AGENDA...2019/05/29 · 2.2 Minutes of the Hospital Advisory Committee (08/05/19) 2.3 Minutes of the Disability Support Advisory Committee (04/04/19) 9.50am 3. CHAIR REPORT 4. EXECUTIVE

BOARD MEETING

Wednesday 29 May 2019

9.45am

AGENDA

Items to be considered in public meeting

VENUE

Waitemata DHB Awhina Conference Centre Snelgar Building Waitakere Hospital Lincoln Road, Henderson

Karakia

E te Kaihanga e te Wahingaro

E mihi ana mo te ha o to koutou oranga

Kia kotahi ai o matou whakaaro i roto i te tu waatea.

Kia U ai matou ki te pono me te tika

I runga i to ingoa tapu

Kia haumie kia huie Taiki eee.

Creator and Spirit of Life

To the ancient realms of the Creator

Thank you for the life we each breathe to help us be of one mind

As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware

Of the need to be fair and transparent in all we do.

We ask this in the name of Creation and the Living Earth.

Well Being to All.

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Waitematā District Health Board, Meeting of the Board 29/05/19

MEETING OF THE BOARD 29 May 2019

Venue: Waitematā DHB, Awhina Conference Room, Snelgar Building, Waitakere Hospital Time: 9.45am

WDHB BOARD MEMBERS Judy McGregor – WDHB Board Chair Max Abbott - WDHB Board Member Edward Benson-Cooper – WDHB Board Member Kylie Clegg – WDHB Board Deputy Chair Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Matire Harwood - WDHB Board Member Brian Neeson – WDHB Board Member Morris Pita - WDHB Board Member Allison Roe - WDHB Board Member

WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Deputy Chief Executive Officer and Chief Medical Officer Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Cath Cronin - Director of Hospital Services Tamzin Brott - Director of Allied Health Fiona McCarthy - Director Human Resources Peta Molloy – Acting Board Secretary

APOLOGIES: Max Abbott

REGISTER OF INTERESTS

Does any member have an interest they have not previously disclosed?

Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

PART 1 – Items to be considered in public meeting

AGENDA

1. AGENDA ORDER AND TIMING

2. BOARD AND COMMITTEE MINUTES

9.45am 2.1 Minutes of the Meeting of the Board (17/04/19)

Actions arising from previous meetings

2.2 Minutes of the Hospital Advisory Committee (08/05/19)

2.3 Minutes of the Disability Support Advisory Committee (04/04/19)

9.50am 3. CHAIR REPORT

4. EXECUTIVE REPORTS

9.55am

10.05am

10.15am

4.1 Chief Executive Officer’s Report

4.2 Health and Safety Performance Report

4.3 Communications Report

5. PERFORMANCE REPORT

5.1 Financial Performance

6. RESOLUTION TO EXCLUDE THE PUBLIC

3



Board/Committee Member

Involvements with other organisations

Last Updated

Judy McGregor (Chair)

Associate Dean Post Graduate - Faculty of Culture and Society, AUT Member - AUT’s Academic board New Zealand Law Foundation Fund Recipient Consultant - Asia Pacific Forum of National Human Rights Institutions Media Commentator - NZ Herald Patron - Auckland Women’s Centre Life Member - Hauturu Little Barrier Island Supporters’ Trust

28/03/19

Max Abbott Pro Vice-Chancellor (North Shore) and Dean - Faculty of Health and Environmental Sciences, Auckland University of Technology Patron - Raeburn House Advisor - Health Workforce New Zealand Board Member - AUT Millennium Ownership Trust Chair - Social Services Online Trust Board member - Rotary National Science and Technology Forum Trust

19/03/14

Edward Benson-Cooper Chiropractor - Milford, Auckland (with private practice commitments) Edward has three (different) family members who hold the following positions: Family member; FRANZCR. Specialist at Mercy Radiology. Chairman for Intra Limited. Director of Mercy Radiology Group. Director of Mercy Breast Clinic. Family member; Radiology registrar in Auckland Radiology Regional Training Scheme. Family member; FANZCA FCICM. Intensive Care specialist at the Department of Critical Care Medicine and Anaesthetist at Mercy Hospital.

25/03/19

Kylie Clegg (Deputy Chair)

Trustee - Well Foundation Director - Auckland Transport Director - Sport New Zealand Trustee and Beneficiary - Mickyla Trust Trustee and Beneficiary, M&K Investments Limited (includes a share of less than 1% in Orion Health Group). Orion Health Group has commercial contracts with Waitemata DHB and healthAlliance Director of High Performance Sport New Zealand Limited Board member, Counties Manukau District Health Board Shareholder – Genesis Energy Ltd.

03/04/19

Sandra Coney Member - Waitakere Ranges Local Board, Auckland Council Patron - Women’s Health Action Trust Member - Portage Licensing Trust Member - West Auckland Trusts Services

15/12/16

Warren Flaunty Member - Henderson–Massey Local Board Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder - Green Cross Health Director - Life Pharmacy Northwest Chair - Three Harbours Health Foundation Director - Trusts Community Foundation Ltd Trustee – Hospice West Auckland (past role) Shareholder - Genesis Energy

12/09/18

4



Board/Committee Member

Involvements with other organisations

Last Updated

Dr Matire Harwood Senior Lecturer - Auckland University Director - Ngarongoa Limited, which is contractor providing services to National Hauora Coalition GP at Papakura Marae Health Clinic Advisory Committee Member - State Foundation NZ (Māori Health) Member Te Ora, Māori Medical Practitioners Step-daughter is a surgical registrar at Waitemata DHB

10/05/18

James Le Fevre Emergency Physician - Auckland Adults Emergency Department Trustee - Three Harbours Foundation Member - Medical Protection Society Member - Northern Regional Clinical Practice Committee Shareholder - Pacific Edge Ltd DHB Representative (Auckland and Waitemata DHBs) - Air Ambulance Co-design Procurement Governance Board (past role) James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society Board Member - Auckland District Health Board (past role) Shareholder - Genesis Energy

21/11/18

Brian Neeson Member - Upper Harbour Local Board Member - Human Rights Review Tribunal Member - Auckland District Licensing Committee Managing Director - BK & VS Neeson Limited Managing Director - Apollo Property Investments Limited Property Development Consultant Chair – Wilson Home Committee of Management (past role)

19/12/18

Morris Pita Owner/operator - Shea Pita and Associates Limited. Shareholder - Turuki Pharmacy Limited Member - Eden Park Trust Board Shareholder and Director of Healthcare Applications Limited. In December 2018 this company won an RFP with Waitemata DHB for provision of the Emergency Q software service to reduce overcrowding in the ED and the company is currently (as at 27 March 2019) in the final stages of negotiation for a potential contract for service at both North Shore and Waitakere EDs. Morris’ wife is a:

Board member - Northland District Health Board Board member - Auckland District Health Board Director - Healthcare Applications Limited Director - Shea Pita & Associates

27/03/19

Allison Roe Chairperson - Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council Member - Wilson Home Committee of Management (past role)

22/08/18

5

Waitemata District Health Board, Meeting of the Board 17/04/19

Conflicts of Interest Quick Reference Guide

Under the NZ Public Health and Disability Act 2000, a member of a DHB Board who is interested in a transaction of the DHB must, as soon as practicable after the relevant facts have come to the member’s knowledge, disclose the nature of the interest to the Board. A Board member is interested in a transaction of a DHB if the member is:

a party to, or will derive a financial benefit from, the transaction; or

has a financial interest in another party to the transaction; or

is a director, member, official, partner, or trustee of another party to, or person who will or may derive a financial benefit from, the transaction, not being a party that is (i) the Crown; or (ii) a publicly-owned health and disability organisation; or (iii) a body that is wholly owned by 1 or more publicly-owned health and disability organisations; or

is the parent, child, spouse or partner of another party to, or person who will or may derive a financial benefit from, the transaction; or

is otherwise directly or indirectly interested in the transaction. If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out responsibilities, then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. A board member who makes a disclosure as outlined above must not:

take part in any deliberation or decision of the Board relating to the transaction; or

be included in the quorum required for any such deliberation or decision; or

sign any document relating to the entry into a transaction or the initiation of the transaction. The disclosure must be recorded in the minutes of the next meeting and entered into the interest register. The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if a majority of other members of the Board permit the member to do so. If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned. Board members are expected to avoid using their official positions for personal gain, or solicit or accept gifts, rewards or benefits which might be perceived as inducement and which could compromise the Board’s integrity. IMPORTANT Note that the best course, when there is any doubt, is to raise such matters of interest in the first instance with the Chair who will determine an appropriate course of action. Ensure the nature of the interest is disclosed, not just the existence of the interest. Note: This sheet provides summary information only. 2

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2.1 Confirmation of Minutes of the Board meeting held on 17 April 2019 Recommendation: That the Minutes of the Board meeting held on 17 April 2019 be approved.

7


DRAFT Minutes of the meeting of the Waitemata District Health Board

Wednesday, 17 April 2019

held at the Boardroom, Level 1, 15 Shea Tce, Takapuna, commencing at 9.50am

PART I – Items considered in public meeting

BOARD MEMBERS PRESENT:

Judy McGregor (Board Chair) Max Abbott Edward Benson Cooper Kylie Clegg (Deputy Board Chair) Sandra Coney Warren Flaunty Matire Harwood Brian Neeson Allison Roe

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Debbie Holdsworth (Director Funding) Karen Bartholomew (Acting Director, Health Outcomes) Cath Cronin (Director of Hospital Services) Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Fiona McCarthy (Director Human Resources) Paul Garbett (Acting Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

There were no media representatives or members of the public present. WELCOME:

The Board Chair welcomed everyone to the meeting.

APOLOGIES:

Apologies were received and accepted from James Le Fevre and Morris Pita. DISCLOSURE OF INTERESTS

There were no additions or other amendments to the Interests Register.

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There were no interests declared that might involve a conflict of interest with an item on the open agenda.

1 AGENDA ORDER AND TIMING

For the open meeting, items were taken in same order as listed in the agenda, except that Actions Arising from previous Board meetings was considered after Item 2.4.

2 BOARD AND COMMITTEE MINUTES

2.1 Confirmation of Minutes of the Board Meeting held on 6 March 2019 (agenda pages 8-32)

Resolution (Moved Allison Roe/Seconded Kylie Clegg)

That the Minutes of the Board meeting held on 6 March 2019 be approved.

Carried Actions arising from previous meetings (agenda pages 33-34)

No issues were raised.

2.2 Confirmation of the Minutes of the Special Meeting of the Board held on 18 March 2019 (agenda pages 35-37)

Resolution (Moved Warren Flaunty/Seconded Kylie Clegg)

That the Minutes of the Special Meeting of the Board held on 18 March 2019 be approved.

Carried

2.3 Minutes of the Hospital Advisory Committee Meeting held on 27 March 2019

(agenda pages 38-48)

Resolution (Moved Sandra Coney/Seconded Allison Roe)

That the draft minutes of the Hospital Advisory Committee meeting held on 27 March 2019 be received. Carried

2.4 Minutes of the Community and Public Health Advisory Committees Meeting held on

20 February 2019 (agenda pages 49-58)

Resolution (Moved Warren Flaunty/Seconded Edward Benson-Cooper)

That the Draft Minutes of the Auckland and Waitemata DHBs’ Community an Public Health Advisory Committees meeting held on 20 February 2019 be received.

Carried

9


3 CHAIR REPORT

3.1 Board Chair’s Report (agenda pages 59-60 )

The Board Chair briefly introduced her report. In answer to a question, she highlighted the comment in the report that it may be useful following the Ministerial visit to Waitakere Hospital, to arrange a wider briefing for regional Members of Parliament about the NRLTIP and this is something that Waitemata DHB could progress at the Regional Governance Group, with Auckland, Counties Manukau and Northland DHBs. In answer to a question, the Chief Executive advised that Auckland Council planners sit on the LTIP planning group and there is a lot of co-operation with the Council in terms of sharing planning information. The Group also talks with Treasury and Auckland Transport at times. He had offered to brief the Mayor of Auckland and Councillors on LTIP, and currently they were trying to set a time for this. The Board Chair commented that if any opportunity arose to consult with local Members of Parliament, that opportunity should be taken. The report was received.

4 EXECUTIVE REPORTS

4.1 Chief Executive’s Report (agenda pages 61-84)

The Chief Executive introduced the report highlighting:

The comments concerning the tragic events in Christchurch (page 61 of the agenda). He also paid tribute to Canterbury DHB which had managed the medical issues incredibly well.

The Ministerial visit to Waitakere Hospital (page 61 of the agenda). A follow up letter from the Minister had acknowledged a well submitted case for the major re-development and expansion of Waitakere Hospital.

The CEO Lecture by the Minister of Finance Grant Robertson (page 62 of the agenda) had been very interesting and well received. The next lecture would be by Professor Ron Paterson on the Mental Health Inquiry.

The Health Hero award for March to Florethel Henderson (page 63 of the agenda) and the very great support shown for this award to her.

The 35 year anniversary of the opening of North Shore Hospital Tower Block (pages 64-65 of the agenda).There were still a number of staff working here who were here on opening day. In the next year he would like to invite back some of the founding staff in recognition of the contribution made.

Mason Clinic redevelopment (page 67 of the agenda).

The summary of findings from the Ministry of Health’s recent publication assessing the quality of care and outcomes for people diagnosed and treated for bowel cancer in New Zealand (pages 71-74 of the agenda).

The CEO Scorecard (page 79 of the agenda). CT scans and MRI scans timelines continued to be the main issue. Endoscopy results were improving. Most of the other measures were looking quite good.

10


Matters covered in discussion or response to questions included:

The achievements of the Well Foundation in raising the funds for the new mobile dental clinic and for the Waitakere Hospital Chapel and Spiritual Centre were acknowledged. It was agreed that the Well Foundation members be invited to the next Board meeting. The Waitakere Hospital Chapel and Spiritual Centre will be formally opened on 4 June and Board members will be invited. There will be a week of events there to celebrate the opening.

The Chief Executive advised that after the Christchurch tragedy, all Government facilities, including hospitals, were placed on high alert. Extra security had been placed for a time at front doors and there remained increased awareness. The management of major public events from a security viewpoint will also need to be strengthened.

Sandra Coney expressed concerns regarding the cancellation of smaller Anzac Day events and the encouragement to attend major events, in particular in the West encouragement to attend the Waikumete Cemetery ceremony, which already struggled for space for ceremonies. It was agreed that these concerns be discussed with the organising authority.

The encouraging response from patients to the telehealth appointment trial (page 71 of the agenda) was noted. The Chief Executive advised that there were several strains with telehealth, including use in primary care. It was being looked at service by service and a number of clinical services had been piloting its use and were keen about it. The next stage is to feed back to wider groups of clinical staff. In response to a request, he agreed that a paper would be provided for the Board at an appropriate point on telehealth in comparison to face to face appointments; including what patients and clinicians think about it and also the safety aspects.

The report was received.

4.2 Health and Safety Performance Report (agenda pages 85-94)

Michael Field (Group Manager, Occupational Health and Safety Service) and Fiona McCarthy (Director, Human Resources) presented this item.

Fiona McCarthy updated the Board on the Influenza Vaccination programme for staff. This had started the previous week and 32% of staff had been vaccinated so far. The target was 60% but they were aiming at 80%. Approximately 90 vaccinators were being used across the DHB over a six week period. The message to staff was based on patient safety. The vaccination this year covered four strains of influenza, including the one currently circulating.

Fiona McCarthy referred to the recent fine of $500,000 for Southland DHB as a result of its liability for a serious accident involving contracted work to decommission an X-ray machine on its site.

The meeting was also advised that a Safety and Security Audit had just commenced and a report was expected from that in six to eight weeks.

Matters covered in discussion and response to questions included:

With regard to aggression, more information will be provided in future reports on drivers of this and what is being done to address it.

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For the influenza vaccination campaign, there had been discussions with Counties Manukau and Auckland DHBs on what they have done and the approaches they use had all been adopted. The campaign particularly targeted those areas with patients at high risk including community clinics and those areas of the hospitals with vulnerable patients or low uptake of vaccinations. In the next week they would start to see what patterns were emerging and work with the Director of Hospital Services on areas to focus on.

Debbie Holdsworth advised that rest homes were responsible for vaccinations, although the DHB sets the expectation.


