Hurunui Health Services Aroha ki te tangata - Care for the People

Hurunui Health Services Aroha ki te tangata - Care for the People Pita Te Hori Community information and feedback booklet ccn.health.nz

Contents Background What is a Model of Care? 2 What s the long-term vision? 2 What can be achieved? 2 Who developed the Model of Care? 2-3 What are the challenges? 4-8 Current services 9 Proposed Model of Care Health services fit for the present and future 10-13 Enhanced integrated healthcare 14-15 Innovative technology 15 Patient care pathways 16 Collective working relationships 17 Have your say Glossary 18 Have your say 19-20

Foreword New Zealand s health system is facing considerable challenges. People are living longer, they re living with long-term or multiple health conditions and the number of our young people who are obese is on the rise. Our health workforce is ageing with 40 percent of doctors and 45 percent of nurses aged over 50 years. The Canterbury health system has its own challenges. In addition to an ageing population, there s an increased demand on our mental health services following the significant earthquakes in 2011 and 2016. A temporary re-build community also increases demand for health services, but because many aren t enrolled with a GP, there is no funding allocation to resource us to meet this demand. Across the Hurunui there are additional complexities. Communities and services are spread across a vast geographical area. There s limited availability of paid and volunteer health workers and they re working with outdated technology, which if developed would support and streamline the delivery of health services. In Canterbury we are ahead of the curve in innovating to ensure our community has access to high quality health services delivered by passionate health professionals. The Hurunui Health Services Development Group, which includes members of the local community, health professionals, health services staff and Canterbury DHB representatives, was established in late 2015 to develop a new model for sustainable health service delivery. After much consideration and investigation, the group has a proposal to share and is asking for your feedback. Now is your chance to shape the type and delivery of health services across our community to ensure they are appropriate for you and your whānau, now and into the future. Mountain biking in the hills surrounding Hanmer Springs For an explanation of terms and acronyms, please use the glossary on page 18 Page 1

Background What is a Model of Care? A Model of Care is a framework for delivering health care, which outlines services that could be delivered and how they could operate. The Model of Care aims to be the basis for: The way you access health services; Identifying what services you need (service planning); Identifying the staff needed to deliver those services (workforce requirements). There are two stages of a Model of Care - development (assessing need, proposing services and seeking feedback) and implementation (detailed implementation plans and implementation of elements). What s the long-term vision? We have a vision for a sustainable, integrated, family-centred health service that acknowledges the geographical diversity of the Hurunui district and enables community choice. Our aim is to enable access to appropriate, timely and equitable health care A sustainable, integrated family-centred health service that enables access to appropriate, timely and equitable healthcare closer to home. closer to home. This vision is underpinned by a number of principles, including: Effective sharing of information which enables better care; Health services and communities working together; Using resources wisely; Patient/ whānau choice considered; Access to services matched to need; Services received closer to home; Continuous improvement. What can be achieved? We believe implementing a new Model of Care will deliver many benefits, including: Targeted health service delivery that supports those with the greatest needs; The development of a more personalised primary healthcare system by placing greater emphasis on empowering you to self manage your health and illness. A reduction in pressure on hospital services by facilitating integration within and between primary and community based services, and providing services closer to home. Who developed the MoC? The Model of Care was developed by the Hurunui Health Services Development Group (the Group), which was formed following a series of workshops held with a wide range of Page 2

