. Enabler 3: Improved Funding and Performance Environment Logic models and indicators for the eight Keeping Well action areas have been finalised and data sources identified for tracking progress. Logic models are also being used to facilitate joined up activity such as the Healthy Skin in Greater Wellington initiative. The Wellington Region Public Health Steering Group is investigating how Services to Improve Access and Health Promotion funding by PHOs could be oriented toward agreed population health priorities such as skin infection, rheumatic fever and respiratory conditions. The steering group is also working toward greater collaboration between DHB population health contracted areas such as Smoking Cessation, Healthy Eating Healthy Action, Family Violence Co-ordination and Suicide Prevention. Keeping Well facilitated a Population Health Strategy planning workshop with Wairararapa DHB and Population Health Unit that identified population health priorities for the next two years to be addressed with an integrated approach. G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 5

Keeping Well Annual Report 2010/11 Enabler 4: Build Knowledge and Capability Keeping Well is facilitating a shared learning approach within the population health sector. RPH is modelling this concept by opening up its training and development opportunities to the wider sector. Shared training also provides opportunity for conversations and relationship development that can lead to collaboration. The newly established population health network has been used to promote and facilitate shared training and development opportunities including: Programme Planning and Evaluation Workshops Two workshops delivered by SHORE Whariki had a mix of RPH staff and participants from Smokefree Coalition, Heart Foundation, Wairarapa Public Health Unit, Regional Screening Services, Pacific church provider, Compass Health, Porirua City Council, Maraeroa Marae Health Clinic, Capital & Coast DHB, WellHealth PHO and Hutt Valley DHB. As a result of the shared Programme Planning & Evaluation workshops, RPH and Compass Health staff have worked to improve collaboration in Porirua. RPH Public Health Advisor Skills Enhancement (PHASE) Seminars Non-RPH participants have provided positive feedback on attending the following seminars: Advocacy in Public Health Porirua Kids Project Media training Public Health Leadership Programme Four places on the Public Health Leadership Programme have been sponsored by Keeping Well. Three participants are from local PHOs and one from Wairarapa Public Health Unit. Outcome Logics and DoView Training Keeping Well is working with Paul Duignan to adapt and provide a training package that makes DoView software accessible to providers in the region. DoView is a visual tool that clearly communicates project outcomes and goals and is used for developing agreed outcomes frameworks. G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 6

Keeping Well Annual Report 2010/11 Healthy Public Policy Keeping Well sponsored participants from Wairarapa DHB, Compass Health, Kowhai Health and the Heart Foundation to attend an introductory course on Local Government delivered by the New Zealand Society of Local Government Managers. Keeping Well is also supporting RPH in developing Healthy Public Policy training which will be open to the wider sector. Workforce Development Baseline Survey Keeping Well has supported an RPH Workforce Baseline Survey with a view to conducting a survey with the population health sector. Support has been offered to Wairarapa Public Health in developing a base line survey for their needs. Cultural Competency Training The RPH Workforce Baseline Survey highlighted the need for more culturally appropriate training for working with Maori and Pacific populations. Keeping Well is supporting RPH in developing cultural competency training which will be available to the wider sector. Whanau Ora Tool Training Keeping Well facilited the sharing of the RPH Whanau Ora Tool training to the Wairarapa DHB. G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 7

Keeping Well Annual Report 2010/11 G:\RPHIntegratedActionProjects\KeepingWell\PhaseIII&IV\WRPHSG\Reporting\AnnualReport2010-11Final.doc 8