4.3 Communications Report (agenda pages 95-100)

Matthew Rogers (Director Communications) was in attendance for this item. The report was taken as read. Matters covered in discussion and response to questions included:

The CEO lectures are traditionally planned for DHB staff, however when relevant other groups are invited. For example it may be appropriate to invite PHOs and other DHB partners. Max Abbott pointed out that there may be good opportunities to engage with stakeholders after the lectures.

With the media clippings ratings, Matt Rogers advised that these are not about the headlines but reflect any references to Waitemata DHB.


5 DECISION ITEMS 5.1 Privacy Maturity Assessment 2018-2019 (agenda pages 101-120)

Amanda Mark (General Counsel) was present for this item.

The report was taken as read.

Matters covered in response to questions included:

Amanda Mark advised that there were a few areas, such as improving the rate of completion of the privacy e-learning module by medical staff, where they were not quite where they had hoped to be, but generally there had been steady improvement in the DHB’s privacy maturity.

There is a proposed amendment to the Privacy Act, but that would not make a major change to the Board’s current approach to privacy.

Resolution (Moved Matire Harwood/Seconded Max Abbott)

That the Board:

a) Approves the attached 2018-19 Privacy Maturity Assessment Report for submission to the Government Chief Privacy Officer.

b) Approves the achievements against targets from 2018-19.

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c) Approves the targets which have been set for improving Waitemata DHB’s privacy maturity over the next 12 months.

Carried 6 PERFORMANCE REPORTS

6.1 Financial Performance (agenda pages 121-133)

Robert Paine (Chief Financial Officer and Head of Corporate Services) introduced this report. He noted that reporting was against the revised budget deficit of $7M for the 2018/19 financial year as submitted for consideration and approval of the Minister of Health. One significant initiative towards achieving that result was encouraging Corporate Services staff to take annual leave in the week following Easter. In his view Waitemata DHB was basically on target to achieve the $7M deficit target at the end of the financial year. The focus was now on the budget for 2019/20 and getting that into better shape, but they would not know how that was looking until after the Government’s budget. In response to a question, Robert Paine advised that it was not necessarily the case that gaps in service and vacancies produced more favourable budget results. Vacancies in clinical roles are not used as a cost saving measure. Where vacancies cannot be filled that usually meant overtime or outsourcing, which is often more expensive than filling the vacancy.


7 INFORMATION PAPERS

7.1 Statement of Performance Expectations (SPE) Performance Report: Quarter Two 2018/19 (agenda pages 134-145)

Karen Bartholomew (Acting Director Health Outcomes) presented this report.

The report was taken as read.

Later in the meeting the issue was raised of why referrals that wait more than 48 hours for a hospice bed were 18% compared to target of >5. The meeting was advised that this may relate to the West Auckland Hospice facility closing its inpatient beds and patients not wanting to go elsewhere. Another development regarding hospice services was an increase in day stay focus, making possible an increase in caseload. A report covering hospice issues will be coming to the Board.


7.2 System Level Measures – Quarter 2 Report (agenda pages 146-166)

Wendy Bennett (Planning and Health Intelligence Manager) and Karen Bartholomew (Acting Director Health Outcomes) presented this report. Karen Bartholomew noted the focus on Maori and Pacific health outcomes.

Matters covered in discussion and response to questions included:

The limitation with the amenable mortality data (12 monthly to December 2015) was noted.

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Karen Bartholomew commented that ASH (Ambulatory Sensitive Hospitalisations) were driven by social determinants, such as housing. A substantial increase in immunisation rates for children was pleasing.

Wendy Bennett advised that work is being done to introduce coding of alcohol related ED presentations at Waitemata DHB as done already at Counties-Manukau and Auckland DHBs.

It was noted that Oral Health is an equity priority, a significant and increasing problem for Pacific and Maori children.

The health issues related to vaping were raised. Karen Bartholomew advised that ARPHS is looking closely at that issue and will provide an update on that. The question of whether or not there is any risk to others (like second hand smoke inhalation for smoking) could also be responded to. The Chief Executive advised that there had been a briefing to the national meeting of CEOs the previous week on vaping. The Government is going to regulate on vaping, including such matters as prohibiting it in areas where smoking is prohibited. The Government has also released a position statement on vaping, including international evidence, which will be provided to the Board. The general advice is that it is best to quit smoking without recourse to vaping, however switching from smoking to vaping may provide a route to quitting smoking.


8. RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 167-170)

Resolution (Moved Warren Flaunty/Seconded Kylie Clegg)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1

Minutes of Meeting of the Board - Public Excluded (06/03/19)

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

Confirmation of Minutes

As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

14





2 Minutes of Special Meeting of the Board - Public Excluded (18/03/19)




3 Minutes of the Audit and Finance Committee – Public Excluded (27/03/19)


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.

[Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

4 Minutes of the Hospital Advisory Committee – Public Excluded (27/03/19)

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.

[NZPH&D Act 2000 Schedule 3, S.32 (a)]



5 All of Government Electricity Tranche 11



[Official Information Act 1982 S.9 (2) (i)]

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Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)]

6 Advanced Interventional Radiology Outsourcing



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


7 Renewal of Lease – 2 Lake Pupuke Drive, Takapuna


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information

16





would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


8 Mason Clinic – Tanekaha Replacement Unit Main Works Contract




9 Elective Capacity and Inpatient Beds (ECIB) Preliminary Design Phase to Project Completion Professional Services Procurement




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10 Regional Flexible Funding Pool Application and Governance Structure across Auckland




11 Surgical Mesh - Urogynaecology



Carried The open meeting concluded at 10.48a.m. SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 17 APRIL 2019 CHAIR

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Actions Arising and Carried Forward from Previous Board Meetings as at 22 May 2019

Meeting Date

Agenda Ref

Topic Person Responsible

Expected Report back

Comment

06/03/19 4.3 Communications - give thought on possibility of elevating public debate on key population health issues and provide comment to the Board.

Matt Rogers

Matt to provide a verbal update at meeting 29.05.19

06/03/19 5.2 Leapfrog Programme Stage 3 – consider whether there are possibilities of assisting those DHBs who have limited resources to undertake this type of work.

Robyn Whittaker

Currently (April 2019) having discussions with our CIO including about proposed Digital Academy. Will be giving consideration to this request from the Board.

17/04/19 4.1 Telehealth – paper to be provided at an appropriate time on telehealth in comparison to face to face appointments, including what patients and clinicians think about it and also the safety aspects.

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2.2 Minutes of the Hospital Advisory Committee meeting held on 08 May 2019

Recommendation: That the Draft Minutes of the Hospital Advisory Committee meeting held on 08 May 2019 be received.

20


Draft Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 108 May 2019

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 1.34 p.m.

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Judy McGregor (Board Chair) Max Abbott Edward Benson-Cooper Kylie Clegg (Deputy Board Chair) Warren Flaunty Brian Neeson

ALSO PRESENT

Dale Bramley (Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Cath Cronin (Director of Hospital Services) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director Human Resources) Tamzin Brott (Director of Allied Health) Lorraine Bailey (IDF Performance Manager) Peta Molloy (Acting Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

There were no members of the public or media present. WELCOME

The Committee Chair welcomed those present. APOLOGIES

Apologies were received and accepted from Sandra Coney, Allison Roe, Matire Harwood and Morris Pita.

DISCLOSURE OF INTERESTS

There were no additions to the Interests Register. There were no interests declared that might give conflict with a matter on the open agenda.

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1. AGENDA ORDER AND TIMING Items were taken in the same order as listed in the agenda.

2. COMMITTEE MINUTES

2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 08

May 2019 (agenda pages 8 - 18)

Resolution (Moved Kylie Clegg/Seconded Warren Flaunty) That the Minutes of the Hospital Advisory Committee meeting held on 08 May 2019 be approved. Carried Actions Arising (agenda pages 19) The actions were noted. No issues were raised.

3. PROVIDER ARM PERFORMANCE REPORT 3.1 Provider Arm Performance Report – February 2019 (agenda pages 20 - 79)

Executive Summary/Overview

Cath Cronin (Director Hospital Services) summarised the key highlights reported in this section of the report. Matters covered in discussion and response to questions included:

That a paper would be presented to the Committee focussed on ESPI.

That the Auckland region is represented on the Cancer Health Information Strategy Governance Board. Cath Cronin noted that she is on the Committee along with Richard Sullivan (Director, Cancer and Blood, Auckland DHB) and Ailsa Claire (Chief Executive, Auckland DHB). The DHB shares what it is doing in the area with the group.

That with regard to ORL (Otorhinolaryngology) patients waiting longer, it was noted that locums could be used to assist with reducing the wait time.

Human Resources No issues were raised. Acute and Emergency Medicine Division

Dr Gerard de Jong (Division Head Acute and Emergency Medical Services) and Alex Boersma (General Manager Acute and Emergency Medical Services) were present for this section of the report.

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Alex Boersma introduced the report, noting the highlight of the month ‘Role Extension for Cardiovascular Unit Nurses – Implant Loop Recorder Implanter’. The scorecard was also noted. Gerard de Jong noted the update provided on the Implementation of Home Based Wards at Waitakere Hospital. The Committee agreed that a letter of appreciation would be sent to those involved acknowledging their commitment to this programme by so many people. Gerard also noted that RACP basic training was credited for one year at both the North Shore and Waitakere Hospitals; the significant improvement in training was noted. Matters covered in discussion and response to questions included:

The Committee Chair acknowledged the achievement on patients being seen within two hours of triage in ADU.

Noting that Counties Manukau DHB presents information on the number of presentations seen by Provider staff; Gerard advised that in dialogue with external colleagues, it is intended to look at data collected to determine benchmarking.

Specialty Medicine and Health of Older People Division

Dr Gerard de Jong (Division Head Acute and Emergency Medical Services) and Brian Millen (General Manager) were present for this section of the report. Brian Millen summarised the reported highlight of the month – ‘Māori Workforce Development’. The work in this area was acknowledged and should be rolled out extensively. The Committee Chair asked that the outpatient DNA rate be disaggregated by ethnicity, this could also be done for each service and will assist in identifying any potential inequities. Child, Women and Family Services

Meia Schmidt-Uili (Head of Division Medical Child Women and Family), Emma Farmer (Head of Division Midwifery) and Marianne Cameron (Head of Division Midwifery) were present for this section of the paper. An apology was received from Stephanie Doe (General Manager). Meia Schmidt-Uili noted the reported highlight for the month, the launch of the new mobile dental clinic (page 53 of the agenda). Emma Farmer summarised the key issue ‘increased maternity and neonatal demand’ update provided. She noted that there had been an increase in admissions, but it is not yet clear if this is a trend. Matters covered in discussion and response to questions included:

That there is a lot of women presenting with diabetes and pregnancy; the first diagnosis is given when pregnant.

That with regard to the increase need for neonatal cots, Marianne Cameron noted that babies very near to discharge (around one week) had been out-lied

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to neonate nurses in the Hine Ora Ward. The outlie of neonate babies can only be done if it does not create a capacity issue in another area; each case is considered individually.

There is a lot of work continuing in the area of oral health and improving arrears. The service is being looked at region by region.

Specialist Mental Health and Addiction Services

Dr Susanna Galea-Singer (Director and Head of Division), Pam Lightbown (General Manager) and Alex Craig (Head of Division Nursing) were present for this item. Alex Craig summarised the highlight of the month ‘clozapine project’ (page 61 of the agenda), the project trains providers giving confidence to work with a wider range of people in this area. It was noted that clients are frequently under the care of the Waitematā DHB SMHA for two or three years before being transferred. The transfer of community detox clients is done in liaison with GPs. Matters covered in discussion and response to questions included:

That the DHB will consider submitting to the New Zealand cannabis referendum when more information is available.

Susanna Galea-Singer noted the increase in Whitiki Maurea referrals (page 62 of the agenda). This is being addressed with a budget bid submitted and the Psychiatry Regional Training Services having a registrar available for support. The capacity of the team needs to be reviewed and increased.

Noting that the scorecard reports that bed occupancy is running at 100%. The Committee Chair requested historical bed occupancy be provided over the past five to ten years to show upward and downward trends.

Surgical and Ambulatory Services

Debbie Eastwood (General Manager), Jonathan Wallace (Head of Department), Charles McFarlan (Clinical Director) and Penny Andrew (Director i3) were present for this item. Debbie Eastwood introduced the paper, noting in particular the update provided on surgical pathology (page 67 of the agenda). Jonathan Wallace noted that the report shows a gradual trend upwards for CT scans and MRI scans done within six weeks. He also noted the update provided on Diagnostic Services. In response to a question from the Committee Chair, Jonathan confirmed that these services would be presenting balanced scorecards. Penny Andrew summarised the more detailed information provided on the three pathways reported (from page 69 of the report): Abscess Pathway, Acute Cholecystitis Pathway and the Appendicitis Pathway.

The Committee received the report.

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4. CORPORATE REPORTS

4.1 Clinical Leaders’ Report (agenda pages 80 - 87)

Jocelyn Peach (Director of Nursing and Midwifery) and Tamzin Brott (Director of Allied Health) presented this paper. An apology was received from Andrew Brant (Deputy Chief Executive Officer and Chief Medical Officer). The Chief Executive summarised the Medical Staff report. Jocelyn Peach summarised the Nursing and Midwifery and Emergency Planning Systems section of the report. In response to a question about the workforce planning and professional development update related to the new graduate intake being low, it was noted that whole sector needs to work on increasing intake and ensuring students complete the programme. Tamzin Brott summarised the Allied Health, Scientific and Technical Professions section of the report, noting in particular the #O2TheFix toolkit shared nationally. Kylie Clegg acknowledged the presentation to be given by Heather Gunter (mother of Matthew Gunter) as part of the ACC Treatment Safety programme bringing Matthews story to New Zealand. She referenced a similar campaign ‘one ear in and one ear out’ where the mother of a teenage was tragically killed running across railway tracks with headphones on. The campaign is to encourage people to not wear headphones in both ears in certain situations.

4.2 Quality Report (agenda pages 88 - 182)

Penny Andrew (Clinical Lead, Quality), Jacky Bush (Quality and Risk Manager) and David Price (Director of Patient Experience) presented this report. In response to a question during the discussion of item 4.1 regarding the presentation from Heather Gunter (mother of Mathew Gunter) Jacky Bush advised that Heater Gunter is presenting at the DHB on Friday 21 June at 8am. Matters covered in discussion and response to questions on this item included:

That NZEWS (New Zealand Early Warning System), part of the Patient Deterioration Programme, was launched in April 2019, the scoring system for NZEWS is a national system. Penny Andrew acknowledged the work of the staff involved in the launch. An update will be provided to the Committee on this later in the year.

That the reported (page 96 of the agenda) standardised mortality rate is the lowest achieved.

Noting that it is international hand hygiene week.

Monitoring complaint response times continues and data is being reviewed of a survey undertaken, as reported in the Complainant Survey Report (page 170 of the agenda). Jacky Bush noted that a complainant survey will be undertaken on an annual basis. Reports will be presented to the Committee either six monthly or annually; the Committee Chair suggested the reports coincide with the HDC reports released.

The number of Measles cases occurring in the Auckland area was noted.

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David Price noted that he had completed a workshop on how to DHB welcomes people and providing a good reception environment; consumers were involved with the workshop.

Interviews for the new DHB Consumer Council are scheduled to take place next week.

Random calls continue to be made to different numbers across the organisation. The majority of calls made are connect quickly and if a message is left a response is received.

4.3 Human Resources Report (agenda pages 183 - 188)

Fiona McCarthy (Director Human Resources) summarised this item, noting in particular the update provided on Workforce Development. In response to a question about the progress and targets to grow the Māori Workforce, it was noted that the Rangitahi programme provides information on where people are employed after completing the programme. There is less visibility of this in relation to the Pacific Academies.

5. INFORMATION PAPERS 5.1 Winter Plan May- October 2019 (agenda pages 189 - 212)

The Committee noted the Winter Plan May-October 2019. 6. RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 213 - 214)

Resolution (Moved Edward Benson-Cooper/Seconded Kylie Clegg) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:




1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 27/03/19



Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

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2. Quality Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons.

[Official Information Act 1982 S.9 (2) (a)]

4. Human Resources Report



Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons.

[Official Information Act 1982 S.9 (2) (a)]

Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


CSSD That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


Carried The open session of the meeting concluded at 3.46 p.m. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 08 MAY 2019

COMMITTEE CHAIR

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2.3 Draft Minutes of the Disability Support Advisory Committees meeting held on 04 April 2019

Recommendation: That the Draft Minutes of the metro Auckland DHBs Disability Support Advisory Committees meeting held on 04 April 2019 be received.