health professionals in 2015. It s objective was to make recommendations for improving and future-proofing health services across the Hurunui. In developing the new Model of Care the Group considered what would best meet yours, your whānau and the wider Hurunui community s needs, while ensuring sustainability both now and into the future. The Model of Care that has been developed is expected to improve your access to services and provide clinically sustainable and cost-effective service delivery. From the outset, the Group wanted to acknowledge the contribution of unpaid workers and volunteers who support the delivery of health services in the Hurunui. Name(s) Perspective/ expertise/ locality Deirdre Carroll Māori Perspective/ Te Ngāi Tūāhuriri Rūnanga Sue Smith Practice Nurse (Waikari) David Smith Practice Manager (Hanmer Springs) Faye Daly District Nurse (Cheviot) Win McDonald Secondary Care / Rural Hospitals (CDHB) Dr Rex Yule General Practitioner / Business Owner (Amberley) Marie Black Local government (Chair) / Plunket perspective - retired Aug 17 Susan Mowat Consumer / Independent of Locality Sheryl Banks/Kirsty Scarlet Practice Manager (Amuri) Garry Brown Community Pharmacy /Business Owner (Amberley) Tsarina Dellow St John Volunteer (Hanmer Springs) Glenda Rich Community Service Provider perspective Bill Eschenbach Rural Canterbury PHO Through their shared time and skills, the delivery of health and social services is supported, and in many situations, enhanced. The Group has worked together to produce this proposed Model of Care. The thinking is well advanced in some areas. In other areas, the proposal is still a concept and needs to be further developed. In all cases, no decisions have been made. Sean Lester/Kirsty Mann Linda Watson Michael James Dr Lorna Martin Sue Coleman Shona Urquhart-Bevan Ruth Robson St John / Organisational/ Patient Pathways Allied Health CDHB/Planning & Funding Alliance Leadership Team Sponsor Aged Residential Care CCN Rural Health Project Manager/ HHSDG Facilitator CCN Programme Manager Membership as at date of publication Page 3

Challenges know from our experience with the Canterbury earthquakes that there will be an ongoing demand for earthquake-related care and mental health services over the next decade. We need to factor this in to our MoC. Population - trends While the overall population of the Hurunui district is predicted to grow steadily over the next 20 years, the population of some towns is declining. The greatest proportion of growth is occurring in the Amberley-Leithfield and Hanmer Springs wards. Hurunui s population is considerably older than the average across New Zealand, with people aged 65 and over accounting for nearly a fifth of the population Places where population is ageing fastest and also most likely to decline include the rural towns of Cheviot, Culverden, Waikari and Hawarden, where there is not a significant driver for migration. What are the challenges? We have an opportunity to proactively explore more effective and efficient ways to deliver these services by approaching our challenges innovatively. Page 4 Post earthquake recovery The community is still recovering from the devastating earthquake that struck North Canterbury in November 2016. There has been an increased need for psychosocial help, and we Population - ageing Hurunui s population is considerably older than the average across New Zealand, with people aged 65 and over accounting for nearly a fifth of the population. This number is set to increase to nearly a third of the

population by 2036. With an ageing population comes increasing health needs. Sustainability of general practices Some general practices face issues around long-term sustainability. These issues are exacerbated by the predicted population decline in some towns in the Hurunui district. Provision of aged-care services There are three aged-care facilities operating in the district: Cheviot Rest Home provide 14 rest home beds. Services include long-term care, respite care, palliative care and carer support/ day care; Amberley Rest Home and Retirement Studios provide 12 en-suite studio rooms and nine rest home beds. Services include rest home level long-term care, respite care and carer support/ day care; Adriel House and Rest Home (Amberley) provide 42 dementia rest home beds. Services include rest home level long-term care as well as respite care, palliative care and carer support/ day care. Waikari Hospital is a ten-bed facility providing hospital level long-term care, respite More than seven percent of the Hurunui s population identifies as Māori care, palliative care and carer support/day care as well as short-term general medical and surgical convalescence care. Maternity services are not available at Waikari Hospital. Nearest maternity services are located in Rangiora. Some health centres report that there is still an unmet need for hospital level care in the Hurunui, particularly hospital level respite care. It is reported that referrals to the existing facilities are limited because many patients needs cannot be met in a community hospital, particularly when they don t have the appropriate technology and staffing available. Geographic diversity/ location The Hurunui starts at Leithfield Beach and extending to the Conway River, south of the Kaikōura Peninsula. It is predominantly rural - while parts of the community are only half an hour from Christchurch, other parts are up to two hours from Christchurch. Depending on the time of day, this travel time can increase. Ethnic diversity The Hurunui district population is less ethnically diverse when compared to the national demographics. At the time of the 2013 Population Census, 93.4 percent of people in the Hurunui District identify as European, compared with 74 percent for New Zealand as a whole. Around eight percent of our population identifies as Māori. Page 5