Public Section Public Health Update Action: For Noting From Peter Gush, Service Manager Dr Annette Nesdale, Clinical Head of Department Date 21 November 2011 Subject Regional Public Health Recommendation That CPHAC note the contents of this public health update. Introduction In April 2011 we provided CPHAC with an overview of Regional Public Health s (RPH) work in the fields of protection and prevention with examples of what was working well regionally in both the Capital and Coast DHB (C&CDHB) and Hutt Valley DHB (HVDHB) specific populations. Remembering that RPH s priority areas for 2011/12 are: (i) Working with Maori (ii) Child Health (iii) Engagement with primary care In this report we will be providing you with an outline on population health and the work that is currently underway in RPH along with some achievements to date. This report includes: 1. Keeping Well 2008-12, Wellington Region Strategic Plan for Population Health 2. Recent update on submissions 3. Alcohol Harm Reduction discussion 4. Communicable Disease for the sub-region update We would be keen to explore with CPHAC during our discussions what your expectations are of an effective public health unit such as RPH. 1. Keeping Well 2008-2012 (Wellington Region Strategic Plan for Population Health) Keeping Well is the overarching population health strategy for the greater Wellington region; Capital & Coast, Hutt Valley and Wairarapa District Health Boards. The aim of the strategy is to lift population health by improving the performance of the population health sector. The sector includes agencies and organisation that have a stake in improving health outcomes for the region s population including; Ministry of Health, Capital & Coast DHB, Hutt Valley DHB, Wairarapa DHB, Regional Public Health (RPH), Maori Providers, Whanau Ora providers, Pacific providers, Primary Health Organisations, Non Government Organisations, Local Authorities and Central Government agencies. In July 2010, RPH was handed the contract to facilitate the implementation of the strategy. Two dedicated staff took up appointments in September 2010, and other appointments were made in January and July 2011 to fill the 3 FTE resource. RPH revised a draft Implementation Plan based on the Stage 1 Evaluation recommendation and proposed some new directions. This included focusing on children and young people as a population group in recognition of the poor health and 1

wellbeing status that children have in New Zealand. Another approach was to actively support projects that would provide examples of the strategy in action. The 2010/11 Implementation Plan was based on enablers that would drive action and create a supportive infrastructure to improve the performance of the population health sector. The Keeping Well Annual Report 2010/11 describes progress against these enablers (see separate paper). To date in 2011/12, the Keeping Well team has been involved in a range of projects across the three DHBs. A major focus has been on subregional work to prevent and manage skin infections (see below). Other highlights include providing communications support to the Porirua Kids Project; supporting the Positive Pomare Group and facilitating the preparation of the Housing Displacement and Health information paper; supporting a joint HVDHB and C&CDHB funding application to the Ministry of Health s Pacific Grant Fund for the purposes of developing a Pacific cultural awareness training package for mainstream health services; and supporting population health sector participation in the Maori Affairs Select Committee Inquiry into the Determinants of Wellbeing for Maori Children and Honorable Paula Bennett s Green Paper for Vulnerable Children submission processes. Healthy Skin in Greater Wellington In May 2011, Keeping Well facilitated an inter-disciplinary meeting of people in the health sector known to be interested in reducing serious skin infection for children. Further meetings followed in July and September. The group has developed an agreed Healthy Skin in Greater Wellington roadmap (outcomes framework) which includes ten action areas (see Appendix 1, page 16). The aim of the initiative is to facilitate a whole of system approach. The multi-disciplinary group has representation from Capital and Coast, Hutt Valley and Wairarapa DHBs and includes participation from population health, primary, secondary and tertiary services (see Appendix 2, page 17 for projects linked to the initiative). A Working Group has been established to progress the Common Messages, Guidelines and Protocols action area. The group is led by Adrian Gilliland (GP Liaison, C&CDHB) and Theresa Fowler (Primary Health Nurse Consultant, HVDHB) with support from Mary Strang (Public Health Advisor, RPH). The group has developed a Healthy Skin Tool for use by health professionals and allied workers (see Appendix 3, page 18). This is a guide for health professionals and allied health workers to ensure consistent messages are given about the prevention and management of skin infections in children. It can also be used as an education tool with clients. The tool will be trialed for six months with the opportunity for users to provide feedback and suggestions for improvement. It will be distributed with an accompanying letter to explain its use. It will also be copied on to card so that it can be put on the wall, and be reusable. A poster and pamphlet are currently being developed to support the tool and will be more appropriate for clients to take away. A launch of the poster and pamphlet is being planned for the second week of December. The group is also developing a Protocol for the Management of Skin Infections in Children in the Primary Care Setting. While Keeping Well has a focus on child health, these resources are applicable and can be adapted for any group. Ultimately, the initiative aims to reduce Ambulatory Sensitive Hospitalisation rates by empowering whanau to manage their health in their home through a whole of system approach that could be used for other high priority health issues such as respiratory conditions and rheumatic fever. 2. Healthy Public Policy Submissions RPH has made an initial submission to the Maori Affairs Select Committee Inquiry into the Determinants of Wellbeing for Maori Children. A further opportunity to submit is due when the post election committee resumes on 28 November and RPH has arranged meetings for C&CDHB, HVDHB and WDHBs to support the development of submissions. RPH is also linking with DHBs in preparing submissions on the Honorable Paula Bennett s Green Paper for Vulnerable Children. RPH will share its first draft including key messages and a submission template in early December. Submissions are due by 28 February 2012. 2