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Minutes of the Regional Disability Support Advisory Committee

Held on Thursday, 4 April 2018 at 1.00am Senior Citizens Room, Fickling Convention Centre, 546 Mount Albert Road, Three Kings, Auckland

PART I – Items considered in Public Meeting

BOARD MEMBERS PRESENT

Colleen Brown (Committee Co-Chair) Jo Agnew (Committee Co-Chair) Catherine Abel-Pattinson (CM Health Board Member) Dianne Glenn (CM Health Board Member) Katrina Bungard (CM Health Board Member) Michelle Atkinson (ADHB Board Member) Robyn Northey (ADHB Board Member)

ALSO PRESENT

Debbie Holdsworth (Director Funding, WDHB & ADHB) Samantha Dalwood (Disability Advisor, WDHB) Sanjoy Nand (Chief of Allied Health, Scientific & Technical Professions, CM Health) Sue Waters (Chief Health Professions Officer, ADHB) Vicky Tafau (Secretariat) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

There were no public or media representatives present.

WELCOME

The Chairs opened the meeting at 1.10pm and welcomed all those present to the meeting. 1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed on the agenda. 2. GOVERNANCE

2.1 Apologies

Apologies were received and accepted from Allison Roe, Edward Benson, Gwen Tepania-Palmer, Judy McGregor, Margie Apa, Dana Ralph-Smith and Katrina Bungard for lateness.

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2.2 Disclosure of Interests

Ms Tafau will make noted amendments to the Disclosure of Interests.

2.3 Disclosure of Specific Interests There were no special disclosures in relation to today’s agenda. 2.4 Minutes of the Previous Meeting

Confirmation of the Minutes of the Regional Disability Support Advisory Committee meeting held on 4 April 2019. Wording change advised by Ms Atkinson and noted by Ms Tafau. Moved Colleen’s paper into a General Business section added to the end of the Agenda. Resolution (Moved: Dianne Glenn/Seconded: Michelle Atkinson) That the minutes of the Regional Disability Support Advisory Committee meeting held on 4 April 2019 be approved. Carried

2.5 Action Items Regiseter Currently still waiting for some DOI’s, titles are being amended. Ms Holdsworth followed up with the MOH who have identified issues with privacy as being a barrier to this information being shared. It was suggested that the Co-Chairs send a letter to the new DDG (Adri Isbister), advising that we have received the letter of expectations. Action Ms Holdsworth and Ms Dalwood will draft the letter and send to the Co-Chairs for their approval and signature. The DHBs are interested in a mechanism that would facilitate the sharing of data. The letter should include a timeframe. Action Mid-Central Prototyping: Ms Dalwood to provide a link to Ms Tafau to a presentation that Lorna Sullivan has already done. For information purposes for the Committee members.

Katrina Bungard arrived at 1.30pm

Action Buildings & Services: Audit was taken in 2011 by Auckland, Waitemata have been included in this from the time of their amalgamation. Determine if there has been a similar audit been undertaken by CM Health. Ms Brown to follow up with Margie Apa. Action Equity based provision for Maaori & Pacific – debate was held around whether or not this action item should sit with the committee. WDHB/ADHB believes this should sit with MHAC. CM Health will check with their Chairman of the Board to determine his view.

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The committee agreed that it was crucial to be able to capture the data that identifies patients as disabled/impaired as this information is only provided on a voluntary basis. There is not coding or capturing of this data in order for a report to be generated. Action Ms Dalwood will send links to the Maaori & Pacific Disability strategies for dissemination to the committee for their information.

3. DISCUSSION

3.1 Letter of Expectations from the Minister of Health

Data collection: Information that Taikura Trust holds is the baseline. We know it’s not 100% accurate and that people will still sit under the radar, but this would be a start. It was determined that a presentation from Taikura Trust on the data that they hold would be beneficial to the committee. MSD recently held a series of meetings looking at the implications of Accessibility Legislation and what possible framework should be developed to support such legislation. It is the DHBs responsibility to ensure that their providers have accessible services. The Committee agreed that it needs to be confident the Implementation Plan is addressing what the community has advised that they need and expect. The work that is being done to improve outcomes for disabled people should be part of meeting the Minister’s expectations. Health Literacy isn’t about what information people can understand, rather it’s about how organisations provide information in formats the people can understand. Action ADHB/WDHB will share their Health Literacy policy with CM Health. DHBs are shifting toward making health literacy a focus when co-designing services, etc. One of the challenges will be assisting front line staff to be able to impart the required information in a meaningful way.

4. DISCUSSION

4.1 NZ Disability Strategy Implementation Plan 2016-2026: Progress Report (Samantha Dalwood, Disability Advisor, WDHB) It was agreed that this would be a metro Auckland plan. The progress document reports quarterly – and gives an overview of what that has been done. The progress report was reviewed with questions presented by the committees. Each progress report is to be saved into the RDiSAC resource centre. A suggestion was made that at the top of the paper to state that this is a variance reporting system.

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The Regional Disability Advisory Committee: Received this progress report. Moved: Catherine Abel Pattinson/Seconded: Robyn Northey Carried

4.2 Proposed Regional Disability Advisory Committee DRAFT Work Plan 2019 (Sanjoy Nand)

Deep dives: can we find out what autism international best practice is, as advised by an expert and then determine where are our DHBs are in relation to this. Three top things we could do better. Focus on Child Autism: transitioning into Adult Health Services. Action A presentation by Autism NZ at the September meeting is to be organised. It was agreed that a lot of the issues are at the interface between Government agencies and providers/patients so having MOH, MOE, MSD sitting at the table at each meeting would be of benefit. Data: first deep dive. What is currently available, what isn’t available? The data that we do have, where does it sit?

5. GENERAL BUSINESS The question was asked as to whether there is any community representation at this committee? It was suggested that one community representative could be invited from each metro DHB. Action Community Representation is to be an agenda item for the 6 June 2019 meeting. Consider the rationale for having community representative on the committee.

The meeting concluded at 3.15pm. SIGNED AS A CORRECT RECORD OF THE AUCKLAND METROPOLITAN DISTRICT HEALTH BOARDS REGIONAL DISABILITY SUPPORT ADVISORY COMMITTEE MEETING OF 4 APRIL 2019. Colleen Brown, Committee Co-Chair Jo Agnew, Committee Co-Chair

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3.1 Board Chair’s Report

Recommendation: That the report be noted.

Prepared by: Judy McGregor (Board Chair)

The Waitematā DHB undertook its strategic conversation with Ministry of Health (MoH) officials in

Wellington on May 15, 2019. The CEO and members of ELT presented on health outcomes in the

region, the financial position and outlook, financial sustainability and the impact of MECA

settlements including the implications if there is not top up funding. Discussion also covered the

capital programme, developments in Maori health, community and primary care and reducing acute

demand by community and hospital initiatives. It was a high quality presentation and as Waitematā

DHB chair I felt immense pride in the DHB’s progress. The MoH promises earlier Annual Plan

engagement for 2019/20 and prioritised sustainability of the health sector as its current strategic

drive. The Minister will follow up with calls to Chairs.

DHB Chairs’ Meeting with the Minister of Health Hon. David Clark - 9 May, Wellington

1. Shift in emphasis from equity to sustainability

The Minister thanked DHBs for their commitment to the equity priority. He had witnessed a lift in the volume of conversations on equity around the country. Now he wanted to emphasise financial sustainability to ensure continued confidence of taxpayers that the sector was managing its finances prudently and to ensure the wider confidence of government that DHBs were credibly managing within budgets. Budget 2019/20 would see money for mental health and addiction and a further contribution to DHB sustainability. Mental Health- be prepared to support government’s response and to deliver new investment and services and improve---Addictions- help expand services-make sure services available.

There will be an updated ministerial letter of expectations to reflect new emphasis on financial sustainability.

2. Governance

Government was willing to act on health governance issues- Commissioner at Waikato, and maybe assistant commissioners. Crown monitors continue at Counties Manukau and Southern. There would be further governance changes indexed to performance.

Governance role responsible for, and critical to, risk management and helping to set strategic direction with CEOs, and additionally having the ability to challenge when necessary. DG to be consulted re any new chief executive appointments. For Boards to champion improvement in sustainability re finance, risk, clinical and service delivery they needed to insist on appropriate information with system level data to underpin decision-making.

At the first cut many budgets were not acceptable and showed a deterioration. Improved budgets second round with appropriate risk mitigation, viable options, how budgeted expenditure would be maintained throughout year including ways to contain expenditure such as tight management of recruitment, leave, and new approaches to service delivery.

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Performance against Minister’s priorities has been varied. The Minister asked for a shift of dialogue away from why things are too hard or unfair to a more constructive approach.

3. Areas of ministerial emphasis

Timely access to care critical, service access and waiting time performance

First specialist assessments,

Radiology waiting times poor, MRI, particular attention, want to see improvement. Board must be appropriately monitoring.

Capacity management- productivity, waste, workforce at top of scope

Financial forecasting directly linked to service delivery contracts

Clinical plans for long waiting lists- ophthalmology etc

4. Planned care

New approach/direction to planned care not just limited to hospital settings. Planned care strategic approach released soon for engagement. Service user preferences canvassed in a different way. Could involve the provision of care somewhere else, reducing hospital attendance and cost of non-attendance. Should result in more services, same costs. Skin lesion example. DHBs need to be asking the questions of where, how and by whom…and take full advantage of a new suite of measures that improve access and timeliness. Transition involved with require buy in from GPs, DHB alliances, regions, Ministry team. Chairs asked for a full day with Minister for direct conversations after elections. Chairs indicated it would be a good idea if Minister met boards as well. Regional inductions for new boards will be undertaken.

5. Primary health care.

Chairs asked how DHBs can influence the next budget round in relation to health sector decision-making about funding priorities in the sector. Several chairs mentioned the desire for increased emphasis on public health prevention and national strategies around immunisation, obesity, alcohol etc.

The Director General Dr Ashley Bloomfield said he supports DHBs creating social licence re obesity/ alcohol prevention. Outlined Ministry endeavours in national breast screening, bowel screening etc and new resourcing of the Population Health directorate in the Ministry. He said the proportion of DHB budgets on their provider arms were increasing annually. DHBs could make deliberate choices to free up funding including how services are provided regionally.

Targets- Old set of measures are still part of performance reporting. Expectation still there and results are reported to Minister. New framework has 25 outcomes will go to Cabinet. Slightly broader suite of measures and all reported by ethnicity and strong emphasis on equity. 2019/20 start.

6. Ombudsman’s Office

The Chief Ombudsman Peter Boshier addressed concerns raised by Canterbury over an OIA

ruling relating to the minutes of Audit and Finance Committee. He indicated that he was always

prepared to talk to DHBs about policy matters and provide ‘indicative’ opinions, without

undermining the OIA process. From July 2019 his office had jurisdiction under the OPCAT

protocol to spot audit private lock up dementia facilities in New Zealand, to address a significant

gap in the oversight of the security and wellbeing of staff and older people in such facilities

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outside of DHB control. The Ombudsman also referred to policy review work under way re the

Protected Disclosures Act in relation to whistle-blowing. While the rights and obligations are set

out in legislation there are no imperatives about what to do if you have a whistleblowing

incident in an agency which is expected to “use its best endeavours” to resolve the issue.

Consumer Council

The interviews for the Consumer Council demonstrated the commitment of applicants to Waitematā

DHB as part of their community life. A very impressive and diverse range of nine applicants (selected

from more than 52 who applied) talked with us about their aspirations for the council. Many of

those who had experience of Waitematā DHB as patients or whanau spoke of “wanting to give

back”. Those selected from interviews will join four representatives from Health Links North,

Waitakere Health Link, Ngati Whatua and Te Whanau o te Waipareira to make 12 members in total.

Judy McGregor, Chair.

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3.1 Chief Executive’s Report Recommendation:

That the Chief Executive’s Report be received.

Prepared by: Dr Dale Bramley (Chief Executive Officer)

1. News and events summary

A number of events of significance took place across the DHB over the past six weeks: CEO Lecture – We welcomed Professor Ron Paterson back to Waitematā DHB for a CEO lecture on Tuesday, 14 May. Prof Paterson was last here in 2018 listening to submissions as the chair of the 2018 Government Inquiry into Mental Health and Addiction. He returned to discuss the inquiry process, what was learned and what comes next. More than 200 staff members attended the event and a number of other sites tuned in via video link to gain some insight from the very heart of the inquiry.

Strong turnout for the CEO Lecture featuring Professor Ron Paterson

Excellent results - North Shore Hospital has received the maximum possible accreditation (five years) from the Royal Australasian College of Physicians (RACP) for the way we are training new doctors. The same result was achieved for Waitakere Hospital in 2018. The surveyor noted the even spread of workload, high level of support for trainees and the broad and diverse experience of general medicine they received. This is an excellent result and I want to thank Director of Physician Education Dr Cheryl Johnson and Associate Chief Medical Officer Dr Jonathan Christiansen for their role in this achievement. Leading by example - Our staff flu vaccination campaign is well-underway now with more than 3,600 staff getting vaccinated already. Immunisation is a simple and effective way of protecting ourselves – as well as those who are entrusted to our care. It’s one way we can make our homes and hospitals as flu-free possible through the colder winter months. We also participated NZ Immunisation Week (29 April to 5 May) to highlight the importance of ensuring we are all protected against serious,

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preventable diseases. Being immunised is particularly important in Auckland with the prevalence of measles and pertussis (whooping cough).

ELT are leading by example and have had their flu vaccinations

Anniversary celebrations – On 17 April, we celebrated the 20th anniversary of Dr Jocelyn Peach’s time with Waitematā DHB. Jocelyn, our Director of Nursing and Midwifery, graduated as a nurse in 1978 and has held a number of senior nursing leadership roles in the Auckland region. She works tirelessly in her role and is known for her little acts of compassion and kindness carried out quietly behind the scenes. Jocelyn is a champion for Waitematā DHB and truly epitomises our organisational values. A Facebook post recognising Jocelyn’s anniversary received more than 120 comments within hours of being posted, demonstrating how highly she is respected by friends and colleagues.

Waitematā DHB CEO Dr Dale Bramley is pictured with Dr Jocelyn Peach.

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An act of kindness – It’s nice to see our staff are still thinking of those affected by the tragic attacks in Christchurch. We recently received a ‘thank you’ message from mental health staff at Canterbury DHB after they received a surprise lunch shout courtesy of their Waitematā DHB counterparts. Our staff, led by registered nurse Samantha Meale, donated money to have pizzas delivered to the team as a show of support for the work they are doing for all those impacted by the tragedy. This was such a lovely gesture and a true example of how the compassion we encourage and display within our own DHB can spread. Thank you to Samantha and her colleagues for your thoughtfulness and kindness.

The community mental health team in Christchurch

Showcasing Waitematā on a world stage – Clinical Director of Urology Dr Madhusudan Koya was selected to lecture on the role of Cxbladder (a NZ product produced by Pacific Edge) in reducing flexible cystoscopy in the management of non-muscle invasive urothelial bladder cancer at the American Urologic Association’s annual meeting in Chicago (3-6 May). This showcased Waitematā DHB and our innovative practices in urology to an international specialist audience. Encouraging future careers – Awhina Centre at Waitakere Hospital hosted 60 Rangatahi cadets for a day as part of the Rangatahi Health Symposium. The event, which aims to inspire young Māori to pursue careers in the healthcare sector, included presentations from staff across a range of disciplines as well as hands-on practical work using our training equipment. Both Te Karere (TVNZ) and Māori TV covered the event. Here is a link to the Māori TV coverage: https://www.maoritelevision.com/news/regional/60-rangatahi-maori-get-kick-start-health-sector Making a fuss of midwives - We recognised the wonderful midwives at Waitematā DHB on International Day of the Midwife (5 May). Midwives play an important role in sharing knowledge to support and empower women to bring new life safely into this world. It was wonderful to celebrate and acknowledge their contribution.

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Midwives at North Shore Hospital celebrating International Day of the Midwife on 5 May

Celebrating our nurses – It was International Nurses’ Day on 12 May, so I want to take this opportunity to thank our thousands of nursing staff who continually provide the best care for everyone across all corners of our DHB and out in the wider community. The roles and responsibilities our nurses carry out on a daily basis have certainly evolved over time. The skillset they bring plays a huge part in ensuring all facets of our DHB can work effectively. Nurses touch the lives of many of our patients and their families when they are most-in-need. They consistently display humanity, integrity and compassion.