There is a growing migrant population as more farm workers from overseas are employed across the Hurunui district The Hurunui takiwā (district) sits across two Papatipu Rūnanga (traditionally owned lands). The takiwā of Te Ngāi Tūāhuriri Rūnanga centres on Tuahiwi and extends from the Hurunui to the Hakatere river and inland to the Main Divide, with offices based at Tuahiwi Marae. The Te hapū o Ngati Kuri extends from Te Parinuiowhiti (White Cliffs South of Blenheim) to the Hurunui River and southwest of the Main Divide, with offices based at Takahanga marae in Kaikōura. There are no marae located in the Hurunui district. We also have a growing migrant population as more farm workers from overseas are employed to support the agricultural sector. We need to ensure that health services are delivered in a culturally appropriate way, to improve equity of access for the whole community. Health workforce There are a shortage of trained health professionals in the rural setting, and this figure is increasing. Factors contributing to this include: An ageing population with growing health needs; An ageing healthcare workforce; Increasing national and international health Page 6

workforce shortages, particularly rurally; A significant number of local workforce made up of part-time workers; Different demographics and expectations of younger healthcare workers; Increasing cost of training and compliance. In addition there is: A growing need for home support workers to support the ageing population; A need to develop a culturally diverse workforce; A rising expectation by clinicians and the public for access to new technologies and the increasing costs of such technology and treatments; Significant pressure in new funding across the New Zealand health system, requiring better ways of prioritising resources and providing care to those who need it most; Lots of varying health information which is sometimes difficult for you to navigate. To address these challenges, primary care services may need to work in different, more integrated ways. District/ community nursing services The district nursing service delivers a diverse range of generalist and specialist nursing services seven days a week, including wound The district s nursing service delivers a diverse range of generalist and specialist nursing services care, stoma care and palliative care. District nurses, who often work in isolation and have to travel large distances, work closely with general practice teams to coordinate care for people living remotely. We recognise there is an opportunity to enhance both the acute community nursing service as well as develop an enhanced restorative community service model, utilising general practice and district nursing as the coordination point. Home care services There are challenges in delivering a restorative home care service in the Hurunui because of the availability of trained home care workers and home-based nurses. Access to funded/ volunteer services could support this service. Public transport services Limited public transport and a reduction in the number of community volunteers can sometimes make it difficult for you to get to and from your appointments. This is expected to be an ongoing challenge, especially when combined with the projections for an ageing population. Ambulance service St John has units stationed in Hanmer Springs, Culverden, Cheviot and Amberley. The implementation of double crew units should see an increase in paid staff manning units across Canterbury, but there is some potential to better use a volunteer workforce in the interim. St John works to response times based on the severity of the call out, so this can result in a perceived longer wait by you and the health centre/prime practitioner who may be working to stabilise you for transportation. Page 7

Respite care for under 65s The funding for respite care for people under the age of 65 is limited, so as part of this Model of Care we want to improve access to respite care for this age group. Information technology connectivity Ultrafast broadband is required to provide Telemedicine and so Hurunui staff can access education sessions via video link. Not all practices have reliable access to the ultrafast broadband needed for reliable video links. General practice services Primary care services are delivered from five medical centres across the Hurunui. Four of the practices are run by community trusts (Hanmer Springs, Amuri (Rotherham), Cheviot and Waikari) while the Amberley practice is a privately owned business. We want to design an integrated healthcare service across the Hurunui, to enable collaborative health service planning and support collaboration and sustainable health care delivery. Delivery of after-hours care At the moment, Hurunui health staff work on two shared rosters: One covering Hanmer Springs, Amuri and Waikari centres, and the Page 8 Primary care services are delivered from five medical centres across the Hurunui other covering Cheviot and Amberley centres. The service is supported by a mixture of medical practitioners; a nurse practitioner and rural nurse specialists. Challenges in delivering after-hours services include: The remoteness in some areas in the Hurunui; No rostered general practitioner available after-hours in either Cheviot or Waikari. In Waikari this impacts the flow of services at Waikari Hospital (for example, admitting a patient into the hospital or transfers between hospitals, which need to be carried out by a medical practitioner) Because of the after-hours cover arrangement, some patients have to travel north for acute care and if necessary they may have to travel back to Christchurch for further assessment and /or treatment. There is an increasing number of patients seeking treatment from Amberley Medical Centre who are not enrolled in any of the Hurunui practices, including patients from outside of the district. To combat these challenges, we propose that all existing primary health services remain available in the Hurunui district, but they may need to be delivered differently. The current health services will be strengthened, enhanced, and complemented by the introduction of a number of new services, which have been identified as ways to enhance the collective health and wellbeing of Hurunui residents. Take a look at the information on pages 10-17 to find out more about what enhancements and new services are suggested as part of the proposed Model of Care, and what the changes mean for you and your family.