3. Alcohol Harm Reduction RPH reported to CPHAC in April 2011 on our multi-faceted approach to reducing alcohol related harm. In the earlier report we outlined the major strategies RPH uses in this area: supply control, demand reduction, problem limitation. In this current report, RPH seeks to: Briefly outline how the liquor licensing process works Outline ways in which CPHAC members can contribute to reducing alcohol related harm in their communities Inform CPHAC members about the impact of recent changes to alcohol legislation Provide an update on local activity Liquor Licensing Process Under the current Sale of Liquor Act 1989, all premises wishing to sell alcohol must first apply for a Liquor Licence. Applications are made to the District Licensing Authority (DLA) for one of four types of licence; on licence, off licence, club licence or special licence, depending on premise type and sales conditions. The DLA will then forward on licence and club licence applications to the Police and RPH to investigate. The Medical Officer of Health has 15 working days after receipt of this application to report back to the DLA and Police. For the majority of premises, a face-to-face meeting is arranged with the applicant to assess their capability to provide appropriate host responsibility as well as observe the premises and environment to ensure both the applicant and premises will comply with all aspects of the Sale of Liquor Act. A report either opposing or not opposing the licence is then forwarded to the DLA and the Police. If no opposition is received from public health, police or the community within 20 working days the DLA may assume there are no matters of concern and grant the licence. Newly granted licences have a one year probationary period followed by three year renewals. The Medical Officer of Health may object on grounds of host responsibility, statutory breaches of the Act, (e.g. suitability of the applicant to operate a licensed premise, sales to a person under the purchase age, supply of liquor to intoxicated persons, not providing adequate food/non-alcoholic beverages) and matters of notable public health concern related to the object of the Act. All opposed licenses are referred to the Liquor Licensing Authority for a decision. Opportunities for Involvement in the Reduction of Alcohol Related Harm For those interested in following licensing applications, these are advertised in the public notices section of local papers. As individuals and as agencies, you have an opportunity to object if you have an interest greater than that of the public generally. For example, if you live close to the premise, or your business is in close proximity and will be affected by its presence. For your objection to be seriously considered, speaking at the hearing is strongly recommended following the written objection. Alcohol reform can additionally be supported by individuals and agencies participating in submissions at local and national level. RPH is regularly involved with such work and is happy to inform those interested of such opportunities and to share our evidence and knowledge to assist others in the process. There is much knowledge and information held by others that they may wish to share with RPH or put forward themselves that would assist in this work. For example, the impact of alcohol on emergency departments, hospital admissions, primary care consultations, family violence and traffic incidents. 3

