Hutt Valley DHB Maori Health Action Plan 2012-2013 Whanau Ora Ki Te Awakairangi Towards a Healthier Hutt Valley
INTRODUCTION Executive Summary/Foreword The Hutt Valley DHB Māori Health Plan (MHP) defines its planned intentions and actions toward improving the health and reducing inequalities of Māori and their whānau in Te Awakairangi. It will link closely to the activities identified in both the HVDHB Annual Plan and the Central Regional Services Plan. Background With the Central Regional Service Plan (RSP) effectively replacing the District Strategic Plan, DHBs are now required to work collaboratively within their regional context as well as addressing nationally identified health targets and indicators. From 2012/2013 DHBs will implement their Annual Plans (APs) setting the DHB s direction and approaches toward addressing the health targets and priorities nationally, regionally, and more specifically sub-regionally and locally. The Hutt Valley DHB (HVDHB) recognises and respects the Treaty of Waitangi, and the principles of partnership, participation and protection, acknowledging the special relationship between the Crown and Tangata Whenua under the Treaty of Waitangi. The HVDHB Maori Health Plan also recognises the Ministry of Health s Māori Health Strategy (2002): He Korowai Oranga which sets the direction for the health and disability sector in relation to Maori accompanied by Whakataataka the separate action plan. Aligning with the development of APs and RSP, a stand-alone DHB Maori Health Plan (MHP) is also a requirement for 2012/13. The MHP provides the context and mechanism by which DHBs will be able to monitor and measure their performance and effectiveness to improve Maori Health outcomes and reduce inequalities which exist between Maori and non-maori. Similarly, the MHP is a plan identifying local priorities, actions and measures. The development and review of the plan will form the work programme for Maori Health on an annual basis, with progress against the measures being reported regularly. Process for developing the Māori Health Plan In developing the plan, input, guidance and advice has been sought from within the DHB s Maori Health Unit and workforce, and the two Maori specific advisory groups. The Māori Partnership Board (MPB) advises strategically at a governance level directly to the Board. At an operational level the Māori Health Services Development Group (MHSDG) informs service planning and delivery across the DHB through advice to the executive management team. Although these two groups are key sources of advice to the Hutt Valley DHB, they are not the sole means by which the DHB engages with Māori. Established long-term relationships, partnerships and understandings exist across a wide range of health and social sector services and groups, including Māori providers, and Nga Iwi Māori mana whenua and taurahere alike. Several interagency services and non-government networks are also important for the DHB. These networks provide opportunities to address the social determinants of health for Maori and others. Te Awakairangi Regional Board is a specific Maori forum facilitated by Te Runanga O Taranaki Whanui Ki Te Upoko O Te Ika. It links to local Marae and Kokiri locations, sporting and social clubs, Kohanga Reo and Kura as well as other agency sector representation i.e. Te Puni Kokiri, Housing, ACC, local councils, Education etc. A new feature is the local Whanau Ora provider initiatives of Te Runanga O Taranaki Whanui and Takiri Mai Te Ata (Kokiri Seaview) who each deliver health and social service programmes within Te Awakairangi. The DHB expects that these initiatives will impact positively on the DHB s delivery of health services for Maori. 2
Measuring our effectiveness A set of national priorities have been identified to improve health outcomes for Māori health. The national priorities are divided into nine heath issues, each with one or more indicators used to measure progress. We will monitor our effectiveness by: Reporting to the DHB Board and its advisory committees, as well as Meeting the reporting requirements of the National Health Board (NHB) and the Ministry of Health (MOH) utilising the Quarterly Reporting Database. 3