Nurses from Lakeview Cardiology Ward at North Shore Hospital

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Health Excellence Awards The Health Excellence Awards have been re-energised and are currently open for entries. The categories have been expanded and there are now 12 award categories. The judging criteria has been streamlined and aligned to our organisational values. The awards night is on 29 October. International collaboration - Clinical Director of Otorhinolaryngology Dr David Grayson and Surgical Registrar Dr Kai Sheng Saw presented at the Royal Australasian College of Surgeons (RACS) 88th Annual Scientific Congress (6 May to 10 May) in Bangkok, Thailand. The RACS conference is an opportunity for surgeons from across Asia-Pacific to present their experience, wisdom and opinions to their colleagues within an international forum. Dr Grayson shared his insights into the benefits of using Twitter for connecting, educating and updating surgeons globally. Dr Saw discussed his research into survival rates for patients who had surgical interventions compared to those who did not. Hand Hygiene – It was international Hand Hygiene Awareness Day on 5 May and we had stalls promoting the importance of hand hygiene in the foyer of both hospitals in the week following. This year’s message to staff was Champion clean hands. It’s in your hands. Waitematā DHB has the largest hand hygiene auditing program in New Zealand and consistently has the highest hand hygiene compliance in the nation. Mason Clinic update – Te Aka is now fully-operational as a 15-bed medium security unit and, when paired with Tane Whakapiripiri (a 10-bed minimum security unit) part of a culturally unique Kaupapa Māori pathway of clinical care. This is the first such pathway of its kind in New Zealand and there is nothing like it internationally. Further detail on the unit is included within the Māori Health update. Chapel opening - The Waitakere Hospital Spiritual Centre has been extended to include a new outdoor area and deck. The main contractor has completed the extension and we look forward to the dawn blessing and official opening on 4 June. This will be followed by a community day featuring Filipino groups and local schools (5 May), Pacific day (6 May) and multi-faith services (7 May). Special thanks to the Well Foundation and our generous donors and supporters who have made this place of peace a reality.

The new Waitakere Hospital Spiritual Centre

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Easter celebrations – As a small token of our gratitude to staff for their ongoing hard work and dedication, we distributed hot cross buns to everyone for Easter. Special thanks to all the people who spent many hours preparing the buns for distribution.

Pictured are some of the many helpers who made this year's Easter hot cross bun run a reality for DHB staff

Café changes – Following refurbishment, ESC Café at North Shore Hospital (NSH) reopened on 17 May with a new menu that provides our staff and visitors with a wider variety of options. Habitat Café in the main hospital at NSH is now under refurbishment and will be followed by Deli Marche café at Waitakere Hospital. Asthma awareness – World Asthma Day (8 May) was a good opportunity for us to share some expertise with our community. One in seven children in New Zealand live with asthma. We helped people learn more about what to do in an asthma emergency by answering some commonly asked questions for our community. Read here - https://bit.ly/2VjuFxT Industrial action – Excellent contingency planning in advance of the five-day strike action (29 April to 3 May) by resident doctors ensured adequate roster coverage was maintained during the strike period – keeping any impact on patients to an absolute minimum. Thanks to all of the staff and volunteers who worked together to minimise the disruption to patients and their whānau during this time.

Creating a culture of appreciation

A further 43 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member whose nomination is considered worthy of acknowledgement receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting are included as Appendix 1.

2. Upcoming events Looking toward the upcoming months, we can expect to see:

4 June – Dawn blessing and official opening of the Waitakere Hospital Spiritual Centre followed by several days of multi-faith celebration events involving various community groups.

First week of July – First meeting of the Waitematā DHB Consumer Council.

4 July – ‘Get up, get dressed and get moving’ campaign on wards to promote active recovery.

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Currently underway – Refurbishment of x-ray room at North Shore Hospital to make way for new equipment. CT scanner expected to be completed in late June.

Start of enabling works for the ECIB project on the North Shore campus.

4 July – Matariki Awards

29 October – Health Excellence Awards at ASB Waterfront Theatre.

3. Future Focus

The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be. The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience.

The Leapfrog Programme is a finalist in the Business Transformation through Digital and IT category of the NZ CIO Awards. The winners will be announced at the awards dinner on 16 June. Delwyn Armstrong, Sharon Puddle and Stefan van der Walt from i3 presented our Qlik Sense journey at a Qonnections Qlik Global Conference in Texas (13 – 16 May). The presentation included the Leapfrog programme, criteria-led discharge, SOS Outpatient Cards, the Acoustic Neuroma Pathway and ED data exploration, to fit the conference theme of transforming care. For the Patient Reported Outcomes Measures (PROMs), the end-to-end electronic system is almost complete and patient surveys are coming in to the DHB’s data warehouse in almost real-time. Work on the visualisation of PROMS in clinical portal is nearly finished. Areas already collecting data include orthopaedics where the Oxford hip and knee scores are being used to inform surgical practice and in diabetes for the self-management of adolescent diabetes. The trial of electronic progress notes on Ward 15 has gone extremely well. The initial plan was to add three patients per day but by the second morning, the medical team asked if we could use the system for all of their patients as it was so much faster and more convenient. All patients on Ward 15 were using the system within the first week and there have been 4,300 notes recorded in the four weeks since it was introduced. Feedback has been extremely positive and more than 230 clinicians have used the system. A business case is underway that would see the system rolled out across both hospitals. The Telehealth trials continue, with 266 appointments scheduled (64% acceptance rate) and tweaks being made to improve the system. 4. Board performance priorities The following provides a summary of the work underway to deliver on the DHB’s priorities: Relief of suffering Progress:

Patient Experience

Better Outcomes Progress: On track National Inpatient Survey

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National Survey Quarter One (January - March 2019)

For the first quarter of 2019, Waitematā DHB scores for communication and partnership were our highest since the national survey was introduced. There was a notable increase in the communication and partnership domain this quarter as seen in the run chart below (Graph 1). All other domains are above our median score. Friends and Family Test In April 2019, we achieved a Net Promoter Score (NPS) of 75 and received feedback from 974 people. The NPS continues to perform well and scores above the DHB target of 65.

Waitematā DHB Net Promoter Score over time

HQSC weighted results

Communication Partnership Co-ordination Needs

8.4 WDHB

8.5 WDHB

8.2 WDHB

8.5 WDHB

8.3 National Average




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Consumer Council Shortlisting and interviews for the new Consumer Council are complete and we will be appointing the full 12-member council in June. We are aiming to have the first meeting in the week commencing 1 July to orientate the members and introduce them to our DHB. Achieving the health targets – March 2019

Better help for smokers to quit (maternity) – 89% (target 90%)

Improved access to elective surgery – 105% (target 100%)

Shorter waits in ED – 95% (target 95%)

Faster cancer treatment – 88% (target 90%)

Increased immunisation – 92% (target 95%)

Raising healthy kids – 100% (target 95%) Health Quality and Safety markers Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, Acute & Emergency Medicine completed 100% of falls risk assessments, Specialist Medicine & Health of Older People completed 88% and Surgical & Ambulatory completed 96% on admission. Of those, Acute & Emergency Medicine completed 92%, Specialist Medicine & Health of Older People completed 69% and Surgical & Ambulatory completed 64% within eight hours of admission (against a target of 90%). Hand Hygiene The Hand Hygiene Compliance Audit result for April 2019 is 89%, exceeding the national target of 80%. Healthcare-associated Infections The CLAB insertion bundle was used in ICU on 100% of occasions in April 2019. The insertion bundle compliance exceeds the national target of 90%.

Living our values Pink Shirt Day - Working with compassion is something we promote throughout Waitematā DHB and with the annual Pink Shirt Day campaign coming up on Friday, 17 May, this serves as another reminder. Staff are encouraged to wear pink to condemn bullying and endorse kindness. Many of you would have entered the area of healthcare because of your natural affinity to care for people, so help spread that message by wearing pink.

Patient whānau-centred care standards review The patient whānau-centred care standards review has been completed and a report has been drafted with a variety of recommendations, which include increasing awareness and developing a scoring system that incorporates quality improvement initiatives and outcomes. Medication safety A community event involving more than 20 consumers took place in early May to discuss medication safety. In partnership with the pharmacy teams at both Waitematā DHB and Auckland DHB, the

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patient experience team is looking for ways to enhance the communication and information that we provide about medications to our patients and their whānau.

Community feedback session on medication safety

Health literacy After two years of development and consultation, the Health Literacy Policy has been endorsed by ELT. The policy will be published in May and a new staff intranet site developed including health literacy resources. This will be followed by a health literacy symposium for up to 150 people later in the year. Māori patient experience plan The Māori Patient Experience Plan has now been endorsed by the Māori Health Equity Committee. The plan includes key recommendations that will ensure there are more opportunities to understand the experience of Māori patients and whānau within our DHB, including increased reporting of feedback and insights at a Board level. Māori Health Māori scorecard

Shorter waits in ED – 95% (target 95%)

Helping smokers to quit (hospitalised) – 99% (target 95%)

Older patients assessed for falling risk – 100% (target 90%)

Raising healthy kids – 100% (target 95%)

Te Reo Māori Programme Update Mā te reo, te ahurea. Mā te ahurea te tangata. Mā te tangata, ka aroha. Te Reo Māori as a professional development programme for staff and whānau was introduced in February 2019 at Waitematā DHB. There are currently 79 Waitematā staff enrolled in the programme. A new intake for 2020 will commence in November. Matariki Awards The annual Matariki Awards were introduced last year as an opportunity to promote and celebrate our values and individuals or groups in our organisation that are gold standard examples of our values. We will continue with this theme in 2019. Staff are encouraged to nominate anyone who

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embodies the organisational values through the work they do to improve Māori health outcomes. Nominations are open until 31 May and the awards ceremony is scheduled for 4 July. Mason Clinic update Te Aka and Tane Whakapiripiri medium secure units at Mason Clinic are providing a culturally unique Kaupapa Māori pathway of clinical care for patients in what is believed to be a world first. The specialist facility offers holistic cultural engagement for more-effective rehabilitation. A wharenui (meeting house) built into the front entrance is where service-users of all ethnicities will be welcomed on arrival and is expected to have extra significance for those of Māori ancestry who make up a significant proportion of the facility’s population at any one time. A culturally respectful treatment philosophy often enables people to reconnect with themselves and their whānau and can play a critical part in a person’s recovery. Having a wharenui at the entrance sets the scene for the type of holistic cultural engagement provided. Iwi-DHB Partnership Board In April, we developed a new version of the Terms of Reference for the Iwi-DHB Partnership Board, which is currently being circulated for approval before it is sent to the Minister of Health. At the meeting in April, it was agreed that:

The Partnership Board would provide a platform for Māori and health sector leaders to galvanise their collective expertise, knowledge and resources across services and districts to deliver outcomes for Māori.

Its purpose will be the maximisation of Māori health outcomes (including outcomes chosen by iwi) as well as the elimination of health inequities between Māori and non-Māori. This will be achieved by co-designing a new system and services that value Māori whānau, improves their experience of health services and addresses immediate health issues, while also addressing underlying determinants of ill-health.

The Partnership Board’s functions will include setting a strategic agenda for Māori health gain, overseeing the DHBs’ performance and investment in Māori health and leading reviews of services and programmes where disparities between Māori and non-Māori exist.

Pacific Health

A number of events have focused on equipping young Pacific people with the skills and knowledge to transition into tertiary study and follow careers in the healthcare sector. Events have included a fono (meeting) to celebrate the achievements of scholarship students from Waitakere College on 27 March and The Regional Health Science Academy Year 11 Leadership Conference with students from seven Auckland schools. The conference (28 and 29 March) delivered health science modules specific to Pacific communities. The Pacific team also took part in a Year 13 camp for five Health Science Academy schools, which involved a full panel discussion with Pacific health professionals.

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CEO SCORECARD

Actual Target Trend Patient Experience Actual Target Trenda. Better help for smokers to quit - maternity 89% 90% q Complaint Average Response Time 16 days ≤14 days q

a. Better help for smokers to quit - primary care 88% 90% p Net Promoter Score FFT 76 65 q

Improved Access to Elective Surgery - WDHB 105% 100%

Shorter Waits in ED 95% 95% q HQSC Quality and Safety Markers - Quarterly Trend

Faster cancer treatment (62 days) 88% 90% q Older patients assessed for falling risk 98% 90% p

Increased immunisation (8-month old) 92% 95% Older patients assessed sig. fall risk with care plan 94% 90% q

Raising Healthy kids 100% 95% Good hand hygiene practice 89% 80%

Occasions insertion bundle used - ICU 99% 90% q

Occasions maintenance bundle used - ICU 92% 90% q

e. Surgical site infection rate per 100 procedures 0.8 ≤0.93 q

Waiting Times Actual Target Trend b. Antibiotic in the right time 97% 100% p

ESPI

ESPI 1 - 90% OP Referrals processed w/n 10 days Compliant Improving outcomesESPI 2 - % patients waiting > 4 months for FSA Non-Compliant Better help for smokers to quit - hospitalised 98% 95% q

ESPI 5 - % patients not treated within 4 months Non-Compliant a. Ambulatory Sensitive Hospitalisation rate (ASH) 0-4 5641 ≤5263

Diagnostics f. Annual amenable mortality rate (per 100 000) 62.9 ≤63 p

% of CT scans done within 6 weeks 71% 95% p Population coverage/Access Trend

% of MRI scans done within 6 weeks 70% 90% a. Cervical Screening 71% 80%

Urgent diagnostic colonoscopy (14 days) 96% 90% q Breast screening 65% 70%

Diagnostic colonoscopy (42 days) 49% 70% pc. Bowel Screening

Surveillance colonoscopy (84 days) 41% 70% p % referred for colonoscopy (45 days) following +ve iFOBT 95% 95% q

TreatmentPatient Flow a. HSMR (Source: Health Round Tables) 0.79 ≤1 p

Elective Surgical Discharges (YTD) a. Surgical intervention rates (per 10,000 pop)Elective Discharges - Total 15,303 15,064 p - Angioplasty 16.1 12.5 p

Elective Discharges - Provider Arm 10,338 10,397 p - Angiography 42.0 34.7 q

Elective Discharges - IDF Outflow 4,965 4,667 p - Major joints 22.7 21 q

Efficiency - Cataract 43.0 27 p

Outpatient DNA rate (FSA + FUs) 7% ≤10% qg. # NOF patients to theatre (48 hours) 93% 85% q

a. Average Length of Stay - Electives 1.49 days ≤1.49 days p ST elevation MI receiving PCI (120 mins) 85% 80% q

a. Average Length of Stay - Acutes 2.71 days ≤2.41 days q AT&R referrals assessed (2 working days) 96% 90% q

Staff Experience Actual Target Trend Major Capital Programmes Time Budget QualitySick leave rate 3.3% ≤3.4% Elective Capacity and Inpatient beds (TBC)

d. Turnover rate - external 13% ≤14% Mason Clinic Tanekaha replacement

Lost time injury frequency (12 mth rolling average) 16 ≤10 q

Financial Result Trend

Expense/Revenue (YTD Total) 1,379,439 k 1,372,599 k q

k. Health Targets - Monthly Actual Target Trend Health Targets - Quarterly Actual Target Trend

Shorter Waits in ED 95% 95% qa. Better help for smokers to quit - maternity 89% 90% q

Increased immunisation (8-month old) 86% 95% a. Better help for smokers to quit - primary care 87% 90%

Better help for smokers to quit - hospitalised 99% 95% q Raising Healthy kids 100% 95%

Faster cancer treatment (62 days) 67% 90% q

k. Quality and Safety Markers - Monthly Quality and Safety Markers - Quarterly

Older patients assessed for falling risk 100% 90% h. Surgical site infection rate per 100 procedures 0 0.93

Older patients assessed sig. fall risk with care plan 81% 90% p

g. # NOF patients to theatre (48 hours) 100% 85% Maori Workforce - QuarterlyMāori percentage of overall workforce 6.7% 7.0% q

Māori percentage of priority workforce group 5.6% 5.8% q

New employee ethnicity not specified 0% ≤5%

Existing employee ethnicity not specified 2% ≤5% p

Performance indicators: Trend indicators:

Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month

Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month

Performance was maintained

Contact: Victoria Child - [email protected] - Reporting Analyst, Planning & Health Intelligence, Planning, Funding and Health Outcomes, Waitemata & Auckland DHBs Team

Waitemata DHB Monthly Performance Scorecard

CEO ScorecardMarch 2019

2018/19

1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header).