Supporting Local Alcohol Policies In preparation for the advent of local alcohol policies and enquiry into all licensed premises, RPH completed a study focusing on the business practices of off-licensed premises in Porirua City 1. Some findings have been tabled here which may help CPHAC members to be involved in reducing alcohol related harm in their communities. Bottle stores tend to cluster in residential areas of high deprivation Premises are less visibly attractive and cluttered in poorer locales In such areas price variance from (low to high) is small and focuses on selling at low prices Cheap single bottle sales of products that attract youth are common Advertising is far more visible in areas of low deprivation and specials are often bulk packaged products with no visible limits on quantity Advertising and marketing strategies are more varied in bottle stores as compared to other store types. This sits alongside national survey data on alcohol use in New Zealand which states that deprived communities exhibit polar behaviour i.e. have the highest numbers of those that drink heavily and those who drink the least 2. RPH is concerned that such business practices would seem to exploit the addictive properties of alcohol and those most vulnerable in the community. These deprived areas are also those with the least access to healthy food 3. In such environments health outcomes are cumulative. Through the adoption of local alcohol policies and through supporting community action, RPH and our partner organisations can foster cultural and legislative reform to support individuals, whanau and communities, particularly those most vulnerable. Legislative Changes The Alcohol Reform Bill 236-2 (2010) has been examined by the Justice and Electoral Select Committee and their report was released on 25 August 2011. The Committee recommended the bill be passed with minor amendments. Subsequently, the bill has passed its second reading in Parliament and is awaiting its third and final reading before becoming law. This final reading is scheduled for after the election. A copy of the bill with amendments is available on www.legislation.govt.nz. For a summary of the proposed changes to the law and their potential impact on the work of RPH please refer to the attached table titled Key Outcomes from the Alcohol Reform Bill, Justice and Electoral Select Committee Report (Appendix 4). Local Activity Update In the July to September 2011 period, RPH worked with communities in relation to the licensing process for two high profile off-license applications. Porirua City The first was an off-license renewal in Porirua East. RPH has provided significant assistance advising on the Sale of Liquor Act and objection process thus ensuring community agencies and residents were fully informed and able to participate. The DLA received 88 objections to the license renewal and/or operating hours of the premises. This represents an extremely high number of objectors, thought to be the highest recorded for a premise objection in the country. A Liquor Licensing Authority hearing has been set for 30 November to determine the outcome. A large percentage of the objectors are expected to attend this hearing and RPH continues to play a role in supporting those community members needing assistance to understand the hearing requirements. RPH is also working closely with Police 1 2011 Boston A, Stallard L 2011 Retail Study Porirua City on G:\PHCDG\Workbench\AlcoholAndOtherDrugs\RetailStudy 2 Ministry of Health 2009 Alcohol Use in New Zealand: key results of the 2007 2008 New Zealand Alcohol and Drug Use Survey 3 Woodham C, 2009 Food Desert of Food Swamp: An in-depth exploration of neighbourhood food environments in Eastern Porirua and Whitby. 4

supporting their objection to the renewal/and operational hours of the premise and is intending to present at the hearing. Hutt City Community Development staff at Hutt Council informed RPH of a new off-license bottle store application in Hutt City. Police and the DLA held concerns for the application due to the suitability of the site but had no further issues. RPH was able to inform both agencies of the poor history of the applicant who had repeat sales to a person under the purchase age. The Medical Officer of Health has lodged a formal objection to the application. Police have since advised us of their support. Wellington City Liquor licensing questions have been raised regarding two proposed supermarkets in Newtown and Mt Cook suburbs. It is likely that the proposed supermarkets will apply for off licenses once the supermarkets have received resource consent and construction is underway. Once the applications have been received, there will be opportunity to have input to the applications. 4. Communicable Diseases For The Sub-Region Meningococcal Year to date RPH has received 11 notifications of meningococcal disease for the HVDHB and C&CDHB health districts (12 cases were notified for the same period 2010). Table 1 shows demographics of these cases. Of the 11 notifications six were notified in September 2011, including a sudden death. Of these six notifications two were group C, three were group B and one was unable to be typed. Local epidemiology confirmed that there was not a region wide outbreak of group C meningococcal disease with the same serotype. A rise in meningococcal notifications in late winter, early spring following a lot of respiratory illness in the community is not uncommon. RPH invited close contacts of the September / October group C meningococcal cases to a vaccination clinic to receive vaccination for group C meningococcal. A total of 39 contacts were vaccinated. Table 1 Demographics of meningococcal cases from 1 st January to 8 th November 2011 C&CDHB HVDHB Number of 7 4 cases Age range Under 4 years 3 17-25 years - 4 Under 4 years 3 17-25 years - 1 Ethnicity European 4 Pacific 3 Maori - 0 European 1 Pacific 1 Maori - 2 Sero Group Group C 3 Group B 3 Grouping unknown -1 Group C 1 Group B - 3 Measles Year to date RPH has received eight confirmed cases of measles. Six of these were notified between 28 September and 8 November. In comparison, there were only two confirmed cases of measles notified in 2010. In excess of 250 contacts have been traced, their immunisation status determined and advised in accordance to their measles immunity. Region wide alerts have gone to all food premises, in light of the three cases in food premises staff and the high potential for measles to be spread in this setting. Information has been sent to all the Early Childhood Centres (ECC) and schools and to staff and students in tertiary facilities and staff who work at long term care facilities. Information 5