Current services Page 9

What s being proposed? There are five key areas for development and in some cases, change, proposed as part of the Model of Care. They are: 1. Health services fit for the present and the future; 2. Enhanced integrated health care/transfer of care; 3. Innovative technology (information/equipment); 4. Patient care pathways (including after-hours pathways); 5. Strong working relationships. 1. Health services fit for the present and future The following enhancements and additional services are proposed as part of the new Model of Care, and the HHSDG is seeking your support and feedback towards further development of these proposals. Proposed service Description What it means for you 1. An enhanced after-hours service. Page 10 1. The proposed model for after-hours care in Hurunui aims to provide safe, accessible, time-appropriate, affordable, after-hours care which is as close to home as possible. The model supports alliances between Hurunui practices by providing a district service that is accessible to all practices, patients and visitors to the area. It proposes two teams for after-hours care - Hurunui North (Amuri and Hanmer Springs) and Hurunui South (Amberley, Waikari and Cheviot). It further proposes that an observation service be located in Amberley, at the junction of the two main travel routes south to Christchurch (see proposed service number 2). 2. This means these practices will work together to provide a rostered service for patients needing to access acute after-hours care. 3. Through this alliance, staff will be shared in addition to other resources. It is anticipated there will also be secure sharing of patient records to ensure safe delivery and continuity of care. 4. There has been a subgroup working on the operationalisation of this after-hours alliance, which is well advanced in its thinking but no decisions have been made at this stage. If you or your family/ whānau need acute care after-hours, you will receive care from either the northern or southern area rostered service where you are enrolled. You would be able to go to either the northern or southern clinics to be seen in after-hours clinics, as part of the after-hours alliance. Under this alliance, people enrolled in a Hurunui practice would receive services as an enrolled patient at any of the five practices.

Proposed service Description What it means for you 2. An acute observation service which enables observation and care to be delivered closer to home. This service will determine either if you should be admitted to Christchurch or if you can be cared for in the community, under the care of the general practice team. 1. Pop-up observation services will be provided in general practice so you can be observed by a nurse, doctor or paramedic up until a determined time in any one day for example through normal working hours and up until 7pm. 2. In addition to this, it is proposed that a in and after-hours observation unit be established and located in Amberley for those people who would benefit from daytime/overnight observation, rather than straight admission to Christchurch Hospital. The observation centre is proposed to be located in Amberley for reasons of 24-hour medical cover resourcing and flow/ direction of care, should you need secondary/tertiary hospital care. 3. As part of this service non-urgent conditions could be assessed and treated in your home with referral to the acute observation service when needed. Using the observation service workforce is also a consideration. Please note: Further investigation is required to locate an appropriate site in Amberley as part of the proposed observation service. You and your whānau may be able to receive treatment and observation at home, in your primary care service or in the proposed observation unit in Amberley, rather than having to be transferred to an after-hours facility or the Emergency Department in Christchurch. 3. Provision of aged home-based care, rest home residential care, dementia and hospital level care services across the Hurunui. 1. Where possible and appropriate, services will be delivered in your home with your family/whānau supported by district nursing; restorative home-based care and palliative care support teams. 2. To consider the future needs of our ageing population it is proposed a taskforce be established to design a model of aged care service provision that takes into account both the geographical spread of the population and the predicted trends of population ageing, growth and population decline. 3. The provision of hospital level care also needs to meet standards set by Canterbury District Health Board which includes access to 24-hour cover by a medical practitioner. 4. It is proposed that this taskforce will be established once the Model of Care has been finalised and will also consider provision of respite care for under 65s. You are supported to age well in your own home, or as close to home as possible, and in your own community. Page 11