2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed.

3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large.

a. Reported quarterly - Dec 18

b. Sep Q1 2018/19 (latest HQSC data available).

c. Bowel Screening - New Indicator - % referred for colonscopy (within 45 days) following positive iFOBT (Sep 16 - Dec 18).

d. Employees taking positions outside of the hospital/DHB

e. Prelim Data Sep Q1 18/19

f. Annual data - latest available 2015

g. Coding dep, rolling 3 mths - Feb 19

h. Reported quarterly - latest available, Jun Q4 17/18

k. Small volumes result in sensitivity to traffic light criteria

Health Targets

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

Maori Scorecard

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APPENDIX 1 – CEO Recognition Marcus Stembridge - Registered Nurse, Rata Unit. Nominated by Shivika Singh. “Marcus has been fantastic at organising and co-ordinating the CnR trainers and have been open to new ways of delivering the training at Mason Clinic. He has devoted a lot of his time towards the reducing seclusion and restraint project and the humour at the training is enjoyed by many staff.” Jenny Singh - Clinical Nurse Specialist, Tanekaha Unit, Mason Clinic. Nominated by Shivika Singh. “Jenny has such enthusiasm in developing and delivering the wellness group for our service users and also for picking up and recommencing the nurses forum at Mason Clinic. Her initiative for starting DBT informed nursing at Mason Clinic is an excellent idea.” Sharon Price - Charge Nurse Manager, Forensic Prison Team. Nominated by Shivika Singh. “Sharon has been doing a fabulous job at managing the team with minimal staff and also holding her own caseload. She managed to achieve a good balance between clinical practice and managing the team. Well done.” Azizun Nisha - Charge Nurse Manager, Forensics Management. Nominated by Shivika Singh. Azizun has faced some challenges transitioning from working as a colleague to a charge nurse manager on the unit, however, she dealt with those challenges really well. Her key behaviours of ensuring there is open communication on a regular basis with her team is a factor that enables her team to be involved in decision making. Azizun values their views and enables them to take a greater clinical operational leadership in day to day matters.” Mae Alipao - Registered Nurse, PACU Theatres. Nominated by Jaymelyn Panteleon. “Mae cares for her patients with compassion and kindness. She also cares for the staff while in her coordinator role in Recovery. She is always ready to give a hand to other staff even though she has many of her own and she maintain calmness in a very busy day. She happily passes her knowledge and skills to new staff. A very dedicated nurse.” The following staff members were nominated by Sarah-Jane Reweti. Tony Dawson, Cayla Jensen and Shane Lencse - Registered Nurses, He Puna Waiora. Martin Jones - Health Care Assistant, He Puna Waiora. “During a recent challenging and volatile situation, Tony, Cayla, Shane and Martin acted with integrity and professionalism. All parties safely managed the situation above and beyond what would be expected, encompassing the DHB’s values, specifically they worked 'with compassion', 'everyone matters' and 'better, best and brilliant'.” Christina O'Hara - Registered Nurse, Child and Family West. Nominated by Catherine Deeney. “Christina has gone out of her way recently to support my practise with a family to improve outcomes for the children involved, including putting together some amazing resources, and being available for consult. Thanks so much Christina you have made a difference!” Lis Cowling - Programme Manager, Funding - Primary Care. Nominated by Debbie Holdsworth and Celeste Gillmer. “Lis is incredible - she always makes time to discuss any issues or questions. She is definitely an approachable resource for our whole primary health care nursing development team.” Anna Morrow - Occupational Therapist, Inpatient North Therapies. Nominated by Sarah Franks. “Anna recently received some outstanding feedback from a patient on Ward 7 who described her as a 'beautiful soul' and someone who she 'could really open up to'. Anna strives to extend her OT skills and knowledge upholding the DHB value of ‘better, best, brilliant’ with not only this patient but all patients she sees. Anna also shows her compassion for all and wants to do the best for her patients. She always has a great attitude and is happy to learn and teach things on to others.” Lisa Jones - Corporate Support Manager, Mental Health Services. Nominated by Pam Lightbown. “Lisa often goes above and beyond in her role to ensure she undertakes a thorough job as well as bringing her wealth of knowledge and experience in lots of areas to support the services. Lisa is always professional and has a great sense of humour too!”

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Jennifer Button and Maria Te - Roster Specialists, Acute & Emergency Medicine. Nominated by Katrina Holland. “Jennifer and Maria are both experienced Registered Nurses who use their knowledge in nursing and health care to ensure that wards have fair and equitable rosters. Their experience and knowledge ensures they are able to give expert advice and guidance to staff. Both of them have great communication and listening skills and have a very professional and sensitive approach when dealing with people. They are always available to help and 'everyone matters', is demonstrated by both of them every day.” Gloria Paterson, Sally Monk, Esmari Oosthuizen and Kelsey Tatton-Brown - Physiotherapists, North Therapies. Nominated by Sharon Russell. “The Pelvic Health team have worked tirelessly over the last year to produce educational resources and to provide educational sessions for this patient population. They have streamlined a service from an inpatient and outpatient perspective to ensure all patients are given equal opportunity whilst ensuring the sometimes sensitive information they impart is given in a professional but welcoming manner. All members of the team demonstrate our value of 'best care for everyone'. Well done to you all.” Rachel Le Maitre - Clinical Nurse Specialist, Renal Ambulatory Non-Dialysis Team. Nominated by Janak de Zoysa. “Rachel is a dedicated and passionate Clinical Nurse Specialist. Recently we had arranged admissions that could not be easily accommodated. She stayed on for several hours, working closely with the duty managers and ward staff to facilitate their admission and ensure appropriate pre-procedure care was provided. This is one of many instances where Rachel goes above and beyond the standard level of care.” Alwin Lim - Registrar, Assessment Treatment and Rehab. Nominated by Kirsten Ter Braak. “Alwin consistently demonstrates the core value of 'better, best, brilliant'. He is a very efficient, well organised, kind and a very positive team member. He is always responsive and compassionate to his patients and colleagues and implements best practice to deliver and maintain high standards.” Sharon Giles - Operations Manager, Waitemata Central. Nominated by David Price. “For going above and beyond to ensure patients have a positive experience at Waitematā DHB.” Eireen Sharma - Orderly, Clinical Support Services. Nominated by Dr James Brennan. “I had not met Eireen before, but she was incredibly helpful to me over the past week when I was following up a missing parcel. I really appreciated her thoughtfulness and considerate touch, following up and checking in until the package was found. Thank you Eireen!” Penina Felise-Mackay - Operations Manager, Pacific Support Services. Nominated by Angela McCormick. “I give thanks and praise to God for the trust you have in our angel Penina and the God-send she has been! For her two broad shoulders to cry on, her fellowship in Christ to share with us in the hospitality she gave to our teams here. To the solace she’s given to the grieving whānau of our Muslim brothers and sisters and to the collective DHB family that we are. Her presence has uplifted us all.” Nicole Atkinson - Clinical Administrator, Radiology Services. Nominated by Jo Boyd. “For her savvy skills and being proactive in organising extra CT MAKO clinics to accommodate the high number of patients waiting to have knee joint replacements at the ESC. Nicole is an asset to the ESC Ortho team and the Radiology department. Thank you Nicole for all you do and for going the extra mile.” Jeong Lee - Occupational Therapist, Community Rodney & West. Nominated by Carli Hay. “Jeong has stepped into the relatively new Duty OT role, providing maternity cover. She works tirelessly with a compassionate attitude to ensure clients are seen in as timely a manner as our staffing level allows. Jeong is always willing to assist with the many queries coming her way, which supports the wider OT team to provide a better service.”

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Tracy Purdy - Nurse Educator, PACU Elective Surgery Centre. Nominated by Wendy Casey. “Tracy recently held our NSH PACU Symposium, Enhancing the Patient Experience. Over 200 internal and external Nurses as far away as Wellington, attended this workshop. Tracy worked for weeks preparing the workshop on top of her usual busy schedule. Planning such a huge event was amazing and I think Tracy should get some recognition as she displayed our values of 'better, best, brilliant'.” Dr Jonathan Christiansen - SMO, Medical & ECC Management. Nominated by Sakina Mayor. “My friend's mother was admitted into ICU recently and sadly passed away. My friend spoke of what compassion Dr Jonathan Christiansen demonstrated at a time when she could not understand what brought on her mum’s cardiac arrest. She felt that maybe she had mixed up her mum’s medication and mentioned this to Jonathan who took the time to give her a hug and reassurance that it was nothing she had done. My friend has nothing but praise for Jonathan’s compassion. Great job Jonathan.” Ronitha Reddy - Clinical quality coordinator, Mason Clinic. Nominated by Shavika Singh. “Ronitha participates in practice standard development within Mason Clinic that influence positive outcomes for the patient e.g. policy and guidelines development and review. Ronitha does a lot of behind the scenes work to assure that patients are receiving the best care. Words alone are not enough to explain all she has done for the service. Thank you!” Carole Schneebeli - Clinical nurse advisor, New Graduate Nursing. Nominated by Shavika Singh. “Carole is accessible, available and responsive to the needs of others, encouraging critical thinking and problem-solving for individuals and with the context of teams. Carole motivates staff with a shared vision and enthusiasm to achieve better outcomes for themselves and for their service users.” Barry Kennedy - Clinical nurse specialist, Mason Clinic. Nominated by Shavika Singh. “A big thank you to Barry for doing a secondment with the Forensic Prison team who have been very short staffed and had an increased workload. You have offered your support to the team and also are managing to still fulfil parts of your role as a clinical nurse specialist.” Mia Parata - Cardiac physiology technician, Cardiology Technicians. Nominated by Juliette Wood. “Mia has gone above and beyond to assist us in up skilling our team. We are grateful for her willingness to work alongside us, her depth of knowledge and her time and guidance.” Karen Vince - Specialty nurse, Quality and Training. Nominated by Jason Cabral-Tarry. “Karen is compassionate, welcoming, respectful and positive in all her roles be it-charge nurse, supervisor, project leader, newsletter editor or just all round brilliant colleague! She has gone above and beyond during the connecting care transitions project and is a true champion of the DHB value of better best brilliant.” Teresa Stanbrook - Professional leader, Dietetics. Nominated by Lauren Rosser. “Teresa has been a fierce advocate for dieticians and the dietetic profession in NZ and WDHB. She has contributed countless new initiatives and innovations over the years and has role modelled WDHB values consistently. She has encouraged the professional development of dieticians, offering support with learning needs and CASP. She has provided support to us as a team and as individuals and we will miss her as our Professional Leader.” Willise Ruha - Acting clinical coordinator, Te Atea Marino. Nominated by Craig Heta. “Willise is extremely dedicated to achieving best care for everyone. She goes above and beyond her role to support our service users to get the best possible outcomes. Her experience and passion for excellence in clinical practice is greatly appreciated.” Beatrice Roots - Registered midwife, Waitakere facility. Nominated by Chris Zack. “For her compassion, expertise and dedication in her work at the maternity ward at Waitakere Hospital and going above and beyond for patients on the ward.” Astrid Smith - Consumer support worker, Quality and Training. Nominated by Andrea Dawe. “For the energy, commitment and creative thinking Astrid puts into her work with clients, and for the ways she consistently acknowledges, supports and works in collaboration with clinicians.”

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Ratna Paudel - Immunisation data administrator, Child & Family North. Nominated by Natasha Myers. “Ratna is a wonderful colleague who goes above and beyond in her role to support our team. In addition to her great skills in administration, she is friendly, approachable, professional and willing to assist. She drives quality improvement processes in regards to our fleet vehicles and keeps things operating smoothly and efficiently. She is a pleasure to work with and helps us achieve ‘better, best, brilliant’.” Genesis Dumdum - Patient care assistant, general surgery. Nominated by Patricia Heavey. “Genesis is such an asset to the General Surgical Team, booking all of our ESC patients for surgery. She quietly “gets the job done” despite her huge workload - maintaining a compassionate and professional manner with both staff members and patients.” Cairine Meier - Rehabilitation coordinator, Occupational Health. Nominated by Fiona Joshi. “Cairine has been absolutely wonderful – great communication skills, she has the wonderful gift of listening - making me feel heard, well supported, and that I matter. She explains everything clearly and is compassionate and kind. She explores ways of supporting me in my work tasks and gets back to me in a timely manner. Cairine is one of those amazing people I am so glad to have met. I really appreciate all her hard work in this role.” Yvonne Bawayan - Registered nurse, PACU, ESC. Nominated by Tracy Purdy. “Yvonne works tirelessly admitting surgical patients. She nurses with a very high standard of professionalism and dedication to patients in her care, demonstrating empathy and compassion to all. She underpins the Waitematā DHB values of 'best care for everyone'.” Roseby Cabato - Registered nurse, PACU, ESC. Nominated by Tracy Purdy. “Roseby cares for her patients with kindness and compassion, continually striving to provide the best care for all she encounters. She works tirelessly never seeking acknowledgement for her dedication and hard work. She mentors new staff happily passing her knowledge and skills. Roseby is an asset to the ESC Peri-operative team.” Bryan Veloso - Registered nurse, theatre, ESC. Nominated by Tracy Purdy. “Bryan is a dedicated nurse ensuring all in his theatre team provide the best possible care for all patients. Bryan leads the theatre team with dedication, passing his wealth of knowledge and skill to the younger members of his team. Bryan recently handled a delicate situation in the team with professionalism achieving a successful outcome. Bryan demonstrates the WDHB values of 'better, best, brilliant'.”

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4.2 Health and Safety Performance Report

Recommendation:

That the Board receives the report. Prepared by: Michael Field (Group Manager, Occupational Health and Safety Service) Endorsed by: Fiona McCarthy (Director, Human Resources)

1. Purpose of report

The purpose of the Health and Safety Performance Report is to provide quarterly reporting of health, safety and wellbeing performance including compliance, indicators, issues and risks to the Waitemata DHB.

2. Strategic Alignment

Community, whanau and patient centred model of care

This report comments on issues and risks that impact on staff health and safety and therefore patient care and organisational culture.

Emphasis and investment on both treatment and keeping people healthy

This report comments on organisational health and safety information via incident reports, health monitoring and identified hazards.

Intelligence and insight This report provides information and insight into staff workplace incidents and what Waitemata DHB is doing to respond to these and other workplace risks.

Evidence informed decision making and practice

The leading and lagging indicator dashboard is based on current best practice indicators and targets.

Outward focus and flexible, service orientation

Health, safety and wellbeing risks and programmes are inherently focused on staff, visitors, students and contractors. All strategic and operational work programmes and policy decisions are discussed with relevant Services, such as site visits and approaches to reduce risks.

Operational and financial sustainability

As appropriate, programmes of work will outline how Services will ensure operational sustainability, how measures of success are set and value and return on investment is monitored.

3. Executive Summary For the March reporting period Waitemata DHB has met the majority of leading and lagging indicators. A particular highlight is our influenza vaccination rate which is 59% against a target of 60%. This time last year we had vaccinated 33% of staff. With the influenza season here, it is good to see staff prioritising protecting themselves, our patients and our wider community from medical complications and death that can be caused by the influenza virus. The DHB is now stepping up the vaccination campaign to target areas of low update and medically compromised patients. Our

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thanks to Maura Murphy who has overseen the influenza campaign as well as the wonderful efforts from in team vaccinators, infection prevention and control, occupational health and safety, Waitemata central and communications teams. Our target for pre-employment health screening prior to commencement was 48% against a target of 70%. Managers have been contacted to follow up staff who have not been screened and to clarify the expectation that all staff complete their pre-employment health screening. In addition we are employing an extra nursing resource to help screen and follow up staff to ensure pre-employment screening has occurred before commencement. Overall, reported incidents have reduced with a downwards trend since June 2018. In relation to top accident types:

1. Slips, trips and falls increased by five this month to a total of 19; 5 fell on stairs, 4 slipped on wet

surfaces, 4 tripped (no cause identified), 3 fell due to objects in their way, 1 fell due to equipment

failure, 1 tripped due to an uneven surface and 1 collapsed due to illness.