includes advice that children without measles protection will be required to be away from school/ ECC for 14 days if there is a confirmed measles case in the facility. A teleconference with the DHB Maori and Pacific advisors is scheduled for later this month. RPH facilitated a measles response and contingency planning meeting with HVDHB and C&CDHB with good representation from relevant services. A region wide decision has been made advising primary care to bring forward the 15 month immunisations to 12 months and increase opportunistic immunisation for all ages up to 42 years. Weekly Public Health Alerts have been going to Primary Care Centres, After-hours Centres, Wellington Free Ambulance staff, Pharmacists, Emergency Department and Hospital staff in the greater Wellington and Wairarapa regions, informing them of the current measles situation in the region. This information has been posted on the RPH website for quick reference by GPs and the general public. RPH has worked with C&CDHB on a series of posters promoting measles immunisation. Copies of these posters will be distributed to primary and secondary care and Maori and Pacific providers within the greater Wellington region in second week of November. Strong media interest was useful in raising community and health professional awareness about immunisation. Key messages focused on advising adults up to 42 years old to get a free MMR as they may not have measles protection. Table 2 Demographics of measles cases from 28 th September to 8 th November 2011 C&CDHB HVDHB Number of 6 0 cases Age range 19-41 N/A Ethnicity European 4 Asian - 2 N/A Pertussis (Whooping Cough) Whooping Cough is a highly infectious bacterial disease, which affects the respiratory system (breathing tubes). Whooping Cough spreads when someone with the bacteria coughs or sneezes, spraying droplets of fluid from the nose or throat. Whooping Cough usually starts with a cold and irritating cough, but this then develops into spasms of coughing, which may end with vomiting, or with a whooping sound. Complications can include pneumonia, ear infections, and symptoms related to the effects of coughing. It can be particularly serious in children under one year of age who are more at risk of serious complications including in very severe cases brain damage and death. Seventy-three cases of pertussis were notified from 1 October to 8 November 2011, 26 of these were from the week of 31 October. Table 3 shows demographics of these notifications. Thirty one were confirmed cases, 13 probable cases, 10 suspected cases and 19 cases are under investigation. The 23 probable and suspected cases have clinical symptoms of pertussis but were not laboratory confirmed. Cases reside in all areas of the sub-region except the Wairarapa. Of the confirmed cases, 16 were fully vaccinated children (age range 9 months to 15 years). Protection from vaccine or disease lasts 7-10 years. When high levels of pertussis is circulating, even fully vaccinated people can get ill, though in a milder form. 6

National Data (Source: EpiSurv) Nationally a noticeable increase of pertussis notifications has been noted since August this year, with 573 cases reported since, compared to 189 for the same period last year. The cumulative rate since 1 January 2011 was recorded as: West Coast DHB (461.4 per 100 000 population, 151 cases) Nelson Marlborough (92.7 per 100 000, 128 cases) Hawkes Bay (59.9 per 100 000, 93 cases) Capital and Coast (39.1 per 100 000, 114 cases) Hutt Valley (37.6 per 100 000, 54 cases) Table 3 Demographics of pertussis cases from 1 st October to 8 th November 2011 C&CDHB HVDHB Number of 43 30 cases Age range 4 months to 84 years 28 days to 49 years Ethnicity European 33 Pacific 3 Maori - 7 European 28 Pacific 0 Maori - 2 Pertussis notifications for the last 12 Months (Greater Wellington) (Nov 2010 to Oct 2011) 7