Proposed service Description What it means for you 4. An enhanced acute community nursing service providing the most appropriate urgent care options for you at any given time, with the intent of avoiding a hospital admission. 1. General practice and acute community nursing deliver packages of care that allow people who may otherwise need an Emergency Department visit and possible hospital admission to be treated in their own homes or community. There is an opportunity to extend this service to include home visits and for a flexible funding package to be developed through the Acute Demand Management Service (ADMS). 2. The full use of electronic nurse standing orders will support this enhanced acute community nursing service. 3. PRIME initiated medical call-outs and the provision of stabilisation services by rural general practice or by district nursing Services before transportation to hospital will be considered by a small working group under Canterbury Clinical Network s Urgent Care Service Level Alliance. You and your whānau are supported to receive some types of acute care at home and in your own community, rather than requiring a visit to the Emergency Department. 5. Restorative Community Service Model for the Hurunui and the development of agreed pathways. 1. The enhancement of the current service would see the general practice team and the district nursing service (as the coordinators of care) integrated with the home-based community service provider to deliver a wrap around service, supporting the restoration of function and independence for people who have experienced a period of illness or a hospital stay. The care package would be responsive to patient needs and goals and would enable patients to maintain independent living at home, or be discharged to home after a hospital event to continue with their rehabilitation. The intent here would be that they reduce their need for home support and increase their function and independence at home, over time. 2. This involves your care team and could include the general practice team; district nurses; physiotherapists; occupational therapists, Whānau Ora navigators and case workers etc. 3. The use of Acute and Personalised Care Plans will be part of this integrated approach. If you or your whānau have experienced a period of illness or reduced function, you will be supported with a package of care, delivered by care workers and health professionals, to restore your function and independence so you can live well at home and in your own community. Page 12

Proposed service Description What it means for you 6. Enhanced transfer of care from secondary to primary care/ community care. 1. Primary and secondary services will work together to put a discharge (transfer of care) plan in place, prior to discharge from hospital, that takes into consideration services in the rural setting. 2. It is also proposed that a rural transfer of care hospital health pathway be developed to ensure that an optimal standard of care is achieved for you when you re transferred from secondary care to the rural primary care setting. Transfer of care is planned and services are in place to meet your identified needs before you are discharged/ transferred. 7. Consideration of extended scope for Allied Health services. 1. We want to support advanced roles for pharmacy, such as assessment and treatment of minor aliments; referral for mental health assessment etc. 2. Ensure there is equitable access to allied health professionals across the district (physiotherapy and occupational therapy). You are supported to access the services you need, and all health professionals are empowered to provide or enable the right care and support, to the right person, at the right time and in the right place. 8. Consideration of a coordinated and targeted response to supporting migrant worker access to health and social services. 1. A coordinated response is required to support and advocate for the delivery of improved and culturally appropriate health services for migrant farm workers living and working in the Hurunui. It is proposed that this will be a shared approach across all five practices. If you re a migrant worker living and working in the Hurunui, you ll be supported to access coordinated culturally appropriate health and social services. 9. Transportation 1. We want a coordinated transportation service across the Hurunui district. 2. Links will be made to work that is already underway by the community development Together Hurunui Forum. Alternative responses will be investigated to increase the number of ambulance service volunteers by being flexible about how we use the current workforce. This includes the use of rural nurse specialists, rural practice nurses and rural firefighters. You ll be supported with transport when the need arises. Page 13

2. Enhanced integrated health care Proposed service 1. Integrated care across all five primary care teams in the Hurunui. Page 14 1. To enable coordinated healthcare across the Hurunui and create potential economic efficiencies, it is recommended that the existing four Community Health Trusts consider the creation of an integrated entity (i.e. single Trust, joint venture, or other). 2. It is further proposed that a strategic partnership is formed with this integrated entity and the privately owned practice in Amberley for the purposes of health service planning, collaboration and sustainable health care delivery across the Hurunui district. 3. It is proposed this strategic partnership will provide clear pathways for patients seen in-hours and out-of-hours with provision for how services will be delivered. 4. What it will mean for the workforce: Description 4.1. Workforce resources are potentially shared across the district and medical back up is enhanced; 4.2. Both doctors and nurses who are willing can work at the highest level of their scope of practice; 4.3. Continued development of a district-wide clinical education and training programme for primary care and community health care will facilitate clinical integration and strengthen relationships; 4.4. Any economies generated by efficiencies are redirected into health care delivery in the Hurunui district; 4.5. Appropriate levels of healthcare professionals are maintained and/or access to this resource through use of technology; 4.6. A secure shared patient record is accessible across all practices for after-hours service delivery, to supplement the information on HealthOne and allow the provider to enter details in the patient record, even if the patient is enrolled in a neighbouring practice; 4.7. Appropriate administration staff levels are maintained and services are reconfigured to address any areas of duplication. Note: Where there is any change in working practice proposed, it will be the responsibility of the employer to consult with staff, unions and other registration bodies. What it means for you You and your whānau will still have access to health services in your area. You are better supported in the community to stay well in your own home, or as close to your own home as possible. You ll have access to specialist clinics using Telehealth where practical. There will be better continuity and consistency of care through an integrated health service team that can respond to your health needs.