Slips, trips and falls posters have been developed and distributed to the Health and Safety

Representatives for display within their areas and the OH&SS have displayed them in common areas.

With wet weather now an additional hazard use of ‘slippery when wet’ signs and posters are also in

use.

2. Moving and Handling incidents increased this month from 11 in February to 18 in March with the Moving and Handling team reviewing and following up on all incidents, including auditing moving and handling equipment in the areas injuries were sustained.

3. Aggression incidents overall increased by 2% from last month. The number of physical injuries

increased from 78 in February to 89 in March. A number of actions are in place to manage the likelihood of incidents occurring and/or to reduce the severity of consequence when incidents occur:

Appropriate clinical management of clients including utilisation of the STEP matrix which allows staff to assess any risks associated with community visits.

Manager lead investigation of incidents.

Risk assessments.

Training including CALM communication which is now core for some services; and the on line module ‘Introduction to staff safety and security at Waitemata DHB’.

Introduction of MAPA (Managing actual and potential aggression) training from March/April.

Provision of appropriate protective equipment for security staff including impact proof clothing and body cameras.

Review of the roles and responsibilities in emergency events (code orange).

Review of Security arrangements.

Duress alarms and community ‘check in’ procedures.

Internal audits on the management of hazards and risks. In March, 56% of reported aggression incidents were physical with 44% verbal. Most incidents were caused by people who had no intent to harm (91%) and 96% of incidents were instigated from patients or visitors. The DHB has recently successfully participated in a review by Worksafe, of work undertaken following a concern raised in May 2018 about third party maintenance of equipment. Worksafe are comfortable with our actions to date and that we have liaised with vendors to ensure they are undertaking equipment maintenance in line with accepted standards and relevant legislation.

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4. Performance Dashboard

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5. Work related injury Claim Data for March 2019 Outlined below is our injury claims data for March. Work injury claims data is for all work injuries currently managed by the DHB, including injuries that may have been incurred in previous years, up to and including injuries for March 2019. High accident events account for approximately 86% of the claims. As requested in the previous Board meeting, additional information has been included to highlight total cost and number of days lost due to high incident type injuries.

High Accident

Injury type

Lost days

this month

% of cost this

month

Cost this

month

Year to date trend for injury claims

Moving and handling 57 30% $37,339

Slips Trips Falls 44 24% $30,017

Aggression 25 13% $47,379

While aggression incidents are shown as trending upwards, the % of cost is lower than 4 months ago. Actions taken to mitigate high accident types are noted in the Executive Summary.

INJURY CLAIM DATA

Total: Injury Claim Report for March 2019

Lost days Treatment

cost

Weekly compensation

costs (80% of salary) Staff cover cost Total

Number of lost

days for month

$ total for

month $ total for month

$total cover cost

for month

Total $ cost for

month

187 $67,438.60 $36,971.46 $46,214.33 $150,624.39

6. Stakeholder feedback 6.1 Facilities and Development - Key Performance Indicators HIGHLIGHTS The appointment of an acting Facilities and Maintenance works manager has ensured Facilities Maintenance have completed three of the required four Toolbox Talk meeting for the month of March. The acting Works Manager has confirmed that conducting the four monthly Toolbox meetings will be achieved going forward. RISK AND ISSUES The District Facilities Manager is working to develop and implement a Facilities Management Contractor panel. All new contracts established will be dependent on the contractor meeting the

55


expectations of the HS200 Health and Safety Questionnaire before they will be approved for the panel. The table below provides an oversight of the department’s adherence to work monitoring, contractor management and health and safety performance.

Health and Safety Statistics - March 2019

Facilities Development Facilities Maintenance Total

Incidents and accidents

Lost Time Injuries 0 0 0

Serious Harm Accidents 0 0 0

Accidents Requiring Medical Attention 0 0 0

Accidents Requiring First Aid 1* 0 1

Near Miss Incidents

This Month 6* 0 6

Monthly Average 2

Year to Date 30

Safety Inspections completed this Month

Projects

(16 inspections required,

17 inspections completed) 106% Not Applicable

Facilities Operations

(22 inspections required,

7 inspections completed) Not Applicable 31.8%**

H&S / Toolbox Meetings this Month

Projects 100% Not Applicable

Facilities Operations

(4 reports required,

only 3 occurred this month)

Not Applicable 75%***

Contractor Site Inductions

This Month 27

Year to Date 443

KPI comments: * All recorded “near miss incidents” and “accidents requiring first aid” were of a minor nature. Evidence

recorded to demonstrate all events/incidents investigated and remedial actions completed.

** Issue with completing safety inspections has been escalated to the Executive Health, Safety and

Wellbeing Committee for review.

*** The appointment of an acting Works Manager early in March ensured 3 x meetings held.

Injuries and Accidents Incidents and accidents are monitored across all DHB sites and include data for staff and contractors.

Near Miss / Incidents Near Miss and Incidents are monitored across all DHB sites and include data for staff and contractors

Safety inspections Safety Inspections are expected to be completed weekly during the construction period for all projects.

Health and Safety Toolbox

meetings

All contractors and staff are expected to attend one health and safety / toolbox meeting per construction

week for projects.

Facilities maintenance staff are expected to attend fortnightly health and safety / toolbox meetings.

Contractor site inductions This is an indication of the number of new contractor staff on site and will vary significantly with construction

project work load.

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7. Health and Safety Risks

As discussed during the Board H&S Workshop, we have introduced new reporting of our key hazard areas and the resulting actions. The table below outlines our key health and safety risk categories, commentary on the current projects related to that risk whether those projects impact the likelihood or consequence/outcomes of that risk. Traffic lights indicate progress of each project. Key

Progress Indicator

Red Major delays

Amber Minor delays

Green On track

Risk Measure Addressed

L Likelihood

C Consequence

Risk Update Start Date Est. Date to

Complete Progress Indicator

Risk Measure

Addressed

Biological Risks Blood and Body Fluid Exposures (BBFE)

Needle stick injuries

Needleless Systems: Both North Shore and Waitakere Hospital audits have been completed and recommendations either closed or being followed up. Audits Complete: 100% Audit findings to be discussed at the next Executive Health, Safety and Wellbeing meeting A ‘sharps safety week’ has been scheduled for December 2019, in-line with the international sharps awareness month. Complete: 0%

Sep 2018

Dec 2018

Dec 2018

Dec 2019

L L

Splashes Incorporated within all BBFE related projects, including Personal Protective Equipment (PPE).

Ongoing Ongoing L/C

Substances hazardous to health

Asbestos Register

Work has commenced with uploading information from Management, Refurbishment and Demolition surveys. Complete: 60% Refurbishment surveys are carried out prior to invasive works. Current projects underway are: Taharoto building demolition

Oct 2017

Ongoing

April 2019

Ongoing

L

Mould OH&SS continue to review all air testing reports relating to mound and provide advice to the relevant Service managers and Facilities. There are no adverse results to date.

Ongoing Ongoing C

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Chemicals HSNO Audits: Review of new Act has been completed and audits of 33 high risk areas (67 physical locations) have recommenced. Audits completed: 58% Business case for Hazardous Goods Store for Waitakere Hospital: Not due yet. Trial on transferring HSNO waste within the main hospitals: 6 week trial at North Shore Hospital has been completed. Trial review and recommendations report has been finalised. Trial: Complete: 100% Review and recommendations paper: Complete: 100%

Sept 2016

Dec 2016

Jun 2018

Dec 2020

Dec 2019

Oct 2018

March 2019

L L

L/C

Ergonomics

Moving and Handling

On-going actions: Meetings with managers will continue to be held to discuss moving and handling requirements including training, to provide support to services. There are no concerns to date.

Ongoing Ongoing L/C

Posture There is online self-assessment guidance available for all staff to access and 25 workstation assessments have been completed since July 2018. Workstation assessments are ongoing, as staff requests them.

Ongoing Ongoing L

Physical

Machinery A schedule has been set up for Facilities Maintenance staff to check/review and service all machinery. There are no concerns to date.

Ongoing Ongoing L

Equipment Clinical Engineering hold a master file of all clinical equipment across WDHB and this equipment is serviced on a recurring schedule. There are no concerns to date.

Ongoing Ongoing L

Electrical safety A project to identify all electrical equipment has been completed, with all external contract maintenance providers having been contacted and the standards that equipment is serviced to have been reviewed for compliance. Clinical Engineering holds all records, including service maintenance schedules. Clinical Engineering following up with all non-compliant suppliers. Complete: 95%

Ongoing May 2019 L/C

Uneven surfaces

On-going actions: Communications continue to be developed and released regarding Slips, Trips and Falls hazards, focussed heavily on staff rushing to complete tasks. Each incident of this type is followed up by OH&SS, with any corrective actions tracked to completion. There are no concerns to date.

On-going

On-going

L/C

58


BIEMS Upgrade: Project initiated and delivery underway. Final estimate of completion is end-June 2019. Delivery Complete: Stage 1: 85% and Stage 2: 20%

Dec 2017 March 2019 L

Roading Pedestrian Crossings: Stage 1 of the North Shore Hospital pedestrian crossings programme (repainting of existing crossings) has been completed. Stage 2 (planning and implementation of new crossings) is underway. Physical works will start 23 May for the repainting of new crossings – a total of 5 crossings to be completed at North Shore Campus. Due to weather conditions, back up dates for the works for NSH are the first week of June 2019. WTH Stage 2 repainting of new crossings will commence June 2019 after NSH has been completed with a total 9 crossings to be completed. Planning complete: 90% Physical works complete: 50%. Helipad: The pedestrian crossing to service the helipad, including appropriate lighting, has been scheduled for completion in Q1 2019. Construction will start first week in June and will take a total of 16 days. Helicopters will need to be diverted during this time. Planning complete: 40% Physical works complete: 50%

Oct 2017

Oct 2017

Feb 2017

March 2019

April 2019

July 2019

L L L

Buildings Loading Docks: CAPEX has been approved to finalise the concept design. A Business Case is due to the Executive Leadership Team once confirmation has been received from Fire Engineer regarding the proposed location for the waste/recycling bins. Estimate time for construction to start will be July 2019. Planning complete: 85%

Feb 2017 Jul 2019 L

Emergency Management

Fire Fire evacuation drills are conducted regularly by the Fire Safety Officer and fire safety equipment, such as sprinklers and smoke alarms, are regularly audited for compliance, overseen by Facilities. Responsibility for hospital based emergency management sits with the Director Hospital Services and for Community Services sits with the Director of Nursing

Ongoing Ongoing L/C

Civil emergency WDHB conduct desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes contact points with Civil Defence.

Ongoing Ongoing C

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Bomb threats WDHB conduct desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes evacuation and contact points with Emergency Services (Police and Fire). Drills are completed annually.

Ongoing Ongoing C

Firearms WDHB conduct desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes evacuation and contact points with the NZ Police. Drills are completed annually.

Ongoing Ongoing C

Psychological

Aggression The new Managing Aggression and Potential Aggression (MAPA) training is currently being arranged across the DHB. The following actions have been completed: •four educators are now accredited to deliver the MAPA Foundation programme •All four educators are scheduled to be accredited in the beginning of August to deliver the MAPA Advanced programme •Scheduling for staff to attend MAPA Foundation training has been scheduled from May - September and we are working on determining how to release staff to attend. Complete: 75% (due Aug 2019) Additional Security Door Access, North Shore Hospital: New access way and design approved by internal stakeholders (OH&SS, ED and Security). Project manager allocated to progress. Design stage: 100% Installation complete: 0% (completion due Aug 2019)

Feb 2018

Oct 2016

Aug 2019

Install from Aug 2019

L/C

L/C

Bullying and harassment

Toolkit on Speaking up about bullying and harassment on Staffnet. Complete 100% Compassionate communications planned for Pink Shirt day (17 May 2019) to encourage staff to speak up for behaviours we love to see. Complete 100%

Ongoing Ongoing L/C

Lone workers Community Worker Alarm Project: Final smartphone application has been identified and agreed. Notifications of alarm activation have been set up to be directed to the NZ Police, at their recommendation. Smartphone rollout to staff has commenced. Evaluation. Complete: 100%

Feb 2017 June 2019 C

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Rollout to Community Workers. Complete: 100%

Stress/Distress/Fatigue

Wellbeing research pilot survey complete and data being analysed for staff feedback. Complete: 100% EAP services in place. No issues. Partnering with the Mental Health Foundation on: Development of a wellbeing pocket guide. Pilot – 5 ways of wellbeing Evaluation of Mental Health first aid and Mental Health 101 education sessions. Complete: 100% Guideline on Healthy Sleep Complete: 100%

Aug 2018

Ongoing

Jan 2018

Ongoing

July 2019

May 2019

Available on

staffnet

L/C

Safe staffing Centralisation of nursing rosters: Complete: 100% RMO rosters: House Officers rosters developed, consulted and implemented: 100% Registrar rosters: rosters developed, consulted and implemented: 25% Consultation complete but not yet implemented. Rosters will be implemented once recruitment for specific rosters is complete- this is occurring with all urgency. Complete: 75% Nursing Care Capacity Demand Management (CCDM) and NZNO MECA Accord recruitment: CCDM: Trend care team recruitment: Complete 100% CCDM: Services completing CCDM FTE reviews: 0% (First due February 2019) Accord recruitment: Complete: ICU 100%; ED 0%; Midwifery 100%; Critical Care Outreach 100%; RNs/Shift Co-ordinators 100% District Nurses 100%; Health Care Assistants 58%

Sep 2018

Dec 2018

Nov 2018

Feb 2019

Dec 2018

Dec 2018

Jun 2019

Feb 2019

Jun 2021

Jun 2019

L

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4.3 Communications Report

Recommendation:

That the report be received.

Prepared by: Matthew Rogers (Director, Communications)

Communications support The communications team provided advice and support to the following projects/campaigns/issues/ events over the last six weeks:

Staff flu immunisation programme

Measles vaccination information for the public

Pink Shirt Day promotion

Privacy Awareness Week

International Nurses’ Day

International Midwives’ Day

Flu immunisation comms aimed at over-65s

Health Excellence Awards promotion

Planning for opening of new CT scanner at North Shore Hospital

Waitakere Hospital Chapel opening preparations

Mother’s Day proactive pitch

Hand hygiene campaign

Telehelath initiative promotion

End PJ Paralysis campaign preparation

Staff car parking options

Blood donation drive

Rural Point of Care Testing programme proactive pitch preparation

Site works staff communications

Career profiles for Recruitment Team

Five-day RMO strike communications

CEO Lectures X 2

Compassion campaign

Smoking cessation promotion

Annual Plan content

Ongoing implementation of Board decision re incorporation of macron

Major facilities development communications

Identification, scheduling and production of social media content and issues management

Ongoing publication of messages via the Medinz primary care communications platform

Health Heroes awards coordination

Coordination of responses to ‘Dear Dale’ emails to the CEO from DHB staff

Review of content for submission to health sector publications

Ongoing weekly internal communication via StaffNet home page and Waitemata Weekly

Ongoing management of Official Information Act responses

Liaison with Well Foundation Marketing and Communications

Ongoing liaison with Metro Auckland DHB communications leads

62


Ongoing after-hours and weekend media line cover and senior management communications support

Proof-read leaflets, booklets and brochures for various departments

Ongoing compilation and distribution of proactive media material

Event photography and video

Drafting of correspondence from the corporate office

CEO Board Report

Review of copy for DHB website

Management of organisation-wide screen saver content

Approval of all-user staff emails

Weekly Board briefing

Fortnightly A Note From the CEO email to all staff

Weekly National Health Targets and clinically-led metrics updated and communicated

Waitemata DHB website – Google Analytics Statistics

Waitemata DHB website

Number of visits

April 2018

April 2019

Total visits to this site 59,614 62,337 (+4.56%) New Zealand 55,769 28,748 Australia USA

1,244 664

845 775

United Kingdom 249 207 Top areas April 2018 April 2019

32,856 12,116 4,179 3,254 2,500

Waitemata DHB staff page 31,039 Home page 14,097 North Shore Hospital Waitakere Hospital Contact us

5,881 2,726 2,284

Traffic sources

April 2018

April 2019 74% 23% 3%

Search traffic 67% Direct traffic 26% Referral traffic

5%

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Social media Facebook Waitemata DHB Facebook page likes have increased by 91.6% since April 2018, with 6955* current likes (3629 likes - April 2018). Total audience reach between 15 April 2019 and 15 May 2019 was 95,079 views. Top three posts between 1 April 2019 and 30 April 2019:

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1. Career Profile - Nursing (Audience reach: 28,987 including 5,840 engagements )

65


2. Strike reminder. (Audience reach: 17,392 including 1,087 engagements)

66


3. Strike announcement (Audience reach: 14,664 including 212 engagements)

*As at 15 May 2019.