Map of the greater Wellington region showing the spread of Pertussis cases from 1 st October to 8 th November 2011 6. RPH Brochure Attached for your information at the end of this report is a copy of the new RPH Brochure, outlining the ways in which RPH contributes to keeping people health in the greater Wellington subregion. 7. For discussion: What does CPHAC expect of/from RPH? 8

Appendix 1

Appendix 2 10

Appendix 3 11

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Appendix 4 Key Outcomes from the Alcohol Reform Bill, Justice and Electoral Select Committee Report Report Released 25th August 2011, second reading in parliament completed, currently waiting for third and final reading until after the election. Legislative Reform Youth Reform 1. Split Purchase Age off-license purchase age to rise to 20 years, onlicense purchase age to remain at 18 years. 2. Parental/guardian consent required for supply of alcohol to minors by others of the purchase age Alcohol Accessibility 3. Alcohol in supermarkets to be limited to a single non-thoroughfare location. 4. Territorial Authorities may elect to implement local alcohol policies, being responsive to the needs of the community (density, hours, location, public health impact etc) Alcohol Marketing 5. In supermarkets all in-store advertising and promotions is restricted to the single display area. Other Parliamentary Actions Supplementary Order Paper released to raise the purchase age to 20 years for all premises. Implemented in Transport Legislation Alcohol BAC level for drivers under 20 years is zero. RPH Position Raise purchase age to 20 years for all premise types. Supply to minors by parents or guardians only. RPH considered the ideal long term position to be that off-license sales be restricted to liquor stores dedicated to the sale of alcohol. RPH supported an intermediary step with the bill reform where alcohol purchase has its own separate checkout system. Local Alcohol Policies must be mandatory. Alcohol Marketing made progressively more restrictive following the three stage proposal recommended by the Law Commission. Key Service Delivery Implications for Public Health N/A N/A N/A Increased use of alcohol related epidemiological data, health statistics and demographics required in decision making. N/A 6. No alcohol promotion may advertise a discount of more than 25% off the normal purchase price. N/A 13

Alcohol Pricing 7. Alcohol industry required to release to government information on pricing and sales of alcohol. Licensing Process 8. Medical Officer of Health to enquire into all premise applications and renewals. 9. Public Health, Police and Licensing Inspectors to work in partnership in the licensing process. 10. Data and key information on alcohol related matters to be shared between the key licensing organisations. 11. Community decision making in licensing process via Local Alcohol Policies, and Community Licensing Boards Government has requested more research on the effectiveness of minimum pricing and what these prices should be. Immediate implementation of a 50% increase in alcohol excise tax followed by the introduction of a minimum pricing regime as recommended by Economic Consultants engaged by the Law Commission. Supported in the draft legislation. Supported in the draft legislation. Supported in the draft legislation Supported in the draft legislation. Requested that Local Alcohol Policies be mandatory. N/A Currently it is mandatory for public health to enquire into and report on on-license and club premises. (Reform extends this function to include off-licensed premises). Reinforces the collaborative practice we promote in service delivery Increased requirement for data and statistics on alcohol and health matters Increased requirement for epidemiological, health and demographic data required by public health to inform licensing board of likely impact of granting licensing decisions. 14