1 Hutt Valley DHB s Māori population and their health needs Māori, at 25,300 people, make up 17.4% of the population in the Hutt Valley. Our Māori population is generally younger than the rest of the population, and experiences higher levels of deprivation than non-māori. If Māori are to achieve the same level of health as other New Zealanders, their health status should be understood in the context of the broader determinants of health, particularly social, cultural and economic status. Strategies to improve Māori health should be effective at improving access to quality health care services for Maori. The Hutt Valley DHB Health Needs Assessment identifies a range of conditions where significant disparities exist for Māori. These include: 1.1 Population and Health Profile This section describes the Hutt Valley DHB region s population and population health needs comparable for Maori and non-maori. 1.2 Demographics Hutt Valley DHB is home to 3 percent of the national population. Geographically it is an urban DHB, covering two territorial authorities: Hutt City and Upper Hutt City. Our neighbouring DHBs are Capital & Coast DHB, and Wairarapa DHB. Figure 1: Hutt Valley DHB district Maori Population 4
Key features of our population include: Our population is currently approximately 144,570 1, projected to increase to around 147,240 by 2026 Population distribution (age, gender, ethnicity) is similar to the New Zealand population, but with a slightly higher proportion of Maori (17%) and Pacific island people (8%), when compared to the national average. Our population is currently slightly younger than the national average 70% of the population reside in Lower Hutt The proportion of people residing in urban areas (98.1%) is higher than the national rate (86%). There is variation in the level of deprivation across the Hutt Valley, with 25% of Lower Hutt within Quintile 5, compared with 11% within Upper Hutt (compared to an average of 20%). 1.3 Health behaviours and risk factors for Māori: When compared with non-māori in the district, Māori experience: Higher prevalence of smoking Lower consumption of vegetables and fruit Lower rates of breastfeeding Higher rates of hazardous drinking, and Higher prevalence of obesity. Health status: When compared with non-māori in the district, Māori experience: Higher rates of death from cancer (especially lung), cardiovascular disease, stroke, and suicide Higher prevalence of asthma, diabetes, and depression Poorer oral health Health service utilisation When compared with non Maori in the district, Māori experience: Higher rates of avoidable hospital admissions Higher rates of hospitalisation of children for dental conditions and asthma Greater unmet need for a GP. These factors indicate that our existing activities in the following areas need to continue and increase in emphasis: 1 2010 NZ Stats Population Projections 5
Continuing our positive engagement with our community providers, including through the cluster of Whanau Ora providers, with a focus on education, prevention and outreach services particularly amongst Maori, Pacific and low-income people, and Working closely with primary care to address: long term conditions, avoidable hospitalisation, and to reinforce education and prevention, particularly amongst people with higher needs. 1.6 Health behaviours and risk factors for non- Māori Our population s rates for health risk factors are broadly similar to the national rates, i.e. for smoking prevalence, physical activity, hazardous drinking, obesity, high cholesterol, and high blood pressure. Worse or significantly worse rates, when compared with national figures, occur for: Consumption of fruit and vegetables Breastfeeding. Health status When compared with national figures, our population experiences: Higher population rates of chronic conditions; diabetes prevalence, asthma prevalence, chronic obstructive pulmonary disease prevalence, and chronic mental health disorder prevalence Similar leading causes of mortality, with the addition of stroke. Health service utilisation When compared with national figures, our population has: Similar leading causes of hospitalisation, with the exception that asthma is a leading cause of hospitalisation for Maori, Pacific and Asian children aged 0 to 4 years, and diabetes is a leading cause of hospitalisation for Maori and Pacific people 65 years and over.