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Twitter Waitemata DHB Twitter followers have grown by 10.3% since April 2018, with 2413 current followers* (2187 followers as at April 2018). Total audience reach between 1 April 2019 and 30 April 2019 was 22,400. Top tweet between 1 April 2019 and 30 April 2019: Measles symptoms video - (1,360 reach)

*As at 15 May 2019.

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OIAs received A total of 23 new Official Information Act requests were received between 5 April and 14 May 2019: S. Maude (NZ Doctor) - Financial information regarding the number of drug trials hosted in

2017/18. K. Brown (Radio NZ) - Information regarding cases transferred to Waitemata DHB as a result of

Christchurch terror attack. A. Hudson (Healthwest) - Copy of business case for NCHIP relating to Plunket bus collaboration

and immunisation outreach services. Private requester - Copy of mother’s medical records. A. Gaudin (Pharmacy Guild) - Copy of all submissions and analysis re Enhanced Residential Care

Pharmacy Services project. G. Fraser (FYI website) - Details of DHB-funded gender-reaffirming healthcare services currently

available for transgender patients. G. Fraser (FYI website) - How many transgender patients have accessed different types of

gender-affirming healthcare services. Te Ringa Mangu (FYI website) - All information, documents and communication with 'Nga Hau E

Wha' and individuals associated with the organisation. S. Lehnhard (FYI website) - Information regarding assaults against nurses by members of the

public from 2013-2018. B. Keogh (Stuff) - Request for data and policy information regarding intersex children who have

received genital surgery within their first year of life. D. Clent (Stuff) - Number of complaints made regarding breastfeeding and formula feeding

policies/practices. B. Keogh (Stuff) - Information regarding publicly funded fertility treatment. M. Badilla (BCI NZ) - Details regarding North Shore Hospital campus infrastructure works. J. Chilton-Towle (Pharmacy Today) - Submissions received during aged residential care

consultation on Enhanced Residential Care Pharmacy Services project. P. Pennington (RNZ) - Details of inspection programme for passive fire defects and repairs to

clinical buildings. M. Atkin - School dental tooth decay data for 2014 – 2016. M. Savage - Information regarding the use of physical/mechanical restraints for mental health

services. A. Wiggins (NZ Herald) - Information regarding the number of hours worked by senior

doctors/consultants in maternity wards. C. Korte - Number of mesh procedures undertaken using the Trans Obturator System mesh tape

from Jan 2009. K. Brown (Radio NZ) - Details regarding the cost of paying senior doctors to provide cover during

all five doctors strikes. R. Medenilla (BCI NZ) - Information regarding North Shore Hospital campus infrastructure works. K. Davies-Haycock - Information regarding policy development. A. Hudson (Healthwest) - Copy of any progress reports regarding NCHIP and business cases.

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Media Clippings – 3 April – 14 May 2019

Positive +

Neutral 0

Negative -

Page no. Dominion Post

1 More than 60 measles cases confirmed 0

42 Baby exit strategies 0

Page no. Listener New Zealand

5 Prescription for success 0

Page no. North Shore Times

3 Free street parking perk ends 0

16 Dental services ‘overwhelmed’ 0

20 Conversations: Parking around North Shore Hospital 0

54 Flu leaves ‘fighter’ in coma 0

Page no. North Harbour News

10 House and business sold to help child 0


Page no. NZ Doctor

8 Finding skin cancer a matter of chaos and clues says melanoma expert

0

9 Waitemata DHB criticised after teen escapes from psychiatric care unit

-

Page no. NZ Herald / Weekend Herald

11 Injury linked to child tooth decay 0

12 ‘Postcode lottery’ for weight loss treatment 0

26 ‘It was up to him if he would wake’ 0

28 ‘Coward’s’ punch smashes woman’s face at pub 0

32 From tiny cut to lost toe ‘so fast’ 0

34 Kayaker critical 0

35 Stranded kayaker had all but given up, say cops 0

37 Harsh truths and heavy burdens 0

50 Hundreds dying on hospitals’ waiting lists 0

57 Surviving cancer in NZ can be a lottery 0

60 12 hospital beds and 500 assaults -

61 The place where every day is Mother’s Day +

Page no. Rodney Times



30 Boy recovers from crash 0

Page no. Sunday News

41 Mum ‘ropeable’ as four-day wait for measles test results leaves friends in limbo

0

70


Page no. The Press, Christchurch


Page no. Waikato Times

2 More than 60 measles cases confirmed 0


56 Flu leaves young ‘fighter’ in coma 0

Page no. Western Leader


48 Measles results take 4 days 0

TOTAL:

Positive + 1

Neutral 0 30

Negative - 2

Total items 33

71


5.1 Financial Report for April 2019

Recommendation:

That the Board receives this report. Prepared by: Simon Watts (Deputy Chief Financial Officer), David Dodds (Financial Planning Manager), Cliff La Grange (Deputy Chief Financial Officer Funder) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary

ACC - Accident Compensation Commission DHB - District Health Board ED - Emergency Department FTE - Full Time Equivalents IDF - Inter District Flow MECA - Multi-Employer Collective Contract MHSOA - Mental Health Services Older Adults MoH - Ministry of Health MRI - Magnetic Resonance Imaging NGO - Non-Government Organisation NZNO - New Zealand Nurses Organisation PHO - Primary Health Organisation RMO - Resident Medical Officer SLA - Service Level Agreement -

Background

The following report summarises the financial performance of the DHB for the YTD and month of April 2019. The report covers all operating units of the DHB, being the Funder Arm, Provider Arm and Governance. At a DHB level, overall financial performance continues to improve with the forecasted deficit being revised down from the original $14.7m to $7.0m. The DHB is on track to achieve this revised target this financial year.

1. Executive Summary

1.1 Highlights

$2.7m deficit for April 2019, $0.3m favourable to budget.

$9.5m deficit YTD April 2019, $0.8m unfavourable to budget.

$7.0m deficit forecast for 2018/19, in line with the budget. The original forecast deficit of $14.7m has been revised down to a deficit of $7.0m due to improving financial performance. This impact has been the result of an improved forecast result in the Funder, offset by cost pressures within the provider. The net effect is an overall improvement in financial performance.

72


Key financial impacts on the Funder Arm include:

Lower than planned demand, especially in pharmaceuticals.

An assessment of certain provisions as at 30/06/2018, as recommended by Audit New Zealand.

Lower than forecast IDF outflow. Key financial impacts on the Provider Arm include:

timing and cost of MECA settlements,

industrial action impacting elective surgery,

extraordinary winter acute demands,

delays in the realisation of savings under the financial sustainability programme. The financial sustainability programme has contributed savings of $7.7m against a plan of $10.8m, with delays in the implementation of some initiatives. Monthly updates on the programme are reported to the Audit and Finance Committee. Looking ahead, the DHB has now engaged EY consultants to peer review the current savings programme and work with the executive to assess potential areas of opportunity for efficiency gains and revenue generation. In the next financial year the financial sustainability programme will be tracked via the DHBs enhanced project management solution due to go live in July. A new programme manager was appointed in April to manage the programme, to provide guidance on individual projects and ensure momentum is maintained. The financial position as at April 2019 indicates a net worth of $603.6m. Refer to section 7.2 for a detailed statement of financial position. Refer to section 7.3 for a detailed statement of cash flow.

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1.2 Financial Indicators

Table 1: Financial Indicators for April 2019

1.3 Financial Forecast 2018/19

Waitematā DHB forecast a $7m deficit by year end, a breakeven result against budget 2018/19. The financial performance is anticipated to improve over the remaining months despite surgical pressures. This is due to the expected benefits of continued focus on financial management. The operational outlook for the remaining months of the current financial year relate to on-going cost pressure notably in surgical services. There are also concerns around industrial action that may impact service delivery. Key impacts on the year end forecast 2018/19:

Revision of the 2018/19 Annual Plan from $8.7m to $7.0m

Industrial action impacting elective services

Higher than planned acute presentations in winter

Delays in financial sustainability benefits

MECA settlements.

FINANCIAL PERFORMANCE

$ millions

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Funder Arm 5.8 0.5 5.3 18.4 12.2 6.2 35.7 14.7 21.0

Provider Arm -8.6 -3.5 -5.1 -29.2 -20.9 -8.3 -44.5 -21.7 -22.8

Governance Arm 0.1 0.0 0.1 1.3 0.0 1.3 1.8 0.0 1.8

DHB Result : Surplus / (Deficit) -2.7 -3.0 0.3 -9.5 -8.7 -0.8 -7.0 -7.0 0.0

FINANCIAL POSITION

$ millions


Crown Equity (net worth) 603.6 604.4 -0.8 603.6 604.4 -0.8 606.1 606.1 0.0

Capital Expenditure 2.4 3.1 0.7 18.2 28.5 10.3 24.7 34.5 9.8

Cash Flow Balance 68.3 28.3 40.0 68.3 28.3 40.0 38.1 10.7 27.4

CLINICAL ACTIVITY


ED Attendances 9,246 9,233 -13 94,820 91,764 -3,056 115,910 111,873 -4,037

Acute Volumes (WIES) 5,400 5,437 37 54,683 55,094 411 65,396 66,149 753

Elective Volumes (WIES) 1,362 1,495 -133 14,288 15,786 -1,498 17,496 19,249 -1,753

ED (emergency department) attendance figures are per the activity volume report (AVR) excluding primary care voucher attendances

The unfavourble variances in ED Attendances reflects higher than planned presentations

The favourble variances in Acute Volumes (WIES) reflects a lower than planned acute demand

The negative variance in Elective Volumes (WIES) reflects under delivery

Month YTD Full Year

Month YTD Full Year

Month YTD Full Year

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2. Waitematā DHB Consolidated Financial Performance

2.1 Financial Result

Table 2: Waitematā DHB Consolidated Financial Result for the month ended April 2019

2.2 Financial Performance April 2019

Revenue ($3.315m favourable) - The favourable revenue variance includes MECA timing benefits offset by expenses, and revenue from

PHARMAC rebates that are now accounted for as revenue relating to the new MoH Combined Pharmaceutical Budget (CPB) strategy. Up until December 2018 the rebates had been accounted for and budgeted as an offset in pharmaceutical expenditure. From January onwards the rebate has been accounted for as revenue (unbudgeted).

Expenditure ($2.989m unfavourable) In the month personnel costs were impacted $3.3m by financial adjustments for the accrual of Holiday Pay Act provisions and anticipated year end actuarial provisions.

- Personnel costs are anticipated to track unfavourably to budget this year due to MECA impacts partially offset by additional funding support from the MoH, and additional FTE appointments approved after the formation of the annual plan necessitated in order to maintain safe clinical services, which are funded with additional revenue. Refer to section 3.0 for commentary on Funder Financial Performance.

2.3 Financial Performance YTD

Refer to section 3.0 for Funder Arm commentary on YTD financial performance. Refer to section 4.0 for Provider Arm commentary on YTD financial performance.

CONSOLIDATED FINANCIAL PERFORMANCE

$ 000's Full Year

Actual Budget Variance Actual Budget Variance Budget

REVENUE

Crown 150,722 147,472 3,251 1,502,024 1,474,454 27,569 1,769,451

Other 2,512 2,448 64 23,810 24,524 -714 29,542

Total Revenue 153,234 149,919 3,315 1,525,833 1,498,978 26,855 1,798,993

EXPENDITURE

Personnel 62,553 56,678 -5,875 563,213 547,743 -15,470 660,287

Outsourced Personnel 2,302 1,302 -1,000 17,651 13,210 -4,441 15,936

Outsourced Services 5,883 5,058 -825 52,721 51,936 -785 62,120

Clinical Supplies 10,604 10,731 128 105,274 104,441 -833 126,344

Infrastructure & Non-Clinical Supplies 9,474 9,267 -207 95,608 98,862 3,254 111,574

Funder Provider Payments 65,080 69,869 4,790 700,867 691,493 -9,373 829,732

Total Expense 155,895 152,906 -2,989 1,535,334 1,507,685 -27,648 1,805,993

DHB Result : Surplus / (Deficit) -2,660 -2,986 326 -9,500 -8,707 -793 -7,000

Month YTD

75


Revenue ($26.9m favourable) The favourable variance in the year to date was made up of:

- Funder revenue $15.6m favourable to budget. - Governance revenue $0.4m unfavourable to budget. - Provider revenue $11.7m favourable to budget.

Expenditure ($27.6m unfavourable) The unfavourable variance in the year to date was made up of:

- Funder expenditure $9.4m unfavourable to budget. - Governance expenditure $1.8m favourable to budget. - Provider expenditure $20.0m unfavourable to budget.

2.4 Trend in Financial Performance YTD

Figure 1: Cumulative Variance to Budget 2018/19

The movement in January reflects the revision of the 2018/19 Annual Plan from $8.7m to $7.0m.

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3. Funder Arm Commentary On Financial Performance

3.1 Financial Performance April 2019

The Funder total core result variance was $5.33m favourable for the month and $6.20m favourable for the YTD. This is the net position across all four of the Funder divisions. The four Funder divisions are: Funder NGO, Funder Own Provider, Funder IDF and Funder Governance. Funder NGO is the main focus of Funder performance and refers to contracted health services delivered by third party providers consisting mostly of community services providers. Approximately 80% of such services are demand based delivered by means of a National Agreement with little or no opportunity to directly influence either the number of service providers and/or the number of patient presentations. The $6.20m favourable YTD position consists of a favourable Funder NGO variance of $3.72m, a favourable Funder Own Provider variance of $0.73m, a favourable Funder IDF variance of $1.74m and nil variance within Funder Governance. It is important to note that a significant component of Funder variances are in effect offsets resulting mostly from MoH mandated strategies and changes introduced after DHB budgets have been confirmed. For example, the significant additional funding for MECA settlements received after the final funding advice results in a large revenue variance and an equivalent large expenditure variance when paid over to the Provider as required. The table below summarises the key components of the Funder core result from a revenue and expenditure perspective and across the four Funder divisions. Table 3: Funder Arm Financial Performance

FUNDER & GOVERNANCE FINANCIAL PERFORMANCE

$ 000's Full Year


REVENUE

Funder NGO 44,585 44,218 368 456,389 442,178 14,210 530,614

Finder Own Provider 74,513 72,437 2,076 733,219 724,370 8,849 869,244

Funder IDF 26,162 26,152 11 262,143 261,515 628 313,818

Funder Governance 1,328 1,281 47 12,922 12,809 113 15,371

Total Revenue 146,588 144,087 2,501 1,464,673 1,440,872 23,801 1,729,047

EXPENDITURE

Funder NGO 38,850 43,718 4,868 440,465 429,978 -10,487 515,914

Finder Own Provider 74,351 72,437 -1,914 732,486 724,370 -8,117 869,244

Funder IDF 26,229 26,152 -78 260,402 261,515 1,113 313,818

Funder Governance 1,328 1,281 -47 12,922 12,809 -113 15,371

Total Expense 140,758 143,587 2,829 1,446,275 1,428,672 -17,603 1,714,347

CORE RESULT

Funder NGO 5,735 500 5,235 15,924 12,200 3,724 14,700

Finder Own Provider 163 0 163 733 0 733 0

Funder IDF -67 0 -67 1,742 0 1,742 0

Funder Governance -0 0 -0 -0 0 -0 0

FUNDER RESULT Surplus / (Deficit) 5,830 500 5,330 18,398 12,200 6,198 14,700

Month YTD

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3.2 Total Funder Arm Revenue

The Funder total net revenue variance was $2.50m favourable for the month and $23.80m favourable for the YTD. Most of this variance is a consequence of new and/or changes in MoH initiatives introduced after budgets had been set and have equivalent expenditure variances that offset.