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CPHAC Pub (11) 5 Public Section - CPHAC Action: For Noting Author Sandra Williams, Director, Planning and Funding, CCDHB Date November 2011 Bridget Allan, Director, Planning, Funding and Public Health, HVDHB Subject Planning and Funding Directors Report Purpose The purpose of the report is to provide an update on the activities over the last month relating to both CCDHB and HV DHB Planning and Funding Directorates. This is the first report in this format. Section 1 is a section with updates on items which are common to both DHBs. Section 2 relates to CCDHB only and Section 3 related to HVDHB only. Recommendation That CPHAC notes the contents of this report. Section 1: Common Topics 1.1 Primary Care 1.1.1 After Hours Services The Government has announced plans to extend free doctor's visits for Under Sixes to afterhours care. We are waiting on further information from the Ministry of Health outlining how the proposed change in funding will be implemented 1.1.2 Diabetes Get Check Get checked Programme In September, Health Minister Tony Ryall has announced that the Diabetes Get Checked programme would be wound up. The decision follows a review of the programme which found it is not producing the desired improvement in outcomes for people with diabetes. The funding used for the Get Checked programme will continue to be invested into diabetes primary care in New Zealand. The Ministry of Health has not yet advised us on how the funding will be used in the future. In the meantime, the Get Checked programme will continue to fund primary care until June 2012 to ensure that every New Zealander with diabetes can have a free annual check up with their GP or GP practice nurse. 1.1.3 Health Target Diabetes and Cardiovascular Disease The Ministry have announced that effective 1 January 2012 the current Better diabetes and cardiovascular services health target will be replaced by a new national target called More heart and diabetes checks. The target will measure the number of completed cardiovascular O:\Corporate\Governance (GV)\Board and Committees 2011\11-2011\CPHAC\Public\Item 4 - Directors of PF Report.doc

CPHAC Pub (11) 5 risk assessments for all eligible persons within the last five years (which includes a diabetes check). The target goal is 90 percent. Data will be sourced from the PHO performance programme. The Health Target will be phased (like the PPP indicator) over the next three years: 60 percent by 1 July 2012, 75 percent by 1 July 2013 and 90 percent by 1 July 2014. Sandra Williams Director, Planning and Funding Capital and Coast DHB Bridget Allan Director, Planning, Funding and Public Health Hutt Valley DHB O:\Corporate\Governance (GV)\Board and Committees 2011\11-2011\CPHAC\Public\Item 4 - Directors of PF Report.doc

CPHAC Pub (11) 5 Section 2: Capital and Coast DHB 2.1 Primary Care 2.1.1 New Integrated Anticoagulant Service Model and Transition of appropriate anticoagulated patients back to Primary Care The C&C DHB Integrated Anticoagulant Working Group has developed guidelines and an Integrated Model for Anticoagulation Management. The model will help to ensure that there are systems, guidelines and processes in place to enable primary care and secondary care to provide standardised and linked anticoagulation management for patients. These Guidelines have now been launched and provide guidance on the management of Enoxaprin, Warfarin and Dabigatran and are available on the Healthpoint website under Blood and Cancer. 2.1.2 Electronic Copies of all Radiology Reports performed at C&C DHB being sent to GP Practices C&C DHB are now sending an electronic copy of all reports performed by the C&C DHB Radiology Department to the patient s GP practice. These text reports include plain x-ray films, ultrasound, and CT and MRI reports. The reports will be sent when authorised by the radiologist and will be clearly identified as copies. 2.1.3 Electronic Referrals rollout to GP Practices underway This initiative is currently in a roll out phase. Memorandum of Understandings are in place with all PHOs, except Cosine, who are currently completing this requirement. An electronic reconciliation of the referrals with resultant bookings in the hospital system has been implemented. Compass Health in supporting the GPs from all PHOs to implement the e-referrals solution. The roll out is expected to be completed before Christmas. 2.2 Child Health: Child and Youth Health Strategy 2.2.1 Phase I Work is continuing to implement the next phase Improving Child Health Outcomes in Porirua City. (Phase I). Rheumatic Fever, skin conditions and respiratory illness are identified as key priority areas. Rheumatic fever funding from the Ministry of Health Work is underway on exploring options for modifying the original proposed model of service delivery with the Porriua Kids Group following a meeting with the MoH on 9 November. O:\Corporate\Governance (GV)\Board and Committees 2011\11-2011\CPHAC\Public\Item 4 - Directors of PF Report.doc