2 National Priorities The national priorities identify Māori health issues. The indicators (or targets) show how the DHB will measure progress over time in addressing each issue. These measures include Health Targets and DHB Performance Measures shown in the DHB Annual Plan (AP) that are either a Māori specific measure or are of significance to Māori health. Health Issue DHB Actions Indicator(s)Target 1. Data Quality Support PHO s to ensure ethnicity identification data in their registers are accurate and encourage PHO s to implement this action as a target for 2012/13 Accuracy of ethnicity reporting in PHO The PPP Indicator for Valid NHI includes ethnicity recording on patient registers. The Programme goal for this indicator is 99.5% of recorded NHI are valid The latest PPP data shows that we have 99.8% valid NHI recorded. Slightly above the programme goal. 2. Access to care Work with PHOs to monitor the percentage of Maori enrolled in PHOs and address any issues identified. This will be managed through the reporting process within agreed timeframes, The Hutt Valley population has high rates of Ambulatory Sensitive Hospitalisations, especially for Maori. The DHB is addressing these through a range of projects outlined under child health and long term conditions in the District Priorities section below. (1) Percentage of Māori enrolled in PHOs (y) Maori will reflect 17% of PHO population enrolled in the Hutt Valley Quarterly joint monitoring against maori enrolments rates will be undertaken and agreed remedial strategies implemented to manage slippage (2) Ambulatory Sensitive Hospitalisations rates per 100,000 for the 0-4, 45-64, and 0-74 age groups (y) Maori 0 4 < 152 Maori 45-64 <108.07 Maori 0-74 < 119.8 84% (21407) of Maori living in the Hutt Valley are enrolled in a PHO 7
3. Maternal health 4. Cardiovascular disease The Hutt Valley has low rates of breastfeeding, especially for Maori. Continue to support local breastfeeding initiatives aimed at increasing exclusive breastfeeding rates Maintain the Maori BF function to engage and support Mums from ante-natal to post natal up to 6 months Maintain input into local, regional and national training and networking opportunites to ensure knowledge of best practice is maintained, considered and implemented The Hutt Valley population has high rates of CVD for Maori. The DHB is addressing these through a range of projects outlined under long term conditions in the District Priorities section below, and by working closely with local PHOs. 80% (20456) are enrolled in Te Awakairangi Health Network or Cosine Primary Care Network 4 % (951) are enrolled in other PHO s, 906 of these are enrolled with PHOs in Capital and Coast. 45 of these are enrolled with other PHOs that are not Hutt Valley or Capital and Coast PHO s. Exclusive breastfeeding at 6 months (y) Target 27% at 6 months (exclusive) Monthly monitoring of engaged Mums from birth are reported and shared Monthly monitoring of engaged and BF Mums is reported (1) Percentage of the eligible population who have had their CVD risk assessed within the past three years (q) (ht) Target 75% (2) Number of tertiary cardiac interventions (y) (no target, information only) check The target for Maori is 60% of eligible population have had their CVD risk assessed within the past three years. This increases to 75% in 2012/13 and 90% in 2013/14. 5. Diabetes The Hutt Valley population has high rates of diabetes for Maori. The DHB is addressing these through a range of projects outlined under long term conditions in the District Priorities section below, and by working closely with local PHOs. (1) Percentage of people who attend their diabetes annual review (DAR) (q) (ht) Target 75% (2) Percentage of people with diabetes who complete a DAR and have a HbA1c level less than 8% (q) (ht) Target 73% 8
6. Cancer Hutt Valley DHB has improved screening rates for Maori women over the past few years, but progress is still required to reach the same level as for non-maori women. The DHB is addressing this as outlined under cancer in the District Priorities section below. (1) Breast Screening (6) 70% (2) Cervical Screening (6) 75% up to 80% by Dec 2014 60.2% up to 80% Reporting of cervical coverage has changed to women aged 25-69 years not 20-69 as was previously to alignwith international best practice. Note: many countries only begin screening at age 25yrs. Previous coverage was based on the 2001 census. NCSP coverage is now based on the Statistics NZ 2006 census population projections to ensure more accurate reporting. The national 3-year coverage2[1] rate for all women aged 25-69 years was 74.8% to March 2012. National Cervical Screening 3-year coverage rate for Maori 58.2%, 7. Smoking Hutt Valley DHB has improved its advice and help processes for hospitalised smokers significantly in the last year, achieving 88%overall in Q2 of 2010/11, and 91% for Maori upto 95% by July 2012 Work is underway with primary care providers to achieve the smoking target. 90% of people will have received quit advice in primary care settings by July 2012. (1) Hospitalised smokers provided with advice and help to quit (ht) (y) (2) Current smokers enrolled in a PHO and provided with advice and help to quit (ht) (y Hospital data shows that 96.12% of Maori who smoke are provided with advice and help to quit. This is slightly above the target of 96% 9