Proposed service Description What it means for you 2. Extension of generic health nurse roles that have special interests and extended use of advanced nursing roles. 1. Enabling the best blend of generalist and specialist extended nursing roles available as a resource across the district through training and a shared skills development strategy i.e. Hurunui registered nurses have extensive generalist skills and some have special expert knowledge of chronic diseases that are prevalent in the Hurunui district i.e. diabetes, respiratory, renal diseases and cardiac conditions. It is proposed that, where these nurses are willing, this will become a shared resource across the Hurunui. 2. To support the maintenance and extension of service coverage. This would include the use of nurse-led clinics with medical back-up across the district or nurse practitioner-led clinics. 3. It could also consider nurse career development pathways from graduate to rural nurse specialist/nurse practitioner that support the sustainable delivery of services in the Hurunui. You will continue to have access to services with your primary care team. The vision is for registered nurses with specialist knowledge and nurse practitioners to see you for general health appointments, in addition to scheduled doctor appointments. You would have access to special interest clinics i.e. women s health including intra-uterine device insertion, youth clinics; community mental health or men s health clinics. 3. Innovative technology Proposed service Description What it means for you 1. Telehealth (video) clinics with specialists in Christchurch and advocacy for access to improved rural broadband. There is a vision for pre-arranged or emergency clinics or consultations with specialist consultants including mental health service; palliative care specialists; emergency department etc to be held by Telehealth. The following equipment is needed to support and enable this greater use of technology: 1. Access to ultra-fast broadband/ fibre broadband/ other broadband; 2. Ongoing technology support which will provide a sustainable infrastructure and allow for maximising effective use of technology. The vision is that general practice and PRIME teams will be enabled to link with their Emergency Department colleagues to consult on emergency situations in the field, or from any one of the five primary care health centres. This can include the use of video and use of photo imaging to support diagnosis. Along with your local general practice team, you will be able to link to a specialist who is located in Christchurch. You may be able to receive assessment, follow-up and treatment using this secure video link e.g. oncology check-up via Telemedicine facility with local nurse present to support you; specialist mental health or palliative care consults. Page 15

4. Patient care pathways (including after-hours pathways) In order to better coordinate local health services, it is proposed that a set of guidelines be developed outlining the best methods for caring for all of our patients. These guidelines, usually called Pathways for Care or Patient Pathways, help health professionals provide you and your whānau with more consistent, coordinated and integrated care. These are yet to be scoped and developed and will be an integral part of the implementation step. Examples of Pathways for Care include long term conditions, preventative care, youth health care, urgent/ emergency, older person s care etc. In order to better coordinate local health services, it is proposed that a set of guidelines be developed outlining the best methods for caring for patients across our district Proposed service 1. The potential adaptation/ adoption of St John referral pathways. Description 1. Investigate the use of St John and Access Community Health (Home Care Provider) to assist in the assessment and referral for falls risk, Chronic Obstructive Pulmonary Disease (COPD) and heart failure pathways, mental health assessment and referral etc. What it means for you You are supported to access the services you need, and all health professionals are empowered to provide or enable the right care and support to you, at the right time and in the right place and Any door is the right door. Page 16