CPHAC Pub (11) 5 Healthy Skin in Greater Wellington C&C DHB are part of multi disciplinary work group looking at skin infection. More information on this work stream is in the Regional Public Health update paper on the agenda for this CPHAC meeting. 2.2.2 Child and Youth Health Action Plan Phase II Work continues on progressing Phase II of the Child Health Action Plan for consideration by CPHAC early in 2012. The focus of Phase II will be on: 1. Mental health 2. Access to Primary Health Care 3. Child Injury 4. Family violence/child protection 5. Disability The Steering Group is to consider a number of engagement options at its next meeting in early December 2011 as well as aligning the development of the Plan and the DAP process. 2.3 Health of Older People services 2.3.1 Respite Care The contracts for Respite care have now been rolled forward with an increase in price to enable equity between the permanent bed day price and the respite rate. These placements are incentivised further by paying the provider for both day of entry and day of exit from the placement It is expected that this will make the service more sustainable and encourage providers to take more respite residents and more effectively meet the needs of the population. An RFP has been issued for a dementia day care centre in the Kapiti region. 2.4 Other 2.4.1 Regional Bariatric Surgery Service Five surgeries have now been completed in total with four more scheduled for November 2011. Another Eight candidates have been scheduled into the C&C DHB clinic for November 2011. Sandra Williams Director, Planning and Funding Capital and Coast DHB O:\Corporate\Governance (GV)\Board and Committees 2011\11-2011\CPHAC\Public\Item 4 - Directors of PF Report.doc

CPHAC Pub (11) 5 Section 3: Hutt Valley DHB 3.1. Primary Care 3.1.1 Population Registers The latest population data for October December 2011 shows that 97.8% (140,363) Hutt residents are enrolled in a PHO. This is an increase of 664 people enrolled with PHOs since last reported. Of those enrolled, 80% (112,159) are enrolled in Te Awakairangi Health, and 13% (18,598) are enrolled with Cosine Primary Health Network, while 7% (9,337) are enrolled with Capital Coast PHOs other than Cosine Primary Health Network. There is a small number (269, or.02%) of people who live in the Hutt Valley but are enrolled with PHOs that are neither Hutt Valley nor Capital and Coast. Currently we estimate that there are approximately 3,000 Hutt residents that are not enrolled in any PHO. 3.1.2. PHO development - Te Awakairangi Health Te Awakairangi Health has signed MoUs with the four contributing organisations in order to continue Services to Improve Access (SIA), Health Promotion and Valley-wide contracts for 2011/12. Kowhai Health Trust (the managed services organisation) have signalled several changes in their management structure, including the resignation of the CEO. Impacts and opportunities for Te Awakairangi Health and Kowhai Health Trust are being investigated as a result of these changes. One trustee, Dr Hans Snoek has resigned from the Board, and processes are underway to replace him in accordance with the Trust Deed. 3.1.3. Telephone Nurse Triage Service The Telephone Nurse Triage service enables patients of Hutt Valley general practices to access medical care twenty four hours a day by ringing their own general practice. During the 2010/2011 year there were 28,055 calls made to the Telephone Nurse Triage service. Of the total number of patients who called 17,096 (61%) were given advice that allowed them to manage their illness at home and see their GP the next day. Fewer than 2% of calls were referred to the ED department/ambulance. Patients referred to an after hours provider numbered 1201 (4.3%) of the total. 3.1.4. Subsidy for Under Sixes Attending After Hours As previously reported, we have established a 15 month pilot with the three After Hours/Extended Hours providers in the Hutt Valley to subsidise the after hours fees charged for children under six years of age. The subsidy is a $6 reduction to the cost of the visit for the patient. The pilot is running run from April 2011 to June 2012. We have allocated around $47,000 for the pilot. In the first six months, the pilot has subsidized more than 3,500 visits. O:\Corporate\Governance (GV)\Board and Committees 2011\11-2011\CPHAC\Public\Item 4 - Directors of PF Report.doc