8. Immunisation Hutt Valley DHB has achieved well in immunising children up to two years old, achieving 92% overall in Q2 of 2010/11, and 94% for Maori. The health target has changed for 2012/13, now focussing on 8 mth olds. Hutt Valley DHB has achieved good results in immunising against seasonal influenza in the eligible population but needs to reach higher levels. The target is 90% of enrolled patients who smoke and are seen in General Practice, will be provided with advice and help to quit by July 2012. Quarter four of the Primary care data shows that 32%of Maori have received brief advice in Primary Care. We have a considerable way to go to reach the target for all ethnicities. We continue to work closely with RPH to increase the number of people who received brief advise in Primary care. (1) Percentage of 8 mth olds fully vaccinated (y) (ht) Hutt Valley DHB targets for 2012/2013 for all infants 85% by July 2013 90% by July 2014 95% by December 2014 Our Plan is that: Every baby is enrolled with the NIR on discharge from birthing facilities Every baby is registered with a GP and enrolled with a PHO before they are two weeks old Newborn Enrolment Policy We are developing a process for all Hospital birth events discharge notification to be sent to the chosen Wellchild Tamariki Ora provider (i.e. as for GP notifications). (2) Seasonal influenza immunisation rates in the eligible population (65 years and over) (6) Baseline coverage 64.6 target to 75% Seasonal reporting 9. 9..Whanau Ora A health system that works in a seamless and reporting activity at a District level. 10
integrated manner with other Government agencies and the community and social sectors to support the improvement in wellbeing and health outcomes for New Zealanders. New addition 11
Maori Health: Regional Priorities Regional Māori Health Plan 1 1 Technical Advisory Services. (2010). Central Region Māori Health Plan: Tū Ora (Draft). In collaboration with Technical Advisory Services (TAS), the development of a draft Regional Māori Health Plan, Tū Ora, has been completed for the Central Region. Tū Ora aspires to guide an ongoing improvement in Māori health and Māori health outcome. Change Enablers To enable change, Tū Ora identifies four focus areas as key areas of action: 1. Māori Workforce Development 2. Quality Service Provision 3. Collaborative Action 4. Sharing and measuring Information It is envisaged that the targeted actions underlying these focus areas will support improvement and sustainability over time by optimizing the planning, funding and delivery of health provision for Māori within the Central Region. PRIORITY ONE MĀORI WORKFORCE DEVELOPMENT Objective Action Impact Measured By Increased Māori Capacity and Capability Continue to roll out Kia Ora Hauora Māori Workforce Development Programme Support current scholarship initiatives targeting Māori uptake of Health related study pathways Support CRTAS to increase its Māori capacity and capability and advance regional inequalities work Provide regional support of the implementation of Nga Manukura o Apopo emerging Increased enrolment of Maori in health related study pathways Increased enrolment of Māori in health related study pathways Proactive engagement on CRTAS led work to drive a greater impetus on addressing Māori inequalities in the central region Increased Maori Clinical Leadership. Recruit a minimum of 250 new Māori onto health related study pathways (seconday or tertiary) A minimum of 20 scholarships per annum Quarterly meetings A minimum of three places filled by Central Region Māori nurses annually 12
and advanced leaders in Māori Nursing and Midwifery Clinical Leadership training Improved responsiveness Develop targets aimed at improving service access and clinical interventions for Māori to regional services in the areas of: Cardiac Renal Cancer Improved relationships Support Māori Relationship/Partnership Boards to implement at least one joint Central Region DHB Leadership Hui per annum to create opportunities for regional engagement. Implement a Bi-annual Central Region DHB Māori health development conference:tu Kaha Reduced disparities Improved mainstream responsiveness Improved regional relationships Improved across sector collaboration and relationships Targets developed, agreed and reported annually Any age related criteria reconsidered to address the earlier onset of chronic health conditions experienced by Maori Annual joint Board hui implemented Conference implemented 13