Funder NGO Revenue

Funder NGO revenue variance was $0.37m favourable for the month and $14.21m favourable for the YTD. The YTD variance consists of $2.37m favourable in baseline revenue, $0.37m unfavourable in Crown Funding Authority variations/contracts revenue and $12.21m favourable in other government revenue. The $2.37m favourable YTD variance in baseline revenue is mainly due to the post budget funding by the MoH for the Mental Health Pay Equity Settlement and is partially offset by a reduction in the 2018/19 In Between Travel wash up revenue. The $0.37m unfavourable YTD variance in CFA/Contracts revenue is mainly due to a YTD adjustment for Pay Equity for Home Based Support Services and is mostly offset by additional revenue for funding new Primary Health Initiatives relating to Zero Fees for Under 14s, Community Service Card holders and reduction in First Contact Care. The $12.21m favourable YTD variance in Other Government revenue is mainly due to revenue received from PHARMAC relating to the new MoH Combined Pharmaceutical Budget (CPB) strategy. DHBs are now receiving revenue from PHARMAC that is being funded out of what was previously budgeted and funded as CPB Drug rebate. This had previously been accounted for as a rebate offset in pharmaceutical expenditure but is now accounted for as revenue (unbudgeted).

Funder Own Provider Revenue

The Funder Own Provider revenue variance was $2.11m favourable for the month and $8.89m favourable for the YTD. The YTD variance consists of a $2.87m favourable variance in baseline revenue, a $3.13m favourable variance in CFA variations/contracts revenue and a $2.89m favourable variance in other Government revenue. The $2.87m favourable YTD variance in baseline revenue is mainly due to the Mental Health component of MECA settlements. The $3.13m favourable YTD variance in CFA variations/contracts revenue is mainly due to the Personal Health component of the MECA settlements and the Safe Nursing funding. The $2.89m favourable YTD variance in Other Government revenue is related to the CPB policy change mentioned earlier and results from the unbudgeted Hospital Medicines rebate component of the CPB rebate now received as a combined rebate to the Funder rather than separately to the Provider Arm.

Funder IDF Revenue

The $0.63m favourable YTD variance in Funder IDF relates to the 2017/18 National MoH IDF wash-up process which was settled in October 2018.

3.3 Total Funder Arm Expenditure

The Funder total net expenditure variance was $2.83m favourable for the month and $17.60m unfavourable for the YTD. The YTD expenditure variance consists of $10.49m unfavourable in Funder NGO expenditure, $8.15m unfavourable variance in Funder Own Provider expenditure, $1.11m favourable in Funder IDF outflow expenditure and $76k unfavourable in Funder Governance expenditure.

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Of note and as previously explained, the most significant variance drivers within Funder have a converse and equivalent offset either between Funder divisions and/or between Funder revenue and Funder expenditure. As a consequence Funder revenue and expenditure variances can be relatively large but with little or no impact on the Funder Core Result. The main and underlying cause of such offsetting variances are MoH funded strategies that are implemented after budgets have been finalised.

Funder NGO Expenditure

The $10.49m unfavourable YTD variance in Funder NGO expenditure is the net consolidated position across all services. The key unfavourable component of the variance is a consequence of Pharmaceutical expenditure and mostly driven by the previously explained PHARMAC/MoH CPB strategy. Budgeted CPB drug rebate funding that was budgeted as an offset (reduction) against Community Pharmacy expenditure now accounted for as revenue. This is a post budget change which results in a significant favourable revenue variance offset by an equivalent significant unfavourable expenditure variance. This notwithstanding, the month and YTD variances are contributed to by the normally expected variations in business as usual factors across Funder NGO services. The business as usual variances mostly arise out of variations in demand/utilisation within Community Pharmacy, General Practitioner Demand, Age Related Residential Care (ARRC) and Primary Health Organisations (PHO) noting that these services constitute the most substantial component of Funder NGO expenditure. As previously explained there are also the standard variances related to new MoH funded Initiatives expenditure (initiated after budgets had been set) that are offset by equivalent revenue variances and have a nil net impact on the core result. Funded initiatives variances include the variations in Pay Equity and new expenditure for Primary Health Initiatives relating to Zero Fees for Under 14s, Community Service Card holders and reduction in First Contact Care. Conversely is also the favourable impact relating to budgeted Funder NGO initiatives not yet contracted. Other factors influencing the NGO variances include adjustments in PHO expenditure related to patients and general practitioners moving between DHBs with the equivalent offsetting variances in IDF Outflows.

Funder Own Provider Expenditure

The $8.15m adverse YTD variance in Funder Own Provider expenditure mostly relates to the additional funding allocated (paid) to the Provider Arm for the NZNO Nursing Settlement, the PSA Nurses MECA Settlement, the PSA Allied MECA Settlement, Safe Nursing Funding and Capital Charge Revaluation 2018-19.

Funder IDF Expenditure

The $1.11m favourable YTD variance in Funder IDF expenditure mostly results from adjustments relating to the 2017/18 national IDF wash-up process.

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4. Provider Arm Commentary on Financial Performance

4.1 Financial Statement

Table 4: Summary of Provider Arm Financial Performance for April 2019

Performance against the 2018/19 Annual Plan for the month of April shows a deficit of $8.6m which was unfavourable to a deficit budget of $3.5m, by $5.1m. Performance against the 2018/19 Annual Plan for the YTD April shows a net deficit of $29.2m which was unfavourable to a net deficit budget of $20.9m by $8.3m.

4.2 Service Commentary on YTD result

Table 5: Provider Arm Financial Performance for April 2019 by Service

PROVIDER ARM FINANCIAL PERFORMANCE

$ 000's Full Year


REVENUE

Crown 78,526 75,821 2,705 770,281 757,952 12,329 909,648

Other 2,493 2,443 51 23,856 24,474 -618 29,482

Total Revenue 81,020 78,264 2,756 794,136 782,426 11,711 939,130

EXPENDITURE

Personnel 61,643 55,552 -6,092 554,272 536,484 -17,789 646,775

Outsourced Personnel 2,040 1,054 -986 15,473 10,726 -4,747 12,955

Outsourced Services 5,404 4,594 -809 47,927 47,299 -628 56,555

Clinical Supplies 10,603 10,731 128 105,246 104,440 -806 126,343

Infrastructure & Non-Clinical Supplies 9,955 9,819 -136 100,450 104,384 3,934 118,201

Total Expense 89,644 81,750 -7,894 823,369 803,333 -20,036 960,830

Provider Result : Surplus / (Deficit) -8,625 -3,486 -5,138 -29,233 -20,907 -8,325 -21,700

Month YTD

$000's Total

Actual Budget Variance Actual Budget Variance Variance

PROVIDER ARM FINANCIAL PERFORMANCE YTD

Acute & Emerg Medicine 3,367 2,987 380 122,856 118,367 -4,488 -4,108

Sub Specialty Med HOPS 6,893 7,622 -730 81,315 78,959 -2,356 -3,086

Surgical Services 7,717 6,862 855 150,799 149,495 -1,303 -448

ESC 0 0 0 22,665 22,903 238 238

Child, Women & Family 5,819 5,682 137 78,022 77,623 -399 -263

Mental Health 6,978 4,776 2,202 116,525 112,713 -3,812 -1,610

Corporate & Provider Support 763,362 754,496 8,866 251,187 243,272 -7,915 951

Total Provider 794,136 782,426 11,711 823,369 803,333 -20,036 -8,325

Direct Revenue YTD Direct Expenditure YTD

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Acute and Emergency Medicine ($4.108m unfavourable YTD) The unfavourable variance was due to premium cover costs for medical staff, additional sessions to shorten the patient waiting list, RMO strike cover cost by senior medical officers, extra beds and resources required to meet high winter demand and high watch costs. The service has a number of initiatives to get back on track including; flexing beds, managing staff turnover, a review of patient watches, nursing models of care in ED. Specialty Medicine and Health of Older Persons Services ($3.086m unfavourable YTD) The unfavourable variance was due to increased patient watches in the Kingsley Mortimer Unit, increased demands in District Nursing, and increased demand for mobility aids. The service has a number of initiatives to get back on track including a review of ACC events, and enhanced services for mobility aid managements. Surgical and Ambulatory Services ($488k unfavourable YTD) While tracking close to budget overall the service continues to benefit financially from additional revenues from orthopaedic ACC cases, and lower volumes due to the impact of industrial action and acute bed encroachment from medical services. Offsetting this, additional costs have been incurred with over-allocations of registrars, outsourced skin lesions, and unplanned repairs and maintenance costs. The service is facing cost pressures in the remaining months to ensure Elective Services Performance Indicators (ESPI) compliance, plans to deliver to plan on outsourced MRI and ultrasound scans, and unbudgeted outsourced costs to meet Interventional Radiology demands that exceed internal capacity. Elective Surgery Centre (ESC) ($238k favourable YTD) Three factors have reduced the capacity to deliver to plan and resulted in the favourable financial variance YTD; industrial action, acute bed encroachment at North Shore Hospital impacting ESC, and the holiday closure. This has resulted in lower costs. Offsetting this, the service has realised higher than budgeted non-volume related clinical supplies, e.g. repairs and maintenance, and minor purchases. Child, Women and Family Services ($263k unfavourable YTD) The unfavourable result YTD was the result of on-going patient demand driven cost increases across predominately Maternity (antenatal assessments and caesarean section activity) and Neonatal services involving use of external staffing resource and overtime to cover vacancies and roster gaps, cleaning outsourced costs, patient food and to a lesser extent increased maintenance costs in the mobile dental units and fixed dental facilities. These cost increases have been partly mitigated by service wide vacancies and an improved revenue position. The service remains focused on achieving its identified cost reduction initiatives. Examples of these being; the Auckland Regional Dental Services transition to an electronic based patient communication platform as part of the overarching Outpatient Flow Tool initiative (traditional postage to email), renegotiation of service contracts and product pricing reviews. Specialist Mental Health and Addiction Services ($1,610k unfavourable YTD) The unfavourable result YTD was due to the use of locums to cover medical vacancies and increasingly ‘acute’ caseloads. This is particularly the case in the Rodney region, both for adult and child and youth specialist psychiatrists. There remains a difficulty recruiting to nursing vacancies, again specifically in more specialist areas such as child and youth as well as intellectual disability. Also, vacancies in both the adult inpatient units and forensics are covered with overtime rates which are paid at a premium. To minimise vacancies, a Retention and Recruitment Committee continues to explore and implement initiative to attract and retain staff. Corporate and Provider Arm Support Services ($951m favourable YTD) Revenue is favourable $8.864m due to additional revenue from MoH for Care Capacity and Demand Management (CCDM), Capital Charge and MECA settlements, along with additional cost recoveries and includes additional interest income $384k and back-dated SLA in Primary Health Care Nursing for vaccination program at Auckland DHB $307k. Also contributing were favourable personnel costs due to vacancies along with risk pool provisions $431k; this was offset with unfavourable variances driven primarily by a lag in

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implementing some of the financial sustainability initiatives and unfavourable expenditure in Facilities outsourced maintenance and consultants costs $1.324m. Overall the cost overspends in Facilities have improved and result has been closer to breakeven over the past four months.

5. Waitemata DHB Financial Position

5.1 Summary of Financial Position

Table 7: Summary financial position as at April 2019

$000's Mar-19 Variance to Jun-18

Actual Budget Variance Actual Last Month Actual

Crown Equity 603,626 604,377 (751) 606,285 (2,658) 613,126

Represented by:

Cash & Bank Balances 68,277 28,319 39,958 56,343 11,934 29,078

Other Current Assets 95,319 80,837 14,482 87,585 7,734 63,872

Current Liabilities -302,612 -250,084 -52,528 -281,801 -20,811 -241,042

Net Working Capital -139,016 -140,928 1,912 -137,873 -1,143 -148,092

Fixed Assets 729,257 734,369 -5,112 728,772 485 751,387

Long Term Investments in Associates 44,564 44,412 152 44,564 0 43,277

Term Liabilities -31,179 -33,476 2,297 -29,179 -2,000 -33,446

Total Employment of Capital 603,626 604,377 -751 606,285 -2,659 613,126

30th April 2019

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5.2 Detailed Statement of Cash Flow Table 8: Detailed Statement of Cash Flow as at April 2019

Note: closing cash forecast at 30th June 2019 is $38.1m, due to a reduction in the forecasted funder payments.

6. Statement of Capital Expenditure

Expenditure on the development of major capital programmes is assumed to be recouped from the Crown and as such is being funded from cash reserves outside of the capital envelope. The Portfolio Investment Committee continues to robustly prioritise all investment requests to ensure best value is achieved from the available capital budget. More detail on capital expenditure will be provided in the next monthly report. Table 9: Summary of Capital Expenditure as at April 2019

$000's

Actual Budget Variance Actual Budget Variance

Cash flows from operating activities:

Inflows

Crown 142,932 147,472 -4,540 1,492,750 1,466,759 25,991

Interest Received 171 129 42 1,922 1,541 381

Other Revenue 3,308 2,446 862 26,599 28,909 -2,310

Outflows

Staff 57,486 56,677 -809 555,062 544,688 -10,374

Suppliers 8,632 20,629 11,997 184,234 205,149 20,915

Other Providers 65,080 70,122 5,042 700,867 701,214 347

Capital Charge 0 0 0 18,326 18,474 148

GST (net) 0 0 0 793 639 -154

Net cash from Operations 15,213 2,619 12,594 61,989 27,045 34,944

Cash flows from investing activities:

Outflows

Capital Expenditure 3,279 3,614 335 21,504 27,804 6,300

Investments 0 0 0 1,286 0 -1,286

Net cash from Investing -3,279 -3,614 335 -22,790 -27,804 5,014

Cash flows from financing activities:

Net cash from Financing 0 0 0 0 0 0

Net increase / (decrease) 11,934 -995 12,929 39,199 -759 39,958

Opening cash 56,343 29,314 27,029 29,078 29,078 0

Closing cash 68,277 28,319 39,958 68,277 28,319 39,958

Closing Cash Balance in HBL Sweep account 68,277 28,319 39,958 68,277 28,319 39,958

Month YTD

$000's Full Year


Capital Expenditure

Land 0 0 0 0 0 0 0

Buildings & Plant 1,552 1,420 -132 9,078 11,402 2,324 13,957

Clinical Equipment 186 1,103 917 4,808 11,022 6,214 13,227

Other Equipment 118 342 224 1,675 3,420 1,745 4,105

Information Technology 346 0 -346 2,232 300 -1,932 400

Motor Vehicles 206 230 24 448 2,384 1,936 2,844

Total Capital Expenditure 2,408 3,095 687 18,241 28,528 10,287 34,533

Month YTD

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6 Resolution to Exclude the Public

Resolution:

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of

items to be considered Reason for passing this resolution in relation to each item


1. Minutes of Meeting of the Board - Public Excluded (17/04/19)




2. Minutes of the Audit and Finance Committee – Public Excluded (08/05/19)



[Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


3. Minutes of the Hospital Advisory Committee – Public Excluded (08/05/19)





4. 2019/20 Northern Region Service Plan –

That the public conduct of the whole or the relevant part of the proceedings

Obligation of Confidence The disclosure of information would not be

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First Draft Version of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)]

5. Community Pathology Parent Company Change of Ownership





6. Regional Information Systems Strategic Plan Workspace Business Case




7. Radiology Service – Proposal for Continuation of MRI and Ultrasound Outsourcing for FY 2019/20


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982

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S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


8. Endoscopy Service (Gastroenterology): Proposal for Continuation of Outsourcing for the FY2019/20




9. Expansion of the Special Care Baby Unit at Waitakere Hospital




10. Supporting the Establishment of the Northern Iwi-DHB Partnership Board

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding

Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence.

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would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

[Official Information Act 1982 S.9 (2) (ba)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


11. Diabetes Retinal Screening




12. Bilateral Policy Alignment



13. ProCare Governance That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]


14. Establishment of Child Health Information

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result

Commercial Activities The disclosure of information would not be in the public interest because of the

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Platform – Coordination Hub

in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


15. Mason Clinic - Tanekaha Replacement Unit Main Works Contract




16. Mason Clinic Sale and Purchase Agreement: Due Diligence




17. Resolution for Patient Dispute

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result

Privacy The disclosure of information would not be in the public interest because of the

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in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


18. Legal Update That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

Legal Professional Privilege The withholding of the information is necessary to maintain legal professional privilege. [Official Information Act 1982 S.9 (2) (h)]


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Documents

AGENDA...2019/05/29 · 2.2 Minutes of the Hospital Advisory Committee (08/05/19) 2.3 Minutes of the Disability Support Advisory Committee (04/04/19) 9.50am 3. CHAIR REPORT 4. EXECUTIVE