5. Collective working relationships To deliver on this new integrated Model of Care, the maintenance and development of strong working relationships is required to ensure that the best possible service is available to you. In addition to this, continued training and support to staff via the Canterbury DHB, Canterbury Initiative, Pegasus Education Programme and Rural Canterbury PHO will ensure continuity and consistency of care, and maximise the resources available across our rurally diverse community. These important relationships include, but are not limited to: The Hurunui community Te Ngāi Tūāhuriri Rūnanga and Tuahiwi Marae. Te Rūnanga o Kaikōura and Takahanga Marae Hurunui District Council Rural Canterbury PHO Local pharmacy services St John Plunket Allied health providers Access Community Health Dental services Local schools Community groups Canterbury DHB departments and divisions Canterbury Clinical Network The Canterbury Initiative Governmental organisations e.g. ACC, Work and Income Nongovernmental organisations e.g. Presbyterian Support Services Well-being North Canterbury, Barnardos Community Development Groups e.g. Together Hurunui Forum Rural Support Trust Frog Rock, Waikari Images kindly provided by Hurunui District Council, Canterbury District Health Board (CDHB), Hanmer Springs Health Centre and Waikari Health Centre. Icons designed by freepik Page 17

Glossary Acute Health conditions which come on quickly and would rapidly become worse without medical intervention ADMS After-hours Allied health ARC Care teams CCN Acute Demand Management Service - general practice and acute community nursing deliver packages of care that allow people who would otherwise need an emergency department visit / possible hospital admisison, to be treated in their own homes Outside of normal working hours. Also referred to as out of hours. Health professional who provide services that are complementary to medical services, such as dietitians, social workers, physiotherapists or speech language therapists Aged Residential Care = age-related residential care Any person who is involved in your care, from your general practitioner to your pharmacist and physiotherapist Canterbury Clinical Network is a collective alliance of healthcare leaders, professionals and providers from across the health system CDHB Clinician Equitable HealthOne Health pathway / patient pathway PHO Primary care PRIME Restorative Standing order Stoma Telehealth/ Telemedicine Tertiary care Transfer of care Page 18 Canterbury District Health Board - the main planner and funder of health services in Canterbury and a provider of hospital and specialist services A person who works directly with patients, rather than in a laboratory or as a researcher Care that doesn t vary in quality based on personal characteristics, such as ethnicity, gender or geographic location A secure record that stores health information including GP records, prescribed medications and test results A set of guidelines health professionals agree are the best methods for caring for patients. These guidelines help health professionals provide patients and their whānau with more consistent, coordinated and integrated care Primary Health Organisation Usually the first primary port of call for health needs, such as a General Practice team. Usually refers to day-to-day care Primary Response in Medical Emergencies - timely access to pre-hospital emergency treatment in areas where access to appropriate skills, such as paramedics, are not available Support that is central in restoring a patient to their greatest potential for independence A written instruction issued by a medical practitioner, dentist, nurse practitioner or optometrist. It authorises a specified person or class of people (eg, paramedics, registered nurses) who do not have prescribing rights to administer and/or supply specified medicines and some controlled drugs. A surgically made opening from the inside of an organ to the outside - usually diverts faeces or urine into a pouch on the outside of your body Health services are delivered via video because the patient and health provider are not in the same physical location Advanced medical investigation and treatment, sometimes on an inpatient basis and usually provided in a hospital Sometimes called a referral or discharge, a transfer of care is when you are transferred from one care team to another

Have your say... Thank you for taking the time to find out more about the proposed MoC - now is your chance to have your say, by providing your feedback. We d like feedback on what you like and agree with, as well as suggestions for changes, or other ideas. Your feedback will be incorporated into the Model of Care. Please use this pull-out page to provide feedback on each aspect of the proposal (referring to page and point number) and either: put it in the drop boxes at your nearest medical centre or council service centre; or post it to Canterbury Clinical Network, PO BOX 741, Christchurch. Alternatively you can submit your feedback using the online feedback form at: http://bit.ly/2yoswm3 or email feedback to: info@ccn.health.nz The deadline for feedback is 4pm, Friday 22 December 2017 Comments/ suggestions Example: Pg 18, no 4: I agree we need to enhance our acute nursing service because... Page 19

Comments/ suggestions Example: Pg 18, no 4: I agree we need to enhance our acute nursing service because... Page 20 Published November 2017 ccn.health.nz