4. District Priorities Annually, as part of preparing the Annual Plan, the DHB seeks input from the Maori Partnership Board and the Maori Health Services Development Group to identify priorities for the next year. Health Issue Actions Indicators & Targets Primary Health Care Working with the new PHOs in the Hutt Valley to develop Effective and comprehensive PHO s PHO Maori Health Plans that address the relevant issues Maori Health Plan is developed. identified under specific topics below. Indicators as per specific areas will focus on a. Improving the accuracy of ethnicity reporting, and b. Increasing the number of Maori Determinants of health Continue to engage with intersectoral approaches that reduce inequalities and disparities which impact on Maori health, with support from the sub-regional Keeping Well public health strategy. enrolled with the PHO Annual Hutt Valley DHB Improving Equity shows evidence of intersectoral activity impacting positively on Maori health. Child Health Cellulitis/Skin Conditions Respiratory Conditions Rheumatic Fever Implement initiatives to address the high level of avoidable hospitalisations in the Hutt Valley, specific to child health cellulitis / skin conditions, and respiratory conditions Maori Health Coordination service to continue support for discharge and referral processes from secondary services to the community, to ensure patients receive ongoing support in the community. Build on established relationships with Whanau Ora and Maori health service providers, PHO community health workforce, public health nursing services, Keeping Well personnel and stakeholders to share information, collaborate and develop solutions to improve overall child health. Reduction in ASH rates for children aged 0 4years, for Skin conditions and respiratory conditions Agreed models of care crossing primary/secondary continuum 0-4 Maori 45-64 Maori 0-74 Maori Sep-10 11/12 target 152 141.06 103.46 108.07 121.06 119.08 14
Continue intersectoral commitment and work with community stakeholders who address environmental factors impacting on respiratory conditions for Maori Tamariki and their whanau i.e.tu Kotahi Asthma project Healthy Homes, Hutt Housing Forum etc Immunisation Support Maori health service providers and Whanau Ora providers to work with whanau to complete Well Child vaccination schedules. Provide information and active support to whanau and Pakeke/Kaumatua to be vaccinated annually for influenza. Maintain and nurture meaningful relationships across the broader health and community sector to ensure connectedness and integration packages of care for children and whanau are improved. Achieve 90% % rate at eight months for all, Maori by 30 June 2013; 90% overall by 30 June 2014; and 95% overall by 30 December 2014 Breastfeeding Implement HV Maori Breastfeeding strategies that support Maori mothers and their whanau to breastfeed their pepi; and sustain for at least the first six months following birth. Improve discharge and referral processes from Maternity to community following birth to better support the maintenance of breastfeeding. Continue to support the Maori BF Co-ordination, Mum4Mum initiatives and support for Midwives to improve Maori BF rates. Maori Breastfeeding status at o six months 27% 15
Long Term Conditions Diabetes 3 Cardiovascular Disease (CVD) Respiratory Support the implementation of the HV Diabetes Care Improvement Package from 1 July 2012 Work with the new PHO, Maori health service providers and Whanau Ora providers to improve uptake of CVD risk assessment focus by Maori. Implement co-location opportunities for Maori community based dietetic advice and support for whanau. Health of Older People Information about services developed and distributed appropriately (with a strengthened role for community workers) so that Pakeke (45 to 64 yrs) and Kaumatua (65 plus) and their support whanau are informed and aware of services available to them to live healthy fulfilling lives within their own homes and communities. Work with providers to ensure their day programmes for older people are culturally appropriate, socially stimulating and easy for Pakeke/Kaumatua to access. Initiate respiratory project with Tu Kotahi Maori Asthma Society focussing on Kaumatua. Smoking Work with new PHO to enhance focus on assisting Maori smokers to quit. Strengthen referral and follow-up for identified smokers to local and national smoking cessation services (e.g. Aukati Kai Paipa (Maori Cessation), and QUIT telephone support Increase the percent of the eligible adult population who have had a cardiovascular disease (CVD) check with in the last five years to 75%. Percent of the eligible adult population who have had a cardiovascular disease (CVD) check with in the last five years. The eligible population in the Hutt Valley is 32,333 (PPP Data as at June 2011). Diabetes Care Improvement Package. PP20: Submission of quarterly reports re improved management for long term conditions (CVD, diabetes and stroke] Submission of quarterly reports through the PHO Performance Programme. Kaumatua forums, Marae activity groups, and other opportunities to hui with Kaumatua and whanau to actively seek feedback and opportunities to improve will be conducted twice before July 2012 Improved awareness and understanding of Respiratory related conditions for Kaumatua through health literacy approaches Consistent key messages developed and understood by both patients, whanau and health professionals Development of a Maori COPD Resource Kit which can be used by patients, whanau and health professionals 95% of hospitalised smokers will be provided with advice and help to quit by July 2012. 90percent of patients who smoke and are seen by a health practitioner in 16
Cancer Breast Cervical services) and to community health workers for additional support. Build on established relationships with Whanau Ora and Maori health service providers, and PHOs to continue efforts to o Increase the number of eligible Maori women participating in BreastScreen Aotearoa programme o Increase the number of eligible Maori women participating in Cervical Screening programme primary care, are offered brief advice and support to quit smoking. Within the target a specialised identified group will include: Progress towards 90 percent of pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit. 1) Breast Screening 70% 2) Cervical Screening 63.1% on 3 yr pathway up to 80% 3) Target for 12/13 Cervical is 75% (please note that 80% coverage target is incremented over 3 financial years 2011/12, 2012/13, 2013/14) Mental Health & Addictions Ensuring that changes to the model of care for mental health services (one that delivers a collaborative and integrated service based on need) maintains timely access for Maori clients to high- quality, trustworthy, responsive mental health and addiction services ranging across the spectrum of promotion and prevention, through to primary, secondary and tertiary services. Implement the Maori Mental Health and Addictions Action Plan in response to the Post Review Assessment report. * Plan is agreed and implemented by October 2012. Workforce - Capacity and Capability building Continue work to expand Maori participation in the health workforce in multiple ways, including: o Scholarships programmes o Maintain active support and contribute to the National Kia Ora Hauora programme o Tu Tangata students initiative o making secondary care training opportunities A minimum of 20 Tu Tangata scholarships will be awarded before June 2012. A minimum of 3 Tu Tangata students will be in place to work within HVDHB and Community based settings on approved summer projects by June 17
o o o available to primary care and community workers HWNZ initiatives Continued implementation of the regional Kia Ora Hauora project Enhance the capability of DHB staff, including development of leadership and effective responsiveness to Maori and whanau by facilitating training in Sacred Souls Te Raukura Wananga Maori Health Literacy Whanau Ora models of care Data Quality Continue to build on improved ethnicity data collection for Maori Update Improving Equity report annually to inform the Board and other advisory groups of progress to address identifiable health disparities and inequalities for Maori within the Hutt Valley. 2013 HWNZ Hauora funding availability will be widely circulated and promoted among HVDHB staff and NGO s for application 3 Sacred Souls training sessions will be delivered by June 2013 Minimum of 5 Te Raukura Wananga sessions will be delivered by June 2013 2 Maori Health Literacy training will be developed and delivered in a Maori community setting with participation from Maori Community workers by June 2013 Annual monitoring of Maori Workforce FTE Clinical, Management, Admin and other Analyse and report Maori data comparable to non-maori data for MHP priorities (as outlined above) Monitor ethnicity data in PHO registers through the PHO Performance Management Programme. Whanau Ora and sector integration Support whanau ora collectives in Te Awakairangi as they develop their Plans of Action Provide opportunity to the collectives to promote whanau ora locally. Maintain Whanau Ora RLG membership and activity Encourage whole of community engagement through participation at hui such as the HV Governance group. Maintain HVDHB visibility in whanau ora communities and activities of interest Narrative reporting on activity and achievements being made locally 18